August 18, 2006 #2,666 Editor-Barry Block, DPM, JD

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PA Podiatrist Provides Back to School Shoe Buying Advice

It’s time for back-to-school shopping and that means new shoes. How do parents and kids pick the best footwear? According to John Walter, DPM, recently retired from the Temple University School of Podiatric Medicine, because children’s feet continue to grow and develop into the teen years, good, supportive shoes are critical for foot health.

“A lot of the sneakers out now are really quite good as long as they fit well,” Walter said. “For support and to keep dirt and foreign objects from entering the shoe, children’s sneakers and shoes should always be tied. This will also help prevent kids from coming out of their shoes and spraining an ankle.”

Children’s foot health has long-term implications. “Often, the painful knee and hip problems we see in adults have developed over several decades of poor foot and postural mechanics that were never addressed earlier with the proper shoes or orthotics,” said Walter.

NV Podiatrist Coordinates Professional Networking Group

The Summerlin Lions Club has added a new component. It's formed a Business and Professional Networking Group. The networking component was coordinated by Dr. Lawrence M. Rubin, a Summerlin podiatrist. He said the new group provides a win-win situation, allowing people to make business connections while helping out others.

Dr. Lawrence Rubin

"People are so busy these days," Rubin said. "Giving back to the community isn't high on their list of priorities. So this makes it easy for (business owners) to help others."

Each member will help the Lions Club's main community support effort, the Eyeglass Recycling Program, by placing a used-eyeglass collection box in their foyers.

Source: Jan Hogan, Summerlin South View (NV) [8/16/06]

Spanish Podologists Hone Skills at NYCPM

The New York College of Podiatric Medicine (NYCPM) recently hosted fifteen podologists from Spain in cooperation with the Universidad Complutense de Madrid, providing them the opportunity to attend a challenging course on anatomical dissection and surgical skills taught in the College’s new Clinical Skills Center by members of the NYCPM faculty.

Michael J. Trepal, D.P.M., Vice President for Academic Affairs and Dean at NYCPM, directs this semi-annual program of visiting students from Spain, now in its fifteenth year, on behalf of the College. Professors Ricardo Becerro de Bengoa, D.P.M., a graduate of NYCPM, and Marta E. Losa Iglesias, work closely with Dr. Trepal to direct the program. Both of these course directors accompanied the students on their visit.

Spanish Podologists at NYCPM

This photo shows the 15 Spanish podologists with Louis L. Levine, NYCPM President & CEO (second from left); Michael J. Trepal, DPM, VP and Dean of Academic Affairs (fifth from left); Professor Marta E. Losa Iglesias (fourth from right); and Professor Ricardo Becerro de Bengoa, DPM (far right).

NYCPM has a longstanding affiliation with the podology community in Spain that was initiated by the late Professor Anthony Hernandez of NYCPM and is carried on in his memory. Teaching the students from Spain were two NYCPM faculty members: Anthony C. DiLandro, Ed.D., Associate Professor, Department of Morphological Sciences; and Daria Dykyj, Ph.D., Professor, Department of Morphological Sciences. Their work with the Spanish students involved lower extremity cadaver dissection as well as videotaped demonstrations.

Texas Med-Mal Insurers Record Gains After Tort Reform

Texas medical malpractice insurance companies have been doing a lot of good lately by reducing doctors' insurance premiums. They've also been doing very well themselves. In the three years since Texas lawmakers passed so-called medical liability reform measures that drastically limited the amount negligent doctors and their insurance companies have to pay to harmed patients, Texas' biggest medical malpractice insurance companies have been tripping over each other to announce premium cuts for doctors. But the insurance companies have been less enthusiastic about publicizing the wealth they've been able to amass since tort reform went into effect and their medical malpractice lawsuit payouts dropped like a rock.

Source: Austin Business Journal via Modern Healthcare [8/16/06]

Query: Torn Posterior Tibial Tendon

A woman came in with pain and swelling along the course of PT tendon in tarsal tunnel. MRI confirms partial tear. Here's the tough part? She's a profession actress doing a one-woman show....on her feet several hours once or twice 6 days weekly and contracted for another year. I have her in a BK pneumatic walker when off stage, but how to treat her onstage? I'm hoping she can switch to shoe gear that will accept an AFO, but that's not a given. Her present costume shoe is a dress shoe with 2" heel. Right now she's just using a compression dressing because she feels it helps. I have her taking ultrasound since some studies do indicate it may speed healing. Yes, I know she needs to adjust her stage attire to protect the tendon (She's aware the partial rupture can become complete), but what more can I do until she accepts the reality?

Larry Aronberg, DPM, Lake Worth, FL, lwp01@bellsouth.net

RE: Reception Room Educational Video (Marc Hudes, DPM)
From: Multiple Respondents

ACFAOM has exclusively sponsored a series of podiatry DVDs produced this year by Visual Education Concepts, LLC.

http://www.visualed.org/store/productdemo.asp?ProductID=50&RedirPage=/store/index.asp

The first DVD was unveiled at the Midwest meeting in Chicago and covers the field of podiatry, and at the APMA meeting we introduced one specifically on the diabetic foot, that Andrew Boulton. Gregg Young and Steve Krych consulted on. We have plans for one on heel pain, this fall and then wound care shortly thereafter.

Norman Wallis, PhD, Executive Director, American College of Foot & Ankle Orthopedics & Medicine

http://www.Animator2000.com is available in a CD and DVD format. It features 54 animated surgical procedures which can be run simultaneously or individually. Individual animations are also available to be added onto your website for patient education. They are also available for a PDA.

Linda Koepsel, Seabrook, TX

There is a simple and inexpensive way to produce a very nice reception room "promo" of your skills and practice. I use a PowerPoint slide show. I have my voice included and use some very "cool" transitions. I often change the message as needed. I use a touch screen computer and the patient touches the "boxes" on the screen. I often incorporate video clips, etc.......

Patients love it. The cost is just a little time. And I become the "star"

Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@doctorbret.com

RE: Foot Solutions (Lloyd Smith, DPM)
From:Patrick J. Nunan, DPM

I would disagree with Lloyd Smith, DPM in regards to Foot Solutions, at least in my area. The employees that my patients have dealt with are all CPeds who work closely with the podiatrists in the area. The stores in the Cincinnati area provide OTC insoles such as Lynco Orthotics and do provide custom-made orthotics, usually the flexible kind, from AmFit. The patients who get the AmFit devices are people who are sent in by orthopaedic surgeons or customers who come in off the street and make it clear they will not go to a doctor, but want to try their own treatment first.

The largest running store in this area also provides AmFit and other OTC insoles. I have found that these stores are often a source of referrals if you have a good relationship with the owner and employees. With the internet and availability of many OTC devices (night splints, arch straps, stretching devices) more and more people are self diagnosing and treating. In my area, very few orthopaedic surgeons, including some that have podiatrists in their groups, will refer to patients to us for orthotics. They will still send patients to pedorthotists, physical therapists, or shoe stores before they send to us.

The orthopaedic surgeons do not usually take the time to visit the various stores and establish a relationship with the employees and owner. What I have found is that the patients that go to this store are sent to my office when something they provide doesn't work or they have severe problems that Foot Solutions gives them a list that should be referred out. We will not get those referrals from the free standing pedorthotists.

Patrick J. Nunan, DPM, West Chester, OH, PJNDPMRUN@aol.com

RE: Anodyne Therapy National Coverage Decision (Ken Malkin, DPM)
From: Barry Mullen, DPM

Dr. Malkin makes an excellent fiscal argument why our profession may not want to fight to maintain the ability to provide and be compensated for a service that is remunerated so poorly. This is the case when Anodyne therapy is solely utilized. Dr. Udell relates his Anodyne therapy success in patients suffering from diabetic peripheral neuropathy complications. He further states that therapeutically, since his patients have benefited, that's reason alone to fight for this service provision for it to remain in our podiatric treatment armamentarium. I agree 100%. One issue has nothing to do with the other. As physicians, our sworn medical oath mandates we keep our patient's best interests at heart with respect to the medical decisions we make. Medicare's pending decision to try and eliminate Anodyne therapy clearly doesn't hold their subscriber's best medical interests at heart and is solely based on fiscal rationale. Here's why.

We, too, like Dr. Udell, have enjoyed tremendous Anodyne therapy success treating various complications associated with diabetic peripheral neuropathy. Our greatest successes occur when this therapy has been combined with both gait and balance training (97116) and range of motion exercises of the lower extremity (97110). Patients literally need to be educated and retrained how to walk. The overall average length of combined therapy is 45 minutes. Patient outcomes, with respect to restoration of plantar sensorium through Anodyne's peripheral blood flow enhancement, and gait stability restoration through PT, are consistently improved. This therapy is FDA approved and enjoys efficacy for other conditions as well. The PT modality component is well compensated, hence CMS' fiscal rationale for its proposed elimination. The effect is to try and reduce service utilization through forced outsourcing but at the patient's medical expense.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

Editor's note: Dr. Mullen's full note appears at: http://www.podiatrym.com/letters2.cfm?id=10533&start=1

SEEKING ASSOCIATE POSITION - NEW YORK

Hardworking, ethical and well trained PSR-24 trained podiatrist seeking a part-time associate position in Westchester county or surrounding areas. Please contact (206) 919-2832 or bbrick2@yahoo.com

EQUIPMENT FOR SALE - PODIATRIC CHAIR

Midmark 416 podiatry exam chair. Lincoln Park Chicago, IL. Great chair. I moved office and no longer need it. Must sell. Blue color (will e-mail photo on request). 773-871-3338

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE POSITION - NEW JERSEY

Seeking associate for practice in Ocean County area. Seeking a hardworking, ethical, energetic and well trained (PSR 24/36) individual. MUST be willing to do all aspects of podiatry! Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

ASSOCIATE POSITION - GULFCOAST OF FLORIDA

Great opportunity in rapidly growing practice for a PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548-bed hospital system, new hospital is being built and multiple surgical centers. Candidate should perform rearfoot & ankle surgery, including Charcot reconstruction. Candidate needs to be ethical and motivated and must have a current Florida license. Established practitioner or new practitioner OK. Salary + percentage + benefits including insurance and 401K. Fax CV to (239) 566-8778.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

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