The Voice of Podiatrists

Serving Over 14,601 Podiatrists Daily

August 16, 2013 #4,850 Publisher-Barry Block, DPM, JD

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Children More Active in Proper Fitting Shoes: CA Podiatrist 

“If a child’s feet hurt, they will be far less likely to participate in outdoor sports and other activities that keep them moving and physically fit,” said CPMA President Carolyn McAloon, DPM, a podiatric physician and surgeon in private practice in Castro Valley, California.   

Dr. Carolyn McAloon

“With childhood obesity considered an epidemic today, it is vital that parents take just a few moments during this busy back-to-school shopping season to select a shoe that provides adequate support and fits properly. It is one of the easiest ways to keep a child pain-free and healthy,” Dr. McAloon said.

Limit Wearing of Stilettos to Prevent Permanent Damage: Aussie Podiatrist

Many women love to strut their stuff in stilettos, but they are called killer heels for a reason. Corrina Petric, from the Australian Podiatry Association, said high heels force the body into an unnatural position and urged women to wear them only occasionally or risk permanent pain and damage.

Corrina Petric

"High heels affect the feet, legs, and the back," she said. "The more you wear them and the longer you wear them, the greater the chance of damage. Wearing a heel transfers the body weight forward to the ball of the foot. Minimal weight is borne by the heel."

Source: Angela Pownall and Matilda Price, The West Australian [8/15/13]

FL Podiatrist Elected Chair of Podiatry Board

The Florida Board of Podiatric Medicine elected Dr. Chet Evans to serve as its Chair. He succeeds Dr. Beth Pearce, who served on the board for fourteen distinguished years. In addition to practice, Dr. Evans is currently the President and CEO of AnchorMed, a medical and residency program development and medical organization management company.

Dr. Chet Evans

Evans was formerly the Vice President for Medical Education and Program Development at Lake Erie College of Osteopathic Medicine (LECOM) in Bradenton, Florida.

NY Podiatrist Presents Study at Forensic Conference

Forensic podiatrist Dr. Bryan B. Kagan presented his study, "Comparing Static Shod Foot Impressions With Barefoot Foot Impressions," at the 98th International Educational Conference of the International Association for Identification in Providence, Rhode Island on August 6, 2013.

Dr. Bryan B. Kagan

Forensic specialists and law enforcement officials from Europe, South America, the Middle East, and Canada were in attendance. Dr. Kagan practices in White Plains, NY. He will be teaching Forensic Podiatry at the New York College of Podiatric Medicine this coming academic year.

Query: Bulbous Toes Bilaterally

This active young female patient presented with bilateral bulbous 3rd/4th toes. The DIPJ is mildly contracted, but the ends of the toes are otherwise quite "bulbous." They get very red, cracked, and painful at the skin fold.

Bulbous Toes Bilaterally

I have dispensed a gel buttress pad for her to try. Other than surgery, any thoughts on treatment? 

David Kahan, DPM, Sacramento, CA

Query: Cross-Country Runner Using Spikes

What are the advantages and/or disadvantages of a 16 year-old male running cross-country on grass using spikes?

Martin E. Karns, DPM, Miami Beach, FL

RE: The Passing of James Moore, DPM

I had the pleasure of knowing Dr. Jim Moore as a teacher, mentor, colleague, and friend. He was a true gentleman and great role model for all of us who learned from him. He acquired and shared extensive knowledge of biomechanics. He was a dedicated podiatric physician and educator who consistently taught that success in podiatry came from putting the needs of the patient above all else. Jim had a positive influence on all who knew him, and our profession is better off for his influence. May he rest in peace!
 
Ronald A. Sage, DPM, Maywood, IL

RE: Severe Heel Pain After Plantar Fasciotomy (Mark Aldrich, DPM)
From: David Zuckerman, DPM

It is very nice that we have additional treatment modalities such as RF and/or lasers to treat post-surgical pain and inflammation. Lasers can heal nerve problems such as neuropathy and more. I stress that the most important aspect of dealing with a complication is very simple - find out what the diagnosis is, and just don't throw a laser or RF at the problem. I am not saying  that you can't help this specific case with a laser, but you won't help the patient without a specific diagnosis. Do a complete blood work-up. I have seen five cases of anklyosing spondylitis post-ESWT.

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

RE: Staged Procedures for Digital Deformities (Ivar Roth, DPM, MPH)
From: Michael J Marcus, DPM, Kevin A. Kirby, DPM

If a patient has mild to moderate deformities of the forefoot, for ex. bilateral HAV or HT 4 and 5, I will in many cases give the patient an option of doing one foot or both at the same setting. However, this is also based on other factors. These include if they have household assistance, job circumstances, other responsibilities, as well as the patient's general medical health. However, I do agree with Dr. Roth that bilateral surgery, when possible, is truly cost-efficient.

Obviously, if a patient has severe deformities that would require NWB, then a unilateral surgery would be favored. I do not find that one's complication rate is any greater performing bilat. vs unilat. procedures. Many orthopedic surgeons I know frequently perform bilat. TKAs. Lastly, staging procedures in an individual foot is sometimes necessary in DM reconstructions and severe deformity corrections such as adult talipes equino varus; also, in cases that involve complex rearfoot reconstruction as well as forefoot. However, I find it unethical when I hear members of our associations recommending doing the HAV in one setting, and the 2nd met and HT in another.

Michael J Marcus, DPM, Montebello/Irvine CA, ftmed@aol.com

I find the suggestion that podiatrists who recommend unilateral versus bilateral surgical procedures do it "for one purpose only, and that is to make more money" quite insulting. I routinely recommend unilateral surgical procedures versus bilateral surgical procedures to my patients, when possible. The biomechanics of recommending unilateral procedures in the bipedal human is quite clear. With unilateral surgical procedures, the bipedal human has only half of their weight-bearing appendages compromised. With bilateral surgical procedures, the bipedal human has all of their weight-bearing appendages compromised. I think that any intelligent and ethical podiatrist would understand this basic biomechanical concept and use this knowledge to design the best surgical, or non-surgical, treatments for their patients, regardless of the reimbursements expected for those treatments.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Diagnostic Ultrasound (Bryan Markinson, DPM)
From: Martin E. Wendelken, DPM, Bill Greco, DPM

The use of diagnostic ultrasound in the identification of tumors on any location of the foot should not be understated. I have identified 4 malignant soft tissue masses that appeared to be “ganglions”, some of which were injected by others thinking they were ganglions. Therefore, all soft tissue masses are examined using diagnostic ultrasound before we inject or aspirate them.  

One oncologist unfortunately stated to one of the referrals that injections into tumors can complicate treatment and may cause spreading of the cells/mass (causing legal issues for one of the podiatrists). This technology can improve patient care, however, it is clearly operator-dependent. As far as guided injections, sonography can allow for exact placement of injectable medications in the area where the pathology is located as determined by the US exam. We have found, in fact, that this reduces the number of injections to achieve a satisfactory result. 
 
Martin E. Wendelken, DPM, RN, NY, NY, drmew@optonline.net

Is the example of ten ultrasound-guided steroid injections an example of the fallibility of ultrasound or the incompetence of care, bordering on malpractice, of one individual?

Ultrasound as a practice adjunct will provide the practitioner valuable information. Is the mass cellular or fluid? Is it lobulated or a single chamber? Are there extensions of the mass beyond...

Editor's Note: Dr. Greco's extended-length letter can be read here.

RE: Diagnostic Ultrasound (Michael Forman, DPM)
From: David Secord, DPM

Here's a relevant article on this topic: "Ultrasound Guidance for Intra-articular Injections Improves Clinician Accuracy" Arthritis Rheum. 2010;62:1862-1869.

Summary

The use of ultrasound guidance has been advocated as a technically superior method for performing intra-articular injections. This study compared clinical efficacy and technical accuracy in 184 patients who underwent either ultrasound-guided intra-articular injections or blind injections.

One third of blind intra-articular injections were found to have been inaccurate. Moreover, injections performed by a trainee rheumatologist using ultrasound guidance were shown to be more accurate than those performed by more senior rheumatologists performing blind injections.

No significant difference between the two groups was noted in the clinical outcome measures used (Visual Analogue Scale, modified Health Assessment Questionnaire, and the EuroQol 5-domain questionnaire, erythrocyte sedimentation rate and C-reactive protein levels), except for an improvement in Visual Analogue Scale joint function scores in the ultrasound-guided injection group at 6 weeks.

David Secord, DPM, Corpus Christi, TX, ledocdave@hotmail.com

EQUIPMENT FOR SALE - Q-CLEAR LASER

Brand new Light Age Q-Clear laser. This is a very unique one time opportunity. Recent special purchase permits sale of only a few units at the largest discount available. Rapid return on investment. Complete system with warranty and expert training included. Contact Dr. Holfinger at 216-390-9757.

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.

ATTRACTIVE OPPORTUNITY IN NORTHERN CALIFORNIA

30 year old practice for sale, furnished office, hospital and physician referrals. Seeking conscientious, well trained DPM with wound care experience. Submit CV to dr.jeanturner@yahoo.com

PRACTICE FOR SALE - STAMFORD, CONNECTICUT

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 - CENTRAL FLORIDA

Busy two doctor practice seeking the help of an ambitious associate to help handle the patient load. Position will lead to partnership for the right individual. Two office practice with hospital, surgery center and wound care center privileges. Good mix of surgery, wound care and general podiatry. Great salary with incentives, benefits, malpractice. Must have FL license. Suburban setting, close to attractions. Please send cover letter, CV and copy of surgical log to;  footpainbegone@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

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 - 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

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

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