The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 04, 2007 #3,031 Editor-Barry Block, DPM, JD

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Congratulations to Neil Schleffler, DPM of Baltimore, MD, our weekly survey contest winner, who has won a copy of Bones and Cartliage by Brian K Hall (Value$104) .

Oral-B Professional Care 9100

This week's prize is an Oral-B Professional Care 9100 Triumph by Braun (Value $89). To enter the contest, complete the survey at www.podiatrym.com and send us question #45, along with your name and address. Be sure to vote in the survey for the 2008 inductees in the PM Podiatry Hall of Fame. All entries are eligible for the grand prize of a one-week Windjammer Caribbean Cruise.

Podiatrists are Best Trained Foot Specialists: TX DPM

On a car, the only parts on the road are the tires. On the human body, the only parts usually on the ground are the feet. But while even the best radial tire wears out over time, feet need the best care to last a lifetime."Foot care is important, as is the care of any highly functioning part of the body," said J. Marshall Devall, D.P.M., assistant professor of surgery with the Texas A&M Health Science Center College of Medicine and a podiatrist at Scott and White.

Dr. J. Marshall Devall

"Difficulties with the feet - or poor care and/or lack of attention once a problem occurs - often cause severe pain, disability, and loss of job and quality of life," Dr. Devall said. "Most people do not show their feet, so they tend to lack the care and attention that their hands and fingers receive, for example. People usually place far too much emphasis on their footgear when it comes to maintenance of the feet rather than the foot itself."

"Podiatrists these days are being trained the best and most thoroughly of any medical practitioner with regard to foot problems and concerns," Dr. Devall said. "Podiatrists are specialists, but we don't treat foot problems without respect for the rest of the body. We work with the primary or referring physician to manage problems through biomechanical, medical, and surgical treatment."

Source: Sealy News, [8/31/07]

IL Podiatrist Retires After 42 Year Career

Macomb, IL has lost one of its most accomplished and prolific medical care providers the city has ever been privileged to have with the retirement of podiatrist Max Rexroat, D.P.M. It’s a 42-year-old career that began inconspicuously with a leg injury on Rushville High School’s football field nearly a half-century ago. “I was interested in medicine but I wasn’t sure what field I wanted to go into,” Rexroat said. “I was playing football and I tore a knee up and had something wrong with my foot. I later found out that the reason I tore my knee up was because of my foot and that got me interested in podiatry.” That day shaped the future of the podiatry field in Illinois.

Dr. Max Rexroat

Rexroat earned his doctorate of podiatric medicine from the Illinois College of Podiatric Medicine in 1966 and joined McDonough District Hospital only a year later. He was the first podiatrist on the staff and was trained to do outpatient surgery using local anesthesia. “Initially, the physicians didn’t understand how I could do all the orthopedic surgery under local anesthesia,” Rexroat said. “I had to explain it to them. Now, of course, we do most of our procedures under local anesthesia with sedation,” he added.

Source: Nathan Woodside, Eagle Publications [8/31/07]

MO Podiatrist is Accused of Overbilling Medicare for Toenail Trimming

A Missouri podiatrist and her employer have been indicted on a healthcare fraud charge and 29 counts of making false statements for allegedly overbilling Medicare for trimming patients' toenails on dozens of occasions. Denise Hardy, 43, and the South St. Louis Orthopedic Group Inc. were indicted Thursday, according to documents made public Friday.

The indictment says Hardy lied on medical forms by claiming that the patients whose nails she trimmed had nail fungus, when she knew that most didn't. Medicare does not pay for routine toenail trimming or care. It does, however, if it helps the patient walk without pain or under certain conditions if there is a problem with the nail, such as fungus.

After receiving a letter from Medicare, she changed the diagnosis that she used in her billings from nail fungus to peripheral vascular disease. She claimed that walking caused some of her patients’ pain, even when those patients were paralyzed, the indictment says, and never told staff that the patients had circulatory problems. The indictment also says that Hardy billed Medicare for services that she didn't provide, claiming she had trimmed the toenails of 96 patients on one day in February 2001 and 85 on one day in January.

Source: Robert Patrick, St. Louis Post-Dispatch, [09/01/2007]

Query: Conflict of Interest for Experts

What is the current status of "professors" at the colleges acting as expert witnesses? I thought I read something about a prohibition recently put into place that it was a conflict of interest i.e., to train podiatrists and then testify against them or was this only with APMA office holders?

Ivar Roth, DPM, Newport Beach, CA

Editor’s comment: PM News does not provide legal advice. Each college has its own policy regarding the appropriateness of its faculty testifying against podiatrists. The recent conflict of interest ban you read about was a New York State Podiatric Medical Association (NYSPMA) Resolution banning its board of trustee members from testifying against another NYSPMA member. Although APMA has no formal policy prohibiting such testimony, it would be political suicide for any APMA BOT member to do so.

We believe that it would be in the best interest of the profession for all podiatric colleges, as well as every APMA state component to adopt a similar policy.

RE: Uncontrolled Gout (Randy Lisch, DPM)
From: Kazu Suzuki, DPM, Paul T. Slowik, DPM

Is this really gout? or pseudo-gout? or something else? You should be able to make the definitive diagnosis from the crystal analysis of joint aspirate or even surgically excised tophi, if you are intervening surgically. If it is gout, allopurinol is still the drug of choice. As allopurinol is a competitive inhibitor of xanthane oxidase, you will need to titrate up the dose as needed, until you can lower the serum uric acid level down to 5mg/dl to "unsaturate" the joint fluid that is super-saturated with uric acid and crystals. I often see patients who are under-treated with inadequate dose of allopurinol. Intra-articular cortisone injection would reduce the inflammation, but it won't treat the under-lying cause (hyperurecemia).

I would stay away from any OTC or herbal products, unless it has good clinical evidence (of safety and efficacy) to justify your recommendations. The patient should not drink alcohol, especially binge drinking tends to bring out gout attacks. Also, in severe cases (such as this one), the patient should avoid purine-rich foods (meats and seafood etc).

If the patient was "given up" by two rheumatologists, I suggest you look for third or fourth opinions from competent rheumatologists, until the patient is satisfied. More information and the listings of rheumatologists can be found under the ACR (American College of Rheumatology) websites. I just checked the website & there are 12 rheumatologists listed in Austin Tx. Good luck...

Kazu Suzuki, DPM, Los Angeles CA, kazu88@gmail.com

I had 2 similar patients with two different presentations: 1: The first patient was an uncontrolled diabetic who would have multiple attacks in different parts of her anatomy, mostly podagra, 1st MTPJ. Prednisone either orally or interlesional injections were contraindicated for obvious reasons. She was on 600 mg. of allopurinol. I consulted her IM doc who suggested we go above the usual max dose of allopurinol. We titrated her up 100 mg. at a time checking her renal and liver function weekly and eventually had her up to 900mg a day. This worked, she's had no attacks nor untoward effects for the last 3 years. I told her her we were going above the PDR's max dose which she consented to.

Next was an elderly patient on dialysis who had multiple tophi which were asymptomatic except for one at her hallux IPJ. She had a small non-infected draining ulcer for several months. I tried everything as far as wound care but nothing worked. Chronic gouty tophi ulcers and chronic ostoemyelitis are very hard if not impossible to distinguish even in the light of bone scan, MRI's and cultures. I decided to give her 0.2 ml. of Decadron intralesionally and within 2 weeks it healed. I understand these are only two patients, but I thought I would share what worked for me.

Paul T. Slowik, DPM, Oceanside, CA, foothold@msn.com

RE: Requirements for a Podiatrist to Serve as a Coroner (Scott Hughes, DPM)
From: Mark E. Pfeifer, DPM

First of all you have to understand the difference between the *Coroner's* office and the *Medical Examiner's* office.

A Medical Examiner is an M.D., usually with a background in forensic medicine/pathology. They serve in larger metropolitan areas and have the ability to perform autopsies and have laboratory facilities available for their use. A Coroner can be a lay person and have absolutely no medical experience at all. Both function to pronounce a person dead and they need to perform that duty prior to the body being moved from the scene. The body is then transported either to a morgue for further work up or directly to a mortician for prep and burial. Both sign an official death certificate required by the State for burial, if it is deemed that the person succumbed to natural causes.

If foul play is suspected, the body is transported to a Medical Examiner's office for further investigation which can sometimes be many miles/hours away from your local setting. (Note: a chain of custody must be maintained if a criminal event is suspected, such as homicide/suicide.)

A Coroner is an elected office in your local government setting and is usually a part time salaried position. A Medical Examiner is a hired, full-time salaried position and is not elected.

I was involved with the coroner's office and sheriff's department in my local community for many years and the coroner before my time "in office" was the local barber. Before him it was an EMT. So to answer Dr. Hughes question directly, there are no minimum requirements to be a Coroner and it is not out of our scope of practice. After all, they are not patients and they are *deceased. It is expected though that one performs his duties as a Coroner in a professional manner and treats all parties involved with respect and dignity.

Mark E. Pfeifer, DPM, Eagle River, WI, mpfeifer@tds.net

RE: High Cost of Malpractice (Allen Jacobs, DPM)
From: Barry Mullen, DPM

Editor’s note: This extended length letter appears at: http://www.podiatrym.com/letters2.cfm?id=15501&start=1

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

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

CRYOPROBE SALE: ADDITIONAL PRICE REDUCTION!*

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $9750.00 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

SATELLITE PODIATRY OFFICE FOR RENT - TUCSON, ARIZONA

Modern x-ray with automatic processor. Professional atmosphere. office is shared space in a chiropractic office with separate front desk. Excellent start-up opportunity for a new doctor Front desk staff, copy machine, fax are also available. Contact Dr. Parks at 520-544-2445 or parksovc@aol.com

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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