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July 16, 2012 #4,515 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Breaking in Shoes

The type of leather will affect how easy it is to break in a new pair of shoes, says Dr. Joshua Kaye, a Los Angeles-based podiatrist. Calfskin, a supple leather that conforms to the shape of the foot, generally breaks in faster than full-grain or top-grain leather. Expensive shoes tend to have thinner leather and to stretch more as you wear them.

Dr. Joshua Kaye

Dr. Kaye suggests that shoppers flex various shoes' leather between their fingers to compare thickness and flexibility. Suede is generally a softer material, comparable to finer leather in terms of thickness and ease of break-in.

Source: Ray A. Smith, Wall Street Journal [7/11/12]

Foot Pain is Not Inevitable for Seniors: APMA President

"While staying active is a great way to preserve overall health and can positively impact foot health, aging can naturally increase the risk of certain foot ailments," says Joseph Caporusso, DPM, a podiatrist and president of the American Podiatric Medical Association (APMA). "It's important to know the symptoms of age-related foot ailments and take steps to minimize their impact on your overall health." 

Dr. Joseph Caporusso

"Foot pain does not need to be an inevitable part of growing older," Caporusso says. "Wearing the right type of footwear for your needs, and paying attention to foot health can help keep boomers moving into their senior years."

Source: Las Vegas Review-Journal [7/13/12]

MI Podiatry Group Collects Supplies for Troops

Walk into the offices of NorthPointe Foot & Ankle, and right in the middle of their reception room is a big box with an American flag and a sign that says, “Just the Basics! Donations for our Troops.” It’s the brainchild of Medical Assistants Craig Alexander and Mike Lane, who know what it’s like to be in military service far away and missing the comforts of home.

Members of the NorthPointe Food & Ankle team Dr. Jeffrey Frederick (from left), Maxine Munoz, Jenn Nunley, Dr. Michael Schey, Mary Kennedy, Dr. Charles Kissel, Darcy Elwart, Dr. Lee Hoffman, Venita Favors, Michael Bendzick, and Heather Barum.

Alexander and Lane, a former Marine, wanted the clinic to collect essential items like toothbrushes, toothpaste, shaving cream, disposable blades, lotions, and spray deodorant, as well as treats like candy, magazines, and hand-held games, and ship them to troops in Afghanistan. “We pitched our idea to the doctors, and they went for it right away,” Alexander said. The NorthPointe doctors donated 200 pairs of brown socks, but more are always needed.

Source: Jeanne Towar, The Oakland Press [7/13/12]

It's Bastille Day Everyday for Retired NJ Podiatrist & Wife

Dr. & Mrs. David Zuckerman's expansive home on the first tee of Woodcrest Country Club's golf course is so French that you might expect to meet Napoleon himself in the "salon," the home's formal living room. The phone's ring tone is Edith Piaf singing. "Living here is a bit like living in a fine French hotel. Jessica's taste is exquisite, and she's constantly adding and enhancing," says David, 58, who has retired from his practice but currently heads two companies developing ways to treat foot and orthopedic problems through light waves.

Jessica and David Zuckerman in their Cherry Hill home with Josie, their Yorkshire terrier, who joins them on visits to France (Photo Ed Hille).

Luckily, his wife has decorated a home office that besides being regal and sumptuous, is also practical and workable. The desk is one of the home's many showstoppers with its gilt trim and elegant lines. Behind it are bookcases, also with elaborate gilt trim, thoroughly French — and utilitarian, too. Tables are showcases for more of the French china that the Zuckermans have collected on their more than two dozen trips to every region of France over the last 14 years. Gold moldings and a wallpapered ceiling add to the grandeur.

Source: Sally Friedman, The Philadephia Inquirer [7/13/12]

Employees are #1

Don't cave in to patients who abuse, insult, and intimidate your employees. Recognize the incredibly deflating message it sends employees if you side with an abusive patient while ignoring the rights and dignity of your own staff.

Source: Bob Levoy, 222 Secrets of a Hiring, Managing and Retaining Great Employees in Healthcare Practice.

RE: C0₂ Lasers for Onychomycosis
From: David Gurvis, DPM

Read the following paragraph very carefully: ”There are several lasers that have been FDA-approved for treating nail fungus. One of the lasers used for this condition is the CO₂ laser. This laser works by killing the fungus by direct heat. It also bores tiny holes in the nail plate that allow a drying of the nail bed and provides a much more favorable application route for topical anti-fungal agents to be applied.”

These are two statements made to look related but they are not. 1. Some lasers are FDA-approved. 2. A laser used for this condition…  NOTA BENE: it does NOT say the CO₂ laser is approved, just that it is one. Nothing but your own mind relates the two sentences to think the CO₂ laser is approved by the FDA.  Neat trick, huh?

In the "old" days, many did use a CO₂ laser to drill multiple small holes into the nail plate to allow the deeper penetration of topical agents. As far as I know, it never worked well. My understanding is you are able to use anything off label as long as you inform the patient, but you are not legally enabled to advertise an off-label use. This doc may be in violation of the law - not for using the laser, but for advertising it.

David Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Frank Lattarulo, DPM, NY

I have been using phenol sticks almost since their inception and have what I consider excellent results. The occasional regrowth/failure I usually blame on myself rather than the phenol stick. One spicule of growth now and again I see may be from failure to excise the entire nail. However, what I do a bit differently is the use of a Penrose drain more often than not. The majority of patients I do phenol procedures on are the younger non- diabetic/PAD population.

I feel the use of a Penrose for 2-3 minutes is an acceptable risk in most of my patients. For the most part, the chronically ingrown nail population is demographically those who can tolerate a tourniquet for the amount of time the phenolization procedure takes. Of course, I would use regular lidocaine if using the tourniquet. Try this in the correct patient pool and you may see a difference.

Frank Lattarulo, DPM, NY, NY,doclatt@aol.com

You must use a tourniquet when using the Phenol EZ swabs. As the inventor of the Phenol Ez swabs, a dry bloodless field is mandatory for the one application technique which I invented. Blood will neutralize the phenol, therefore multiple swabs must be used to stop the bleeding.
 
Jim Ricketti, DPM, Hamilton Sq, NJ, Drj4foot2012@aol.com

RE: NY Podiatrist Discusses Cold Feet in Diabetics (Chuck Ross, DPM)
From: Robert Wunderlich, DPM
 
I have to disagree with Dr. Ross' statement that warning diabetic patients against soaking their feet in hot water was "overstated."  On the contrary, I don't think it can be stated enough. I present for your consideration this clinical photograph of a diabetic patient with PAD who woke up one night with cold feet and decided to soak them in warm water, as Dr. Ross suggested. The problem of course is that our diabetic patients can have peripheral neuropathy that affects their hands as well as their feet, so testing the temperature with a hand is not necessarily helpful.

Burn in Diabetic Foot

As a side note, it's worth mentioning that a burn like the one in this photograph should be referred to a burn center, according to the American Burn Association's recommendations.(ameriburn.org/BurnCenterReferralCriteria.pdf)
 
Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

Query: Toetal Coverup?

This picture demonstrates the ends women will go to cover up perceived cosmetic issues. This young lady originally got this tattoo for one reason---to cover up the corn on her toe!

Tattoo designed to disguise corn

The corn did not hurt; “it just looked ugly.” It still does not hurt, but she wants it “fixed” without messing up her tattoo.

Tip Sullivan, DPM, Jackson, MS

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