The Voice of Podiatrists

Serving Over 14,601 Podiatrists Daily

August 15, 2013 #4,849 Publisher-Barry Block, DPM, JD

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We encourage you to participate in this year's important annual surveypodiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2014 issue of Podiatry Management. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by completing this confidential survey. The earlier you enter, the more chances you have to win. Please complete the entire survey.

Lower Extremity Biomechanics

This week's prize is a copy of  Lower Extremity Biomechanics by Drs. Stephen F. Albert and Sarah A. Curran  (Value - $110)..

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

I am an unmatched graduate from the Barry University class of 2013. Even though I had some minor setbacks in the beginning, I worked hard to improve myself, and I did not get anything less than a B during my last two and a half years. I passed boards 1 and 2 on the first try. During my rotations, I secured mostly A's and one B. In fact, one resident said that he could not have made it through his on-call assignment without my help. I also volunteered for health fairs.

Dr. Abinash Mishra

Prior to podiatry, I received a Masters in chemistry from the University of Rochester. I consider myself very well rounded. My hobbies include singing, photography, and travel. Having lived in different parts of the country, ranging from college towns to big cities, I am very adaptable and am open to relocation, if necessary.   Abinash Mishra, DPM, amishra42180@yahoo.com

Company Reports Successful Direct to Consumer Podiatry Marketing in TX

Northstar Healthcare, Inc. today announced its financial results for the six months ending June 30, 2013. "Our first direct-to-consumer marketing initiative focused on podiatry in Houston, and we are seeing strong performance early in that campaign," said Dr. Kenneth Efird, Chief Business Development Officer of Northstar. "The Company spent $356K in direct marketing costs during the second quarter and also hired additional personnel to oversee the campaigns."

Microsurgery Institute of Dallas TV Ad

"Due to the length of the marketing cycle, the results of the marketing spending had no material impact on revenues during the second quarter, but will be impactful during the second half of the year. The results from the podiatry marketing campaign are meeting Northstar's projections. The next marketing initiative will focus on spine surgery and is anticipated to launch in the latter part of the third quarter."

Source: CNW Group [8/14/13]

FSU Quarterback Wants to be a Podiatrist

Jameis Winston finishes his photo op with his fellow quarterbacks, takes a few solo shots as well as two or three snaps with his competition for starting quarterback, Jacob Coker, and then starts to head off the field to get ready for FSU Fan Day.

Jameis Winston (L) (Photo: Perry Kostidakis)

Jameis Winston is an 18-year old from Hueytown, Alabama. He plays football and baseball for Florida State University. He wants to be a doctor (a podiatrist to be specific), because when he was little, his grandma and dad always had to go to the doctor and he wanted to help them.

Source: Perry Kostidakis, FSU News [8/12/13]

EHR Costs Outweigh Financial Benefits, Doctors Say

Physicians believe electronic health records can improve patient outcomes but feel that EHR costs outweigh any financial benefits they might have, according to the fourth annual Athenahealth Physician Sentiment Index.

The survey also found that doctors see receiving third-party payments as increasingly complex but are getting less frustrated with the process. Similarly, physicians doubt government involvement can have a positive impact on healthcare, “but the passion surrounding it seems to have lessened,” according to the survey.

Source: Andis Robeznieks, Modern Healthcare [8/14/13]

Query: Popliteal Block for Forefoot Surgery

Typically, I try to use a popliteal block for challenging rear foot cases or cases in which I need muscle paralysis combined with sedation delivered by an anesthesiologist. For forefoot cases, I typically use an ankle block and sedation. Due to the clinical response of longer pain relief that I see with popliteal blocks, I am considering performing more forefoot surgeries under this anesthesia. I cannot recall reading any research comparing ankle blocks with popliteal blocks for forefoot surgeries. What experiences have others had?
 
Tip Sullivan, DPM, Jackson, MS

RE: Non-union Following a Lapidus Procedure (Barry Francis)
From: Tip Sullivan, DPM, Andrew I. Levy, DPM

As we say down here in the South, “Don’t you be kicking that skunk!” The patient is happy and is well aware of the issues. She knows her options – let her kick the skunk if she so chooses.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Caccio, et al., in J Bone Joint Surg Am. 2010 May;92(5):1241(ncbi.nlm.nih.gov/pubmed/19884432) presented the use of extracoporeal shockwave to treat non-unions. Dr. Rompe presented the paper at the International Society of Medical Shockwave Treatment meeting in Chicago in 2011 as a level-1 study showing a faster return to union and better short-term clinical outcomes than traditional open surgical repair in long bones. At 12 and 24 months, the outcomes were equal, but the patients did not need surgery.

I also use ultrasound bone growth simulators for slow healing fractures and osteotomies. To me, it is also critically important that the patient does not smoke and avoids secondary cigarette smoke.

Andrew I. Levy, DPM, Jupiter, FL, rcpilot48@gmail.com

RE: Severe Heel Pain After Plantar Fasciotomy (Mark Aldrich, DPM)
From: Mitchell Wachtel, DPM, Charles Morelli, DPM, David A. Stoller, DPM

A gauntlet AFO may be the best option. This should  be worn a minimum of a year. 
 
Mitchell Wachtel, DPM, North Andover, MA, jacqitch@comcast.net

Get a neuro consult and rule out entrapment of the lateral plantar nerve or any nerve damage caused by the procedure. Consider radiofrequency treatment if the neuro consult is negative.

Charles Morelli, DPM, Mamaroneck, NY,  podiodoc@gmail.com

Your patient might have a subluxed cuboid. Take lateral x-rays of both right and left feet to evaluate the subtalar joint and cuboid joint position. The symptomatic foot might have a different position than the other one, which might indicate a subluxation. Then apply distal  distraction, reducing subluxation. Follow up with a post-reduction x-ray to evaluate the new position.

David A. Stoller, DPM, Mission Viejo, CA, david@missionviejofootcare.com

RE: Staged Procedures for Digital Deformities
From: Ed Cohen, DPM

I would do a Doppler with toe pressures and still refer the patient to a vascular doctor to have a CTA done. I have had a number of patients who did not have enough circulation for surgery but, after they had a vascular procedure performed, they were then able to have foot surgery.

This is great case for MIS surgery since the procedures are so atraumatic and the surgery can easily be done with local anesthesia, without a...

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

RE: Staged Procedures for Digital Deformities (Ivar Roth, DPM, MPH)
From: Robert Kornfeld, DPM, Peter Riznyk, DPM

Really Dr. Roth? Never a problem? It is a bit haughty to hang all of the success of surgery on meticulous technique. Bilateral surgery means twice as much trauma at two distant sites. In patients whose immune system is not optimal, complications are far more likely, as is delayed healing, wound dehiscence, etc. I think anyone who does a fair amount of surgery will have more post-op challenges on bilateral cases as opposed to staging them. That was my experience after 30 years of performing surgery. Remember, you are operating on a patient, not a pair of feet.

Robert Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com

I cannot believe that someone would make a blanket statement that any surgeon doing unilateral cases only does it for the money! I did several bilateral cases during my residency and when I came out, I started to do bilateral cases and found that they almost always were more swollen, had more restricted movement, and compliance by my patients was much worse. I now only do bilateral cases if the patient requires it for insurance purposes or some other reason. I believe the opposite is true. I think that you will find surgeons do bilateral cases because they're afraid that the patient won't come back to have the other foot done. I don't know how a podiatrist would feel comfortable doing bilateral base wedge bunionectomies, Austin bunionectomies, or a bilateral Lapidus. I believe Dr. Roth should be much more careful painting with such a wide brush. I found his statement insulting.

Peter Riznyk, DPM, Orchard Park, NY, opfootdoc@gmail.com

RE: Diagnostic Ultrasound (Bryan Markinson, DPM)
From: Lloyd S. Smith, DPM

Dr. Markinson makes a great comment about ultrasound-guided injections. I offer the following: if an injection using ultrasound paid at virtually the same rate as without U.S., what would you do?  What is the intrinsic work value of using an U.S. machine? Do you need a dedicated room to perform the U.S. component of the procedure?

Is it about the benefit to the patient or the reimbursement? In any and all cases, the benefit of a procedure to a patient is the key component to its worth. I am also quite certain that in the near future, the value of an injection with or without U.S. will be similar. Will this alter your treatment rationale, the use of the U.S. machine, and/or the purchase of one?
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: Surgery on Hearing-Impaired Patient (Jeffrey Worman, DPM)
From: Larry Kobak, DPM, JD

In regard to the inquiry of performing informed consent on patients who are hearing impaired, it is my experience that unless they are also unsighted, diagrams and paper work fine. Have them sign any diagrams used in your informed consent and give them a notepad so they can write down any questions. Write out your answers to their questions. Have your patient sign these documents. Remember, informed consent is a process, not a signed piece of paper.
 
Larry Kobak, DPM, JD, Westbury, NY, lfkobak@gmail.com

Well rounded general and surgical podiatry practice in beautiful Stamford, CT. 35 years. Walk to the hospital and OR. $350k gross / 4 days per week. May lease present office space. Super office manager. Practice offered @ $100k. jefre1@msn.com

PRACTICE FOR SALE - MAINE

30 year, full service practice in Bangor, Maine. Cooperative and appreciative patients. A wonderful community to practice in and recreate during your free time. Owner is semi-retired, now ready to fully retire but will stay for transition. mainefootdoc@yahoo.com.

PRACTICE FOR SALE - HUNTINGTON PARK, CA

46 years same location. Unsurpassed visibility on corner of major intersection. 3 fully equipped treatment rooms. Perfect opportunity to build a strong practice. Must retire due to age. Selling price $30,000 firm. (323) 588-1179 MTWF. evaonofre@hotmail.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to:practiceforsaleswfla@gmail.com

PRACTICE FOR SALE- CONNECTICUT

Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com

ASSOCIATE POSITION - CONNECTICUT

Looking for an associate with 3-year residency training for a practice in Connecticut. Interested in all aspects of podiatry including  foot/ankle surgery and wound care. Hospital located close by with appointment to staff readily available. Will lead to partnership Please send CV to:dsharnoff@hotmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION - CALIFORNIA

Associate wanted for multi-office, multi-doctor practice. Full Time, Self-motivated, highly skilled team player with surgical, wound care and palliative skills. Offices in Northern California Coast, CA License necessary, salary negotiable with possibility of partnership in future. Send CV and letter to:srfctysc@gmail.com

ASSOCIATE POSITION - SOUTHEAST MICHIGAN (MI LICENSE REQUIRED)

Seeking a quality-oriented, patient-focused PSR trained associate for a fast paced, established group practice in Southeast Michigan. This is a secure, long-term position. Emphasis on diabetic foot and wound care.  Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. Partnership possibility for the right individual. If you are highly motivated, ethical and have good communication and clinical skill, please forward CV to:cfsdr@yahoo.com

ASSOCIATE POSITION - CENTRAL PA

Looking for an associate with 3-year surgical residency. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to stringernyc@hotmail.com

 ASSOCIATE POSITION -  PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to: 123bunion@gmail.com

ASSOCIATE POSITION - NYC METRO AREA 

Must participate with HealthFirst, Affinity, Fidelis health plans (2 of 3 OK). Preferably on staff at Bronx or Manhattan hospitals or surgicenters. Excellent opportunity for quick partnership. email CV torrranch7@yahoo.com

ASSOCIATE POSITION – NORTHERN CALIFORNIA/SF BAY AREA

We’re seeking a podiatrist to join multi-office practice. Must have great people skills, great bedside manner, and positive demeanor. California license required. No nursing home visits. Prefer private practice experience. Send CV and cover letter to: ebpod2008@gmail.com

ASSOCIATE POSITION - DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base.  Base Salary$120,000, benefits and bonus structure. EMR;diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.com

OFFICE AVAILABLE - TACOMA, WA

Podiatry clinic available for podiatrist one or two days a week. Current doctor does no bone surgery. Perfect for someone wishing to supplement a current office or a new practitioner looking to get his foot in the door in the Puget Sound area. Email CV and cover letter to 4MYFEET@sbcglobal.net.

NEW PRECEPTORSHIP POSITION NOW OPEN

Philadelphia based multi-doctor practice offering preceptorship. Unique practice blending ‘traditional’ podiatric services with acupuncture, sports medicine and podiatric pain management. Individual must be motivated, personable and have strong computer skills. Please respond by email with resume and  CASPR application. Selection process will be completed quickly, so please respond timely if you are interested. ediamond7@comcast.net

EQUIPMENT FOR SALE - DIOWAVE 15 WATT, PORTABLE 980 LASER

This is a used multiple function laser, plantar fasciitis, Achilles tendonitis, joint pain. nerve pain, post surgical, warts, toenail  problems, two-year plus warranty, MSRP: $25,000. E mail Dr. Zuckerman at:footcare@comcast.net for questions and pricing.

PM News Classified Ads Reach over 14,500 DPMs and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 14,000 DPMs. Write to: bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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