The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 16, 2011 #4,208 Publisher-Barry Block, DPM, JD

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MA Podiatrist Offers Summer Foot Care Advice

Foot problems, pain and strain tend to increase during the summer months. Established Boston podiatrist and board certified foot surgeon Jordana Szpiro, DPM of Boston Common Podiatry, offers tips on how to avoid summertime foot problems that may lead to chronic foot problems. According to Dr. Szpiro, "Summer footwear can cause foot problems or exacerbate existing foot problems because people tend to be more active in less supportive shoes, or they want to be barefoot. 

Dr. Jordana Szpiro

"The cardinal rule for the majority of musculoskeletal foot problems is never to go barefoot. It can also be challenging for those prone to infectious skin diseases such as plantar warts and athlete’s foot which are easily spread poolside, in pedicure salons, and in gyms," says Szpiro.

Source: D Business News [7/14/11]

AZ Podiatry Graduate Delivers Commencement Address

The strains of "Pomp and Circumstance" and the soaring sounds of bagpipes provided a solemn, yet thrilling backdrop for the 403 newly-minted medical professionals, including 26 new doctors of podiatric medicine who took part in commencement ceremonies at Midwestern University's Glendale Campus on June 3rd and June 24th, 2011.

Dr. Rebecca Smith

Rebecca Smith, who received her Doctor of Podiatric Medicine degree from the Arizona School of Podiatric Medicine, offered sage advice to her fellow graduates from the College of Health Sciences' Podiatry, Cardiovascular Science, Biomedical Science, and Health Professions Education programs. "Do not cease in your quest for knowledge and remain diligent and optimistic," advised Smith. "As you continue down your path, hold on to your compassion and humanity. Each of us has earned the opportunity to make a difference for those who need it most."

Source: The Glendale Star [7/13/11]

RE: Alleged Lack of Informed Consent (NY)

Facts: On March 27, 2007, plaintiff Deene Kiefert, 64, a retired hospital records clerk, underwent podiatric surgery during which procedures were performed on two toes of her left foot. Kiefert later sued her operating podiatrist, arguing that one of the procedures - a big-toe bunionectomy that involved removing the digit's joint - had left her in constant pain. Kiefert contended that the defendant had not properly informed her of the potential side-effects of the procedure prior to operating.

Kiefert, who had a history of bunion problems on the big toe of her left foot, claimed she...

Result: Verdict-Defendant, Award Total: $0

Plaintiff's expert witness: Alfred A. Garofalo, DPM New York, NY
Defendant's expert witness: Thomas DeLauro, DPM, New York, NY

Editor's note: The complete text of this reporter can be read here.

Obama Outlines Options on Medicare

Acknowledging that federal lawmakers are “running out of time” on the debt-ceiling negotiations, President Barack Obama in a news conference on Friday said he's still pushing for a big deal and mentioned a few healthcare entitlement reforms under consideration in a deficit-reduction package.

Obama emphasized that leaders should make sure that current Medicare beneficiaries “as much as possible are not affected,” but that it's important to consider changes in later years to ensure the program's sustainability. “What we're not willing to do is restructure the program in the ways coming out of the House where we voucherize the program,” Obama said, adding that modest modifications could yield trillions in savings while still maintaining the program's integrity.

Source: Jessica Zigmond, Modern Healthcare [7/15/11]

Empower Staff When You are Away

Show that you trust your high-performing team. Don’t micro-manage them when you plan to be gone for several days. Let employees know that they can contact you with urgent matters, but explain that you plan to fully disconnect from work. That break will do you some good, and by resisting the urge to check in regularly, you will see how your people perform in your absence.

After you return, check who did what and why. That will allow you to pinpoint in what areas your staff needs coaching.

Source: Adapted from “Leadership Styles: A Powerful Model,” Pierre Casse and Paul Claudel, Training Journal via Communication Briefings

Query: Verapamil

I tried using the Verapamil compound on a handful of patients and did not get much success. I am revisiting the thought on trying it again as I have a patient who currently is not optimized for surgical relief. My question is - is the proprietary compound by PDL labs the only method of delivering the Verapamil that is effective? Has anyone tried injecting a 15% solution of Verapamil into a fibroma? Would this work?
 
Jeffrey Kass, DPM  Forest Hills, NY

Query: Voice Dictation System Compatible with Practice Fusion

I am about to commence use of Practice Fusion and am looking for a compatible voice dictation system? Suggestions please.

Larry Dorman, DPM, Miami, FL

Query: Impression Casting for Diabetic Insoles

Is there any code that Medicare accepts for impression casting of diabetic innersoles? We have used S0395, and Medicare says they cannot identify the code.

There is always a note: "new code 12/2/04" but I can't seem to find to what it is referring. Does anyone know?

Allan Hetelson, DPM, Bensalem, PA

Response: Medicare includes the casting (also scanning) used to create an impression (fabricate a model) of the patient's foot in the orthotic allowance. There is no code that Medicare accepts.

Tony Poggio, DPM, Alameda, CA

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RE: Tenosynovitis, Posterior Tibial Tendon (Hartley Miltchin, DPM)
From: Elliot Udell, DPM

In cases as you described, I have had excellent results in many cases by injecting 1 cc of Sarapin and 2 cc of lidocaine 2% with or without epinephrine. It's risky to inject corticosteroids around a tendon. The above combination seems to give gratifying results without the risk of causing a tendon rupture. The injections should be preceded or followed with the making of an orthotic for the patient which will control any abnormal pronation and remove pressure from the Achilles tendon insertion area. Although Sarapin is approved for spinal injections, many podiatrists have used it off- label with great success for the treatment of neuromas. The case above is another off-label use of this medication.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Post-Operative Complication 2nd Toe (David Weiss, DPM)
From: Robert S. Schwartz, C. Ped

It’s time for a pair of bunion-last, high toe-box, soft leather upper shoes to accommodate her deformities. A rocker sole with fulcrums at the IPJ of the hallux and proximal to the 2nd and 3rd MPJ will allow propulsion without shear and pressure to those areas. Full contact orthoses with met pads and medial support will further protect areas of high pressure and control pronatory forces that are most likely involved in this foot.

Robert S. Schwartz, C. Ped., NY, NY,  rss@eneslow.com

RE: Silastic Implant Complication
From: Jeffrey Manway, DPM

Simply perform a 1st MTPJ arthrodesis. There seems to be a great aversion to treating bunion complications (i.e., hallux varus) with an arthrodesis. However, by performing repeat "reverse" osteotomies and wedges, you are only increasing the likelihood of creating AVN of the metatarsal, all the while shortening the ray with absolutely no guarantee of a reasonable result.

Alternatively, a 1st MTPJ arthrodesis is highly reproducible with very good functional outcomes as reported numerous times in the literature. The body of evidence supporting wedges, reverse osteotomies, and capsulotendinous re-balancing procedures is far more scant. At the very least, fusion should be offered to the patient as an option for definitive treatment.

Jeffrey Manway, DPM, Pittsburgh, PA, jmanway@temple.edu

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815PODO2345@AOL.COM

PRACTICE FOR SALE - NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where... you can see 0-50 patients daily .. .average 100 new patients monthly have zero accounts receivable ... gross $480 M per year .... live in a beautiful community with skiing, hiking, fishing and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or 250-754-4192.

PRACTICE FOR SALE - MISSOURI

Well established, but still growing. Grossed over $300,000 last year. Located in a thriving medical community. Good payer mix. All aspects of podiatry needed in the area. Do not let this opportunity to own your own practice pass you by. Contactfootdoc2002@yahoo.com for more information.

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. E-Mail CV to jermaire@aol.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, Metroplus, and other Medicaid plans. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITIONS - NW INDIANA

2 Full-Time positions open - One for Northwest Indiana. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Busy multi-office practice in L.A./Inland Empire areas in need of full-time or part-time associate for a well paid position. NO Nursing homes! Must have CA license. Medicare and DME numbers are helpful. Please send CV and contact information toscpodgroup@yahoo.com

ASSOCIATE OPPORTUNITY – SOUTHERN NEW JERSEY

Searching for the “perfect” associate for our busy and rapidly growing practice; EMR, ultrasound, vascular studies, and DME. We have advanced surgical and admitting privileging at multiple teaching hospitals. You must bring strong medical and surgical skills to a practice that is sincere about teaching you success in private practice. Hardworking and personable doctors only! Partnership track. If we sound like your “perfect” practice, email CV, letter of recommendation, personal introduction of yourself, why you are passionate about podiatry (like us) and want to live in Southern New Jersey to doctor@sjfootdrs.com

ASSOCIATE POSITION - CANADA

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply todr.cole@shaw.ca

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Seeking associate for busy, growing practice located in Toms River, Ocean County. Looking for PSR 24/36, board eligible doctor. Basic podiatry a must. Practice has a up-to-date EMR and practice management program. Digital x-rays, ultrasound, laser, vascular studies. Excellent opportunity for highly motivated and ethical DPM. Send CV totoesec@aol.com

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