August 23, 2006 #2,670 Editor-Barry Block, DPM, JD

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Proper Shoes important for Seniors, Especially Diabetics: OH Podiatrist

A national study by the Journal of the American Podiatric Medical Association suggests most senior citizens are not wearing the proper shoes, and area physicians say the problem affects the elderly in the Dayton, OH region as well. Thomas Retzios, a doctor of podiatry at Valley Foot and Ankle Center in Dayton, says foot injuries in the elderly are quite common. "As we age, several things happen -- there's a loss in the fat pad in the bottom of the foot and there are arthritic-type deformities than can occur," he said.

Those with diabetes are at particular risk. "They have the same problems that everyone else has, and in addition to those problems, they have loss in sensation," said Retzios. "Diabetes stops circulation, so if there is an injury, if there's a wound, it doesn't heal properly. That's what leads to infections, hospitalizations and in some cases amputations."

Frequent inspection is important for diabetes patients with circulation problems, he said. Patients with especially low sensation in the feet can suffer injury when objects fall into shoes and go undetected. Retzios also warns against improper assessment of shoe support. "It's a misconception that shoes have to be tight to give you good support," he said. "The support comes from the structure of the shoe." For the best overall support, Retzios suggests an athletic shoe. "All the components are incorporated in that type of shoe -- a good cushion midsole, a roomy toe box, a stiff heel counter and then a good arch support," he said.

Source: Ken-Yon Hardy and Lauren Dunford, Dayton Daily News [8/20/06]

OCPM Prepares for Move to Independence

The Ohio College of Podiatric Medicine will be moving its headquarters to Independence, Ohio next spring. As part of its commitment to continue serving the Cleveland area residents, the College is exploring several new clinical sites around the Cleveland area. These include: Huron Road Hospital, Euclid Avenue in Midtown, and, the near Westside around Lutheran Hospital.

Smart Care Via a Mouse, But What Will it Cost?

The electronic medical record seems an example of pure progress, a technology that yields only winners. So it has been cast as a geeky hero in healthcare policy circles. David Cutler, a health economist at Harvard, says that having more information could lead to more care and higher spending. HHS Secretary Mike Leavitt recently said the rollout of EHRs was "the most important thing happening in healthcare." Major technology corporations as well as a crowd of specialist companies are all chasing what they see as a fast-growing, multibillion-dollar opportunity. Yet even the technological optimists expect turmoil from the information revolution they see coming in healthcare.

The electronic medical record, for all its promise, is no silver bullet for the nation’s health system. Placing too much faith in technology, skeptics warn, could be counterproductive. Dr. David Himmelstein, a physician and associate professor at the Harvard Medical School, said: “It encourages the belief that we don’t need real reform, all we need is computers.”

Source: Steve Lohr, New York Times [8/20/06]

Query: Multi-office Software With Call Reminder

I am looking for an appointment program that will work with multiple offices and multiple doctors and also integrate with a phone reminder system to call patients before their scheduled appointment. I have a computer program For billing but it doesn't handle the above requirements. Any suggestions?

Jack Buchan, DPM, Westerville, OH, Jackb3@columbus.rr.com

RE: Alcohol Injections S/P Neuroma Surgery (Scott Werter, DPM)
From: Jeff Kass, DPM

I see no reason why Dr. Werter can't try the alcohol injections and I refer you to Dr. Dockery's article on the topic. At Dr. Dellon's workshop it was brought up that failed neuroma surgeries might be secondary to an underlying tarsal tunnel syndrome. It may not apply for your case, but it is something to think about.

Jeff Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: C/N Tarsal Coalition (Tip Sullivan, DPM)
From: Dennis Shavelson, DPM

Editor’s Note: Dr. Sullivan has provide this MRI of the condition.

C/N Tarsal Coalition

This athlete is a pure example of functional foot type (FFT)(TM) 3, a rigid rearfoot, flexible forefoot. This FFT is characterized by repetitive stress in stance or gait because the rearfoot is very stable and fixed and the forefoot is extremely hypermobile. Since the rearfoot is in fixed inversion (because of the C/N coalition), his forefoot symptoms are exaggerated, however it is likely that others in his family have a similar foot type.

You can cast, prescribe and fabricate a custom-made foot orthotic which compensates both the rearfoot and forefoot pillars to the three body planes, compensates the rearfoot pillar to the forefoot pillar, and compensates the right limb to the left. This orthotic would enable the peroneus longus, posterior tibial, anterior tibial and flexor hallucis longus to leverage and fire with more power and in phase, reducing forefoot hypermobility and enabling your patient to maintain his lifestyle with fewer biomechanical performance reductions.

Once you are diagnosing and treating patients functional foot type-specific, prevention and performance enhancement care via custom orthotics can be instituted before breakdown, symptoms and performance issues arise. In your patient's case, if he was diagnosed years ago and given his custom orthotics, his forefoot symptoms would not have developed to their current level and he would not need your current care.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab, drsha@footworldusa.com

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 - 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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