The Voice of Podiatrists

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August 30, 2007 #3,027 Editor-Barry Block, DPM, JD

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PAD Can Be Detected By Simple Foot Exam: MI Podiatrist

Medical specialists who gathered recently at the American Podiatric Medical Association's Annual Scientific Meeting in Philadelphia released the findings of a couple of studies that emphasize the need for proper foot care and exams. The feet can reveal the first signs and symptoms of systemic diseases such as diabetes and heart disease, and a new study suggests that peripheral arterial disease (PAD), which exhibits a decrease in blood flow to the legs and feet, can be detected by a simple, non-invasive foot and ankle exam.

Dr. Brian Homer

"The underlying cause of many amputations and foot complications is often due to the negative effects of peripheral arterial disease," said Dr. Brian Homer, one of the study's medical specialists who investigated the role of foot exams in testing for peripheral arterial disease.

"If more doctors could identify these risk factors and symptoms earlier, many complications and even amputations could be avoided," he said.

Source: Diana Washington Valdez, El Paso Times, [08/27/2007]

Matthew Werd Elected President Of AAPSM

At the American Academy of Podiatric Sports Medicine Annual Meeting held this past August in Philadelphia, PA, the AAPSM elected Matthew B. Werd, DPM, a sports medicine podiatrist in private practice in Lakeland, FL, as its President. Dr. Werd graduated Magna Cum Laude from the Scholl College of Podiatric Medicine. In addition to being a Fellow and President of the AAPSM, Dr. Werd is also a Fellow of the American College of Sports Medicine (ACSM) and the American College of Foot and Ankle Surgeons (ACFAS).

Dr. Mathew Werd

Elected along with Dr. Werd were: President-Elect- Bruce E. Williams, DPM, Merrillville, IN, Vice President– David M. Davidson, DPM, Amherst, NY, Secretary/ Treasurer Karen Langone, DPM, Southampton, NY and Director James Yakel, DPM, Longmont, CO. Timothy Dutra, DPM, Hayward, CA serves as Immediate Past President. Rita J. Yates, of Walkersville, MD serves as AAPSM Executive Director.

PA Podiatrists Get Some From High Malpractice Premiums

A leading Pennsylvania malpractice insurance carrier says it plans to lower its rates by an average of 11 percent next year. Podiatrist Jack Gorman, of the Bux-Mont Foot & Ankle Care Center in Warminster, said, “Everything helps, but we're really in a deep hole here.” For years, Pennsylvania doctors have been fighting for relief from the high cost of medical malpractice insurance.

Dr. Jack Gorman

Gorman said competition between the insurance companies is less likely to drive down premiums since the carriers often insure some specialties but not others. “If you can get that insurance, it'll help,” he said. “It's always nice to get some relief, but not everyone's getting it.” He said it is still simply too expensive for some doctors to afford insurance and, with a growing population of elderly adults, the problem is likely here to stay.“It's not as bad as it was, but it's certainly not a good situation,” said Gorman.

It is also one that could make it harder for some doctors to make sure their treatment decisions are based solely on what is best for the patient, he admitted. “Most (doctors) I talk to try to avoid doing surgery with a passion,” said Gorman, who added many prefer to have other doctors perform the procedures. “Sometimes, they over-order tests to make sure they cover everything.”

Source: John Anastasi, PhillyBurbs.com [8/27/07]

Query: Weeping Lesion on Leg

An 86 year old caucasian female presented to my office for the treatment of mycotic nails. While examining her, I noticed a weeping lesion on the dorsum of her left leg, below the knee. This began two years ago after trauma and has slowly grown over the past two years.

Weeping Lesion on Leg

Any ideas on what this might be? In my state this is out of scope, so I referred her to a dermatologist.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Arthro Surface Implant (Terence S. Pedersen, DPM)
From: multiple Respondents

I have used the arthrosurface implant for my first MPJ as well as 2nd MPJ pathologies. They have been awesome, the patients tolerate it really well and they are on their feet literally within days if you allow them. I had a non-compliant patient walk on it from Day three, my previous protocol was 1 wk NWB. A few tips I have learned for the best results (FIRST MPJ):

1) use the largest implant that will fit the joint surface, which means that you should choose the bigger of the two stems (screws) whenever you can.
2) decompress the joint by countersinking the screw in 1/4 to 1/2 turn prior to using the joint resurfacing blade.
3) Very early ROM from day 1, if you can. Overall, I love this implant for if they have to go for a fusion, there is enough bone mass for a good hallux fusion in the future.
4) Debride off excessive bone, osteophytes, etc with hand instruments
5) Final tap for good luck

Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

I have developed a personal treatment protocol for the surgical treatment of Grades 1-3 hallux limitus. After removing the marginal osteophytes, loose bone, and synovitis, I evaluate the articular cartilage of the first metatarsal head. The argument has always been, "Which side of the first MPJ should you treat"? I have never personally opened a 1st MPJ and seen more damage on the proximal phalangeal cartilage than the first metatarsal head cartilage. Due to the mechanics of the joint and compression of the proximal phalanx against the first metatarsal head, the damage is always greater on the proximal side of the joint. Therefore, I believe it makes most sense that any hemi implant placed into the 1st MPJ, should be positioned in the first metatarsal head.

My treatment protocol is based upon the size of the cartilage lesion in the 1st metatarsal head. 1-4 m.m. lesions are treated by curettage and sub-chondral drilling. 5-12 mm. lesions are treated with the Osteocure Synthetic Bone Plug. Any lesion greater than 12 mm.'s is treated with the Arthrosurface Hemi-Cap Implant. The Hemi-Cap has a definite learning curve and there are specific pearls to proper joint preparation and placement of the implant. The Hemi-Cap salvages the joint by resurfacing the cartilage and allows some decompression of the joint. My initial results on the first 23 patients are very encouraging. I am cautiously optimistic that this implant will permanently change the future of hallux limitus surgery.

Howard A. Stone, DPM, Glenview, IL, justus313@comcast.net

Let me share my experience. The patient presented with a good indication for the use of this endoprosthesis; .i.e., painful arthrosis of the 1st MTP w/ osteochondral defect of the metatarsal head. The case resulted in failure, with continued pain and limitation of motion. The 'good news' was that is was easily salvagable with removal of the device, and conversion to an arthrodesis.

The procedure has many steps with a large "fuss factor," and therefore I would not recommend it. The company's website is very succulent in its testimonials. I trust it works better in the shoulder than the foot.

Donald Jay Arenson, DPM, Elmhurst, IL, darenson@pol.net

RE: Delayed P & A (Jeffrey Kass, DPM)
From: Multiple Respondents

I am quite surprised to read the debate over whether or not to delay the application of phenol at the time of initial Tx for a garden variety paronychia/onychia. I honestly cannot remember a time when, for this condition I did not phenolize the bed at the same time the avulsion was done. Indeed, a raging abscess or a cellulitis would surely cause me to only avulse the nail and tx with abs...but this is uncommon. My recurrence rates are minimal. I tell patients "The phenol does three things that are in your best interests: 1) It kills the cells that make the offending nail border, 2) It kills the bacteria involved with the infection and 3) It kills the nerve endings, so that you will need little pain meds after the anesthesia wears off." Adjunctive po antibiotics are usually unnecessary. Rarely do I eat my words!

Gilbert D. Shapiro, DPM, Tucson, AZ, gds@happyfeet.tuccoxmail.com

I agree with Dr. Kesselman 100%. Assuming the nail requires permanent matrixectomy I ALWAYS will perform a simple avulsion and never remove as much nail as that when the matrix is destroyed. It never made sense to me to perform a curettement of a phalanx and an application of a caustic substance over a bony surface in the face of an infection. With that said, I have the patient return in a week to make certain the infection has resolved and then schedule the matrixectomy (within the next several weeks) at that time.

Barry A. Wertheimer, DPM, Torrance, CA, bwertheimer@cox.net

I previously used Cortisporin otic or ophthalmic solution post-operatively for phenol burns, but for over two years I have switched to Amerigel Wound Dressing (www.Amerigel.com) for chemical matrixectomies. This product is now packaged with saline, gauze and Band-aids. This eliminates the need for soaking and only requires a once-a-day application! I have found that post-op wounds heal significantly faster, and there is less redness, drainage, and discomfort. This also adds to your bottom line as an in-office dispensing product.

Hal Ornstein, DPM, Howell, NJ, hornstein@aappm.org

Editor’s Note: This topic is now closed.

IN-NETWORK PODIATRIST WANTED – MANHATTAN

Busy Manhattan Office (2 locations) needs IN-NETWORK PODIATRIST, Can start immediately-Do not reply unless you are in with all plans Plz respond to gelus07@yahoo.com

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

PRACTICE FOR SALE - THE BRONX, NY

Price reduced for quick sale. This practice is over 50 years old - many generations of family still see the doctor! Great location, diverse culture, great community. American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

ASSOCIATE POSITION CALIFORNIA- CENTRAL VALLEY

Extremely Fast Growing City, Multi-Physician Group Practice With Unlimited Potential. Busy, Multi-Office Practice Seeking Associate Leading To Partnership. Potential For High Six Figures. No Rest Homes. Please Fax Resume To 1-661-832-7145.

ASSOCIATE POSITION ARIZONA-PHOENIX

Looking to fill two positions for very busy well-established practice.
All levels of podiatric training may apply. Excellent salary, benefits
and incentive package offered. E-mail CV and professional references to jblades@azfootdoc.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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

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