The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 18, 2011 #4,236 Publisher-Barry Block, DPM, JD

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Extended Wear of High Heels Can Cause Foot Damage: IN Podiatrist

High heels make you look great, improve your figure, and are the final touch to a fashionable look, but if high heels do wonders for your appearance, they don't do a lot for foot health. Dr. Michael Nirenberg, a podiatrist at Friendly Foot Care in Crown Point, says he doesn't discourage women from wearing high heels occasionally. "Once or twice a week is going to do minimal damage to your feet," he says. "If you wear heels over a long period of time, then you can do permanent damage to your feet and your body." 

Dr. Michael Nirenberg

"Constant wearing of high heels change the feet permanently," Dr. Nirenberg says. "They also change the way all your joints in your body are aligned. Heels, even the small ones, cause you to fall forward, and the body compensates by contorting the back and changing the positioning of the shoulders and neck, making you prone to herniated discs."

Source: Sharon Biggs Waller, nwitimes.com [8/16/11]

TUSPM Students Win Award

Dr. Kathya Zinszer, Luke Vetti (TUSPM class of 2012), and Ushita Patel (TUSPM class of 2012) with their poster entitled “A Novel Topical Therapy for Pyoderma Gangrenosum using Compounded Hydrolyzed Type I Bovine Collagen.” 

(L-R) Dr. Kathya Zinszer with TUSPM students Luke Vetti and TUSPM Students Win Award Dr. Kathya Zinszer, Luke Vetti (TUSPM class of 2012), and Ushita Patel

Their poster was presented at the American Professional Wound Care Association’s 2011 National Clinical Conference and won second place in the poster abstract competition.

Source: Strides

OH Podiatrist Joins Holzer Clinic

Holzer Clinic has announced the addition of podiatrist, Nathan A. Clark, DPM to their multi-specialty group practice of over 140 experienced professionals. Dr. Clark joins Holzer Clinic specializing in treatment of disorders that affect the foot and ankle. 

Dr. Nathan Clark

Dr. Clark received his undergraduate education from Brigham Young University in Provo, Utah and his Doctorate of Podiatric Medicine from Des Moines University, College of Health Sciences-Osteopathic/Podiatric Medical School in Iowa. Dr. Clark is board-eligible by the American Board of Podiatric Medicine.

Source: The Jackson Times-Journal [8/15/11]

Start Conversations

Initiate conversations with ease at networking events. Follow this simple two-part formula:

1. Make a statement based on where you are or what you observe. Example: “This exhibition hall is packed!”
2. Ask an open-ended question. Require more than a “Yes” or “No” answer, to lead the other person into a discussion. Example: “What are the most interesting booths that you have visited today?”

Follow up by listening attentively and asking further questions.  Remember: People love to talk about themselves.

Source: Adapted from “How to Give Good Small Talk, CLEO via Communication Briefings

Query: Plavix and NSAIDs

Has anyone had any experience prescribing NSAIDs with Plavix? I have a patient with a history of gout to whom I want to give an NSAID when I begin allopurinol. The PDR has it as a contraindication. The patient cannot afford Colcrys as a substitute.  

Brent Rubin, DPM, Bradenton, FL

Query: Digital X-Ray Company That Supports Podiatry

I am looking to purchase a digital x-ray system. I would like to buy it from a company that supports podiatry. Which digital x-ray companies do you recommend?

Cosimo Riccardi, DPM, Ft. Walton Beach, FL

RE: ESWT & NSAIDs (Paul Kesselman, DPM)
From: Paul Busman, DPM, RN

I never used ESWT while I was in practice, but at the hospital O.R. where I now work, we do ESWL (L=lithotripsy) for kidney and ureteral stones. The urologists have the patients withhold NSAIDs and other anti-coagulants for a period of time prior to the procedure, usually about one week. As far as I am aware, the patients are allowed to resume the NSAIDs immediately afterwards. 

Paul Busman, DPM, RN, Clifton Park, NY, paul@busmanwhistles.com

RE: Difficulties with EHR (Joe Borden, DPM)
From Gary S Smith DPM
 
We have been using Cerner for eight months now. We found the system way too time-consuming and less efficient. I use the drop-down menus for nail care but, for all other visits, I dictate and have it typed into the EHR system. This seems to work very well for me. It has greatly reduced stress associated with this and streamlined the whole system. I would give one piece of advice to those looking for an EHR system: Do not buy a system based on getting reimbursed from Medicare because that may not happen. Get a system that works well for YOU. You should never buy a system that does not integrate billing with your EHR. In other words, your EHR should have convenient, practice-specific, drop-down menus that will present you with a billing option complete with modifiers when you are done.

As for Cerner, we should have attested in April but are still waiting. We were supposed to try attesting again two weeks ago, but our contact guy has not returned my office manager's call in almost two weeks. We can't get his supervisor to return any calls and we even called the corporate headquarters, and no one answered the phone or returned our calls.
 
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: Doughnut Tourniquet (Scott Shields, DPM)
From: Carl Ganio, DPM, Jon Purdy, DPM
 
I am assuming that Dr. Shields desires to use this as a digital tourniquet, for the hallux. I have found that those flat 1" rubber tourniquets used for drawing blood in the phlebotomy lab are very useful. They are 18" long. We cut them into 6" pieces. You wrap it around the widest part of the hallux, at about the IPJ level. Then you push it back, and it rolls up, gets tight, exsanguinates and forms a nice tourniquet. They can be cleaned and autoclaved, or just thrown away if soiled, as they are very affordable.
 
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz

I would discourage the use of the doughnut tourniquet. I know of a case where it was not removed by the assistant trained to wrap the toe post-procedure and discovered it only after the patient had left.  With a numb toe, the patient may not realize it is on, resulting in the potential loss of a toe. I’ve never heard of anyone leaving on a hemostat.
 
Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Legality of Maximalist Running Shoes (Robert Bijak, DPM)
From: Brian Kiel, DPM

After looking at the Hoka shoes on their web-site, there is no way I could recommend or use that shoe. First of all, it is very similar to the MBT shoes. There is little to no flexibility, and anyone running on a regular basis will put a great deal of stress on the anterior of the ankle and lower leg, probably leading to shin splints; and with the lack of flexibility, strain on the plantar fascia. Secondly, it appears to be a straight-last shoe which is okay if you need a great deal of medial stability, but for any other type of foot, it is contraindicated. Just like the minimalist shoes, this one is probably eventually doomed to the extinct shoe hall of fame.
 
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Do You Really Need an Office Manager?
From: Jon Purdy, DPM

Yes, yes, and did I mention – YES! I could not disagree more with this posting. I will just give highlights on why I differ, since the role of an office manager has far too many complexities to mention here. An office manager or practice manager is a trusted employee who deals with day-to-day office security, employee management, human resource issues, billing oversight, and patient satisfaction - just for starters.

This applies even if you are a busy one-physician practice. The last thing you should be doing as a physician is talking to your patients about financial issues. You also do not want an upset patient dealing with an employee whose time and skill set is not dedicated to this task. An upset consumer needs...

Editor's note: Dr. Purdy's extended-length letter can be read here.

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