The Voice of Podiatrists

Serving Over 14,601 Podiatrists Daily

August 17, 2013 #4,851 Publisher-Barry Block, DPM, JD

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Congratulations to Robert Scott Steinberg, DPM of Schaumburg, IL, winner of a copy of Lower Extremity Biomechanics by Drs. Stephen F. Albert and Sarah A. Curran  (Value - $110). 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.

Fossil Men's Watch

This week's prize is a Fossil Men's Watch (Value - $95)..

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

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OR Podiatrist Inducted Into Alaska High School Hall of Fame

What makes standout Chugiak High athletes? Their fathers, apparently. A four-year varsity soccer player, 1985 graduate Dr. Ed Blahous Jr. was inducted into the Alaska High School Hall of Fame on Aug. 4, joining his father, Ed Blahous Sr., who was inducted as a soccer coach last year. Blahous Sr., who coached Chugiak soccer for two decades — 18 as head coach — presented his son the award during the induction ceremony at the Millennium Hotel in Anchorage.

(L-R) Dr. Ed Blahous, Jr. and Ed Blahous, Sr.

Blahous Jr., 46, earned varsity letters in soccer, basketball, and football. His prowess helped lead the Mustangs to three state titles in 1983-85. Blahous Jr., a three-time All-Cook Inlet Conference selection, went on to play soccer at Seattle Pacific University where he won an NCAA Division II national championship. Blahous Jr. now lives in Seattle and is the chief podiatrist at the Seattle Sports Medicine Clinic.

Source: Chugiak-Eagle River Star [8/14/13]

AAPPM Student Seminar Resonates With Attendees

The first meeting of its kind, the American Academy of Podiatric Practice Management (AAPPM) Student Seminar, was recently held in Pittsburgh, PA. The more than sixty students from the various podiatry schools in attendance all agreed that the meeting exceeded all expectations. The purpose of the meeting was to prepare third year students for externships, clerkships, and to plan for residencies. Topics included the ins and outs of the externship process, how to stand out on externships, what to look for in a externship, interviewing strategies, CV tips, time management strategies, and more.  

Attendees at AAPPM Student Seminar

Michael Johnson, DMU Class of 2015 and APMSA Liaison to AAPPM said, “By bringing in a blend of residents and top national speakers, all areas were covered to give the attendees the information they need to achieve success in their fourth year at school and tools to best prepare to get a residency program." This annual student meeting will be held once again in Pittsburgh, PA July 18 – 20, 2014.

I believe that I am an excellent fit for a residency position because of my qualifications, strong work ethic, and passion towards continuing my podiatric training. I am a graduate of 2012 and passed NBPME Parts 1 and 2 on the first attempts, and ranked in the middle of my class. I had the pleasure of working at Weil Foot and Ankle Institute (WFAI) as a Research Coordinator for a year. 

I worked on several research studies that were presented at the 2013 ACFAS conference. Currently, these studies are being submitted as research manuscripts to the American Academy of Orthopedic Surgeons (AAOS), Foot and Ankle Specialist and Foot and Ankle Techniques. Further, I worked on research studies that have received National Institute of Health (NIH) grants. Additionally, I worked as an MRI, CT, and EMED technician at WFAI.

Usman Akram, DPM,  Milwaukee, WI, utakram@gmail.com

Query: Wart Surgery Coding

What is the procedure code (Medicare prefers) for electrodessication of a verruca (wart)?

Craig Sapenoff, DPM, West Palm Beach, FL

Response: The CPT code for the service you described is CPT 17110 (or CPT 17111, if you treat 15 or more lesions in a single session). Although Medicare sometimes has an HCPCS code that they'd like you to report as an alternate to the CPT code for the service, that's not the case here. Medicare accepts CPT 17110-17111 for this service, too.

Whether or not the treatment of warts is a covered benefit is another story. You'll have to check your Medicare MAC's LCDs to see if there are specific coverage guidelines for wart treatment. I think you'll find it in the policy on removal of benign skin lesions.

If the patient's condition doesn't meet the coverage criteria, then obtain an ABN from the patient. The patient will then be responsible for the charges.

Joan Gilhooly, CPC, CHCC, Lebanon, OH

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Bulbous Toes Bilaterally (David Kahan, DPM)
From: Stephen Musser, DPM

First, wait and see how she responds to the buttress pad treatment. Second, ask her if she has been in a pool a lot this summer. I've seen similar presentations when patients have been in a pool that has a rough bottom finish.
 
Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

RE: Popliteal Block for Forefoot Surgery (Tip Sullivan, DPM)
From: Philip McKinney, DPM

I routinely use a posterior tibial block, followed by a field block of the surgical area for forefoot surgery. If doing a rearfoot procedure, I do a common peroneal block with a surgical site field block. If the case involves the ankle, or an Achilles tendon location, then I use the popliteal block with a surgical field block.
 
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net

RE: Severe Heel Pain After Plantar Fasciotomy (Mark Aldrich, DPM)
From: Jeffrey Kass, DPM, Michael Forman, DPM

Consider a neurogenic origin; at a local level, a nerve entrapment from the plantar fascial release, perhaps a tarsal tunnel or radiculopathy from the back.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

I have seen several of these cases, one of which was of my own doing that resulted in a trip to court. The culprit was a neuropraxia of the first branch of the medial plantar nerve (Baxter's nerve). Diagnosis is made on MRI, which will show atrophy of the abductor digiti minimi. Clinically, you will see an adducto varus fifth toe due to the loss of this muscle. For this reason, you should always note the position of the fifth toe pre-operatively. It is in an adducto varus position pre-op. The Baxter's n. may have been damaged prior to surgical intervention.

If you Google Baxter's nerve, you will find an excellent article from our Atlanta colleagues that describes this syndrome and the surgical approach to its care.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

RE: Cross-Country Runner Using Spikes (Martin E. Karns, DPM)
From: Keith L. Gurnick, DPM

The use of spikes for high school cross-country running is unnecessary and potentially very hazardous, and in many regions, disallowed for racing. Acute injuries can include laceration to one's self and/or others from the actual sharp spikes. Also, if the running surface is grassy, uneven, or hilly, the spikes can hang up or get caught in tree roots and other surface objects, causing trip and fall accidents. 

Spike shoes in track and field (which is not the same as cross-country running) are designed to be racing flats (very thin, light-weight, and non-supportive). They are designed for racing or for training for sprint racing on flat even surfaces, which in the past, included dirt tracks, where the traction was not great. They still are used on modern synthetic rubber tracks seen in many high schools and colleges around the world today. Also, modified spike shoes are still used on artificial surfaces in many field events to increase foot traction, including high jump, pole vault, triple jump, javelin, etc. Spikes can be very dangerous because they are sharp.

Keith L. Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: Staged Procedures for Digital Deformities
From: Vincent Gramuglia, DPM

I have never had a problem performing bilateral podiatric surgery on my patients. Even the most complex rearfoot and reconstructive forefoot procedures are amenable to this surgical philosophy in my hands. Of course, these patients must meet strict pre-op criteria. First and foremost, they all must be able to do a handstand and walk this way for three blocks minimum. If they pass this simple test, then they are a candidate.

It also helps if they are Olympic gymnasts, astronauts, or yoga instructors. One rule of thumb is to instruct these special individuals not to wear loose fitting clothes (especially a dress) post- operatively.

I think its time to take a stand against the old tired axiom of "do no harm." Our patients today are much more compliant than those cave dwellers, and by the way did Hippocrates have the kind of internal fixation that we have today? I doubt it. Roll the dice...see what happens.

Vincent Gramuglia, DPM, Bronx, NY, a2onpar3@optonline.net

Diagnostic Ultrasound (David Secord, DPM)
From: Elliot Udell, DPM
 
The paper quoted by Dr. Secord states that ultrasound guidance significantly improves the accuracy of joint injection, but ultrasound guidance did NOT improve the short-term outcome of joint injections.
 
What is significant to this discussion is that the joints studied in the above paper were knees, hips, shoulders, and ankles. These are much larger areas of the body where it may be less likely for small amounts of injected fluid to spread out on its own. Nevertheless, even with large anatomic areas, using ultrasound did not improve short -term outcome of joint injections. 

I have just begun to use ultrasound, but cannot swear at this point in time that my injections done without ultrasound were in any way inferior to those done with ultrasound. A strong motivator for me to institute ultrasound-guided injections is that, because so many of our colleagues (podiatric, orthopedic, and rheumatologic) are using ultrasound, many of my patients have told me point blank that they would not allow me to give them an injection unless I used ultrasound. Articles such as the one quoted by Dr. Secord would not sway their opinions. Hence, I bit the bullet and bought the least expensive ultrasound on the market, but one with a very good training package and support.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Outrageous Shoe of the Day

Perfect for the circus or painting ceilings?

Source: Submitted by Melanie Murdock (20/20 Imaging)

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 - Q-CLEAR LASER (USED)

 The first high performance, portable, and truly affordable Dual Wavelength Q-Switched Nd:YAG Laser System for treating onychomycosis, tattoos, pigmented lesions, vascular lesions, leg & facial veins, skin resurfacing and other dermatological conditions. Price: $29,000 Email info@footsurgeon.com for inquiries.

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.

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.

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 NEEDED FULL TIME- MIAMI/DADE & BROWARD COUNTY FLORIDA
 
All phases podiatry, from major ankle surgery to routine care. Must take ER call. Salary plus benefits. Send CV to; footdoctormiami@gmail.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 

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.

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

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