The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 22, 2008 #3,304 Editor-Barry Block, DPM, JD

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Flip-Flops Can Cause Lower Neck Pain: PA Podiatrist

A recent Auburn University study found that wearing flip-flips can lead to sore feet, ankles and legs. Researchers in the AU kinesiology department studied 39 college-age men and women wearing both flip-flops and athletic style shoes. The study found that flip-flop wearers took shorter steps and that their heels hit the ground with less vertical force than when the same walkers wore athletic shoes. When wearing flip-flops, participants did not bring their toes up as much during the leg's swing phase, resulting in a larger ankle angle and shorter stride length, possibly because they tended to grip the flip-flops with their toes.

Dr. Harry Penny

"In summertime, people tend to be more active," said Dr. Harry Penny, a podiatrist with Blair Medical Associates in Altoona. "Unfortunately, that's when they shed their sneakers, which give them support." Flip-flops' soles are so thin that they don't provide adequate shock absorption, Penny said - and that can lead to ankle sprains, tendonitis and the flattening of the arch.

"The shock goes up until it's dissipated," Penny said. "The stress we're talking about - it actually affects everything, with the exception of the arms. Especially lower neck pain - people come in with that, and they don't even have a clue. But the stress has to be absorbed somewhere, until it diminishes."

Source: Ashley Gurbal, Altoona Mirror [7/18/08]

NY Podiatrist to be Featured Guest on Medical Talk Radio Show

Dr. Douglas F. Tumen, a podiatric surgeon with Hudson Valley Foot Associates will be the featured guest on WAMC radio's "Medical Monday" call-in program this coming Monday. Tumen will talk about advancements in the treatment of foot conditions and will take calls from listeners.

Dr. Douglas F. Tumen

Tumen has been practicing podiatry in Kingston for more than 20 years. A graduate of the Illinois College of Podiatric Medicine, he is a diplomate of the American Board of Podiatric Surgery, is board-certified in foot surgery and is a fellow of the American College of Foot and Ankle Surgeons. He also is a marathon runner and a former director of the annual Kingston Classic 10-kilometer race.

Source: Kingston Daily Freeman (NY) [7/19/08]

Long-term Care Should Be Part of Medicare: Survey

Healthcare experts overwhelmingly support adding a long-term-care benefit to Medicare as part of a comprehensive solution to the coming onslaught of baby boomer retirees, the latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey finds.

The survey of 196 leading experts in academia, healthcare delivery, healthcare-related business and government found that 79% of respondents support such a new benefit, which would be backed by a premium. Such cost-sharing was in line with other results of the poll. Some 55% of respondents said individuals and the government should share long-term-care costs, while only 8% thought such costs should be paid mostly by the government.

Another 64% of respondents favored providing tax incentives for individuals to purchase private long-term-care insurance, and 63% backed transferring the responsibility for Medicaid long-term care from the states to the federal government. Respondents also broadly agreed that ensuring adequate financing and a workforce able to meet the needs of the nation’s aging population were at the top of the list of long-term-care policy challenges.

Source: Todd Sloane, Modern Healthcare [7/18/08]

Motivate Staff When They Least Expect it

Little motivational efforts can make a big difference in your staff’s morale. That’s why sending congratulatory notes, making phone calls to express your gratitude or celebrating anniversaries should be an important part of your motivational toolkit.

While you certainly should recognize staffers’ birthdays, you must go beyond the expected and create spontaneous, original recognition opportunities. Here’s an example:

The anniversary of the date a person joined your practice. Send a card to thank the person for his or her effort over the past year, citing specific examples.

Source: Adapted from The Buzz: Little Things That Make a Big Difference to Team Motivation & Leadership by David Freemantle

RE: EMR and Red-Green Color Blindness

I am color-blind and recently purchased Medinotes e, a program in which red and green fonts represent different objects (red objects will never show up in the final document, but green will). The red object is a memory cue of an exam, but once chosen the font turns green. I contacted the vendor but so far they have not been able to solve the problem. I would appreciate any suggestions on how to make this program work efficiently for me?

Name Withheld

Fireworks and Flip-Flops Don’t Mix

This patient (a nurse) and her husband were shooting fireworks on the 4th. One of the rockets misfired and as this patient was making her hasty retreat became lodged between her flip-flop and her plantar foot. “and the rockets red glare” ouch! Multiple literature reports on firework injuries to every other area of the body but literature search did not reveal any other reports of firework injury to the foot.

Fireworks Injury after 12 Days

The above photo is after 12 days of healing. This was a 3rd degree burn with a small 2 mm. area of exposed fat pad. She has been treated with off-loading and local wound care.

Tip Sullivan, DPM, Jackson, MS

RE: To Biopsy or Not? (Larry Aronberg, DPM)
From: John P. Miller, DPM, Michael M. Rosenblatt, DPM

I think the adage, "When in doubt, biopsy" is wise to keep in mind. I would call the dermatologist who recently did the exam and ask him what the lesion is. If I had concern of potential malignancy, I would not take the word of the patient. I think we have all been down that road. Perhaps the dematologist exam did not include looking at the foot. Perhaps the dermatologist is not a really a dermatologist. A phone call to the dermatologist should be appreciated by the dermatologist, educational for you and part of the team approach. The phone call may allay your concerns re. need for biopsy.

Eighty years old and long time presence of a lesion that was not always there are not absolute contraindications to biopsy. If you biopsy and it is a seborrheic keratosis, venous stasis-related lesion, or other benign lesion......you and the patient are both happy. If it is a squamous cell carcinoma or a malignant melanoma, you may save this patient's life.

John P. Miller, DPM, Olean, NY, CMille123@aol.com

Forget practice management and income opportunities. Biopsies of ulcers and cutaneous lesions are essential. Every podiatrist should have a dermatopathologist available to examine those lesions. It is not necessary that they be local. Samples can be easily sent by mail. Then, an effective treatment plan can be instituted.

It's time to stand up for patients and get them the diagnosis they deserve. My impression is that podiatrists biopsy fewer lesions than we should. I think this paradigm must be changed.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: Dictation Software [Joshua Prero, DPM]
From: Jeff Katz, DPM, Greg Mowen, DPM

Our practice has been using Textalk MD for the last four years. They have a very good podiatry product which allows one to use templates or customize each note. It has worked great for us (3 doc practice). Also reasonable and good support.

Jeff Katz, DPM, Vineland, NJ, Toetrukr@aol.com

I have Dragon to be fairly good program, saves a lot on dictation cost, but you have to proofread everything! The program will often miss “he”, she”, and similar small words. I also had trouble loading it onto windows Vista (I believe there is a patch now available). I use medical version 9.1 and just use it with Word pad. It is compatible with most EMRs, Word, Openoffice, etc.

Greg Mowen, DPM, Margate City, NJ, gregmowen@comcast.net

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