The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 26, 2011 #4,243 Publisher-Barry Block, DPM, JD

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Shin Splints Prevalent During Fall Marathon Training Season: IN Podiatrist

Many popular marathons take place in the fall, making late summer “crunch time” for marathon training. John Rachoy, DPM, a board certified podiatrist at Medical Specialists Department of Podiatry, located in Northwest Indiana, says shin splints are the most common ailment below the knee to cause leg pain in runners. While all runners are at risk for developing shin splints, some runners are more susceptible to injury than others. For example, females are twice as likely to develop a shin splint injury, as are runners who run on uneven surfaces such as gravel or sand. 

Dr. John Rachoy

Intrinsic factors such as hormone levels, bone density, structural and biomechanical abnormalities, nutritional status and a previous running injury can also lead to shin splints. Dr. Rachoy says the old adage of “too much too soon” is often the cause of these injuries. “The highest incidence of injury occurs two to four weeks after the start of training,” says Dr. Rachoy.

NYCPM Posters at the 28th Annual Meeting of the American Association of Clinical Anatomists

Robin Lenz (Class of 2013), Garrett Moore (Class of 2014, and President-Elect of the Student Council), Anthony C. DiLandro, EdD, Adjunct Professor of Pre-Clinical Sciences, and Anthony V. D'Antoni, DC, PhD, Director of Anatomy at NYCPM, recently returned from the 28th Annual Meeting of the American Association of Clinical Anatomists (AACA), held in Columbus, Ohio. 

(L-R) Garrett Moore '14 With an Attendee

Robin Lenz was awarded runner-up for best oral platform presentation, and Garrett Moore's poster was very well received, with many scientists approaching him to ask questions. The same was true for Dr. DiLandro, who presented research on his novel method of foot dissection. All told, the NYCPM group made two oral platform presentations and had three poster presentations at the AACA Meeting.

Source: NYCPM Bulletin [Summer 2011]

OH Podiatrist Sees Growing Need for Mobile Health Care

Dr. Frank Washburn, a Cleveland podiatrist, makes Mobile Care calls in the Toledo area three days a week. He started out on his own as a mobile practitioner 15 years ago before joining Mobile Care full time about three years ago. While nursing home and assisted-living visits make up most of Dr. Washburn's work, which is especially crucial for diabetics who need their feet cared for routinely because of impaired blood flow, house calls are picking up. 

Dr. Frank Washburn (photo: Dave Zapotosky)

"They're getting bigger and bigger now," he said. "A lot of people just don't want to go into assisted-living facilities or nursing homes." Some podiatrists and other doctors in the area have been willing to make house calls, said Darren Horrigan, administrator of Nursing Resources, a home health agency in Maumee.

Source: Julie M. McKinnon, Toledo Blade [8/24/11]

Query: CROW Walkers

Is anyone casting for CROW Walkers (Charcot Restraint Orthotic Walker) as opposed to sending patients out? If you are used to casting for Richie Braces, is there much difficulty adapting the technique for CROW walkers? Also, please recommend a lab for these devices.
 
Jay Kerner, DPM, Rockville Centre, NY

RE: Chronic Bruising of Foot (Dawn Foster, DPM)
From: Gino Scartozzi, DPM

With the initial history of trauma, one should be suspect of hemarthrosis. Hemarthrosis may be caused by trauma; medications (chronic use of non-steroidal anti-inflammatory medications, warfarin, aspirin, etc); bleeding disorders (hemophilia); vitamin C deficiencies (scurvy) or certain infections (syphilis.)

Gout should still be suspect since borderline hyperuricemic patients may actually elicit a gout attack from trauma. There are many times that these patients have a high-normal uric acid level, and yet the sedimentation rate is abnormal with blood testing.

Her use of non-steroidal anti-inflammatory medications may be continuing to exacerbate her issue if the pathology is hemarthrosis. The use of steroids, if an infectious etiology exists, may create a worsening scenario for this patient. In the interim, I would use narcotic pain medications to manage her symptoms. I would be inclined to discontinue her current physical therapy regimen since it is worsening her symptoms, and have the therapist start passive forms of physical therapy that would not likely aggravate her symptoms. A joint aspiration of the joint should be performed. The joint fluid aspirated should be sent for culture and pathology. If the aspirate from the joint has a "rusty" or "reddish-brown" tint, hemarthrosis would be a likely cause with this patient's ongoing pain. The aspirate from the joint may also rule out an underlying gout issue.

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Digital X-Ray Company That Supports Podiatry (Dan Michaels, DPM, MS)
From: Alan L. Bass, DPM

I am in the process of combining my office and joining with an office that recently switched from a CR digital imaging system to a DR system from Ann Arbor Digital Devices (A2D2). Even though they had a perfectly good system from 20/20, when they looked at the savings and productivity gains from the A2D2 system, it was a no-brainer for them. The first thing that caught their eye was not having to handle and process cassettes in the DR system.  This reduced the amount of time to take 3 views from over 6 minutes to under 2 minutes. In a busy office like theirs, that 4+ minute savings for each and every X-Ray case really adds up to big labor savings.

Another deciding factor was that A2D2 does not charge any support or upgrade fees for the software; this alone saved the office over $1,200. The software is podiatry-specific, easy-to-learn, easy-to-use, and offers features that put it miles ahead of all the others. Finally, another reason was that this is a podiatry-friendly company and a big supporter of podiatry and the AAPPM.

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Internet Markerting (David L. Kahan, DPM)
From: Steven Lemberger, DPM

I have been using getpodiatrypatients.com. This service provides many advantages over a traditional website.  It sets you with Google reviews, Facebook, monthly emails, Youtube videos, and much more. It has driven patients to my practice over the last two months since I started to use the service.

Disclaimer: I previously consulted for the company.

Steven Lemberger, DPM, Freehold, NJ, footcaredoc@yahoo.com

RE: MD Logic (Joe Borden, DPM)
From: Raymond F. Posa, MBA
 
There is no one best choice; you need to just find the best choice for you. Try out the different interfaces and see which is most comfortable for you.
 
Raymond F. Posa, MBA, Farmingdale, NJ, rposa@themantagroup.com

RE: Doughnut Tourniquet (Andrew Cassidy, DPM)
From: Greg Caringi, DPM

Rather than waste materials, I bring back to the office the "used" latex-free Esmarch bandages from the O.R. My assistants cut the Esmarch bandages into small strips and place them in Cidex until we use them for our nail avulsions or matrixectomies. They are secured with a curved Kelly. This is never a problem. You get lots of small digital tourniquets from each roll. In our O.R., we place the Esmarch bandage over the sterile impervious stockinette for exsanguination.  It never comes in direct contact with the patient's skin.
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

RE: Effects of Laser Treatment for Nails Only Temporary: DC Podiatrist
From: Hartley Miltchin, DPM

I believe the risks of oral medication for onychomycosis far outweigh the benefits. I have prescribed oral antifungals to hundreds of patients but much like my colleagues, family physicians and dermatologists in my area, stopped prescribing these years ago.  Some lasers on the market making claims to treat fungal nails are mere 'toys', and I imagine they  may exhibit a limited, temporary cosmetic effect. The laser of choice to effectively treat onychomycosis of the nails is an ND:Yag 1064 wavelength. This type of laser is a very intense type of laser that has been utilized in the cosmetic industry for years and is very effective. When an ND:Yag laser is used properly, the effectiveness is extremely high, much greater than the oral antifungals success rates. 

Treating fungal nails with any form of treatment is not a cure. Re-infection can occur. My analogy is: if you get strep throat and take antibiotics, the infection will clear in 7-10 days but that doesn't guarantee you will never get strep throat again. I have a cosmetic clinic (since 2006) that uses 1064 ND:Yag lasers. I have used them on fungal nails with an extremely high, not temporary, success rate. My cosmetic clinic has been very pleased with the Cutera laser products, so when they introduced the Genesis Plus for podiatry applications, I purchased one immediately for my podiatry clinic. I highly recommend this particular 1064 laser to treat onychomycosis for long-term effectiveness.
 
Hartley Miltchin, DPM, Toronto, Canada, Doctortoe@aol.com

RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Allen Jacobs, DPM)
From: Donald Arenson, DPM

I fully agree with Dr. Allen Jacobs' interpretation of the CMS's recent ruling regarding compression therapy prescriptions and podiatrists. The winds of change are blowing and they are foul. The governmental changes forthcoming in terms of healthcare delivery, in my opinion, seriously threaten the profession of podiatry. This recent ruling by CMS is simply representative of a structured conspiracy, a ‘chipping away’ if you will, aimed at eliminating all “surplus” of healthcare providers.

Think about it….! Podiatry may be (is) viewed as redundant. After all, the orthopedic foot and ankle surgeons can care for the deformities. The nurse practitioners and PA’s can treat the medical problems of the foot and ankle. The wound care nurses, plastic & general surgeons can debride the ulcers and wounds. The infectious disease specialists can manage the infections. The pedorthists can fit and fabricate orthotic devices and prosthetics. The pedicurists can trim the toenails and calluses. Sadly, I have observed all of these scenarios increasing in my community.
 
Perhaps some of you may view me as ‘paranoid.’ May I remind you all that even paranoid people have enemies. A governmental/allopathic medicine Madame Therese Daefarge is weaving the profession of podiatry into her scarf as we speak. It may be ‘the best of times and the worst of times’ but, without question, it is the time for our profession to recognize that we may be marched to the guillotine very soon unless there is a concerted effort to stem the tide. Where are you APMA? 

Donald Arenson, DPM, Elk Grove Village, IL, darenson@pol.net

RE: Toning Shoe Injury Lawyers (Kevin Kirby, DPM)
From: Steven King, DPM, Evan F. Meltzer, DPM

It must have taken some real marketing geniuses to think these up.  On Toning Shoes: "We will sell you a shoe that 'is proven' to require more energy and is less stable." What would you do if a car salesman tried to use that pitch on you?
 
On Barefoot Shoes: "We will sell you a shoe that is not a shoe thereby you won't get injured from the shoe." How can a 12 ounce Vibram Five Finger be considered barefoot?  They should be called "Flat Soled Shoes" for people who want to ambulate flatfooted, not shoeless. In both cases, these "shoes" have sold hundreds of millions of dollars of product because the market is looking for something new and improved.

Steven King, DPM, CPed, Maui, HI

What profession do you think these lawyers are going to call upon as expert witnesses to testify in their cases?

Evan F. Meltzer, DPM, Jackson, MS

PRACTICE FOR SALE - BOSTON AREA

8 miles north of Boston with sublease available in a modern medical building. Presently working 3 days/week, grossing $300,00 annually with easy potential for full-time. All office and podiatric equipment, instruments, digital x ray, furniture, etc. are included. Turn-key operation. Please e mailfootdoc71@aol.com or call 781 279-2332.

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION – IOWA CITY AREA

Established podiatric clinic looking for an associate to join our team, 4 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to seattlefootdoctor@yahoo.com

ASSOCIATE NEEDED - SO. CAL

Position open for podiatry associate in Southern California. Applicant must be highly motivated and available for long term employment. This practice is extremely busy and requires a hard work ethic and desire to practice in a group practice environment. Excellent salary and benefit package offered. Please e-mail resume to footcare4all@aol.com

ASSOCIATE POSITION - NE GEORGIA

Immediate opening in established practice for PSR-36 or experienced doctor who is ABPS qualified or certified. Hosp./ASC privileges available. Excellent opportunity for partnership or purchase of practice. Contact dpm1942@hushmail.com

ASSOCIATE POSITION - HUDSON VALLEY REGION, NY

Unique opportunity for the right person! We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM. Please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Busy upper east side podiatry practice seeking In-Network Podiatrist. Please email CV toinstitutebeaute@aol.com "Attn: Podiatrist" in the subject line.

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

SPACE AVAILABLE- NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com.

EQUIPMENT FOR SALE – PRE-OWNED DIGITAL X-RAY SYSTEMS

Currently in use Reina-20/20 Extreme CR scanner (OEM iCRco) systems for sale. System includes CR scanner, 4 cassettes/imaging plates, and image acquisition software. Perfect for the low-medium volume practice or satellite office. E-mail Melanie Murdock for details and pricing.melanie.murdock@2020imaging.net

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PM News Classified Ads Reach over 12,500 DPM's and Students

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