The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 31, 2008 #3,312 Editor-Barry Block, DPM, JD

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Sport-Specific Shoes Give Kids a Leg Up: NY Podiatrist

Kids who are properly outfitted for the specific sport they’re playing have an edge, says Westchester-based podiatrist Dr. Charles Morelli, president of the Tappan Zee Division of the New York State Podiatric Medical Association. While many people think of older people when they hear the word “podiatrist,” Dr. Morelli says 25-30 percent of his patients are children and teenagers. He helps with everything from flat feet to warts, ingrown toenails, heel pain and more.

Dr. Charles Morelli

According to Dr. Morelli, picking the right shoe takes more than just heading to the athletics section of the shoe store. “Buying a sport-specific shoe – a shoe designed for the exact sport your child will be participating in – not only improves your child’s performance on the court or field, but also helps keeps him or her free from serious foot and ankle injuries,” he says.

Source: Gloria Smith, Westchester Family, [7/30/08]

NE Podiatrist to Head Health Professions Program

Dr. Twila Fickel of Chadron has been hired to guide Chadron State College’s health professions program beginning this fall. Fickel, 46, recently retired from private practice in Nebraska and South Dakota. She owned and operated the Chadron Foot Center from 1989-2007.

Dr. Twila Fickel

Fickel will teach human anatomy courses at CSC and said she is looking forward to the challenge of classroom instruction, especially interacting with students and sharing their enthusiasm. In addition to teaching, she will serve as chairwoman of the health professions and biology programs.

A native of Gresham, NE, Fickel earned a doctorate from the College of Podiatric Medicine and Surgery of Des Moines, Iowa, in 1988. Prior to that, she earned a bachelor of science degree in mathematics from Peru State College in 1984.

Source: Chadron State College (NE Govt) [7/30/08]

Medicare Seen as Easy Target for Fraud

Medicare pays upwards of $60 billion per year to con artists who defraud the federal government in what has become a quick, easy and relatively undetectable crime, even while lawmakers say that the problem could be stemmed by removing beneficiaries’ Social Security numbers from their coverage cards and developing a claims-verification process.

“Quite simply, Medicare is not sophisticated enough to address the fraud that runs rampant through it,” Sen. John Cornyn (R-TX) said during a Senate Republican Conference meeting. “Every year, Medicare’s anemic fraud control lets slip by an array of schemes that cost the Medicare program and taxpayers $60 billion, if not more.”

A conference committee report cited a number of cases where Medicare was taken for millions of dollars, including instances where medical devices were billed multiple times and medications ordered with no intent of ever reaching a patient. Cornyn and Sen. Mel Martinez (D-FL) have sponsored legislation which, in part, would require Medicare to stop using Social Security numbers as the Medicare Beneficiary Identifier.

Source: Matthew DoBias, Modern Healthcare

How to Reduce Interruptions – Part 2

Jay Conrad Levinson Doesn’t believe that time is money. He believes it’s more valuable than money. Levinson offers these tips on dealing with interruptions that waste valuable time:

• Allow interruptions that you’re sure you can deal with in less than a minute.
• Delegate interruptions to others, but make sure that you also delegate the authority they need to decide for you.

Source: The Ninety-Minute Hour by Jay Conrad Levinson

Query: Formula 3 Anti-Fungal

Does anyone have any experience using Formula 3 Anti-Fungal solution in their office? If so, what outcomes have you been seeing?

Marcie Struck, DPM, Nashua, NH

RE: Ulcer Classification Method (Frank J. DiPalma, DPM)
From: Martin Taubman, DPM

Aside from the well-known Wagner ulcer classification system, here is a popular wound coding method (from my publication, Codes for Podiatric Medicine and More! 2008).

Pressure Ulcer Grading Scale

Stage 1 - A stage 1 pressure ulcer is an observable pressure-related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer present as a defined area of persistent redness in lightly pigmented skin, whereas in darker tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage 2 - Partial-thickness skin loss involving the epidermis or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3 - Full-thickness skin loss involving damage or necrosis of subcutaneous tissue, which may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4 - Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or support structures (for example, tendon or joint capsule). Tunneling and sinus tracts may also be associated with stage 4 pressure ulcers.

Martin R. Taubman, DPM, MBA, San Diego, CA, mtaubman@san.rr.com

RE: Bone Stimulators (Elliot Udell, DPM)
From: Alison D. Silhanek, DPM, Simon Young, DPM

I am writing to clarify that there is a difference between the location and healing potential of the fifth metatarsal avulsion fracture, alluded to by Dr. Young, and the proximal diaphyseal fracture described in the article cited by Dr. Udell. Studies have shown that the former usually heals uneventfully with simple conservative measures, even "benign neglect" (1,2). On the other hand, the literature, including the article cited by Dr. Udell, shows proximal diaphyseal fifth metatarsal fractures to be fraught with delayed healing, often necessitating the use of bone stimulators or even early surgical intervention in the active patient (2).

However, there is a wide range of accepted treatments for both fractures, and it seems to me that it would be better to refrain from making hasty blanket judgments about any one approach given the brief case descriptions offered in a forum like this. To make such a judgment without knowing the full details of the case, and without including an accurate review of the literature (a task better left for a journal article as even those cited here do not do the topic justice), will only increase the confusion that the original poster was trying to resolve. Perhaps it would be better to point the original doctor to a relevant article or at least offer advice without judgment.
1. Wiener BD, et al. Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int. 1997 May;18(5):267-9.
2. Rosenberg GA, Sferra JJ. Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal. J Am Acad Orthop Surg. 2000 Sep-Oct;8(5):332-8.

Alison D. Silhanek, DPM, Medford, NY

If Dr. Udell is describing a Jones type fracture, then I do agree with strict casting and off-loading and the use of a bone stimulator. Jones fractures not treated with strict off-loading do pose a significant healing problem due to a watershed area and possibly increased motion of the independent 5th ray axis occurring at the fracture site.

Don Joy now makes a bone stimulator requiring 30 minutes use per day. If, Dr. Udell is describing a tuberosity avulsion fracture, then in my experience, they have all healed without the need of surgery or bone stimulation. If a patient is neuropathic and non-compliant, an exception can exist. In my experience, even these people healed uneventfully. We can't treat the masses based on one bad experience. Waiting several days or weeks before instituting bone stimulation therapy won't necessarily negatively impact the outcome. The key is to recognize the problem of delayed healing and provide appropriate therapy. We can no longer wantonly initiate expensive therapies.

Simon Young DPM, NYC, NY, simonyoung@juno.com

RE: Prescription Shoes (Bob Kornfeld, DPM)
From: Richard Young, C.Ped.,

In response to Dr. Kornfield on sending his patients to a shoe store with a script for custom molded shoes only to provided with off the shelf:

1) Medicare does not allow off the shelf shoes as a "substitute" for custom-molded shoes.

2) Custom molded shoes are allowed only when anatomical and/or pathological conditions would prevent the proper fitting/function of depth shoes.

3) I assume (hope) the shoe store person was a certified pedorthist. Never the less, that person has an legal obligation to fill the prescription as written unless you, as the prescriber, allow substitutions. If they cannot cast for the custom-molded as prescribed, they should refer the patient elsewhere and notify you.

4) The person filling the script has an ethical and, I believe, legal obligation to discuss any changes he/she thinks may be needed with you BEFORE they make any substitutions or changes.

5) You might consider looking for a C.Ped practicing in a clinical setting instead of retail. While there are many caring and competent C.Peds operating in a retail environment, unfortunately, there are also too many who use their credential more for marketing than to provide actual patient care..

Richard Young, C.Ped., Fayetteville, GA, c_ped@bellsouth.net

RE: Doctor of Plant Medicine (DPM)

I am an avid amateur tomato grower. Last week I noticed a problem with some of my green tomatoes and removed one in order to get an expert opinion.The guy at the nursery looked at it and looked it and told me "your tomato plant is getting too much moisture, not enough sun and it has a Pseudomonas infection. I thought the nurseryman was kidding me because he knows I am a podiatrist but when I looked it up on the internet, sure enough, he was right. Not only do people get pseudomonas infections but tomatoes can as well.

Elliot Udell, DPM, Hicksville, NY

UNIQUE OPPORTUNITY FOR THE RIGHT PERSON! - NEW YORK

We’re in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in the Hudson Valley region of New York State. All DPM´s in our group are board-certified and there is a residency program affiliated with our practice. Please reply to HVFA, PO Box 3300, Kingston, NY 12402-3300; or via email to bud@hvfa.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Multi-office group seeks associate in Southern California for general podiatry in office setting. NO nursing homes! Spanish speaking a plus. Full or part-time. Excellent compensation with potential for partnership. E-mail scpodgroup@yahoo.com for more details.

ASSOCIATE POSITION - WEST CENTRAL MN

Associateship possibly leading to equity ownership. Compensation package of $100,000. Option for partnership or purchase as soon as associate feels ready. 260 402-7490.

ASSOCIATE POSITION – CALIFORNIA

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280

SEEKING ASSOCIATE POSITION - NEW YORK OR CONNECTICUT

PSR-24 trained podiatrist seeking an associate position in New York (Westchester, Putnam or Dutchess County) or Connecticut. Excellent surgical and patient skills. Ethical and hardworking with 3 years of private practice experience. Please contact samalsal@yahoo.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net , fax to 410-486-2049, call Dr. Herbert Rosen 410-580-0255

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice, well-rounded surgery and routine, please email your CV to superrang@bellsouth.net

SATELLITE CLINIC FOR SALE -- CHICAGO, IL

70-75K over last 3+ years working 2 days/week. Devon/California area. Waiting room, x-ray equipment, and offices/treatment rooms updated over last 2 years. Will stay on for transition. (773)761-5381 DrD@globalpodiatry.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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 for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

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