The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 16, 2011 #4,234 Publisher-Barry Block, DPM, JD

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Congratulations to Tip Sullivan, DPM of Jackson, MS, winner of a  copy of Recent Advances in Orthotic Therapy by Dr. Paul Scherer (Value - $129.95).  We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2012 issue of Podiatry Management. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer is necessary) to bblock@podiatrym.com along with your name and address.

Lobby, Kensington Park Hotel

This week's prize is a two-night stay at the Kensington Park Hotel in San Francisco (Value - $456.00)..  

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

Literature Shows Increased Injuries From Barefoot Running: MA Podiatrist

When Gary White jogs around his East Sandwich neighborhood each morning, people still occasionally shoot him funny looks or ask him questions."I don't get too many comments, but I do get a few," White said. But many in the podiatry field remain skeptical of the phenomenon.

Dr. Moira McDermott

"The literature is showing that there is increased injury — almost an epidemic — within barefoot running," said Dr. Moira McDermott, founder of Lower Cape Podiatry in Brewster and a past president of the Podiatric Medical Society. "If you haven't grown up your whole life in your bare feet ... as an adult, your feet need support." Beginners can easily fracture their feet running without shoes, and long-term barefoot runners can develop arthritis and other complications from the prolonged stress, she said.

Source: Sean Teehan, Cape Cod Times [8/13/11]

Lawmaker Urges Study of IT Error Rates

HHS should consider conducting a thorough study about the adoption, benefits, and cost-effectiveness of health information technology that also examines both human and technological error rates, Rep. Renee Ellmers (R-NC) suggested in a letter to HHS Secretary Kathleen Sebelius.

Ellmers, who chairs the House Small Business Committee's Subcommittee on Healthcare and Technology, cited a study in the Journal of the American Medical Association that found of nearly 4,000 computer-generated prescriptions received by a pharmacy chain, about 12% contained errors—a number consistent with error rates in written prescriptions.

Source: Jessica Zigmond, Modern Healthcare [8/12/11

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

Bret Ribotsky: What are the prospects for podiatric students to take the same national boards as allopathic and osteopathic students?

Dr. Jeffrey Page

Jeffrey Page: We've had a number of meetings with USMLE and with COMLEX, the osteopathic counterpart, to discuss a number of different potential collaborations. I am convinced that any of my podiatric medical students would be successful if allowed to take the Part 1 examination of USMLE, that is the basic science examination.

Dr. Thomas Sgarlato

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is podiatric inventor and biomechanics/surgery authority Thomas Sgarlato, DPM. You can register for future events by clicking here

Respond Candidly When You Don’t Know

Suppose a patient asks you a question that you can’t answer. The pressure to appear knowledgeable may tempt you to provide a response anyway. Resist the urge by differentiating between what you know factually, what you intuit, and what you don’t know at all. Consider these responses:

•  “I’ve researched this and can tell you unequivocally that …”
•  “I feel strongly about that, so I advise against doing it.”
•  “All I can tell you is what my instincts tell me.”
•  “My feeling is to go with …, but I’d want to run it through a complete decision-making process.”
•  “I don’t have a clear sense about that. Let me think about it and get back to you.”
•  “That’s not my area of expertise. Have you consulted …, who has worked often with that?”

Source: Adapted from  The Courageous Follower, Ira Chaleff, Berrett-Koehler Publishers, via Communication Briefings

Query: Employing Physical Therapists in New York

In NY, physiatrists and osteopaths employ physical therapists, pay them a salary and bill the insurance company for the services rendered by the therapist. Is it possible for a podiatrist to do the same? If so, is the therapist then allowed to treat any condition he or she is qualified to treat or only what is within the scope of the employer podiatrist?

Lori S. Weisenfeld, DPM, NY, NY

Query: Interesting Story Ideas For Health Show

I am seeking interesting ideas for the new season of my nationally syndicated half-hour better living show "Your Life" which launches this fall. Ideas can be sent to drannamarie@comcast.net.

Anna Marie Chwastiak, DPM, Joppa, MD

Query: Difficulties Implementing EHR

Are there any podiatrists who bought or leased EHR software and found it was too hard or complicated to use?  Are offices able to see the normal schedule of patients with EHR, or is it so time-consuming that they need to see a reduced schedule? 

Joe Borden, DPM, Reseda, CA

RE: ESWT & NSAIDs (Paul Kesselman, DPM)
From: Lowell Scott Weil, Sr., DPM

Although we have read that NSAIDs will delay healing following ESWT or for that matter surgery, there are NO valid, evidence-based  studies that confirm that theoretic assumption. In the two successful FDA studies that we did with ESWT devices, all subjects received post-treatment NSAIDs for two weeks.

In our surgical practice at the Weil Foot & Ankle Institute, virtually ALL surgical patients receive pre-op and 5 days of post-op NSAIDs. Our results with all of our surgeries are consistent with the literature, and our complications such as wound dehiscence and infection  are <2 %.

This reminds me of the furor 35 years ago when we began to use 2mg dexamethasone injections into bony operative sites to lessen post-operative pain. Now, more than 40 years later, we continue to use that practice and have not seen any trends toward problems post-op. We did publish a paper on a blinded study comparing dexamethasone to placebo for post-op pain, and the steroid was statistically the winner, with no more adverse events. Note: we do not use any post-op steroid injections in tendon surgeries.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, Weil4feet@aol.com

RE: ESWT & NSAIDs (Paul Kesselman, DPM)
From: David Zuckerman, DPM

The only study that I have read regarding use of NSAID and ESWT with low energy repetitive ESWT is by Jan Rompe MD. FDA studies withheld NSAIDs up to 12 weeks because they would then be a factor in the effectiveness of ESWT. The end point was 12 weeks or three months. That being stated, here is what we have used over the past 12 years  with shockwave therapy. The use of NSAID along with high-energy ESWT ISN'T contraindicated. Our protocol with the Dornier Epos Ultras is 0.21 mj/cms for  Achilles tendinosis. This is considered low energy even with a regional nerve that is typically necessary. Any energy over .028mj/cms is high energy, anything below is low or medium energy

I  wait  in most cases at least 14 days so that the inflammatory stage of wound healing has passed. To be on the safe side, wait  21 days. There still are no studies or proof that prove NSAIDs do interfere in vivo except for one low-energy study by Jan Rompe MD.
 
You need to consider the overall patient and his needs and other pain and joint problems. If I felt that it would help the patient overall, I would give NSAIDs at any time. We have avoided this entire issue with  the use of high energy lasers (nexus 30 watt ) for pain and inflammation.

David Zuckerman, DPM, Cherry Hill, NJ, footcare@comcast.net

RE: Legality of Maximalist Running Shoes (Robert Bijak, DPM)
From: Kevin Kirby, DPM

I tend to doubt that any elite runners will be racing in the Hoka One shoes, since weighing about 11 ounces for a size 9 shoe, they are simply too heavy to race in.
 
However, Dr. Bijak's point of the "legality" of running shoes is a good point since the United States Association of Track and Field (USATF) clearly states in its rules the following: “3. (a) A competitor may compete in bare feet or with footwear on one or both feet. The purpose of shoes for competition is to give protection and stability to the feet and a firm grip of the ground. Such shoes, however, must not be constructed so as to give the competitor any unfair additional assistance, including the incorporation of any technology which will give the wearer any unfair advantage, such as a spring or similar device. A shoe strap over the instep is permissible.”
 
Interesting in this regard, in 2007, a Texas-based shoe company, Spira, which makes a shoe with an actual spring in their running shoe, filed a lawsuit against the USATF and the International Amateur Athletic Federation (IAAF). They claimed that their rule against “spring or similar devices” in running shoes was “a violation of the Sherman Anti-Trust Act and a restraint of trade.” However, to my knowledge,  the USATF never actually banned the Spira shoe from any competition, and it is commonly believed that Spira’s lawsuit was thought to be part of a marketing campaign for their “banned shoes.”

Kevin Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

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