The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 18, 2009 #3,599 Publisher-Barry Block, DPM, JD

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Flat Feet Sometimes Normal: NY Podiatrist

According to podiatrist Daniel Smith, sometimes flat feet can be normal. "Between 2 to 4 years old, flat feet are a normal developmental variant as children mature into their adult form. Often a child will appear in-toeing or out-toeing at some point in their development. As long as it is non-painful and seen on both sides equally, I tend to have a wait-and-see approach within certain age ranges.", says Smith. "When older children or adults come to my office with a single flat foot and symptoms of pain in the heel, arch or ankle, this warrants further investigation."

Dr. Daniel Smith

"There are several periods in life in which a flat foot develops, and it is somewhat normal as well.", says Smith "During pregnancy, there is a normal stretching of ligaments to allow for passage of the child through the birth canal. The lesser known spring ligament of the foot suspends the topmost parts of our foot and this ligament loosens in a similar fashion. The resulting ligamentous laxity creates a flat-footed appearance, which may or may not be painful. Edema combined with this flat foot change can create one to one-and-a-half size increases in her shoes in a short period of time."

Source: Auburn Citizen [7/14/09]

CLEAR Researchers Present New Findings at 2009 ADA Conference

The American Diabetes Association (ADA) recently held its annual scientific meeting in New Orleans in which approximately 18,000 clinicians and researchers attended the conference. Researchers from the Dr. William M. Scholl College of Podiatric Medicine Center for Lower Extremity Ambulatory Research (CLEAR) presented three abstracts at the meeting.

Dr. Stephanie Wu

At the prestigious oral presentation session, Stephanie Wu, DPM, challenged the old wound culture paradigm that 10⁵/mg tissue bacteria are needed to infect a wound. Dr. Wu's findings found that wounds that didn't appear to be clinically infected actually had 10⁶ to 10⁸/mg tissue range and wounds culture results exhibited "moderate to heavy" counts of bacteria.

Dr. James Wrobel

"This is important work," noted James Wrobel, DPM, acting director of CLEAR. "We have seen other rt-PCR studies that suggest ulcers have much greater amounts and types of bacteria than ever thought and these bacteria become far more virulent as the wound gets deeper. We may have an opportunity to intervene earlier to decrease the bacterial load with debridement and other local means. We'll have to see if the surveillance studies show we have more clinical infections being treated at the outpatient or hospital level."
 

New Definitions Tighten Privacy Rules

Physicians have more reason than ever to keep employees from snooping into patient records. New laws at the federal level, and in some states, make it clear that letting nosy employees slide is no longer an option.

The HITECH Act’s definition of a ‘breach’ now applies to when a person snoops into patient records: “The term ‘breach’ means the unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information, except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information.”

The law also requires CMS and the HHS Office for Civil Rights to investigate complaints where a preliminary inquiry shows that “willful neglect” is the cause. And the law raised the penalties the government can hand down.

Source: Eve Collins, Report on Patient Privacy [7/15/09]
 

Part 11- Rules to Abide By When in Front of an  ALJ - By David Mullens, DPM, JD
 

Although you may be shaking your head wondering why I am telling you these things, trust me. These mistakes are made all the time, and not just by doctors.

1. Never argue with the ALJ - If you are foolish enough to argue with the ALJ, you shouldn’t bother with a Hearing. Put yourself in the position of the ALJ and ask the easy question: "Are you going to be looking for a way to approve payment or deny payment for the doctor who is arguing with you during the Hearing?"

2. Never interrupt the ALJ - When the ALJ is speaking, you are to remain silent. You are only to speak when asked to do so by the judge. Want to know what happens when you start interrupting the judge? See the answer to number 1 above.

3. Do not answer the question you think the ALJ should be asking. - Answer the question the ALJ is actually asking.  This is the biggest problem doctors have during ALJ Hearings. You must listen very carefully to what the judge is asking and you must limit your answer to the question being asked. The judge will allow you plenty of opportunity to say everything you want to say during your presentation of the case in chief. But when the judge asks you a question you must answer that exact question.
 
4. Remain absolutely polite, even if the judge is not. - The easiest way to remain polite is to imagine you are not representing yourself but instead are representing another doctor. If the judge is not polite during the Hearing, that is a reflection on the judge and not a reflection on you – unless you get dragged into reciprocal bad behavior. Once the Hearing degenerates and foul moods prevail, how do you think the judge is going to rule? Yup. See number 1 above.

Query: Delayed Onset Muscle Soreness (DOMS)

What advice do you give to weekend athletes who push themselves too far and have difficulty walking the next day or two. I have used stretching slowly, massages, and yoga, and sometime an NSAID. Any new suggestions?

Bret Ribotsky, DPM, Boca Raton, FL
 

RE: Flatfoot w/ LLD (Charles Morelli, DPM)
From: Dennis Shavelson, DPM

The asymmetric navicular sag on the short side may be enough to cause the LLD. For example, a Charcot foot collapse will almost always cause an LLD on the affected side.

I have seen this clinically in neuromuscular disturbances such as post-PT rupture, Achilles ruptures, plantar fascia ruptures (or post-op EPF), flaccid neurologic etiology (i.e., stroke), and when there are primary postural problems such as scoliosis or a unilateral hip torsion, that compensate secondarily in the foot.

No matter what the etiology, functional foot-type the patient, and take a corrected negative cast, foot type-specific, which will vault the navicular and compensate for sagittal plane collapse. This should “even out” the feet. If there is still an LLD, add lift to the Foot Centring on the short side to compensate.

Dennis Shavelson, DPM, Director, The FootHelpers Lab, DrSha@footworldusa.com

RE: The Certified Foot Care Nurse
From: James E. Laskey, DPM

With the rapid aging of the U.S. population and the increased incidence of diabetes mellitus as well as lower extremity arterial  disease, the demand for routine and “at-risk” foot care is beginning to overwhelm the appointment schedules of many podiatric...

Editor's note: Dr. Laskey's extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=27503&start=1

RE: PhysicianRedFlagRule.com (Chuck Ross, DPM)
From: Jack Hickey, DPM

Our office uses the physicianredflagrule.com program. We thought that we were covered with the program that we wrote ourselves, but we weren't even close. The program has been easy to use, and it has saved my manager countless hours & headaches, plus it really takes you step-by-step on how to recognize and investigate red flags (plus what to do when faced with one). Plus- we weren't aware that most of the theft is done from employees (we'll be getting bonded in the next month or so).

The materials are clear, easy-to-understand, and easy to follow. The staff even get a certificate at the end (We're going to use them as a PR tool). It's worth it- get it.

Disclosure: my office manager (Meghan Hickey) is quoted as loving the program on their website, but she was not compensated for this unsolicited testimonial.

Jack Hickey, DPM Levittown, NY, jhickeydpm@earthlink.net

RE: Insurance and Your Reputation (Robert Kornfeld, DPM)
From: Ray McClanahan, DPM

I would like to commend Dr. Kornfeld, for repeatedly encouraging us to examine our relationships with insurance companies. One year ago, I became an out-of-network provider for all insurance companies, and opted out of Medicare. We had a few patients who did not like the new arrangement, which required them to bill their own insurance companies. But the majority seem quite happy with the extra time, care, and attention they receive.
 
The flow of the clinic is still busy, but much more manageable, with all of our efforts going towards serving the needs of our patients, rather than attempting to satisfy the ever-changing requirements of the insurance companies. I have time to e-mail and call patients. The patients have increased access to my schedule. I document carefully, but without the fear and paranoia that once accompanied my charting. 
 
I am seeing fewer patients, with improved income, and I enjoy podiatric medicine again. My staff is happy, and our clinic has become a place of healing again. I worried a lot over the course of the past year. I fretted over the disgruntled patients, who wanted it to be like it was before. But ultimately, I had had enough, and needed a change. I have successfully eliminated the middleman. I would urge you to do the same, but also recognize the uniqueness of everyone's practice situation, and consequently wish to be sensitive to the reality that all podiatric practices are not like mine. That said, I have been extremely gratified with the choice we have made to not participate with insurance companies, and truly believe that many of you would similarly benefit, by making the decision to not participate. I hope it will encourage you to evaluate your relationships with medical insurance companies, and ask yourselves if it is worth it to participate.
 
Ray McClanahan, DPM, Portland, OR, footdr@nwfootankle.com

RE: ACFAOM Conference
From: John Lampe
 
This was a wonderful conference. The presentations my colleagues and I saw were superb. I would highly recommend to any company – especially small ones that are introducing new products – that they exhibit at ACFAOM. We found that the conference was a little more relaxed than others. This gave us the chance to have quality conversations with practitioners and other exhibitors and to hear more of the presentations. Congratulations to the planners and organizers!

John K. Lampe, President, Tamarack Habilitation Technologies, Inc.,
johnl@tamarackhti.com

RE: After 15 Years, Albright to Retire from Scholl
From: Multiple Respondents

In the early years of my practice life, I had the good fortune to have as one of my mentors, Raymond Locke, DPM of Englewood, NJ.  Whenever Ray wished to bestow his highest accolade upon a fellow human being, he would call him a “real mensch.” I believe that this description could well have been coined with Terry Albright in mind. A “mensch” is someone who does for others, without having himself in view. A “mensch” is tireless in working towards the welfare of others without trumpeting his own accomplishments. A “mensch” is a person who excels in motivating others, without extolling his own intrinsic worth. A “mensch” is someone who is kind and pleasant to others, even when they do not reciprocate these characteristics.

Terry, I hope that someday when you  sail out of the mist in Camden harbor into Penobscot Bay, with the eagles soaring overhead, and the whales breaching in the distance, that you will hear the words resounding over the water, “well done.”

Edward R. Nieuwenhuis, Sr., DPM, Wycoff, NJ, edfeet@aol.com

Plain and Simple, Dr. Terry....CONGRATULATIONS!

As you take this next "step" into your life of R&R, don't forget those of us still plugging away...who will never forget you and what you have done for this profession! I will miss bumping into you now and again and wish you the best of everything.

Lynn Homisak, PRT, Renton, WA,  

I want to add my voice to those who congratulate Dr. Albright for a job extremely well done. I have known Terry for about 30 years now, having first met him in the Acey-Deucy organization at the House of Delegates. At one time there was an adversarial position between the APMA leadership and the general membership. Terry was among the vanguard of young, energetic, visionary, and innovative leaders who transformed this association into the dynamo and user-friendly “family” it is today.

Terry has always been an inspiration to me. I have always found him to be a person of integrity with a burning passion for this profession and especially the students. I am proud to call him a friend and wish for him and his family only the very best life has to offer as he enters this next phase of his earthly journey.

Wes Daniel, DPM, Gainesville, GA, wdan-gpma@mindspring.com
 

RE: Hold That Dinner Reservation

On Wednesday night, Josh White, DPM, CPed, President of SafeStep, was talking on his Blackberry while walking to meet friends at Peter Lugar’s Steak House in Brooklyn.  Out of the blue, he was punched in the head and his cell phone stolen out of his hand. 

The mugger ran and Dr. White, fortunately wearing New Balance sneakers with PowerStep inserts, gave chase, shouting for the police along the way. People on the street followed while others indicated the way the assailant fled. After five blocks, Dr. White saw a cop who called for help. A block later, other policemen apprehended the suspect.

When asked whether he would go down to the station house to press charges, Dr. White said that he would, so long as his 6:00 dinner reservation could be postponed. It can take weeks to get a table at the restaurant. The sergeant worked things out with the maître d’ and thanked Dr. White for his good citizenship as he said that most victims are fearful to prosecute. The assailant was charged with robbery, possession of stolen property, and resisting arrest; Dr. White and friends reunited and said that the porterhouse tasted particularly good.

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Contact Dr. Ilona Barlam at 206-661-9644.

ASSOCIATE POSITION - WINDSOR, ONTARIO, CANADA

Full-time/part-time podiatrist or chiropodist position available. Please send letter of interest and CV to info@toezone.com

ASSOCIATE POSITION - BOSTON, MA 
 
Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to .comf-massuda@footexperts

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

PRACTICE FOR SALE – WESTCHESTER COUNTY, NY

Established 30+ year old practice. Well respected podiatrist in beautiful Westchester County Owner ill and needs a quick sale. Mixture of surgery and general podiatry. Hospitals in close proximity. Will lease office to buyer. Call Mali McGrinder at 914-434-1663.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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