The Voice of Podiatrists

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August 28, 2008 #3,335 Editor-Barry Block, DPM, JD

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MD Podiatrist Provides Advice on Buying Children’s Shoes

While fashion for a nearly four year old is high on the list..it’s not the most important thing a parent needs to consider when shopping for shoes. Dr. Vincent Martorana, a podiatrist at Franklin Square Hospital Center says a part of good structure and arch includes a rigid shank. "The shank is the area between the heel and forefoot and that shouldn't bend. You can see when I put a load on this, even on the sneaker, it stays rigid in there. A lesser quality shoe won't be as supportive in this area.

Dr. Vincent Martorana

"Another feature is a toe box that is steep enough, that doesn't rub the toes. And of course you want to make sure the shoe is long enough. No more than a half thumb nail's length because shoes that are too big can cause other problems. "You want to make sure you check the fit while the child is standing; in addition you want to make sure it has enough width."

Source: Kelly Swoope, WMAR-TV ABC 2 Baltimore (MD) [8/26/08]

OCPM Alumni Association Welcomes 260 at BBQ

The 2nd Annual Ohio College of Podiatric Medicine (OCPM) Alumni Association Open House and BBQ, co-chaired by Dr. Brian Weiss, Class of 1983 and Dr. Kelly Whaley, Class of 1997, was a huge success! This year OCPM welcomed over 250 guests! Guests enjoyed a great buffet of BBQ ribs, BBQ chicken, brisket, corn on the cob, baked beans, and bread pudding catered by Famous Dave's BBQ.

Drs. David Hintz, Paul Lieberman, and Mr. James Smalley (photo courtesy of Joan Lannoch, OCPM)

In addition, alumni and students enjoyed a variety of outdoor games, including corn hole, croquet, and badminton. Once the sun started to set, many OCPM alumni, students and BBQ guests took the opportunity to karaoke. Stellar performances of the event included Dr. Michael Canales, OCPM Class of 2004, with a rendition of an Eminem song, as well as great performance of "Friends in Low Places" by several OCPM students. All alumni, students, and guests who were in attendance had a great time as they enjoyed the beautiful weather, great food, and fantastic company.

Source: Footsteps (OCPM) [August 2008]

Clinton Keeps Focus On Healthcare

In a speech on the second evening of the 2008 Democratic National Convention, Clinton mentioned healthcare four times and said she “can’t wait to watch Barack Obama sign a healthcare plan into law that covers every single American.”

Se. Hillary Clinton

Receiving thunderous applause and standing ovations from her supporters, Clinton listed the reasons why she—not Obama—ran for president, which included her goal of creating a “healthcare system that is universal, high quality and affordable so that parents no longer have to choose between care for themselves or their children or be stuck in dead-end jobs simply to keep their insurance.” Later, she criticized Sen. John McCain (R-AZ), the Republican presidential hopeful, saying he “doesn’t think that 47 million people without health insurance is a crisis.”

Clinton, who introduced a sweeping healthcare reform plan that eventually failed during her husband’s administration in 1994, will speak at a healthcare forum sponsored by Families USA today at the Denver Center for the Performing Arts.

Source: Jessica Zigmond, Modern Healthcare [8/27/08]

Draw Introverts, Extroverts Together

Introverts and extroverts live at polar opposites. Introverts wonder why extroverts won't shut up and leave them alone, while extroverts wonder why their introverted colleagues seem so standoffish. Yet although their aproaches vary radically, both types can be valuable teammates.

Best bet: Remind others of your own style, and resolve to respect different work styles too. If you are an extrovert, remind others that your enthusiastically voiced ideas may not be your final thoughts on the matter. If you are an introvert, explain to others that you sometimes need time to reflect.

Source: Adapted from: Chatterboxes and Cave Dwellers by Naomi Karten

Query: Use of Space in Local Gym

Our group recently acquired a small space within a fitness facility. Does anybody have an arrangement like this with any health facilities, and if so, what are you utilizing the space for? The room is a 10'x12' square where we have the ability to provide any service or distribute any product we would like and also interact with members on the gym floor at anytime. Along with that, we have access to marketing to the 9,000+ members of this gym and can set up large events, such as health fairs, on a monthly basis. Any and all ideas would be appreciated.

Chad Schwarz, Affiliated Foot & Ankle Center, Howell, NJ

RE: Standard of Care Soft Tissue Masses (Bryan C. Markinson, DPM)
From: Kenneth Meisler, DPM, Martin Wendelken, DPM

We have read both Dr. Markinson's and Dr. Jacobs’ opinions about how to treat soft tissue masses. In our office, all soft tissue masses are evaluated with ultrasound. If you are experienced at ultrasound, it can help determine which lesions are suspicious and which are not.

A classic ganglion is anechoic, appears completely black on ultrasound. If it is also well-demarcated we feel comfortable making a diagnosis of ganglion and treating it as we all have for many years, with aspiration and/or injection of steroid and possible excision. There are lesions that have a heterogenous pattern (comprised of mixed tissue). Lesions such as these should not be aspirated, injected or excised without an MRI being done and then depending on the MRI results, appropriate excision can be done by someone who is capably trained.

In the past year, we have found two lesions which appeared clinically to be ganglions. Prior to treatment ultrasounds were suspicious in appearance and both were fibrosarcomas. Because of our ultrasound prior to treatment we did not risk spreading the lesions by injecting them.

In our opinion, the podiatric standard of care will become that all podiatrists should evaluate soft tissue masses with ultrasound prior to injection or aspiration. In fact, many insurance companies ask for an ultrasound prior to approving an MRI.

Kenneth Meisler, DPM, Martin Wendelken, DPM, NY, NY, kenmeisler@aol.com

RE: Standard of Care Soft Tissue Masses (Bryan C. Markinson, DPM)
From: Bryan C. Markinson, DPM

I fully respect all the concerns about costs, and the rarity of malignant tumors of the foot. First of all, the words “standard of care” were used in the original question posted. I should have never repeated it because my comments were not about avoiding malpractice allegations at all. I already addressed the issues of ganglions, plantar fibromas, and neuromas and agree with Dr. Jacobs.

Nevertheless, in a ten-year period 1995-2005 here at Mount Sinai, our orthopedic oncologist had data-banked 2500 cases of soft tissue malignancy, of which 2.5% were foot and ankle. That’s about 60 cases or six per year; one every two months. Rare or not, many originated in the offices of our colleagues. It was exasperating to understand what it meant for a patient who would have needed a simple ray resection that ended up needing a below-knee amputation simply because the tumor was removed and no identifiable margins could be determined. Some cases involved children.

With all due respect to my friend Dr. Jacobs, this horror, rare as it is, should be no easier to swallow in his community-based, real-life practice than it is in my halls of academia. Nor should it take a letter from a plaintiff’s lawyer to reflect on it. This is not an issue of an under-corrected intermetatarsal angle. Be that as it may,

I’ll let my reputation and history of teaching and helping colleagues, and seeing 900 new patients per year, every year for the past five years stand alone as to whether or not I am being collegial or unduly critical on this issue, or whether or not I am in “daily practice” like the rest of us.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: NAOMI DR (Susan Ott)
From: Pete Harvey, DPM

Thanks to Ms. Ott for responding to my NAOMI question. My further investigation indicates the product is withdrawing from the US market and that 20/20 may assume some tech support for now.

Pete Harvey, DPM, WIchita Falls TX, pmh@wffeet.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION - WV/KY

Huntington WV Ashland KY area associate wanted with reasonable buy-in; great chance for growth; established patient base with all aspects of podiatry great for the established practitioner or new residency graduate. Any interest please respond to greatteayspodiatry@gmail.com

ASSOCIATE POSITION - NORTH TX

North Texas practice looking for motivated, hardworking, personable individual with minimum PSR/24 training. The practice has been well-established in the community for over 20 years. Our practice offers a large self owned office, State-of-the-Art Surgery Center, excellent hospital involvement, and competitive salary with profit sharing. Send CV with references to info@ntfootcare.com, or fax to 903 868-2975.

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.com

EQUIPMENT FOR SALE - DOPPLERS

Selling 2 brand new Dopplers by Hadeco. 1 Hadeco Smartdop-30EX and 1 Hadeco Smartdop-45 Dopplers. Both come with their default accessories included, have never been used and are fully functional. Please email alinka345@gmail.com all inquiries.

ASSOCIATE POSITION AVAILABLE- NEW YORK

Full-time associate position in our well-established Midtown Manhattan and Forest Hills practices. Well-rounded practice with hospital based surgery and all phases of podiatric care. We are seeking PSR 24/36 trained podiatrist with good surgical background. Compensation to also include malpractice expenses. Forward CV to slurie@papapc.net or Fax to # 212-753-3521

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.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 for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

Christie Clinic is a large Multi-Specialty Group practice located in Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or Board Eligible podiatrist to join a well-established Podiatry department. Must be competent in all phases of podiatric care, Surgical and Conservative. This position will involve rotating through multiple office locations with surgical privileges available at two medical centers and two outpatient surgery centers. Very competitive salary, bonus plan, vacation, and health/mp insurances. Forward CV to wpierce@chrisiteclinic.com

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