July 25, 2006 #2,638 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Bruce Frankel, DPM, 63

Dr. Bruce Frankel

The Board of Trustees, faculty, students and administration of the New York College of Podiatric Medicine express their profound sorrow at the passing of Bruce J. Frankel, DPM, Professor and Dean of Clinical Studies. Bruce was a beloved and much-respected member of the faculty since 1977. He received his DPM degree from the College in 1971 and dedicated himself to it thereafter, while also running a successful private practice.

His devoted wife, Bobbi, joined him in giving unstintingly of herself to the College. Our hearts go out to her and the other members of the Frankel family, Shari (Steve Plotka, DPM) and Elicia (Brian Judy). Bruce will be greatly missed.

PM News policy is to recommend that memorial contributions be made to the APMA Educational Foundation Student Scholarship Fund, 9312 Old Georgetown Rd., Bethesda, MD 20814 or to the New York College of Podiatric Medicine, 1800 Park Ave, NY, NY 10035

Physician Income Lags Inflation

Physician income has increased, but it has not kept up with inflation, according to a new study.

Note: Figures for 2003 are adjusted for inflation to 1995 dollars. Percentages are rounded.

Source: Center for Studying Health System Change

Query: Dragon Software

I am a solo private practitioner thinking of using Dragon software instead of a transcriptionist. Staples sells the Dragon standard version for $50, the preferred for $100, and another vendor has the medical version for $900. Is it worth the difference in price for the medical? Is the learning curve steep with the new versions, and if you have problems, do you call Dragon or your vendor (i.e. is it worth more to go to a non-discount vendor to have them to help with questions)? Please relate any experiences good/bad.

Gary Bjarnason, DPM, Roanoke Rapids, NC, planttender@charter.net

RE: Bruce Frankel, DPM

It is with deep sadness that we learn of the passing of Bruce Frankel. Bruce and Bobbi have been a part of my life since I first entered NYCPM in 1972. His kindness to all and his dedication to our profession was unwavering. His love for NYCPM was second only for his love of his family and friends. Bruce will be missed by all of us who he touched and the many people who he influenced. Bruce was one of the best ambassadors for podiatry that I ever met. I am proud to have been one of the many who was one of Bruce's friends. To Bobbi and the rest of the family, Greta joins me in extending our sincere condolences and our prayers. Shalom my friend.

David M. Schofield, DPM, President, APMA

RE: Memorial Service For Richard Baerg, DPM, MPH

A memorial service will be held for Richard Baerg, DPM, MPH on Tuesday, July 25 @ 2:00 PM in the Chapel at the Veteran's Cemetery in Boulder City, Nevada.

Joan E. Williams

RE: Medial Calcaneal Nerve Entrapment (David Gutierrez, DPM)
From: Multiple Respondents

First of all, I think that it is important to establish whether or not there is reproducible pain in the plantar heel by compressing the medial side of the heel or by squeezing the medial heel, rather than by pressing on the fascial insertion area of the plantar heel. I think that most experts would agree that the heel spur is not the painful area but the plantar fascia insertion area may be and the medial calcaneal nerve may be involved. If I can cause the patient's heel pain to be reproduced by compressing the inside area of the heel, then I would strongly consider injecting the medial calcaneal nerve branch to decrease the heel pain. I usually inject eekly with 1/4 to 1/2-cc of 4% alcohol solution just above the weight-bearing skin of the medial heel.

Typically, I will insert the needle and gently move it around until the patient reports pain down into the plantar heel region, then I inject the solution. I might give three to five injections before the pain is totally relieved. I have done hundreds of these injections over the past 20 years with excellent results and no recurrence after one-year follow-up evaluation. Dockery, G.L.: Dilute Alcohol Injections for Nerve Conditions and Keratotic Lesions of the Foot. Podiatry Management. p.117-126, January 2004. http://www.podiatrym.com/cme/Jan04CME.pdf

Gary L. Dockery, DPM, Seattle, WA, Gdockdockery@aol.com

I currently have a patient with this same condition. She underwent EPF approximately one year ago. I have injected just proximal to the maximum point of tenderness with 4% alcohol. After 3 injections, 10-14 days apart, she has nearly 60% pain improvement. I will continue for the full series of 7 injections since she has gotten noticeable improvement after 3 injections.

Paul A. Galluzzo, DPM, Rockford, IL, FTSURG1@aol.com

This is a perfect scenario for the use of cryosurgery by channeling underneath the scar or area of maximum tenderness and freezing any nerve branches that may be entrapped in scar tissue. I’ve had a 90% or better success rate with this technique.

Steven H. Goldstein, DPM, Livingston, NJ, stevefootdr1@cs.com
Similar note: G. Stephen Gill, DPM, MBA

RE: Long-Term Studies on Efficacy of Orthotics (Tip Sullivan, DPM)
From: Multiple Respondents

It is not possible to do a true double-blind study using anecdotal results. Typical orthotics, whether "pre-formed" or custom, do not change the existing osseous malpositioning of the foot and ankle during locomotion in shoes! Common orthotic and surgical therapies are designed for palliation, not correction. The word "orthotics" is used for any type of shoe inserts, whether it is a soft cushion or a firm arch support (custom or mass-produced - oops, pre-formed). Dr. Sullivan may be right, if he is inferring that common orthotics may not be effective in the pediatric patient.

There is one type of orthotic that can change the osseous infrastructure, but there are only three labs that can make them. Yes, it would be great if our colleges picked up on the newer method and did some research, but they can't or won't without a substantial grant. I would be thrilled to provide them the basics of the development, but only if they would contain this orthotic to podiatry only!

Jack Glick, DPM, AFO LAB, Beaumont, TX, jglick@afo-lab.com

Tip Sullivan asked: "why are there no long term (20+ yr) prospective biomechanic studies with a reasonable (n) that indicate whether custom-molded orthoses are effective?" That is simple to answer: MONEY. Research costs a lot.

Craig Payne c.payne@latrobe.edu.au

Dr. Sullivan brings up a good point that we don't have any good long-term studies on the efficacy of custom foot orthoses (CFOs). Even though it would be nice if we could experimentally study the therapeutic effects of CFOs with a well-designed multi-year prospective double-blind study as is commonly performed with oral medications, researching the effects of CFOs is very different.

One of the big problems with trying to do clinically realistic CFO research, [or any custom brace research, for that matter] is that the podiatrists that are the most effective at fully utilizing the therapeutic benefits of CFOs for the treatment of the pain, pathologies, and abnormal gait patterns of patients do not make the exact same orthosis for every patient. These podiatrists may use a multitude of different CFO designs for their patients depending on their weight, age, activity level, foot type, gait function, and specific pathology they have. In addition, these podiatrists will also modify their patients' CFOs depending on their gait function and their symptomatic response to the CFOs in subsequent office visits.

Therefore, if we desire to realistically study the therapeutic effectiveness of CFOs in a large group of patients over a long period of time, then we cannot just give all the patients in the study the same type of generic custom orthosis and compare them to placebo insoles the same way that drug companies perform double-blind studies of oral medications and compare them to placebo pills. The experiment must be designed to allow the podiatrist to make an orthosis that is truly individually customized for that patient and then allow the podiatrist to adjust that orthosis in one or two subsequent visits, so that the mechanical and therapeutic effects of these CFOs for these specific patients may be realistically studied.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE-PARTNER WANTED MICHIGAN-DETROIT AREA WESTERN SUBURBS

Great opportunity-must be hard working, reliable, responsible and good with patients & staff surgical training a plus-partnership after 1 yr. Michigan license required. Fax resume to 248-478-1370 Starting salary $200,000. plus benefits plus percentage. Serious inquiries only

FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations approx 1.5m gross, Buy outright or overtime. Call 561-213-9400 after 7:00 p.m. Serious inquiries only

PRACTICE FOR SALE -ST PETERSBURG, FLORIDA

Well established (27+ years) general Podiatry practice. Great location -surrounded by 4 retirement communities. Must sell quickly due to health reasons. Contact Irwin Ayes DPM at ayesent@earthlink.net or 727-544-5425.

LONG TERM CARE PRACTICE OPPORTUNITY- DOWNSTATE ILLINOIS, & CHICAGO AREA

We specialize in providing conservative ethical care to residents in long term care settings. Immediate part-time positions available in downstate IL, and the Chicago metropolitan region. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300 Fax-773-775-0883.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most- effective way of reaching over 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.