The Voice of Podiatrists

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August 07, 2007 #3,007 Editor-Barry Block, DPM, JD

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IL Podiatrist Uses Topaz For Chronic Plantar Fasciitis

Chronic plantar fasciitis, an extreme inflammation of the tight band of connecting tissue that runs from the heel to the ball of the foot. "This is the area where the fluid builds up, where the inflammation builds up, and it's exactly where it hurts in most people,” said podiatrist Marlene Reid. The causes can range from your foot structure, to an injury, to walking on hard surfaces. "Weight gain, pregnancy, wearing the wrong shoes, new shoes, old shoes, walking on cement is a big problem,” Reid said.

Dr. Marlene Reid

To stop the pain, Reid uses a tiny wand that generates low heat, radio-frequency energy. She marks her spots, then slips the wand through the skin. The energy goes directly to the damaged tissue, and breaks it down. Unlike traditional surgeries, there's no incision, just tiny punctures. It takes about half an hour under local anesthesia. "We don't have to worry about the skin healing, we don't have to worry about the deep tissue healing, and it starts healing immediately though the process,” Reid said.

This procedure -- called the Topaz -- is not for everyone, only severe cases. Most foot pain patients get relief with stretching, anti-inflammatory medication, wearing heel cups or orthotics, cortisone shots or ultrasound therapy. There are also other causes of foot pain. Before any treatment, good diagnosis is critical.

Source: Mary Ann Childers, WBBM-TV CBS 2 Chicago (IL) [8/4/07]

FL Doctor Suspended Amid Allegations Of Fraud

A doctor was suspended from his practice Thursday for submitting false claims, according to the Florida Department of Health. Podiatrist Donald Edward Beckett is accused of making false statements and false representation of a material fact in claims submitted to the Florida Medicaid program, the health department says in a written statement.

He listed a provider that did not provide treatment, according to the health department. Beckett also is accused of fraudulently using the personal identification information of three or more individuals without their consent.

As a result, the state surgeon general issued an emergency suspension order that prevents Beckett from practicing as a podiatric physician in Florida until the Florida Board of Podiatric Medicine reviews the accusations.

Source: Tampa Tribune [8/4/07]

Oregon to Offer Universal Healthcare Coverage by 2010

Oregon will offer health insurance to all uninsured residents by 2010 if the state can carry out a recently adopted plan and if voters approve a cigarette tax. In late June, Oregon Gov. Ted Kulongoski signed the Healthy Oregon Act, a 14-page road map for reforming the state's healthcare system and covering all of the state's roughly 615,000 uninsured residents -- about 17% of the population. The law calls for a health insurance pool for the uninsured and suggests an individual insurance mandate.

The new law:
• Calls for covering 615,000 uninsured residents by expanding Medicaid and the State Children's Health Insurance Program, and offering affordable health care coverage through an insurance pool.
• Creates the seven-member Oregon Health Fund Board to develop a plan by Oct. 1, 2008, to cover the state's uninsured. The board is also to propose ways to contain health care costs and improve quality, with a focus on primary and preventive care.

• Calls for the Health Fund Board to create a committee to examine Medicare policies that contribute to relatively low physician pay rates.

Source: Doug Trapp, AMNews [8/6/07]

Query: Vancomycin Beads

I am looking for a recipe for Vancomycin beads, or source(s) for pre-fab ABX beads--very small ones to place in and around the distal 1st metatarsal & head bone. Any other input (pearls, advice, anecdotes) on employing antibiotic beads for MRSA osteomyelitis and recurrent soft tissue infection (cellulitis, abscess, necrosis) to the soft tissues in this area would be appreciated.

Will Godfrey, DPM, Leesville, LA, WilliamTrekkie@EarthLink.Net

Arthrex’s Mini TightRope Hardware (Bruce Williams, DPM)
From: Multiple Respondents

I have placed a dozen of the Mini-TightRope implants since March, for bunions with intermetatarsal angles up to 19 degrees and in one tailor's bunion. I have assisted my group Partners in placing an additional half dozen. Early results have been outstanding. Based upon your query, I sense you are concerned about the 2nd metatarsal drifting away from the 3rd.

I have not measured any increase in the 2nd intermetatarsal angle. I believe the base of the second metatarsal is too firmly locked into place to move medially.

There is a bit of a learning curve to the procedure, and I have devised a method that makes placement of the implant easier than the technique described by Arthrex. It would be too lengthy to describe here on this forum; e-mail me if you'd like more details. There is a critical step one must take to avoid second metatarsal stress fracture, which is a complication I have seen in one case.

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

I have actually used the mini-tight rope for a revisional bunionectomy twice in older patients. These have done extremely well in a patient where a Lapidus was needed due to a failed Austin/Akin by another practitioner but the patient in my opinion never would have fused due to bone stock issues. These definitely should not be used in replacement for a fusion in a younger, active patient because they have the potential to break therefore losing your correction and there is some valid concern biomechanically, but in your less active, older patients it’s a great new addition to your tool box. After the first one, it’s actually quite simple to put in as well and only adds about 10 minutes to the procedure.

Marybeth Crane, MS, DPM, Grapevine, TX, crane@faant.com

Although I have not used this system in the forefoot, I do have experience with its use in ankle fracture repair. I have seen this system break in a couple of ankles. My only concern would be utilizing this in a high IM bunion deformity, without the indicated shaft or base procedure. I would be concerned about stress related failure. Its application in Lisfranc dislocations is interesting, I'd like to see some randomized studies.

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

I have used the mini tightrope on a supposedly perfect candidate: high IM, reducible, no MPE. We followed personal instructions on how to put it in from Dr. G. Holmes director of orthopedic foot and ankle section at Rush, who worked on developing the mini tightrope. While on the table, the Mcbride/minitight rope reduction was perfect, but we couldn't help but worry whether the button was going to fracture through the second metatarsal. Two weeks post-op the button fractured the shaft of the second metatarsal.

On the other hand, the Tightrope for syndesmotic ankle ruptures is great and we've used it on a few occasions.

Svetlana Zat, DPM, Chief Podiatry Resident, Rush Univ Medical Center, svetlanazats@hotmail.com

ASSOCIATE WANTED - PHOENIX, AZ AREA

A well established, ethical solo podiatry practice wishes to expand its current surgical services in the near future by hiring a full-time associate with PSR 24-36 training which includes very strong surgical rear-foot and ankle reconstruction, diabetic limb salvage and ER trauma. Successful association may lead to partnership. ABPS Board qualified/certification is required. Applicants must be personable and caring to patients. Practice in an office base within a new state-of-the-art orthopedic surgical hospital environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Email complete CV with current references & photo to footdoc352@cox.net

PRACTICE FOR SALE OR SHARING- 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

ASSOCIATE POSITION - LONG BEACH, CALIFORNIA

Busy Long Beach California Practice: Looking for Board certified Associate. Send resume to our Fax@ 562-424-3395

ASSOCIATE POSITION- MEMPHIS, TENNESSEE

A.S.A.P.! Excellent opportunity for well-trained, highly motivated PSR 24/36 or experienced practitioner leading to partnership in one year and complete buy out in five years. Generous salary/benefits first year. Large well rounded practice, heavy in forefoot and rearfoot surgery. Send C.V. - FAX (901) 396-5335 or Email drjoelcook@comcast.net

ASSOCIATE POSITION – MISSOURI

One of our long-term associates needs to relocate due to family reasons. Step into full schedule. Five locations in growing population area without HMO's. Partnership available. Missouridpm@yahoo.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 WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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-NORTH HAVEN

Seeking a part-time associate for a busy, well-established, respected, growing practice. Desiring an ethical, motivated, personable, well-trained PSR12/24/ or 36 podiatrist. Our practice is well-rounded and diverse with a good mix of sports medicine, diabetic care, surgery, podopediatrics, and general podiatry. Email information and CV to Pedy7@aol.com with subject heading “Podiatry Associate.”

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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

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Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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