The Voice of Podiatrists

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August 10, 2007 #3.010 Editor-Barry Block, DPM, JD

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Summer Presents Extra Risks to Diabetic Feet: NJ Podiatrist

People with diabetes must be especially careful to avoid cuts, blisters, and bruises on their feet during the summer, cautioned Marshall Feldman, DPM, a podiatrist.

Dr. Marshall Feldman

“During the summer months, people are more likely to walk barefoot or wear sandals, increasing their risk of cuts and sores,” said Dr. Feldman. “For someone with diabetes, this can be very dangerous.”

Cuts, sores, and blisters take longer to heal when someone has diabetes, according to Feldman, a podiatrist at the Wound Care Center® at Robert Wood Johnson University Hospital at Rahway, which recently celebrated its first anniversary. “A person with diabetic neuropathy may not feel a cut, blister, or sore, which may lead to more complications,” he added. Diabetic neuropathy is a condition when patients cannot feel the pain of a blister or sore. Neuropathy increases with age, duration of diabetes and with increases in hyperglycemia.

Source: Devine Media (NJ) [8/8/07]

New Appointments For Drs. Iorio and DeLauro at NYCPM

The New York College of Podiatric Medicine (NYCPM) has announced that, effective September 1, 2007, Anthony R. Iorio, DPM, MPH, currently Chair of the Department of Medical Sciences, will become Assistant Dean for Continuing Medical Education. He will also continue his teaching and clinical responsibilities, and assist with clinical research trials. Also on September 1, Thomas M. DeLauro, DPM, currently Professor of Primary Podiatric Medical Sciences and Surgical Sciences, will become Chair of the Department of Medical Sciences.

Dr. Anthony R. Iorio

Dr. Iorio is a 1981 graduate of NYCPM. He is a Diplomate of both the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, as well as a Fellow of both the American College of Foot and Ankle Surgeons and the American College of Foot and Ankle Orthopedics and Medicine. He is certified in laser surgery, as well as in arthroscopic surgery for the foot and leg.

Dr. Thomas M. DeLauro

Dr. DeLauro is a 1976 graduate of NYCPM. He has been an NYCPM faculty member since 1978, earning the rank of full professor in the Division of Surgical Sciences and in the Division of Medical Sciences, and has also served NYCPM as Academic Dean. Dr. DeLauro is a Diplomate of both the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics, and a Fellow of several podiatric subspecialty organizations. He has served the profession as editor-in-chief of the Journal of the American Podiatric Medical Association and as a member of the examination committee for the American Board of Podiatric Surgery.

IL Hospital Found Negligent for Credentialing Non-ABPS Podiatrist

The Illinois Appellate Court affirmed a negligent credentialing verdict made against Silver Cross hospital. The case is the first reported in Illinois dealing with a hospital's liability for negligently credentialing a physician, podiatrist, or other healthcare provider.

During the malpractice case, evidence was presented to the jury that Silver Cross Hospital granted hospital privileges to Dr. Paul Kirchner in 1992 contrary to the hospital’s own by-laws. The hospital’s by-laws required that all podiatrists seeking surgical privileges at the hospital have completed either a 12-month podiatric surgical residency program, or be board-certified by the American Board of Podiatric Surgery.

Dr. Kirchner met neither of these requirements in 1992, when he initially began performing procedures at Silver Cross Hospital. Kirchner re-applied several times for continuation of his surgical privileges at Silver Cross Hospital, and each time the hospital’s Board of Trustees granted the privileges in violation of its own rules and by-laws.

Source: Rita Schwab, msspnexus [8/7/07]

Query: Test to Confirm That Osteo Has Resolved

I have a non-diabetic patient with ostomyelitis (diagnosed by plain films ) of the distal phalanx, 3rd toe resulting from a long standing infected ulcer left untreated by the patient.The soft tissue infection has resolved. He has been on antibiotics for about six weeks. The patient is resistant to amputation of the distal phalanx. Would MRI or another modality determine if the osteo has resolved?

Edward Orman, DPM, Perry Hall, MD

RE: Plantar Fascial Pain (Steven Block, DPM)
From: Marc Katz, DPM

I agree with many of those posting that the medial calcaneal nerve is a possible problem. In a pronation injury this nerve is often injured. In addition, I have found that following endoscopic and open procedures the medial calcaneal nerve is often cut or injured and a branch of the sural may also be injured from the lateral scope.

As far as diagnosis, I see no reason to do any fancy testing unless simple methods fail. The easiest diagnosis method is dropping a cc of lidocaine at the medial and lateral calcaneal branches. If that relieves the pain then your diagnosis is solid.

I would also not recommend excision of the nerve, alcohol sclerosing or release prior to trying cryosurgery. I treat many patients that have had these procedures with resultant stump neuroma formation or long healing periods. In addition, the release can cause further edema and trauma in an already painful condition.

When considering cryosurgery, palpation of the tender area may be a good indicator of the pathologic nerve location. However, based on Dellon's finding there are many variations of the medial calcaneal nerve and I have found that cryosurgery in these situations will have a higher success rate using a neurostimulator.

This has been a good thread that will hopefully start docs thinking about the uncommon diagnosis. Also, cryosurgery is an excellent treatment in cases like this if it is indicated after exam.

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

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

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

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