August 22, 2006 #2,669 Editor-Barry Block, DPM, JD

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Foot Pain Can Warn of Major Problem: Julien

Contrary to what many of us think, our feet shouldn't hurt. If they do, they're probably trying to tell us something. Perry Julien, a Georgia podiatrist who specializes in sports-related injuries, says foot pain can sometimes even warn us of a more major problem. For instance, prolonged toe pain can indicate a circulation problem, and significant ankle swelling can signal congestive heart problems, he says.

Bunions, hammertoes and arch problems can lead to arthritis, and favoring one foot more than the other causes stress on the joints that can lead to hip, knee and back problems. Basic foot care includes washing your feet and using lotions and ointments to soothe and moisturize. If you have been on them all day, give them a break and prop them up.

Source: The Detroit News [8/19/06]

Alleged Removal of Too Much Bone During Heel Surgery (Kentucky)

FACTS: Barbara Storms, then age 55, started treating in January of 2000 for heel pain by defendant podiatrist,. On 5-26-00, defendant performed a surgery to relieve the pain - it included removing a portion of her heel.

Following the surgery, Storms suffered a calcaneal fracture. A complex injury, she had many problems, advancing from a wheelchair to a cast. She continues to complain of pain. In this lawsuit, the only claimed damages were pain and suffering.

She sued defendant and alleged negligence during the surgery by him in removing too much bone - this it was argued, led to the fracture. She also pointed to errors in (1) not exhausting conservative care, and (2) failing to adequately follow-up post-operatively. Her expert was a podiatrist from Plantation, FL, David Windom.

Skrip defended the case that his care was proper and that during the surgery, he properly removed a heel spur. He blamed her poor result on a recognized complication, one made worse by plaintiff's own failure to keep the foot non-weight bearing.

Judge Lay's instructions asked if defendant violated the reasonably competent podiatry standard. The answer was no and Storms took nothing.

Result: Defense Verdict

Plaintiff’s Expert Witness: David Windom, DPM, Plantation, FL
Defendant’s Expert Witnesses: James Amis, Cincinnati, OH and Dr. Harold Schoenhaus, Philadelphia, PA.

Source: Kentucky Trial Court Review

Query: Alcohol Injections S/P Neuroma Surgery

I have a 66 y/o female patient who is two months post decompression of Morton's neuroma 3rd web space (done under direct visualization with loupes).She still has the same pain as pre-op. Does anyone have experience with alcohol injections for patients that have had prior surgery?

Scott Werter, DPM, Myrtle Beach, SC, swerter@coastalpodiatry.com

RE:Torn Posterior Tibial Tendon (Larry Aronberg, DPM)
From: Kenneth Meisler, DPM

I have had custom boots made at Vogel Bootery in N.Y.C. They can make them any height and be made out of a stiff leather, almost like an AFO. I have had executives with PT tendon tears who have been able to wear a suit over them and the remaining part of the boot/shoe that sticks out is very attractive and looks appropriate for a suit. They have laces all the way to the top and can be quite supportive, almost like a work boot. I am sure they can make something similar for a woman. The boots can be made to accommodate an Arizona- type AFO, however then they will be much less attractive. It is obviously not as good as a CAM walker or AFO but it might be enough especially if there is not that much standing, walking or running on stage.

Kenneth Meisler, DPM, NYC, NY, Kenmeisler@aol.com

RE: HMOitis vs. MCOitis (Ira M.Baum, DPM)
From: Todd Rotwein, DPM

Dr. Ira Baum, opines that insurance companies should negotiate fees with us. After appreciating the comic aspect of the idea, one must ask, why on earth would the CEOs of multibillion-dollar companies want to bargain with the CEOs of multi-thousand-dollar concerns?

Especially in light of the brilliant business model they have, wherein they hire virtual employees (or "doctors", as we like to call ourselves) to treat their customers, and then let us pay our own overhead. All they have to do is to sit back and periodically reduce reimbursements until the line of practitioners waiting to join their panels dissipates. So friends, if you are waiting for things to change, I need only to refer you to the history of labor relations in the United States.

Todd Rotwein, DPM, Hempstead, NY, drdpm@aol.com

Ed Note: This Topic is now closed

RE: Anodyne Therapy National Coverage Decision (Ken Malkin, DPM)
From: Michael Zapf, DPM

When the Anodyne machine first became available my associate and I rented a unit for 60 days. We tried it three times a week for two months on 30 patients using the protocol recommended by Anodyne. None of 20 people with total anesthesia were rewarded with any feeling whatsoever. We tried it on 10 patients with painful neuropathy. Eight of the 10 patients experienced no reduction in pain. Two of the 10 people with painful neuropathy reported some improvement, great enough that they tried to contact Anodyne to see about getting a home unit. Neither received a response from Anodyne and gave up trying. When I reported my dismal findings to Anodyne they wondered if we had a bum machine and replaced for 30 more days (90 days total). Most of the 30 patients signed up for another month of therapy and none received any greater help than they received during the first 60 days. We returned the unit and have not tried it since.

Michael Zapf, DPM, Agoura Hills, CA, footdr@ix.netcom.com

Ed Note: This Topic is now closed

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- 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 SEEKING

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

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