The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 09, 2007 #3,009 Editor-Barry Block, DPM, JD

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We've just mailed the latest issue of Podiatry Manangement. At 268 pages, this is the largest August issue ever, and is filled with interesting, informative, and useful articles . You'll also find our usual assortment of features, including our columns, and a CPME-approved CME. Be sure to participate in our 25th Annual Practice Management Survey, which can also be taken online. We'll provide you with all the exciting details, along with some of the valuable prizes you can win by entering our survey contest.

Obesity is Linked to Foot Problems: CA Podiatrist

Feet are ravaged by a variety of awful things: bacterial infections, melanomas, corns, bunions, hammertoe, arthritis, plantar fasciitis, athlete’s foot, just to mention a few. Ernie Hook, a doctor of podiatric medicine and surgery with an office in Folsom, CA is president of the California Podiatric Medical Association. We asked him is obesity linked to foot problems?

Dr. Ernie Hook

Dr. Hook responded “Overall, the opinion of my colleagues is ‘yes.’ For every 10 pounds or so you gain, it’s like strapping a bowling ball to your belt. If you have three or four bowling balls, it’s going to put more pressure on your feet. We (CPMA) recommend walking three to five times a week. Walking is huge. Merely by walking, you’re going to reduce weight and many health problems.”

Source: Dan Viera, Redding Record Searchlight (CA) [8/6/07]

TUSPM Student Working at NASA Center

Huntersville, NC resident Camille Ryans is spending the summer working with scientists in the Neuroscience Laboratory at NASA's Johnson Space Center through a National Space Biomedical Research Institute internship.

Camille Ryans

Ryans, a second-year graduate student at Temple University School of Podiatric Medicine, is working on a bed-rest study with the goal of determining the effects of microgravity on lower extremity muscle reflexes. In addition, she is writing a full manuscript to be submitted for presentation at the first international symposium.

Source: Tiffany R. Leonard, Charlotte Observer [8/5/07]

Foot Self-Exams Can Increase Early Melanoma Detection, Survival: ACFAS

Foot and ankle surgeons say routine self examinations of the feet are an important way to find skin cancer early, when it's easiest to cure. Half of the people who learn they have melanoma of the foot die within five years because the cancer had already spread throughout their body by the time it was diagnosed.

Dr. Neil Campbell

"The first question I'm going to ask a patient is, 'How long has it been there?'” says Neil Campbell, DPM, FACFAS, a spokesman for the American College of Foot and Ankle Surgeons (ACFAS).

Foot and ankle surgeons recommend focusing on the three most common areas for foot melanoma: the soles, between the toes, and around or under the toenails. Campbell notes melanoma can develop anywhere on the body, including areas that receive little sun exposure, such as the feet and ankles. If a mole, freckle or spot starts to change over the course of a month and becomes asymmetrical or changes its border, color, diameter or elevation, see a doctor immediately. Those are the ABCDEs, or signs, of melanoma.

Report Card on CA PPO’s in the Works

The California Department of Insurance plans to issue a report card for the six largest PPOs in the state. The voluntary program which the department says is the nation’s first such effort regarding PPO’s should debut in 2009 and will provide information on patient satisfaction and quality of care, including preventive care and chronic-disease management. About 30% of insured Californians are in PPO’s.

Aetna, Blue Shield of California, Cigna, Health Net, WellPoint and UnitedHealth have agreed to participate. Other insurers may sign on later, California Insurance Commissioner Steve Poizner said at a news conference.

Data from the insurers will be collected by the National Committee for Quality Assurance, and the report card will be assembled by the state. For the past six years, California has issued a report card on HMOs, rating them from one to four stars.

Source: Rebecca Vesely, Modern Healthcare [8/7/07]

Query: Duty to Provide Records to Non-Paying Patient

If a patient has not paid a penny for services to date, and then requests a copy of his records, are we obligated to provide it to him?

Howard J. Dananberg, DPM, Bedford, NH

Editor’s Comment: PM News does not provide legal advice. Under both federal law (HIPAA) and under most state laws, physicians are required to provide patients with a copy of their medical records regardless of whether patients have paid their bills. Failure to do so, may result in professional misconduct charges against the physician.

In some states, such as New York, physicians are entitled to charge a reasonable fee (in NY it’s $.75 per page) for copying costs. If a patient does not pay his/her bill, you can seek redress in a court of law. You can also discharge the patient from your practice as long as you send a certified letter providing them with notice.

RE: Plantar Fascial Pain (Steven Block, DPM)
From: Multiple Respondents

In my practice I have found that there is a high correlation between plantar fasciitis and a tight Achilles tendon. Have you evaluated this patient for a functional or actual equinus deformity?

I have had very good success using an endoscopic Achilles tendon lengthening for a patient with a persistent chronic plantar fasciitis.

Jerry Cosentino, DPM, Tampa, FL, gcosenti@tampabay.rr.com

I too have experienced similar recalcitrant cases. I would suggest the possibility of distal tarsal tunnel syndrome. An EMG/NCV may corroborate tarsal tunnel syndrome. A more proximal corticosteroid injection may be of benefit. Surgical release may also be curative. Good luck.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

Although the history does not appear to include any "neuritis" like symptoms, it has been shown that nearly 10% of all heel pain suffers have a "nerve compression" component (see Dellon's studies on heel pain/tarsal tunnel)..might be worth isolating the calcaneal branch via decompression or sclerosing the nerve via alcohol or cryotherapy...(if you feel it correlates)

As for the fascia enlargement..might be good time to try Topaz, which certainly seems indicated

Mitchell A. Barber, DPM, Laurel, MD, mitchbkid@hotmail.com

This sounds like tarsal tunnel symptoms. This of course will not show up on MRI unless there is a space occupying lesion. I've had great success with chronic heel pain in doing a tarsal tunnel release with an EPF. Sometimes I'll remove the medial calcaneal nerve as well and bury it in a proximal muscle. Also the release needs to include the tunnels under the abductor or it won't work. Dellon pioneered this and it works well.

Chuck Anderson, DPM, Norman, OK, andersonfoot@msn.com

Based upon the scenario presented Dr. Block may be dealing with a medial calcaneal nerve entrapement. This is where cryoablation may benefit this patient. We having being doing these procedures for the past four years with great success. We freeze the medial calcaneal nerve and eliminate the pain at the source. Many times neurogenic heel pain is the cause of pain we normally think is caused by a biomechanical problem.

Steven H. Goldstein,DPM, Livingston, NJ, stevefootdr1@cs.com

You may consider a medial calcaneal nerve branch excision if you feel the pain is neural. You may also have missed an original medial plantar nerve branch injury or have caused an injury or entrapment from ESWT or surgery. Consider specialized NCV's to rule this out. Consider iontophoresis, massage therapy but also don't forget the power of a good second opinion.

Randall Brower, DPM, Roswell, NM, randoman33@yahoo.com

PODIATRIC FELLOWSHIP POSITION AVAILABLE – CALIFORNIA

This one year fellowship will emphasize reconstructive foot/ankle surgery and research. Located in beautiful Sonoma Valley California. Must have a current California license and have completed a PSR-24,PM&S 24,or PM&S 36 residency program. Please send all letters of interest and a recent CV to Thomas Chang, DPM, Director, at podiatricri@yahoo.com or call (949) 412-8445.

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 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE POSITION – GREATER BOSTON AREA

Full-time comprehensive practice with hospital teaching affiliation west of the greater Boston area looking for motivated, ethical, surgically trained podiatrist. Competitive salary and benefits. Call 508-872-9288

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Busy multi-dimensional practice. 20 minutes from Philadelphia. Board qualified/certified ABPS. Ethical, motivated, personable. Starting 65K plus health, malpractice, CME, bonus incentive. E-mail resume TotalFootCare@aol.com

ASSOCIATE POSITION - LONG BEACH, CALIFORNIA

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

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

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.”

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