The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 13, 2010 #3,930 Publisher-Barry Block, DPM, JD

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Shoes are Culprits in Aggravating Bunions: IL Podiatrist

Podiatrist Lowell Weil Sr. had to travel to Papua New Guinea to find people without any foot problems. "I went there to look at their feet because there'd been a paper written that showed that none of them had bunions. In fact, they have big toes that go out in the other direction," he said, noting the natives never wore shoes. "I had to see it for myself and I did. I took hundreds of pictures of the natives sticking their feet out."

Dr. Lowell Weil, Sr. (Photo Allison Williams)

That solidified for Weil that shoes are a big culprit in aggravating bunions, although not necessarily causing them. Weil, medical director of the Weil Foot and Ankle Institute in Des Plaines, has seen a lot of bunions, flat feet and other painful conditions below the ankle in 45 years of practice.

Source: Lynne Stiefel, Chicago Sun-Times [8/10/10]

FL Podiatrist Named to Barry Board of Trustees

James V. Stelnicki, a podiatric physician of New Port Richey, FL and past president and member of the Executive Board of the Florida Podiatric Medical Association (FPMA), was elected as the newest member of Barry University’s Board of Trustees. A member of the Podiatric Medical Advisory Council, he established the James V. Stelnicki Scholarship for Excellence in Lower Extremity Vascular Medicine with a $100,000 gift to the university in 2008.

Dr. James V. Stelnicki

Stelnicki received a doctorate of podiatric medicine from the Ohio College of Podiatric Medicine and completed residency training at the Cleveland Foot Clinic and Pinellas General Hospital. Stelnicki is a Florida State Boxing Commissioner presently serving as the Vice Chairman, has been a member of the State Board of Florida Medical Examiners and the Department of Professional Regulation, and has been closely involved with Barry University for more than 20 years.

NY Podiatrist Receives Excellence in Action Award

Dr. David Kreiser, a practicing podiatrist in Brooklyn, recently received the Excellence in Action Award from the New York State Podiatric Medical Association (NYSMPA) at the organization’s annual House of Delegates meeting in June. A member of the NYSPMA for almost 30 years, Kreiser has served as the Kings Division president.

Dr. David Kreiser

“Dr. Kreiser exemplifies everything we were looking for in the recipient of the Excellence in Action Award,” said Len Thaler, executive director, NYSPMA. “He is not only an outstanding podiatrist, but one who goes above and beyond to serve his profession and his patients every day.”

Source: Brooklyn Eagle [8/10/10]

Many Diabetics Wait Until End Stage for Treatment: IL Podiatrist

Proper foot care can reduce the risk of limb loss by as much as 85 percent, according to the American Diabetes Association. Along with keeping blood-sugar levels under control, one of the most important things diabetics can do to avoid serious foot complications is to inspect their feet daily for non-healing cuts and blisters or other problems. "I've had patients step on a tack or a nail and not even know there's a foreign body stuck in their foot because they have no sensation," says Dr. Elizabeth T. Clark, chief of the section of vascular surgery at Mount Sinai Hospital on the West Side.

Dr. Elizabeth Clark treats diabetic patient.

"The sad part of the whole situation is that so many of our patients, for whatever reason ... don't come and seek medical treatment until they're in the very end stages of their disease," Clark says. "It certainly would be a lot easier for them and better for them if we could catch them earlier in the time frame of their diabetes."

Source: Monifa Thomas, Chicago Sun-Times [8/10/10]

MA Podiatrist Part of New Clinical Trial of Collagenase Ointment for Diabetic Wounds

Healthpoint has announced that it has initiated a clinical trial assessing the effectiveness of Collagenase SANTYL® Ointment, as compared to vehicle, on the change from baseline in wound area of diabetic foot ulcers (DFU) over four weeks. The trial will also follow subjects to determine the proportion who achieve complete wound closure within 12 weeks of initiating treatment.

Dr. Vicki Driver

"Foot ulcers are one of the leading causes of hospitalization for all patients with diabetes and present the most common risk for subsequent amputation among diabetics," noted Vickie Driver, MS, DPM, FACFAS, Director, Clinical Research Foot Care, Endovascular and Vascular Services at Boston University Medical Center and one of ten investigators participating in the study. "This study will help inform the clinical community as to whether a widely prescribed enzymatic debriding agent can have a positive impact on wound closure, thereby avoiding the often devastating sequelae associated with this common condition," said Driver.

Source: Medcompare [8/10/10]

CMS Okays First Medical-Necessity Reviews

The CMS has approved the first medical-necessity review audits for the Recovery Audit Contractor program, according to agency officials. Medical-necessity reviews are a type of advanced audit that will determine whether medical care given to a patient was appropriate or not. 

Specifically, the reviews were approved by the CMS New Issue Review Board, which was created by the CMS to offer greater oversight of RAC audit subjects. The agency says it has approved 18 types of inpatient hospital claims and one type of durable medical equipment claim. The RAC program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper.

Source: Jennifer Lubell, Modern Healthcare [8/11/10]

Query: S/P 2nd Toe Arthroplasty 3 months with Swelling at the PIPJ

I did a routine PIPJ arthroplasty on an 83 y.o female who is in relatively good health. Post-operatively everything was going according to schedule, until sutures were removed at the second week. While I tried to re-bandage the toe, she could not tolerate it and stated that it was too tight. I loosened up the bandage. On the following week, she walked in with swelling only at the PIPJ. X-rays were normal.  I tried a compression bandage with Coban until toleration.

I have given her NSAIDs, instructed her to elevate and ice, strapped her toe, and also gave her a steroid injection. It is now three months s/p and the swelling is still present. The swelling is only localized to the medial and lateral aspect of the joint, and when I compress the toe for several minutes, it returns to near normal shape. The swelling will not go away and, as a result, I have an unhappy patient. I have recommended PT but she does not want it at this time. Any suggestions?

Mak Yousefpour, DPM, Los Angeles, CA

RE: Botox for RSD? (Joan Schiller, DPM)
From: Barry Mullen, DPM

With all due respect to Dr. Schiller, I consistently shudder reading posts about podiatric self-management for CRPS, including the answers that some colleagues provide to questions like this one. So, kindly allow me to ask a few pertinent, rhetorical questions. Do any of my colleagues have experience referring CRPS patients to appropriate specialists for definitive, multi-disciplinary medical management?

Can we, as a profession, universally accept the fact that this syndrome is extremely difficult to manage, even in the best, most experienced hands? Can we further accept that...

Editor's note: Dr. Mullen's extended-length letter can be read here.

RE: Growths on 2nd Digit (Patrick Barnes, DPM)
From: George Jacobson, DPM

I have one patient with neurofibromatosis whom I have seen for six years. She already was diagnosed when I first saw her. She has multiple similar digital lesions but also lesions to her legs, arms and face that are visible. I have only recommended removing symptomatic lesions, as I know the diagnosis. 

George Jacobson, DPM, Hollywood, FL, drgeorgejacobson@gmail.com

RE: Plantar Fasciitis and Ultrasound Guidance (Simon Young, DPM)
From: Henry Slomowitz, DPM, George Jacobson, DPM

There appears to be a misunderstanding to my post. Let me make it perfectly clear: I take x-rays on all heel pain patients for all the reasons previously mentioned. Having said that, I would say that greater than 95% of the time, the x-ray gives me little help in diagnosing for sure what the problem is. To Dr. Young in particular, I don't believe that I said that x-rays are unnecessary.
 
Although I don't believe that all injections need to be done by ultrasound guidance, there are injections that should be. In particular, I use ultrasound in the injections for plantar fasciitis as well as injections into the 2nd, 3rd and 4th MPJ's, as well as in other locations. Both ultrasound and x-ray are important for a podiatric practice. Removing trauma and surgery from the mix, ultrasound is far more useful in a podiatric practice.
 
Henry Slomowitz, DPM, Paterson, NJ, minggao@optonline.net

The success rate has classically been 85% using x-ray and "standard measuring technique" with injection therapy, strapping, etc. Is there an increased success rate with US visualization? I am confident that I see >90% success with 1-3 treatments as necessary over 3, 6 and 9 weeks, patient education, strapping, change in shoes, OTC and/or custom orthotics. 

There is nothing wrong with better technology (laser for warts).  Laser didn't improve success rates for verruca plantaris but is a great modality. There is no increased reimbursement for destruction of lesions (by laser).  

George Jacobson, DPM, Hollywood, FL, drgeorgejacobson@gmail.com

RE: Plantar Fasciitis and Ultrasound Guidance (Bob Kelsey, DPM)
From: Kenneth Meisler, DPM, Michael Turlik, DPM

Dr. Kelsey asked if ultrasound-guided injections were in the best interest of the patients. After having given many thousands of injections for heel pain and neuromas without ultrasound guidance, I have switched to giving almost all injections with ultrasound guidance. I have found them to be more effective because I think you can pinpoint the area of inflammation better than by palpation. I have found that I am injecting between 1/2 inch to 1 inch more proximally than I had been without ultrasound guidance. Neuroma injections are given directly into the nerve. I have found the results to be much better than without ultrasound guidance. I also have found many partial tears of the plantar fascia under ultrasound guidance that I did not inject and would have, had I not done the ultrasound. 
 
I practice in NYC and there are many patients whom I see that have previously been to orthopedists; many have seen foot and ankle orthopedists. Many of those patients have received injections for plantar fasciitis, heel pain, and tendonitis. I have found that almost all of the patients who had foot injections were referred to radiologists who performed the injections under ultrasound guidance rather than the orthopedists giving the injections. I am sure the radiologists do not question whether they should bill for the ultrasound. 

Giving an injection under ultrasound guidance into a neuroma takes two well-trained podiatrists, one to do the ultrasound and the other to inject. However, if you take the time to learn these skills, it will help your patients. Do not buy a machine and expect to be able to do this without a lot of practice.
 
Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

I understand the benefits to the device manufacturer, the practitioner, and the industry experts. What is not clear to me is if there is an improvement in patient outcomes when using ultrasound, either diagnostically or therapeutically, in comparison to less expensive conventional procedures for the diagnosis and treatment of mechanically-induced heel pain. Is there any valid, unbiased literature that would clarify this question?

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

PRACTICE FOR SALE - DALLAS, TX

Prestigious North Dallas location; 24 year old practice; excellent mix of hospital surgery, office surgery, orthotics, general podiatry, web site, electronic claim submission. Retiring owner will stay for transition. Owner financing available. dallasfootdr@yahoo.com

ASSOCIATE POSITION - SW FLORIDA

Golf, Boating and Beaches - Great opportunity to join a well established Podiatry Practice. Excellent mix office/surgery, motivated experienced staff. Seeking full time Associate PSR 12-36. Excellent salary & benefits, early buy-in for the right hard-working, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA AREA

Full-time associate with opportunity for partnership with group practice. Candidate must be trained in all phases of podiatry including wound care, surgery, and routine podiatric care. Candidate must have a positive and energetic attitude with a desire to grow in our practice. If interested please email your CV to BergD@readinghospital.org

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

PRACTICE AVAILABLE - WESTERN WASHINGTON

General Podiatry practice in Port Townsend, WA. Nice community, 25+ year old practice, busy 3 days a week with growth potential. Owner leaving area, needs someone to take over the practice, lease and equipment. Contact Jessica at ptpod@yahoo.com or 925-519-0624.

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com or fax 607-723-1567.

ASSOCIATE POSITION – WEST VIRGINIA

Parkersburg orthopedic group seeks established podiatrist or a 24-36 surgically-trained physician. Group offers stability, autonomy and a collaborative environment. Comprehensive benefits and competitive salary starting at $105K with production bonus. Send CV to Mary-MOR@columbus.rr.com 

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857.

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

38 yr old general podiatry practice grossing over $550K. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network and well-equipped surgical suite. Retiring owner will stay on as needed. Email - dpmpracticeforsale@yahoo.com

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

TN PRACTICE FOR SALE (LAWRENCE COUNTY)

Active, established practice includes office building and property ( appraised at 110k) with all equipment and shelf stock included. Great referral network with an excellent scope of practice. Patients on schedule 1 day/ week grossed over 250k last year. 125k OBO Call 931-446-5724 or email mchad500@gmail.com for more information.

ASSOCIATE POSITION - NEW JERSEY - JERSEY SHORE REGION

Part-time associate wanted. Looking for a motivated and ethical practitioner. Competitive salary with incentives. Tuesday AM - Thursday PM - 2 Saturdays/month. Please respond to: NJSHOREFOOTDOC@aol.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

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