The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 20, 2009 #3,600 Publisher-Barry Block, DPM, JD

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HI Podiatrist Discusses Plantar Fasciitis and Footgear

One of the most common foot problems for Island people is plantar fasciitis — inflammation of the tough, fibrous band of tissue (fascia) connecting the heel bone to the base of the toes. Podiatrist Dr. David Yee of the Hawai'i Foot Clinic said he sees three or four cases a day and it is "the first or within the top three diagnoses" in his practice. Why? Certainly bare feet and rubber slippers have a hand (or foot) in it.

Dr. David Yee

American shoes can also contribute to the problem, Yee said, because they don't pair well with lu'au feet. "They are designed for Caucasian foot widths, mostly medium, but it's not uncommon to have patients in Hawai'i with EE widths or even EEEEE widths, so they have stuffed their feet into shoes that don't fit."

Source: Paula Rath, Honolulu Advertiser {7/16/09]

NWPF Presents Awards at 39th Annual Banquet

The 39th Annual Seattle Residency Graduation and NWPF Awards Banquet was recently held at the Seattle World Trade Center. The program was moderated by Douglas Hale, DPM, Swedish Podiatric Surgery Residency Director. This year, the PM&S-36 graduates were Claire Coates, DPM, who will be doing a fourth year of training with a one-year reconstructive foot and ankle surgery fellowship at the University of Texas Health Science Center at San Antonio, and Paul Smith, DPM, who will be starting practice with a multi-specialty group affiliated with Gifford Medical Center in Randolph, Vermont.

Dr. Mary Crawford

This year, the Northwest Podiatric Foundation's Annual Awards were presented by G. Dock Dockery, DPM, Chairman of the Board, to three individuals. The Outstanding Teaching Award was presented to Matthew LaBella, DPM; the NWPF Member of the Year Award was presented to Stephen Mariash, DPM; and, the National Service Award was presented to Mary E. Crawford, DPM. These award winners were nominated and voted on by the residents, members of the medical advisory committee, and the Board of Directors of NWPF.

Depression Doubles Risk for Diabetic Foot Ulcers 

Major depression doubles the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study. Lisa Williams, M.D., from the University of Washington, Seattle stated that the findings strongly suggest screening for and treating depression to prevent this complication. "Depression is twice as common in patients with diabetes," she said at the annual meeting of the Society for Investigative Dermatology.

"At any time, 11% to 12% of patients with diabetes have major depression, and 31% have significant depressive symptoms, which include major and minor depression." Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers, Dr. Williams said. However, she said, "Depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer." Her analysis included data from 3,474 patients enrolled in the Pathways Epidemiologic Study -- a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Source: Society for Investigative Dermatology; Williams LH, et al., "Depression and incident diabetic foot ulcers: a prospective cohort study" SID 2009; Abstract 365 via Diabetesincontrol.com

Part 12 - Concluding an ALJ Hearing - By David Mullens, DPM, JD

At the conclusion of the Hearing, and while you are still on the record, ask the ALJ for a copy of the recording of the Hearing.  Although the doctor (Appellant) is not allowed to make a recording of the Hearing, all ALJ Hearings are recorded at the judge’s end. You are entitled to one free CD copy of the recorded Hearing and you want this CD for several reasons.

If you are unhappy with the ALJ’s decision and you want to appeal to the next level (Medicare Appeals Council in Washington, D.C.), you will have to listen to the recorded ALJ Hearing very carefully to make sure every ALJ error you assert in your written appeal to the MAC is correct.

If you are consistently representing yourself at ALJ Hearings regarding denied Medicare claims, and you are repeatedly assigned to the same unreasonable judge, you will want to be sure you can credibly argue to the supervising ALJ that - based on inappropriate judicial demeanor during multiple Hearings with that judge - you should be assigned to a different judge.

Query: Lipoma or Liposarcoma

I have a patient who has a 3 inch x 3 inch soft tissue subcutaneous tumor on the medial right heel. X-rays negative. Past medical and surgical history is non-contributory. MRI report said lipoma or liposarcoma due to septations seen. I am planning an intra-operative biopsy with frozen section. If it is a lipoma, I will remove it. If it is a liposarcoma, should I excise the tumor and refer to surgical oncologist or just sew up at that point and refer to a surgical oncologist?

Richard Silverstein, DPM, Havre de Grace, MD

Query: PQRI and E-Prescribing

I am curious regarding the number of podiatrists who have successfully incorporated one or both of these measures into their practices in order to obtain the CMS promised 2% bonus for each of these measures successfully accomplished. 

Does anyone have a simplified manner in which they have modified their superbills or other communication forms in order to effect these changes? I am finding this very difficult.

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

RE: Delayed Onset Muscle Soreness (DOMS) (Bret Ribotsky, DPM)
From: Multiple Respondents

From my own personal experience and that of my patients, I've had good results with NSAIDs prior to, during, and after the exercise, along with stretching before and after. If, like me, your patients are not in perfect shape, some degree of soreness is inevitable.  After a long hike in the Adirondack mountains, I've often patted myself on the back the day after the hike when I didn't hurt too much. Then, on the second day, the pain would really set in. Gentle exercise of the same sort that produced the pain in the first place seems to shorten the duration of the suffering.

Paul Busman DPM, RN, Clifton Park, NY, brewerpaul@aol.com

My treatments for DOMS include massage (either professional or self-administered) plus ice water soaking. Of the two, the ice water soaks seem most effective in helping me return to activity the next day. I start with tolerably-cool water in a tub, then decrease the temperature gradually in order to avoid the sudden crying, wailing, and histrionics that occur if I jump directly into already-icy water. Sometimes, I take an NSAID too.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

Try this supplement stack:  Branched chain amino acids - 5 grams/day; glutamine 3-5 gm per day; phosphatidylserine 300mg/day and beta-alanine.

S. Jeffrey Siegel, DPM, Philadelphia, PA, heeldoc1@aol.com

RE: The Certified Foot Care Nurse (James E. Laskey, DPM)
From: Sam Bell, DPM

My first thought in response to the fact that podiatry schedules were being clogged with nail, corn, and callus patients was to say, “then send them to me”, but I do realize that if there were not forward-thinking podiatrists back in the 60's and 70's, then I could never have achieved the training I did back then. So, please tell me more about the CFCN. Where is the training, what is the training and time of training, who certifies the CFCN? Is this something that is happening now, or is this a wish for the future? I have not heard of this before and find it interesting.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

RE: On-Line Back-up (Lynn LeBlanc, DPM)
From: Mark Stempler, DPM

I used to use a tape back-up. It was horrible. It took a long time and was unreliable.  Now I back up using a Maxtor external hard drive. It works great, is very fast, and you don't have to rely on the online company.

Mark Stempler, DPM, Staten Island, NY, drmstempler@verizon.net

RE: Hold That Dinner Reservation (Josh White, DPM)
From: Richard Mann, DPM, Teresa N Tobin, DPM

A podiatrist, a hero, Powerstep orthotics, swift justice, and a great steak. I sense a movie deal in the near future.

Richard Mann, DPM

Many kudos to Dr. White for his courage & obvious good physical conditioning! The orthotics didn't hurt either.

Teresa N Tobin, DPM

ASSOCIATE POSITION-CHICAGO AREA

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.

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