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August 15, 2008 #3,322 Editor-Barry Block, DPM, JD

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“Fitness” and “Weight Loss” Shoes Can Cause Tendinitis: NY Podiatrists

Board certified New York City podiatrist Dr. Johanna S. Youner prides herself on being at the helm of cutting-edge technology and is a proponent of the philosophy of combining health and beauty. Even so, she warns that it’s vital to consult a physician prior to taking part in any new fitness trend. Dr. Youner, along with partner Dr. Emanuel Sergi see countless patients at their Park Avenue practice. People invest in shoes that claim to promote fitness but instead of achieving greater health, they end up with new issues like tendonitis.

Dr. Johanna Youner

“Shoes that claim to encourage and even contribute to weight loss, but require nothing more than walking, are all the rage and while some of those claims are valid, some are not,” says Youner. “It’s a classic case of something that sounds too good to be true actually being too good to be true.”

Dr. Emanuel Sergi

“It’s important to realize these shoes force the foot to actually function differently,” explains Dr. Sergi. “New muscles are engaged in the foot and legs, and if the patient doesn’t use them correctly, they can actually do more harm than good.”

Source: EVLiving.com [8/12/08]

NH Magazine Names 5 to Top Doctor List

New Hampshire Magazine asked New Hampshire doctors who they would choose to provide for the medical needs of friends and loved ones and their choices are here in your hands. To broaden the reach of our poll, this year we list our top doctors along with several other leading physicians in each specialty.

Raef Fahmy, D.P.M, Bedford (Past Top Doctors Winner)

Dr. Raef Fahmy

Other Leading Physicians:

David Court, D.P.M, Dartmouth-Hitchcock Nashua Nashua

Dr. James Dolan

James Dolan, D.P.M, Exeter (Past Top Doctors Winner)

Dr. Anna Ruelle

Anna Ruelle, D.P.M., Keene (Past Top Doctors Winner)

James P. Wilton, D.P.M., Portsmouth

Source: New Hampshire Magazine [8/13/08]

Study Finds 140,000 Bad Reactions to Antibiotics

Bad reactions to antibiotics, mostly allergic ones, send people to U.S. emergency rooms more than 140,000 times each year, government researchers reported on Wednesday. The findings offer another reason for doctors to limit their use of the drugs, which are overused in the United States, the team at the U.S. Centers for Disease Control and Prevention said.

"This number is an important reminder for physicians and patients that antibiotics can have serious side effects and should only be taken when necessary," said the CDC's Dr. Daniel Budnitz, who led the study. Budnitz and colleagues said 78 percent of the adverse events in the study were allergic reactions, ranging from rash to a serious reaction known as anaphylaxis, and the remaining 22 percent were caused by errors and overdoses.

"Because antibiotics are frequently used, both appropriately and inappropriately, if doctors would reduce the number of antibiotics they prescribe to their patients by even a small percentage, we could significantly reduce the number of emergency visits for antibiotic adverse events," Budnitz said in a statement.

Source: Maggie Fox, Reuters [8/13/08]

Double Your Brain Power - Part 1

You probably sometimes wish that you could think faster, grasp new information quicker and recall more of what you read and hear. You can with these tips:

• Tackle information you want to commit to your short-term memory in the morning. Reason: The brain section that stores short-term memory items performs about 15% better in the morning. But switch to the afternoon for items you want to keep in your long-term memory because that part of your memory bank hits its stride later in the day.
• "Reverse and rephrase" to overcome negative thoughts about your ability to learn something new. Example: Instead of "I won't remember what I'm learning," tell your brain "I've already learned to recall many things - names, dates, computer commands. So I can and will remember this."

Source: Double Your Brain Power: Increase Your Memory by Using All Your Brain All the Time by Jean Marie Stine.

Query: Use of Tourniquet with Sickle Cell Trait

Does anyone have experience with the use of an ankle tourniquet in a patient with sickle cell trait. I have read conflicting opinions whether it is safe and appropriate. Any feedback would be appreciated.

William Sachs, DPM, Toms River, NJ

Query: Residency as a License Requirement

Several years ago, we were happy here in Mississippi when the Mississippi State Board of Medical Licensure (MSBML) made a ruling that required at least one year post-grad residency to get a podiatry license in MS. The problem is that they made no contingencies for those people trained before residency programs were easily obtainable. We now have podiatrists applying to our state for licensure who have good practice histories and are apparently good podiatrists but cannot get a license due to “no residency training.”

I was wondering if anyone else has come across this issue in their state and how was it resolved without legal action. Podiatrists in MS do not have their own board and the only input that we have is a 3-member “advisory committee” whose suggestions the MSMBL is not obligated to follow. I believe that MSBML is willing to amend their previous ruling, but they want some sort of a guideline.

Tip Sullivan, DPM, Jackson, MS

RE: Skin Reaction to Fire Ants (Rick Burnell, DPM)
From: Robert E. Kuvent, DPM, Joel Morse, DPM

The first thing I would do is biopsy the lesion. The depigmentation could be secondary to the steroids and the lesion may have nothing to do with the fire ants.

Robert E. Kuvent, DPM, Chandler, AZ

Leukoderma is the name given to any white patches on the skin in which there is a partial or total loss of skin pigmentation. The etiology may be congenital, immunological (vitiligo), post inflammatory, infectious, or chemical/occupational. Trauma and burns also can lead to leukoderma. This appears to be a post-inflammatory type of depigmentation and it may continue to arise even if the patient is not in contact with the “burn” or the chemical.

Repigmentation may or may not occur. This condition is usually more obvious in patients with ethnic skin (blacks, Hispanics, Asians). Depigmentation on the back of the hands and feet is very resistant to therapy. Treatment should be aimed at use of sunscreens on the depigmented skin if open shoes are worn.

Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

RE: Chiropractic Adjustment before Casting for Orthotics? (Howard J. Dananberg)
From: Dennis Shavelson, DPM, Jeff Root

As negative pressures increase for us, I wonder why there has been a relatively deaf ear to what I see as viable additions to the part of podiatry practice that lives between routine foot care and foot surgery? Dr. Dananberg has been teaching manipulation for decades but his work and newer paradigms of biomechanics such as The Bottom Block Theory or my Foot Centering Theory of Biomechanics are being sought after more in the orthopedic, physical therapy and chiropractic communities than here at home.

My personal observation is that our residencies have downplayed the importance of Root, et al. for many years and other than podiatrists like Payne, Kirby and Ritchie, there have not been many advances to the biomechanical literature by DPM’s. In addition, for years our conference podiums are visited by the same corporate-supported material dressed up with new high-tech illustrations. In the 1981 Biomechanics issue of Current Podiatry, at the invitation of the editor, Dr. Wernick, I visited "The Future of Biomechanics in Podiatry" and sadly, many of my predictions have come true, 25 years later.

The best kept secret in podiatry is our ability to offer patients care that includes manipulations, orthotics, motor control and manual therapy as a viable road to foot and postural health and comfort.I continue to quote Bob Dylan by saying "You better start swimming or you'll sink like a stone, for the times they are a changing."

Dennis Shavelson, DPM, New York, NY, drsha@lifestylepodiatry.com

Dr. Dananberg brings up an interesting subject of forefoot supinatus as it relates to foot orthotic therapy and manipulation. Forefoot supinatus is …

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

Editor’s note: Mr. Root’ extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=21324&start=1

RE: Disposal of X-Rays (Marc Klein, DPM)
From: Multiple Respondents

The same company that disposes of our radiographic chemicals pick-up our spent film. I accumulate the "dead film" in a chart box. When it is full, I schedule a pick-up on the same day they pick-up spent chemicals. They usually pay you pennies per pound as they recover the silver.

George F. Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

There are companies in the business of silver recovery that will pick up your x-ray film(s) for disposal (recycling the silver and plastic film base). There may be a service charge for pick up and disposal. For medical legal and HIPAA requirements, please be sure the company you choose has Federal and State EPA transport license numbers in good standing.

Tom Keller, Imaging Specialist, 20/20 Imaging, LLC, tom.keller@2020imaging.net

When I disposed of many charts that were over 7 years old before I retired. I called one of the professional shredder companies. They were able to dispose of the x-rays, however they asked that they be removed from the charts and kept in separate boxes. Although the files were destroyed in the truck on site, the radiographs were taken to a separate facility. I was given a manifest when they were picked up and another copy of the manifest when they were destroyed.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, Stevefootdr1@cs.com

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