The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 24, 2009 #3,630 Publisher-Barry Block, DPM, JD

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NY Podiatrist Offers Foot Care Tips to Returning College Students

In the next few weeks, many college students  will leave the comforts of home to live in a dorm with hundreds of their peers. Getting away from mom and dad may be great, but dorm-life also has its downfalls, including the foot fungus and wart-causing virus that can be picked up in communal bathrooms/showers. "Shared showers are one of the easier places to contract fungus and bacteria because the wet, steamy atmosphere is a great place for them to breed," explains Oliver Zong, D.P.M. popular New York City podiatrist and foot surgeon. He offers some tips for keeping feet fungus-free.

Dr. Oliver Zong

Never go barefoot! Always wear flip-flops when showering or walking around in a communal bathroom. "The easiest way to defend yourself against foot fungus and bacteria is to wear something on your feet, even in the shower," Dr. Zong says. "Athlete's foot and nail fungus are very commonly transmitted in shared showers. Even if the bathrooms are cleaned regularly, that doesn't help if the person who showered right before you had foot fungus or warts, both of which are contagious," he adds.

Source: Medical News Today [8/22/09]

NY-Based Podiatrist Teaches Women How to Walk in High Heels

Stiletto-loving Bostonians can learn to strut like supermodels with Boston Sports Club’s new Catwalk Confidence fitness class this fall. The 50-minute workout is the creation of New York-based podiatrist Dr. Emily Splichal, also known as Dr. Legs.

Dr. Emily Splichal (Photo by Patrick Whittemore)

Mastering a pumped strut is not just about rocking a pair of Blahniks, but survival. “You want to be able to carry yourself properly whether you are wearing heels or not,” said Splichal, 30, a former gymnast. Her Catwalk Confidence regime, also available on DVD, incorporates pilates, yoga, and one-leg balancing positions to strengthen and stretch core muscles.

Abdominal, knee and back strength are key for correct posture and comfort when walking in skyscraper pumps, she said. “When you strike on your heel (while walking) it is one to two times your body weight,” Splichal said. “When you are walking in high heels ... you lose ankle range of motion.”

Source: Tenley Woodman, Bostonherald.com

Woman Claimed Podiatrist Used Improper Fixation for Surgery (New York)

Facts: On Sept. 23, 2004, plaintiff Maria Grozav, 58, an office cleaning worker, underwent surgery on her right foot--a second hammertoe surgery, a second metatarsal osteotomy, and the removal of a neuroma at her second interspace-performed by defendant. Grozav had treated with and been operated on by defendant several times in the previous years. In June 2004, two years after her most recent visit, she had visited him complaining of severe pain that conservative therapy had not helped to alleviate. 

After the Sept. 23 surgery, defendant removed Grozav's sutures on Oct. 5, and by Nov. 9 she said she was feeling much better. But beginning in September 2005, by which point she had returned to work full-time, she visited him three times complaining of intensifying pain. Grozav sued defendant and alleged that he negligently failed to obtain her informed consent to the surgery, to secure the operative site with two forms of fixation devices, to properly advise her of when to return to work and to take x-rays of her foot at two, four and six weeks after surgery to monitor her post-operative condition.

According to Grozav, because defendant had used only an external fixator and no internal hardware to secure her operative site, her osteotomy had healed in an improper position. Her later treating podiatrist, Dr. Oviedo Falcone, testified that defendant would have determined and been able to correct this if he had taken x-rays at two, four and six weeks, which Falcone claimed was the standard of care. Grozav also said that defendant had prematurely allowed her to return to work, claiming that he had said she could return within 10 days of the surgery. Meanwhile, the court dismissed her lack of informed consent claim, predicated on her difficulty in understanding English, on the defense's motion at the end of the plaintiff's case.

Defendant argued that Grozav's healing position was proper and that the external fixation he had used was consistent with podiatric standards for a second metatarsal osteotomy. He disputed Grozav's claim that he had said she could go back to work 10 days after surgery. His presurgical progress notes indicated that he had told her she should remain non-weight-bearing for four to five weeks after surgery. Defendant also pointed out that he had taken post-operative x-rays at one week and five weeks after the surgery and argued that that timing was consistent with the standard of care. The defense said Grozav had not proven that x-rays at weeks two, four and six would have made any difference in her condition.

According to Grozav, her revision surgery had been required because of defendant's alleged departures. She said that although her revision surgery had alleviated her pain at first, she had continuing pain and swelling, had to stay off of her feet after walking distances and could not longer perform as much housework. She made no lost wage claim, since she returned to work soon after defendant's surgery and retired after her revision.

The defense disputed Grozav's claim that defendant's surgery had caused her continuing pain. From their reviews of Falcone's post-operative x-rays, defense experts Edwin Wolf and Thomas DeLauro found only one continuing disability in Grozav: The implant that Falcone had inserted between her metatarsal and toe during his surgery had dislocated and not been repaired. According to the defense experts, that dislocated implant was the source of Grozav's continuing pain, and its removal could mitigate her pain. Falcone, however, disputed whether there was clear evidence that the implant had dislocated.

Result: Verdict-Defendant

Plaintiff's Expert: Ovidio Falcone, DPM; Brooklyn, NY
Defendant's Experts: Edwin Wolf, DPM, NY, NY; Thomas DeLauro, DPM, NY, NY

Source: VerdictSearch New York Reporter Vol. 26, Issue 46.

Pelosi Says House Will Pass Bill with Public Option 

At a meeting with religious leaders in San Francisco, House Speaker Nancy Pelosi (D-CA) said the House will pass a healthcare reform bill that includes a public option plan. “There's no way I can pass a bill in the House of Representatives without a public option,” Pelosi said to applause. “I have to have 218 votes to pass the bill. I expect to have more than that.” Pelosi met with a dozen leaders from local churches, synagogues and mosques at St. James Episcopal Church in San Francisco, and many said they support a government-run plan to compete with private insurers.

Health insurance cooperatives are not a substitute for a public plan, Pelosi said, but if someone wanted to start a co-op in their state, she would not be opposed. “I think the best way to do this is through a public option,” Pelosi said. “If someone else has a better idea, let them put it on the table.”
 
Source: Rebecca Vesely, Modern Healthcare [8/21/09]

Query: Purchasing NaOH

Where does one purchase the NaOH preparation?

Shari Kaminsky, DPM, Florissant, MO

Query: Medicare Audits

I have recently received some phone calls from my patients who told me that they received a phone call from a company hired by Medicare to inquire about services performed. The person then proceeded to ask my patient about if I was their doctor, what services were performed...etc. I have not received info from Medicare about chart audits. Have you heard of anything like this?

Steven Lam, DPM, Albany, NY

Editor's comment: PM News does not provide legal advice. This is likely part of The Recovery Audit Contractor (RAC) program, which has been operating in New York, Massachusetts, Florida, South Carolina, and California, but is now expanding to all 50 states.
 
The goal of the recovery audit program is to identify improper payments made on claims of healthcare services provided to Medicare beneficiaries. Assuming that the patients called verified the services performed, there will likely be no consequences. If, however, patients deny (or do not remember) that you provided the billed services, you will likely receive a request for charts from your Medicare carrier.

RE: Protocol NaOH Matricectomy (Irwin S. Linker, DPM) 
From: Greg Caringi, DPM, Frank DiPalma, DPM,

I have reliably used 10% NaOH for both partial & total matrixectomies for 28 years of practice. I use a tourniquet. I curette both prior to and between applications of NaOH. I use two - 5 second applications for partials. I neutralize with dilute acetic acid (white vinegar). I used to use salt water soaks and either Cipro-HC or Cortosporin otic solution. Recently, I have switched to Amerigel for post-op wound care. The success rate is high and the complication rate is low.
 
I never use this technique when infected. I believe the low tissue pH from infection diminishes effect of NaOH, a strong base. I may slightly extend the application time or use three applications in some instances. A one-minute application time seems excessive and, in my experience, not necessary.  I believe the original research suggests doing the procedure without a tourniquet and applying the NaOH until the bleeding stops. I prefer to do it dry. The matrix tissue will usually turn grey, indicating that the cautery has taken.
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

I have been using 10% NaOH for matrixectomies for the past 25 years and have had great results. I got away from phenol because of the occasional severe reaction to this chemical and most importantly it's carcinogenic qualities.

I use three 10-second applications of 10% NaOH on a small tipped applicator. After the 30-second period, I neutralize the matrix with vinegar. For a total matrixectomy I use three 15-second applications of the NaOH with a total of six applicators. Copious lavage is used after each procedure and the wound is dressed with Amerigel Ointment and a plain gauze dressing if partial, and a piece of Telfa before the dressing if a total was preformed.

I have heard of various home care regimes, however, I have found success with a vinegar and water soak for 20 minutes followed by the application of a hydrogel (I have been using Excell gel lately). I usually see my patients in two weeks for a check-up, and find that they have done quite well. The total matrixectomies take a little longer to heal, as long as you are selective with your patients and respect their co-morbidities, you should be fine. I'd be happy to forward the forms that we use for the home care.

Frank DiPalma, DPM, Athens, GA, fivetoes1946@aol.com

RE: Timing of Charging for Orthotics
From: Lowell Scott Weil, Sr., DPM, Daniel Cheskin, DPM

We had a recent conference call and audit from Aetna that went very well and they gave us great marks on our documentation and coding. However, they had one concern regarding our policy to put a charge through for custom orthotic devices at the time that the patient was cast rather than when the devices are actually fitted and dispensed.

I would like to poll the readership to see how many doctors charge for orthotic devices at the time of casting, and how many place the charge through at the time of dispensing? 
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

Editor’s Note: You can respond to this survey by clicking here.

I believe you can charge a cash fee because the orthotic is a durable medical equipment device and patient contracts most likely have the wording “covered services are physician services.”  The fabrication of the orthotic device is not a physician service, but classified as a durable medical equipment device. Furthermore, if the lab cost is the same as the allowance cost for the durable equipment device, so what? Must a profit be made on marking up the cost of a device? Wouldn’t more patients be able to afford such devices and then benefit from such treatments? As a podiatric physician shouldn’t profits be made on the casting for the device and the subsequent office visits to treat podiatric problems?

Daniel Cheskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: Faxed Requests from Pharmacies to Refill Prescriptions (Richard A. Simmons, DPM)
From: David Cauthon, RPh

Most of the large pharmacy chains have "auto-refill" services for maintenance medications such as anti-hypertensives and anti-diabetes medications. These functions boost prescription numbers for the pharmacy and improve compliance for patients, but they are inappropriate for such medications as inhalers, creams, and eye-drops. It sounds like some pharmacies in your area have been trying to increase the number of prescriptions on auto-refill without thinking about the appropriateness of the particular medications.

If these are mostly from one or two pharmacies, I would contact the pharmacy managers at those stores and let them know how many of these you are getting and that it is inappropriate for these medications to be on auto-refill.  If it is several pharmacies from one chain, I would contact the pharmacy supervisor for that district and discuss it with him/her.

David Cauthon, RPh, AzPOD Class of ‘12,  david.cauthon@azwebmail.midwestern.edu

RE: We're a Medical Doctor (Alan Sherman, DPM)
From: Howard J. Bonenberger, DPM

While I am certain that Dr. Sherman is a podiatrist, I am just as certain that he is not a medical doctor. I know this from the degree initials that he placed after his name. I am not debating his level of expertise in treating matters of the lower extremity. It’s just that only those with an MD are, in fact, medical doctors. If an orthopod who specialized in the foot and ankle called himself a podiatrist, it is my guess that Dr. Sherman might be at the front of the line proclaiming that he is not, in fact, a podiatrist. 

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: A Clever Solution to the Dangers of High Heels
From: Michael M. Rosenblatt, DPM

Two young college students, while walking around NYU in agony from high heels, decided to do something about it. Although they love high heel shoes (HHS), they realized that wearing them all day was akin to torture. So, they developed and patent-pended "Citysoles." These are slip-on low-heel shoes that also come with a tote bag to accommodate the previous HHS. Citysoles (with the tote bag) fit easily in the purse or handbag.

Citisoles

My hat's off to these enterprising young women, who also started a major business. Podiatrists certainly appreciate anything that takes women away from murderous footgear. Citysole developers admit that their product is not designed to "replace" healthy footgear.  Many young women are loath to give up high heel shoes, but would gladly find an opportunity to remove and replace them when the time is propitious.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

WANTED – ASSOCIATE POSITION  – CHICAGO, IL

Hard working and Ethical Podiatric Surgeon looking for Associate/Partnership position in the Chicagoland area. Please contact A773K@aol.com  or cell phone (713) 992-6113. 

ASSOCIATE POSITION - DALLAS/FORT WORTH AREA

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

EQIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com for quick deal.

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITION - NEW JERSEY 
 
Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

PM News Classified Ads Reach over 11,500 DPM's and Students
 
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110

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