The Voice of Podiatrists

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August 31, 2007 #3,028 Editor-Barry Block, DPM, JD

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Compromised Patients Should Avoid Pedicures: TN Podiatrist

Gnarly, neglected feet are gross. So are the oozing sores and scarred legs that could result when bacteria set up shop on pedicure tools or in those wonderful whirlpool footbaths. In response to outbreaks of bacterial infections, states — and spas — are scrambling to tackle the pedi- problem. California's been particularly hard-hit and, last September, Gov. Arnold Schwarzenegger signed a law tightening cleaning requirements and increasing punishments for violators.

Dr. Robert Spalding

That's the only way to make sure tools are entirely sterile, says Tennessee podiatrist Robert Spalding, author of "Death by Pedicure."

If you go in with unhealthy feet, you're more likely to leave with unhealthy feet. Heel cracks, mosquito bites and cuts between the toes from athlete's foot can serve as portals for infection, says Spalding. Those with diabetes, compromised immunity, severe circulatory problems and who are undergoing chemotherapy should not get pedicures at all, he adds. And wait one to two days after shaving your legs to get your toes done.

Source Marge Ely, Washington Post [8/28/07]

IN Podiatrist/County Clerk Rumored to Run For Coronor

Rumors abound that Clerk Tom Philpot, who has served two terms and is ineligible for another, will run for county coroner, an office he held for two terms until six years ago. Unable to succeed himself because of term limits, he ran for clerk and won and has hit his limit in that office. Now he has got to cast around for another place in the county trough in which to land.

Dr. Tom Philpot

Not that he needs to. He is more qualified than most officeholders to make more money outside the government than inside. He is a podiatrist and a lawyer, either of which could bring him a lot more than the $50,000 he makes now.

Early speculation had Philpot running for the 2nd District county commissioner spot, which will be an open contest as Commissioner Fran DuPey has announced she will not seek re-election.

Source: Mark Kiesling, NWI.com [8/27/07]

Number of Uninsured up 4.9% in ’06

The number of people in the U.S. without health insurance coverage increased to 47 million in 2006, or 15.8% of the population, up from 44.8 million, or 15.3%, in 2005, according to the U.S. Census Bureau. It’s the second consecutive year the number of uninsured rose, said David Johnson, chief of the bureau’s housing and household economic statistics division.

The percentage and number of children under 18 years old without health insurance also increased. In 2006, 8.7 million children, or 11.7% of the population, were uninsured, according to the agency. In 2005, 8 million children, roughly 10.9% of the population, went uncovered.

Additionally, individuals covered by both employer-based insurance and government health programs slightly decreased in 2006, according to the Census Bureau’s annual Income, Poverty and Health Insurance Coverage in the United States report.

Source: Matthew DoBias, Modern Healthcare [8/28/07]

Query: Predislocation Syndrome

I’d appreciate any comments from those having experience with predislocation syndrome. I have a patient with a large asymptomatic bunion who has second MPJ pain. Taping, shoe modification, RICE have been unsuccessful. He refuses second arthrodesis/plantar plate surgical treatment and first met osteotomy. What type and amount of steroid could be a last resort prior to forcing surgery?

Michele Parker, Hillside, NJ

RE: High Cost of Malpractice (Comments of Jack Gorman, DPM)
From: Richard Benjamin, DPM

I had to laugh at the comments by Dr. Gorman with respect to rising malpractice costs in PA. As a well known plaintiff's expert, he is one of the reasons for the rising cost in malpractice for podiatrists. His willingness to travel anywhere and say anything to support frivolous claims is proof enough that plaintiff's experts need to answer for their actions when the defense wins or a claim is thrown out.

Richard Benjamin, DPM, Washington, DC, RSBenjamin@aol.com

RE: Weeping Lesion on Leg (Elliot Udell, DPM)
From: Barry Mullen, DPM, Philip Jay Organ, DPM

Without knowing what dermatologic condition existed at the site pre-trauma, based on the limited history offered and current clinical appearance, differential diagnosis includes (in descending order) but is not limited to: Basal cell CA (most common LE skin cancer and often forms post trauma), amelonotic melanoma, squamous cell CA, disorders w/cutaneous granulomatous component (i.e., TB, tertiary syphillis, leprosy, sarcoidosis), pyoderma gangrenosum, and ulcerated nodular melanoma, ulcerated granuloma.

At any rate, a lesion that is present for a year and weeps is not a good sign despite regular margins. Immediate biopsy is essential. A one-year history is an ominous sign for this patient because of the potential significant vertical penetration over this timeframe.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Perhaps a biopsy is the best choice for diagnosing unusual ulcers and other skin lesions. Biopsy choices include a shave-biopsy, punch biopsy and excisional biopsy. In this case, I think one or several punches near the border of the lesion will work well. The technique involves infiltration of local from the periphery in a volume and area sufficient for the number of punches to be taken. It may be best to take two or three tissue plugs selected from different locations within the lesion.

Avoid prepping with a jet type device because it leaves confusing-appearing vacuoles in the tissue. Skin prep uses your choice and the dressing need be nothing more than a hydrogel and a topical of your choice - usually the same materials used for the usual care of the lesion.

Naturally, patient selection should be based on allergy to medications and
vascularity. Amazingly, these punches heal back to the pre-punch appearance in a few days and I've seen no complications.

Philip Jay Organ, DPM, Naples, FL, philorgan@comcast.net

RE: Arthro Surface Implant (Terence S. Pedersen, DPM)
From: Ira Weiner, DPM

I have used the Arthrosurface implant on a few occasions and have found it to be a decent choice for first MPJ arthritis. It is, however, rather complicated to insert and time-consuming. It does require an additional person to keep track of the measurements when choosing the appropriate implant. Frankly, I'm not sure that I would use it again, but in all fairness it does work well for its intended purpose.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

Editor’s Note: This topic is now closed.

INDEPENDENT CONTRACTOR WANTED - KANSAS CITY, MO

Immediate opening for podiatrist as independent contractor. Flexible schedule. All phases of podiatry. Knowledgeable and dedicated support staff. Must be compassionate and personable physician with good podiatric skills. Wonderful place to live and work. Please email CV and letter of interest to: Dr.Fine@FineFootCareCenter.com

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