The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 24, 2007 #3,022 Editor-Barry Block, DPM, JD

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Wearing Flip-Flops No Better Than Walking on a Rubber Band: NY Podiatrist

“Flip-flops have singlehandedly caused more problems with people's feet in the last couple years than probably any other type of shoe," said Dr. Rock Positano, a podiatrist at New York's Hospital for Special Surgery.

Dr. Rock Positano

In addition to aggravating old problems, people with flat feet or high arches can also do long-term, serious damage by wearing flip-flops. "These foot types normally will predispose a person to developing problems with their tendons with joint stability," Positano said. "And long term there is always the possibility of developing chronic tendinitis or overuse injuries not only in the ankle but also the knee, the hip and the back."

Positano said that in moderation, flip-flops are fine. The problems arise when people wear them for long periods and long distances at a time. He also warned that it's not safe to wear flip-flops while driving, as they are not anchored to the feet and can get lodged under the gas pedal or brake. "Basically this is no better than walking on a rubber band," Positano quipped.

Source: WABC-TV (NY) [8/22/07]

DMU Starts Limb Preservation Clinic

Podiatrists at Des Moines University have started a "limb-preservation clinic," which focuses on awareness and early intervention. Too many people have diabetes without knowing it, said Dr. John Bennett, an assistant professor of podiatric medicine at the university. Bennett said he's seen patients come in with foot sores that are infected down to the bone because their nerves were so damaged that they felt no pain. But they had no idea they were suffering from diabetes.

Dr. John Bennett

Once a sore is identified, patients must help heal it, Bennett said. That means keeping their blood sugar under control and keeping weight off the injured foot for weeks or months. Too often, he said, patients fail to change their diets. Many also resume walking before they should. "If it doesn't hurt, they think it's not a problem."

Dr. Robert Yoho, dean of the university's podiatry school, said he has seen major improvements during his 22 years in practice. "It used to be, 'Oh, you've got a couple of gangrenous toes, you need a below-the-knee amputation,' " he said. Now, doctors would first try taking the toes and saving the rest of the foot.

Source: Tony Leys, Des Moines Register, [8/22/07]

13 Year Old FL Ballerina Champion Would Like to be a Foot Doctor

She looks the picture perfect of a beautiful ballerina: big saucers of blue eyes, long blond hair, tapered neck, correct posture. True, she’s only 13. But, in addition to the classic ballet look, Sela Dougherty of Indialantic also has the right moves. Enough to impress judges this summer at the prestigious American Ballet Competition in Miami, where Sela ranked highest among 13-year-old girls in the division of students ages 13 to 15.

Sela Dougherty

When Sela’s not dancing, the eighth grader spends time with friends and playing the piano. She’s studying at the International Baccalaureate program at Cocoa Beach Jr./Sr. High and already has laid out tentative plans for the future. "I’d love to be a professional ballerina," she said, "but if that doesn’t happen, I’d like to become a foot doctor."

Source: Shawna S. Kelsch, Florida Today [8/22/07]

Query: ESWT As “Investigational”

Over the last year, or so, many of the insurance carriers that had previously paid for ESWT as a covered service have reclassified it as "investigational" and have made it a non-covered service, because of lack of "medical necessity." Some of the few carriers that still pay for this treatment now have reimbursements less than the doctor's costs to use the equipment. I am interested in the experiences and feelings of my fellow podiatrists. On a anecdotal level, I had "pretty good" results when I was doing more of this treatment.

Arden Smith, DPM, Great Neck, NY

RE: Stirrup Foot Pain (Doug Mason, DPM, Freeport, IL)
From: Multiple Respondents

I used to work for a riding stable, and even if the stirrup is wide enough for the foot, when a horse moves or you turn while riding your foot shifts to balance yourself in the saddle. Also, it seems obvious, but is the patient wearing pointed-toe boots of leather? That type of she used in the heat with your feet in the dependent position all day can cause blisters in various places. Two more considerations: mounting and dismounting cause the position to change, or kicking the horse (not the same as kicking anything else) forces the heel in and the lateral border against the stirrup for leverage. Stirrups are wood or leather, but neoprene covers are available.

Jordanna Baker, DPM Tampa, FL coastaljlb@yahoo.com

Think "intermetatarsal (Morton's) neuralgia/neuroma." The foot pressure in the stirrup can be similar to walking with an emphasis on the lateral metatarsals. The motion of the horse and stirrup can irritate the intermetatarsal nerve just like walking. Treat accordingly.

Joel Lang, DPM, Cheverly, MD, langfinancial@verizon.net

If the problem is at the fifth met head, it’s probably the fit of the riding boots. The ball measurement of the boot is too narrow at the fifth metatarsal. He has to get wider boots, or boots with more of an outflare (abducted) last. If the problem is at the base of the fifth, it’s most likely that the shank area of the riding boots is too narrow.

Robert S. Schwartz, C. Ped., New York, N. Y., rss@eneslow.com

Editor’s Note: An excellent note by Ray McClanahan, DPM, BS Ed appears at:
http://www.podiatrym.com/letters2.cfm?id=15354&start=1

RE: Wired Network Vs. Wireless Tablet PCs (Mark K. Johnson DPM)
From: Multiple Respondents

Wired network is the way to go! Wireless still has issues to work out and there really is no advantage. Get a server OR add terminal services to a Winxp Pro machine so you can have multiple log-ins. Either way the best equipment to get are Wyse Winterminals. They are inexpensive thin clients that allow you to RDP into a terminal server. This way you only have to maintain and update the server! I use them in my remote office and they just login to the server over the internet. Check out www.thinsoftinc.com if you want to add thin clients to an XP machine.

Paul Baumgarten, DPM, Utica, NY, doc4feet@hotmail.com

Dr. Johnson, you wire what is important (front office billing computers) and go wireless with encryption on what is not. In a professional office setting, you wire all your computer' to a server. Most offices have removable ceiling panels and cat 5e, which is cheap to run and terminate, and the speed you need for things like printers, etc. will be there and you won't go "sluggish" with a wired vs. wireless service. Have a back-up system in place. With USB hard drives so cheap these days, this is a good option. Business routers are superior to "big box" versions of D-Link and Linksys, but the amount of computers will dictate that need.

Wireless has its place in a medical office like having your patients fill out paper work and having them sign HIPAA forms, etc. You can do your EMR notes wireless also, but again I would rather be "plugged in." It is aggravating to have your wireless drop a signal when you are in the middle of a note, etc. Some commercial buildings also have limitation due to RF and EMI interference. Concrete does not help either.

Just as a note: if using the new "N" version routers they really do work, Some models you need to download the "new" firmware even if new or any "g" items on the network will degrade the whole network to "g" and not "N" and you will lose distance and speed.

Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

There are security issues associated with a wireless network. The packets of data being sent through the air from the client to the access point are not encrypted and in plain text. Any person with a “sniffer program”, such as snort, is able to intercept these packets and see the data that they contain. Additionally, the wireless access point needs to be secured to prevent unauthorized access to you network.

The access point can be secured by a process known as MAC filtering (i.e., the only wireless NIC cards that can connect to the access point are known by the access point and identified by their MAC address). Additionally, stopping the access point from broadcasting its SSID (security set identifier) keeps others with wireless NIC cards from knowing there is an available access point in the vicinity.

As for the encryption portion of the equation, (i.e. encrypting the packets of data as they flow through the air) this can be done in a variety of ways. Using a public key infrastructure (PKI) or IP Sec (Internet protocol security) are 2 common methods used to encrypt data packets as well a created a secure tunnel from client to access point through which pass the encrypted packets of data. I believe that 128 bit encryption is sufficient to keep the Feds happy, but I do not know this for sure.

Network professionals can easily secure the access point and set up encryption protocols for you. Doing this does slow the networks some as there is a fair amount of overhead and bandwidth used to do these things but it is usually negligible and not apparent to the end user. Encryption and decryption of packets is done at the processor level so older slower machines may need to be replaced. Unsecured access points and packets of data that are not encrypted as they fly through the air are clear violations of HIPAA. Beware.

Mark J. Tuccio, DPM, Jamestown, NY, drtuccio@stny.rr.com

Each system has its own advantage and drawback. A wireless network is very easy and inexpensive to set up and should be able to reach all rooms in your office (a shielded x-ray room may not be able to get a signal). All that is needed is a wireless router, high speed modem (to connect to the internet) and a tablet PC, laptop or Ultra Mobile Portable Computer that you can take with you into each room. The problem with wireless is that certain rooms may not be able to get a signal and if you do not properly configure the router people can piggyback onto your network and possibly enter your medical files.

A wired network is inherently more secure and can bypass any shielding that would interfere with a wireless network but you can spend a lot of money getting each room wired. You could plug in your laptop, tablet or other device each time you enter room otherwise you would need to keep a computer in each treatment room which could be damaged or accessed by a waiting patient.

Both networks should have a computer directly connected to the router and modem so as to allow configuration. You do not need a powerful system for this so do not spend a lot of money. In fact, a computer from 5 years ago will do nicely. You can also use this computer as a place to back-up your electronic files, making sure to properly encrypt them.

If your office is built in such a way that wireless will not get into the treatment rooms and you do not want to spend to have your office wired, there is a third option. It is possible to run a network through the electrical wires in your office. You can then put nodes into each room which you can hook into a wireless router or access point in each room. This will allow you to access the network with a portable device.

Steven N. Solomon, DPM, JD, Brooklyn, NY, legalfoot@yahoo.com

CRYOPROBE SALE: PRICE REDUCTION!

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $10,500 or best offer. This lists for $14,900.00 new. The CryoPac system comes complete with two fully sterilizable Probes. This system has been used less than 15 times and can be used to treat plantar fascitis, neuromas, and other foot pathology. Please email inquires or your offer to: drsammendicino@gtef.org

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE POSITION – CENTRAL VIRGINIA

Two office practice, fully automated, strong referral base, hospital and surgery center privileges. Full scope of foot and ankle care. ABPS –certified/eligible. Competitive salary/percentage structure and benefits. Email letter of intent and curriculum vitae to jdisabato@virginiafootandankle.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

IN-NETWORK ASSOCIATE POSITION – BROOKLYN, NY

Seeking In-Network podiatric physician in downtown Brooklyn, NY. Part-time and or full-time with flexible hours and all aspects of podiatry, including surgery in a modern office setting with EMR, Sonography, and Digital X rays. Please email resume, including list of participating plans to jr11231@yahoo.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

MANHATTAN, NY GENERAL PRACTICE FOR SALE

Great Midtown East location near Grand Central Station. 614-918-3000 or email sell_my_practice@yahoo.com"

SIERRA VISTA, ARIZONA PRACTICE FOR SALE

Doctor retiring and willing to stay for long transition to assure the new doctor does very well. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

PORTLAND, OREGON 2-PRACTICE LOCATION FOR SALE

Doctor retiring soon and leaving country. This opportunity is 70 miles east of Portland with little to no competition! Check out gorge.net for the area. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

Staff Privileges at Certified Surgical Facility Available- NY & LI

Certified operating rooms which qualify under the new NY Patient Protection Law (which will require accreditation for in-office procedures) are available in Manhattan East 60th Street and Plainview, LI. Staff privileges still available. Space for rent, turn-key operation no investment available.Call 516 433-4447 for information or e-mail podo2345@aol.com

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