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August 16, 2010 #3,932 Publisher-Barry Block, DPM, JD

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Flip-Flops Linked to Increase in Heel Pain in 15-25 Year Olds: NJ Podiatrist

Many of us are loving the warmer weather sporting flip-flop sandals, however, their popularity among teens and young adults is responsible for a growing epidemic of heel pain in this population, according to Dr. Jasen Langley. “We’re seeing more heel pain than ever in patients 15 to 25 years old, a group that usually doesn’t have this problem,” said Dr. Langley “A major contributor is wearing flip-flop sandals with paper-thin soles everyday to school. Flip-flops have no arch support and can accentuate any abnormal biomechanics in foot motion, and this eventually brings pain and inflammation.”

Dr. Jasen Langley

Dr. Langley advises wearing sandals with reasonably strong soles and arch support. “Especially for girls and young women, thicker soled sandals with supportive arches might not be considered stylish, but if you want to wear sandals most of the time, you’ll avoid heel pain if you choose sturdier, perhaps less fashionable styles.”

Source: The Howell Times [7/31/10]

Vibram Running Shoes Not a Fad: VA Podiatrist

Imagine: You make a really ugly shoe, but one that takes a unique approach to ergonomics. A best-selling book heaps praise on your funny-looking footwear. A scientific study in a national journal confirms your shoe's structural excellence. Athletes go ballistic about your shoe, creating fan websites and buying the shoes faster than you can supply retailers. That's the story of Vibram, an Italian company that for 75 years has made soles for high-end hiking boots.

Dr. Ben Pearl

Podiatrists caution that FiveFingers aren't for everyone. People who don't normally run, who are obese, or who have serious foot problems or diabetes should be especially cautious. "It started off as a fad movement, but it's gaining a loyal following that I don't think will fade away," says Dr. Ben Pearl, an Arlington, VA podiatrist who has written about barefoot running on his blog Docforjocks.

Source: Jennifer Alsever, CNN Money [8/13/10]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What recommendations would you have to people who are thinking about starting a residency program?

Dr. Stephen Kominsky

Stephen Kominsky: For someone who is contemplating starting a residency program, you need to have a large supporting cast from both a podiatric and allopathic medicine prospective; residents have to be exposed to a lot of different medical disciplines. Residency programs cannot be based in surgery centers anymore. They have to be based in academic institutions, and there needs to be administrative support. For anybody who wants to give back to the profession and feels that they have the energy to do it, I think it is an incredibly fulfilling and rewarding experience.

Dr. Irvin Kanat

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature PM Podiatry Hall of Fame podiatrist, Dr. Irv Kanat . You can register for this event by clicking here

Query: The Doctors Company

I have been solicited by a malpractice company I am unfamiliar with called The Doctors Company. Has anyone had any experience with this company?

David E. Gurvis, DPM, Avon, IN

RE: Tarsal Coalition (James W. Clark, DPM)
From: Dwight L. Bates, DPM, Peter Bregman, DPM

The classic inter-positional material after bar resection is the extensor digitorum brevis muscle belly. If this patient does not have the bar resected successfully, only a triple arthrodesis later will help because the hyaline cartilage of the subtalar joint will degenerate.           

Dwight L. Bates, DPM, Dallas TX, dlbates04@yahoo.com

This is a surgical case. If you are not comfortable doing this, I would refer it to someone who is. The two most important things to remember when doing these are 1) plan the incision properly to allow access; it is more lateral then you think and 2) take a good-sized piece of the bar out, about the size of your thumb, distal to the last joint. 

(L-R) Incision, Extraction, Coalition, Result

It is not necessary to put something in between the resected bridge, but I have used bone wax with good success. This not only provides better hemostasis, but can also impede new bone growth. Use a TLS drain, as these do bleed quite a bit. Keep the patient NWB for 3-4 weeks, then follow up with PT.  
 
Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

RE: Tarsal Coalition (James W. Clark, DPM)
From: Michael S. Downey, DPM

From the radiographic image provided, this appears to be a complete calcaneonavicular synostosis. Since the symptoms described are mild, I suggest initial conservative treatment with custom-molded orthoses, NSAIDs, and possibly a course of cast immobilization. I would try this for 2-3 months, but if she does not respond, I would not further delay proceeding to surgical intervention. In my opinion, full and generous resection of the calcaneonavicular would be indicated through a dorsolateral Ollier-type incisional approach. 

The key to the success of the procedure is adequate resection of the coalition, and NOT the material interposed. However, my preference for interpositional material remains the extensor digitorum brevis muscle belly, as originally described by Badgley in 1927. Since it must be detached and reflected to fully approach the coalition from the dorsolateral approach, it is quite natural to use the EDB muscle as the interpositional material. As in this case, it is quite common for a calcaneonavicular coalition to first become symptomatic between the ages of 8 and 12. Resection of the coalition while the child/adolescent is still growing is preferred to allow the foot to remodel and adjust to the improved motion as it matures further. Post-operative follow-up with custom-molded orthoses is also recommended.
 
Michael S. Downey, DPM, Philadelphia, PA, Dowpod@aol.com

RE: Appointment Reminder Calling Services (Timothy B. Maclin, DPM)
From: Brian D. Battles, DPM

I have been using Office Ally's ReminderMate, a web-based recall system since January '10. We use the web-based schedule, and ReminderMate does the rest. It has easy set-up, costs $29.95/month for 500 calls, then goes up incrementally. I do not use Office Ally billing program, just the scheduling part. I am really happy with it. No more paying someone to make phone calls and getting answering machines during the day, when there is other work to do.

Brian D. Battles, DPM, Groesbeck, TX, battlesbrian@hotmail.com

RE: Cosmetic Foot Surgery Gaining in Popularity: TX Podiatrist
From: David Secord, DPM

I'm amazed when I read some of the commentary defending cosmetic foot surgery. "We're filling a void" may work for the bottom line, but if you end up being sued, how on earth is unnecessary surgery defended in the courtroom? By the way, a bunion is the result of abnormal biomechanical forces exacerbated by shoes, resulting in an arthritic change and osteophyte formation. That is not cosmetic surgery. Long 2nd toe? Functionally abnormal and prone to callus formation, contracture and pain. Also, not cosmetic. Cosmetic surgery is thinning the digit so that it looks better, or removing the 5th ray to allow a foot to fit into a really thin and stylish shoe.

If you do enough of that sort of thing, I think that eventually, you'll have a sub-optimal outcome and get sued. For the truly cosmetic procedure, there would be no medical indication for the procedure and I'm dying to hear from some of the individuals who contribute to this listserv who are experts on the ability to defend such a procedure. This stuff comes into my office as well. I tell them that I don't do cosmetic surgery on the foot, as there is no indication for it beyond vanity, and it is not worth the possible complications. They go elsewhere, or reconsider the idea (I hope).

David Secord, DPM, Corpus Christi, TX, david5603@pol.net

RE: Two of Atlanta’s Largest Surgical Practices Consolidate
From: Robert Bijak, DPM

I suspect I'm not alone in feeling a little uncomfortable with mega-practices moving in on the solo practitioner. Self-determination and destiny are a few of the attributes that attracted many into the field. I'm not sure where anti-trust laws come into effect, but I don't believe that today's students are looking forward to applying for a job at a mega-practice's human resource department. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Passing of Klaus Schreiner

Klaus Schreiner of Fleetwood, PA died on Aug. 11. He owned Emsold, which markets European-made leather insole products. Klaus supported podiatry for over 50 years. He loved our profession and had thousands of customer friends. His son Eric will continue the business.

Jeff Stone, DPM, Fresno, CA

RE: Doctor, Can't You See That I am Busy? (Elliot Udell, DPM)
From: Charles Morelli, DPM, Narmo L. Ortiz, Jr., DPM

Dr Udell, finish the story. "She looked up at me and said, "excuse me doctor, I am busy texting my daughter who is on vacation in South America."  Then what did you do? I know what I would have done.  
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Unfortunately, the development of communications technology has created a new social dysfunction. While we are now "in touch" with almost anyone and anywhere, a lot of people have forgotten those who are right in front of them. How many times when you go to the movies, a restaurant, a sporting event, at home with your family, or even at the dinner table does someone text someone else? It seems that people want to be anywhere else but where they are.

In other words, cell phones are creating the loss of humanity and consideration to others. With patients and cell phones, you can take a proactive approach and place a sign in the waiting and treatment rooms to prohibit their use while in the office. When I am in front of a patient, I simply stand in front of them and wait a reasonable amount of time so that they know I am waiting for them to be done. Most of the time, they apologize and hang up quickly, so I hardly encounter a problem. The bottom line is, let them know in a polite way that they are there to seek your help and not to talk on their cell phones..

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

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