The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 02, 2007 #3,004 Editor-Barry Block, DPM, JD

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Wearer, Not Flip-Flops Responsible for Most Injuries: FL Podiatrist

"We do see some blisters and injuries and ant bites because of use in the backyard from flip flops, but most things we see as foot and ankle surgeons are from injuries, sprains, fractures, things like that," Podiatrist, Dr. Robert Duggan, said. Dr. Duggan says the biggest problem is we tend to catch the flip-flop on something and get hurt because of the way the sandal is attached to the foot."There's usually a little bit of material that comes between the big toe and first toe and we'll be able to drag the shoe along with us,” Duggan said.

Dr. Robert Duggan

Dr. Dugan says it is not the flip-flop’s fault. He says the injuries tend to occur because the person is wearing flip-flops at the wrong time. "It's usually a very good shoe to use for beach activities and for walking around in our neighborhood, maybe not so good for gardening or athletic events," Duggan said. Dr. Duggan says you should look for flip-flops with arch support and cushioning. Improper cushion can cause us to change the way we walk.

"We actually turn the feet out. That changes the alignment of the leg to the low back and repeated use or a daily use of that can increase some of the pain we have in the low back or knee and hip,” Duggan said. Dr. Duggan says when it comes to flip-flops, size does matter. He says you need to make sure your sandals fit properly and do not slide forward when you walk.

Source: Nancy Gay, Channel 13 News (Central Fl) [7/31/07]

MN Podiatrist Skeptical That Shoes Can Dramatically Change Gait

To heel-strike or to land on your forefoot? The answer depends on the runner, says Minnesota podiatrist and "Great Feet for Life" author Paul Langer. "A lot of people try to alter their gait, thinking there's a more efficient way to run, but it doesn't always work that way," he says. "Your body has a certain movement pattern, and if you alter your body's preferred movement pattern, you'll be more open to injury, and you'll fatigue more quickly."

Dr. Paul Langer

So people have different gaits, and they should just follow their bodies' advice: If heel striking comes naturally, then don't force a midfoot strike. Right?

The problem is, many shoes shape how people run. "Eighty percent of runners in running shoes are heel strikers, but when we run barefoot, we don't run on our heels," says Langer. "We know that shoes do change how we move and run." At the same time, though, he's skeptical a shoe can change a runner's gait dramatically.

Source; Douglas Brown, Denver Post [7/31/07]

PICA Group Acquires PRI’s Insured Podiatry Business

The PICA Group, a Brentwood, TN-based professional liability insurer for podiatric physicians, has purchased the podiatry business from New York based Physicians' Reciprocal Insurers (PRI).

Dr. Jerry Brant

“We are pleased to purchase this piece of podiatric business, an acquisition that will benefit all parties involved,” states Dr. Jerry Brant, CEO of PICA. “PICA is getting access to some of the best podiatrists in the state of New York and the podiatric physicians are joining a company that protects and supports the profession.”

Gerry Dolman, President of AFP, PRI’s attorney-in-fact, mirrors Dr. Brant’s sentiments. “We were planning on an increase in premium of at least 20% for our podiatric insureds. This transaction between PRI and PICA places PRI’s insureds in qualified hands with a company dedicated to the profession.” The finalization of the deal occurred on July 30, 2007 and PRI will begin non-renewing their policyholders starting with their October 1, 2007 renewals.

Query: Foot Scanning Devices

We are trying to locate foot scanning devices that measure foot size, arch size, pressure points, etc. Any assistance would be appreciated.

Dan Kasen, Mount Prospect, IL

Query: Sanding Discs

I am having a problem with the "sand coarse paper 7/8 inch discs" from the E.C. Moore Company. A couple of months ago, the sand grit from their supplier was changed. They are not as effective as the original discs. Does anyone know of another manufacturer of similar paper discs?

Stanley Luksenburg, DPM, Fairview Park, OH

RE: Grafting Materials for Venous Stasis Ulcer (Jeffrey Kass, DPM)
From Multiple Respondents

If the patient truly has a venous stasis ulcer, then the only thing that might be holding the wound back is if there has been no compression to the extremity. Venous stasis wounds are usually accompanied by hypervolemic fluid in the legs, causing the "container" to spill the excess interstitial/lymph fluids outside the body via an external portal, either externally created such as an ulcer or created by the body as a reaction to the hypervolemia.

Also, your posting does not include the patient's medical history, which of course, complicates any type of wound healing, especially if the PMH includes renal dysfunction, diabetes, PVD, or CHF.

Most conservative wound products and treatments in conjunction with lower extremity compression therapy (i.e. Unna Boot, Profore, 3M Coban 2-Layer) should reduce the venous ulcer in size and depth over a period of weeks, if the patient is compressible.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

Apligraf actually has an approved clinical indication for venous stasis ulcerations. I have used it for nearly ten years with good success. Three points are critical is its use and success: 1) the wound must be adequately debrided including removal of the indurated margin 2) apply a non-adherent covering to the actual graft per protocol (I use Mepitel and Bactroban cream over this) 3) it is essential to use a mutli-layer compression dressing to manage the edema (without this failure is assured). Large ulcerations typically will take more than one application.

Tim Vogler, DPM, High Point, NC, Timothy.Vogler@cornerstonehealthcare.com

Once the wound bed is healthy and granular, there is no substitute for the split thickness skin graft (STSG). The artificial skin graft substitutes are good for wound bed preparation conjunction with S&N's Versajet, however for definitive closure, the STSG is the way to go.
Additionally the underlying cause of the stasis needs to be addressed, for example: compression, vascular consult and medical management, etc... Otherwise, a nice closed ulcer will re-ulcerate or a new one will develop.

Gerald Mauriello Jr., DPM, MA, Jamaica, NY, mauriellodpm@gmail.com

I have used many of the grafts out there and in our wound center we tried some products side-by-side. Hands down, Apligraf has been the best. I am not a speaker for the company and have no professional ties to the company. Many of the products being pushed are basically collagen. They have little to no living material. They are pushed as a matrix to allow your cells to build.

I have found that Apligraf works because it has all of the growth factors of normal skin and viable skin cells. That claim cannot be made by others. I also would say that compression must be done in combination with the Apligraf. The coding for the graft is one of the few that is clear cut.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

At our wound institute, we obtain arterial and venous Dopplers on all VSU's, and provided they meet the insurer's criteria re: duration of wound, we are quite successful with Apligraf and hyperbaric treatments. Our standard of care is usually to pre-treat the wound with 15-20 HBO TX's followed by the Apligraf and more HBO Tx's.

Frank Lattarulo, DPM, NY, NY, DOCLATT@aol.com

RE: Billing Software ( Ian S Goldbaum, DPM)
From: Multiple Responses

We use CollaborateMD (formerly ClaimGear). It's an Internet-based main-frame, accessible from any computer, can be used by several users at same time & beginning Dec 2007, a flat rate of $199/mo. for unlimited data entry & electronic posting. Can also use electronic billing & scheduling. Daily CPID updates via e-mail.

Robert K. Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net

We have been through a multitude of software companies. Last year, we went with Athena Health out of MA. They do it all, and we now have our accounts receivables down to 30-45 days at the most. Athena is web-based. We feel that we have hit a home run with this company. The Wall Street Journal had a recent article stating that they were the #1 medical billing service.

Michael J. Schneider, DPM, Avon, CO, mjs10vail@aol.com

Editor’s note: This topic is now closed.

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

POSITION AVAILABLE- MANHATTAN, NY

Immediate position for a part associate to work x3 days/wk. Office based OR suite with nitrous and power. Midtown-Park ave. entrance with a total of four treatment rooms and a private office. Candidate must have PSR/24 with experience, Interested parties Fax CV, references and requirements to (770)497-4343.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-486-3548 ---------------------E-Mail sschneider@homephysicians.com -- www.homephysicians.com

NEW JERSEY - OCEAN COUNTY - IMMEDIATE OPENING!

Part time associate wanted. Tentative hours: Tues - AM, Thurs - PM, Sat (every other) - AM Definite growth potential. Looking for an ethical and conscientious practitioner. Competitive salary with incentives. Great working environment! Please fax CV to:(732) 695-0223 or e-mail to shorepodiatry@aol.com

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

ASSOCIATE POSITION – PART TIME - BRONX, NY

Part time associate position available in the Bronx, NY. Two days a week. 30K/yr + incentives. Full-time position may be available shortly. Must be ethical, hardworking, and Spanish speaking a plus. Please email resumes to Scottdeis@aol.com

ASSOCIATE- SOUTH JERSEY

PT/FT wanted for progressive (EMR, Digital x-ray, Diag U/S ), ethical, full scope group practice. A motivated team player with very good surgical and routine skills. ABPS cert and 24/36 PSR preferred but will take experience into consideration. Located between Phila. and the shore. A very fair benefits /compensation package. CV and references Toetrukr@aol.com

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION - CONNECTICUT- HARTFORD

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Board-Certified Podiatrist to add to our three-physician Podiatry division. This Podiatrist will provide all aspects of Podiatric care. We will consider candidates with 2- or 3-year training and who are ABPS-Certified/eligible. CSG is a highly-regarded practice in the Hartford Hospital medical community with an exceptional support structure and a strong referral base. We offer competitive salary and bonus, partnership opportunities, excellent benefits, and reasonable overhead. To apply, visit https://home.eease.com/recruit/?id=21426 or fax a CV to 860-524-2653. No phone calls. EOE

PRACTICE FOR SALE OR LEASE- CENTRAL FLORIDA

Practice all phases. Wound care, hyperbaric privileges nearby. Excellent building, location, and exposure on busy highway. Outstanding place to live and work; low penetration by managed care. Ample parking and accessibility with 2,000 sq. ft building designed and equipped for podiatry (lease or buy) 7 minutes from hospital. Great price, terms and opportunity to grow. 352-357-7499 - windnwave@earthlink.net

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