The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 29, 2007 #3,026 Editor-Barry Block, DPM, JD

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Back-to-School Shoes Need to be Supportive: WI Podiatrist

Backpack? Check. Loose-leaf paper? Check. Supportive shoes? Well, maybe not. As parents and children prepare to begin their back-to-school shopping, doctors recommend parents encourage their children to wear sensible shoes. Many teenagers wear flip-flops to school, said Dr. Thomas Staysniak, a podiatrist at the Bone and Joint Clinic in Wausau, WI.

Dr. Thomas Staysniak

Flip-flops offer little protection from nails and other sharp objects or even sunlight, Staysniak said. The lack of arch support can cause a painful inflammatory condition called plantar fasciitis, tendinitis of the Achilles tendon and forms of arthritis. And doctors are concerned that these foot problems -- which once tended to plague older people -- are showing up in younger patients. "They're fashionable," but they're just pieces of foam rubber with little support, Staysniak said. While they are OK for short trips to the garage or beach, they do not offer enough support to wear all the time.

Some people appear to be more prone to problems than others, Staysniak said. Sandals, dress shoes and sneakers that support the arch of the foot are better choices for everyday footwear. "I'm a big fan" of running and walking shoes, Staysniak said.

Source: Amy Olson, Wausau Daily Herald [8/27/07]

NYCPM Signs Externship Agreement with Israel’s Sheba Medical Center

The New York College of Podiatric Medicine has announced that it has signed an externship agreement with the Sheba Medical Center at Tel Hashomer, in Israel. Fourth-year students who are in the top third of their class at NYCPM are eligible to apply for the externship, which will run a minimum of sixty consecutive days.

Dr. Israel Goldstein

The externship agreement was negotiated and brought to fruition by Israel Goldstein, DPM, Adjunct Instructor of Primary Podiatric Medicine at NYCPM. The program is headed in Israel by Itzhak Siev-Ner, MD, head of the Department of Orthopedic Rehabilitation at the Sheba Medical Center at Tel Hashomer.

The Sheba Medical Center, situated on a 150-acre campus on the outskirts of Tel Aviv, is home to major research centers in regenerative medicine, neuroscience, cancer, heart disease and genetics. It handles more than one million patient visits a year, including 200,000 emergency visits, and conducts more than two million medical tests of all types each year, as well as at least twenty-five percent of all Israeli medical clinical research.

Medicaid Rx Must Be On Tamper-Resistant Pads

A new law requiring tamper-resistant pads for certain Medicaid prescriptions means that many physicians will have to change their prescription-writing habits, depending on how states implement the law.

The Centers for Medicare & Medicaid Services issued guidance Aug. 17 on how to meet the prescription pad provision. It was slipped into a military spending law Congress adopted in late May. The rules focus on written orders, not verbal, faxed, or electronically transmitted prescriptions.

CMS exempted from the law prescriptions paid for by Medicaid managed care organizations and those for patients in nursing homes and other institutions, which together constitute a large chunk of Medicaid prescriptions. Of the 53 million Medicaid recipients, nearly two-thirds are enrolled in managed care plans, CMS estimates.

Source: Doug Trapp, AMNews [9/3/07]

Query: Arthro Surface Implant

I’d appreciate any comments from those having experience with the Arthro Surface Hemi Cap 1st MTPJ implant.

Terence S. Pedersen DPM, Yankton, SD

Query: Billing Fabrication of PPT Insert

When the doctor makes a PPT insert for a shoe or surgical shoe (usually to off-load an ulcer), how is this billed?

Sue Rupp, PMAC, Mechanicsburg, PA

Response: I would recommend using code, CPT CASH...and directly charge the patient at the time of service. I do not know of an insurance that would pay separately for making an insert of PPT to for a shoe or post-op shoe

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: The Use Of Cyanoacrylate Glue For Nail Fungus Binder
From; David Secord, DPM

The August 28th issue of PM News featured a story about a California Podiatrist who Created a New Nail Fungus Treatment Based on Super Blue. I'm interested to know whether Dr. Nguyen has looked into the accumulation of cyanide in the nail bed and bloodstreams of the patients. I remember seeing documentation of this same thing in women who have their nails done on a consistent basis at salons, which also use a type of cyanoacrylate glue to attach the fake nails, with detectible levels of cyanide in their bloodstreams and high levels in the nail bed. I would think this is a major drawback on the use of such a binder on the nail.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

RE: Delayed P & A (Jeffrey Kass, DPM)
From: Carl Solomon, DPM, Paul Kesselman, DPM

The responses to Dr. Kass’ query focus on possible complications but none answer his specific question “…I was curious if the procedure would still work if performing the phenol and alcohol one week later…” Unfortunately, this is another example of something for which we have no controlled studies, so all I can do is to offer another anecdotal opinion.

My personal belief is that there is a point in time after a portion of nail is removed, when the bed and matrix will have produced some new nail tissue that will act as a barrier to the phenol’s ability to successfully ablate the bed and matrix. Certainly that happens a few weeks after a portion of the nail is excised, but is there a little barrier that presents itself after two weeks…one week…a few days? I don’t think anybody knows.

So whenever partial excision of a nail border with I & D is followed by a P & A within a relatively short period of time, my very anecdotal method is to aggressively curette the proximal nail grove prior to application of the phenol. I’ve often encountered a dense nail-like material even a couple weeks after the I & D. Direct extension chemical osteomyelitis or inoculation of the periosteum is something I’ve never encountered.

Carl Solomon, DPM, Dallas, TX, cdsol@baylorhealth.edu

I find that it is best to wait until the infection/inflammation from the initial procedure has well resolved. I also tell patients at the time of their initial procedure should they not wish to go through this procedure a third and fourth time they must have the follow-up matrixectomy well before the nail recurrs and the area becomes reinfected or re-inflammed.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Privileges at Certified Surgical Facility With MRI- 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. Rent or Lease Extremity MRI. Turn-key operation no investment needed. Call 516 433-4447 for information or e-mail podo2345@aol.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

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

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