The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 29, 2011 #4,245 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Proper Shoe Sizing

A big issue that many people have is wearing the right size shoes. "The problem with foot sizing is that the foot is three-dimensional but most of the devices we use to measure, like the ruler or Brannock device, are two-dimensional," says podiatrist Dr. Robert Conenello.  

"The take-home message is that you have to try on the shoe as a starting point," says Conenello.

Source: Sheely Ng, WPIX-TV [8/25/11]

"Meet the Masters Audio Show" Celebrates its 100th Program

This week Podiatric Success' Internet series "Meet the Masters" broadcast its 100th show. This series, launched in August 2009, created and hosted by the award-winning speaker, Dr. Bret Ribotsky, features conversations with luminaries of the podiatric community. 

Dr. Bret Ribotsky

"Meet the Masters" profiles today's dynamic podiatric medical and surgical professionals, and provides an in-depth analysis of each master, sharing his or her successes and experiences. Meet the Masters is broadcast live on Tuesday nights at 9 PM (EDT). All 100 shows can be downloaded at www.podiatricsuccess.com

NC Podiatrist Is Avid Horticulturist

Dr. Bob Hatcher is a foot doctor with an avocation in horticulture. "He has a library full of garden books, and he studies them or the Bible when he reads," his wife Linda said. The Hatchers' Red Door Farm on Carpenter Pond Road has become a destination for members of the international ministry of the First Baptist Church in Durham, where on one Thanksgiving, they shared Southern hospitality and a traditional holiday feast with about 150 Chinese and Russian visitors. 

Dr. Bob Hatcher and his Garden

With his affinity for nature and wildlife, Hatcher chooses ornamental plants accordingly. He has mixed a huge variety of fountain grasses into sprawling borders. The varied shapes and colors mingle in a rich palette of greens, yellows, and blues.

Source: Carol Stein, News Observer [8/27/11]

Query: Brachymetatarsia

My patient is a 21 year old female with typical presentation of brachymetatarsia of the left foot, 4th metatarsal. Her 4th metatarsal is 2 cm shorter than the right side. She has an unremarkable medical/surgical/medication history. She walks for exercise, but has not been active the past year due to the left foot becoming more uncomfortable. 

Brachymetatarsia

The cases I've done for brachymetatarsia have been younger patients and I've used an external fixator. In this case, I think the patient might be better served with an osteotomy and allogenic bone graft, but I'm concerned about getting enough distraction after the osteotomy to insert and fixate a 2cm bone graft. Any tips or pearls would be appreciated.
 
Eric Edelman, DPM, Syracuse, NY

RE:  Chronic Bruising of Foot  (Dawn Foster, DPM)
From: Howard Dananberg, DPM

This history of this problem is chronic bruising following “a simple ankle sprain” with moderate to severe pain increasing with immobilization and treatment. A diagnosis of CRPS was made and treatment was instituted. From Dr. Foster’s comments, pain never resolved, although the intense level decreased. This is the type of extreme problem which responds to ankle and cuboid manipulation. The results, at times, are immediate and pain finally resolves. The reasons are as follows:

Following ankle sprain, arthrogenic inhibition of the peroneus longus can occur. This is a neurologic state in which the peroneals become so “weakened” as to not support the medial side of the foot.  It would not be unusual to see 1st MTP joint pain result. It relates to the fibula losing its ability to translate superiorly. Limited ankle joint dorsiflexion with the knee extended is the hallmark. 

In addition, nociceptors begin to function antidromically, in which signals are no longer from distal to proximal (periphery to core) but rather from proximal to distal. Neuropeptides are secreted from the distal free nerve endings, which causes hypersensitivity to these same nerves. Also, neuropeptides (substance P, calcitonin gene-related peptide, etc.) are known to cause vasoactivity. This can be dilatory or constrictive and can be phasic. These same chemicals are implicated in conditions like CRPS or even migraine headache. It may be responsible for the visible bruising.

Manipulation of the ankle and cuboid can often result in immediate resolution.The results of a study on ankle manipulation appear in JAPMA, Sept 2000. I have posted manipulation tutorials which can be seen by searching "Dananberg, Manipulation" on Youtube.   

Howard Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

RE: Autoclaves (Elliot Udell, DPM)
From: Lowell Scott Weil, Sr., DPM

MidMark 11 is great - we have several. We also have several of the earlier models that have held up for years. Check the used medical equipment market on the Internet for great buys, and with the history of Midmark, it's a good value.

Lowell Scott Weil, Sr., DPM, Des Plains, IL, weil4feet@aol.com

RE: CROW Walkers (Jay Kerner, DPM)        
From: Susan Bartos
 
Earthwalk Orthotics has partnered with TruLife for its braces and AFOs. TruLife is a global manufacturer of orthopedic and physical rehabilitation products. All of their podiatric braces are fabricated in the facility formally known as Seattle Systems. We have received very positive feedback from our DPMs who have ordered CROW walkers through Earthwalk, via TruLife. A knee-high, STS, fiberglass, casting sock is simple to apply, and works very well for casting for a CROW walker.
 
Susan Bartos, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com

RE: Dragon Medical Practice Edition Version 11 Coming in September (Larry Kasova, DPM)
From: Robert Kuvent, DPM

I have been a Dragon user for at least 12-14 years. I currently use Medical v 10. I have used medical and nonmedical versions. I do not think the Medical version is worth the outrageous differential. It still needs to be taught podiatry terminology as well as drug names and medical conditions, just like the regular version. Also, the error rate is no different. Save your money.
 
Robert Kuvent, DPM, Chandler, AZ, FtFixr@gmail.com

RE: E/M Codes and CPT 11750
From: Paul Somers, DPM

Our policy is to make a diagnosis and schedule the patient for a surgical procedure within the next few weeks. In our opinion, a permanent nail procedure, CPT 11750, is a surgical procedure that has complications, although few. In fairness to a patient, the procedure requires a large bandage to the great toe; therefore, a shoe that they came in with may not allow for room. There is some shoe disability with a CPT 11750, and  the patient should be made aware of this and come prepared. With patients who have been in your practice and have been  previously treated for incurvated nails, it is a matter of judgment and the patient's needs.
 
It is my opinion that it is NOT contrary to the "standard of care" to perform a CPT 11750 on an initial visit, just not good practice management.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

RE: Effects of Laser Treatment for Nails Only Temporary: DC Podiatrist (Hartley Miltchin, DPM)
From: Elliot Udell, DPM
 
Dr. Miltchin states, "The laser of choice to effectively treat onychomycosis of the nails is an ND:Yag 1064 wavelength."
 
We live in the era of evidence-based medicine. Are there any studies showing that this particular device is more effective than other lasers that are being studied and marketed to podiatrists?  Two other lasers have been studied, and the findings have been published. Have there been any studies supporting the laser ND: Yag 1064?
 
In general, anecdotal evidence acquired from treating patients in our offices is useful and often publishable. The problem with using in-office anecdotal findings to support the use of a laser device is that readers may pay over 80 thousands dollars for the machine. Patients will then be required to fork over thousands for the treatment. Because we are dealing with such high costs to doctors and patients, it would seem logical that studies supporting efficacy should be made prior to doctors making such costly investments.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

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

Although I agree with Dr. Jacobs and everyone else in that matter, there is one point I want to get across. Why is that when things like this happen, everyone automatically calls upon the APMA to do something? Is it because the two thousand dollar membership fee per year obligates the APMA? After six years of practicing podiatry, I have learned that the APMA will not really do much.

As a matter of fact, none of the medical organizations, including the AMA, will do much for their constituents. So, if you feel that something needs to be done and you need to be heard, then do it yourself. We are all tired of being cut out of everything and getting less money every day; yet everytime this happens, we only want the APMA to do something. This is why we lose.

Mak Yousefour, DPM, Los Angeles, CA, makdpm@yahoo.com

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

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 - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - MANHATTAN

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

ASSOCIATE POSITION – ANNAPOLIS, MARYLAND

Incredible opportunity for the right person to integrate long-term into a well established practice. Must be personable, highly motivated and bright individual with outstanding surgical and non-surgical ability. Excellent salary and benefits. Email CV and salary requirements to Marylandfootcare@live.com

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 toseattlefootdoctor@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 

SPACE AVAILABLE- NYC & LI

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