The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 04, 2009 #3,640 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Some Runners Should Avoid Motion-Control Shoes: CA Podiatrist

Dr. Amol Saxena, a podiatrist in the Sports Medicine Department of the Palo Alto Medical Foundation in California, cautions that if you have a family history of medial (inside) knee arthritis, or if you’re bow-legged, avoid motion-control shoes and devices, as they contribute to wearing out the medial knee joint.

Dr. Amol Saxena

Orthotics prescribed by a podiatrist after careful medical evaluation, however, can help many runners decrease pain and increase stability in unstable joints. “I also encourage people who don’t have foot problems to walk around the house, or even do some exercise, in bare feet,” says Saxena. “This provides a stronger platform so your muscles can absorb shock and support your joints better. In cultures where people go barefoot, in general, there is less osteoarthritis.”

Source: Mark Winitz, Running Times [October, 2009]

NJ Podiatrist Delivers Welcome Address at Ramapo College

John V. Guiliana, DPM, MS had the honor of delivering the Welcome Address to over 2,500 incoming freshman and their parents at Ramapo College in  New Jersey on Sunday, August 30th. The theme of his talk centered around the "transition" that parents and students will go through in this new journey, as well as the importance of staying "connected" to each other. 

(L-R) Ramapo College President Dr. Peter Mercer, Dr. and Mrs. John Guiliana

Dr. Guiliana serves on the President's Parents Council at Ramapo and has a scholarship fund for 4th year students who commit to furthering their education through graduate studies. He has influenced numerous students to pursue podiatric medicine as their career choice, including his son Stephen who is a first year student at OCPM. Dr. Guiliana is a Trustee of the American Academy of Podiatric Practice Management.

MO Podiatrist Sentenced and Fined for Medicare and Medicaid Fraud

A St. Louis podiatrist has been sentenced to three months imprisonment and seven months home confinement for submitting false bills to Medicare and Medicaid, Acting U.S. Attorney Michael Reap said Tuesday. Denise Hardy, 45, was also ordered to pay over $89,000 in restitution to Medicare and Medicaid.

Hardy, who was employed at South St. Louis Orthopedic Group Inc., created false statements on podiatric examination forms and other medical records for submission to Medicare and Missouri Medicaid for podiatric services that she provided from 2000 through 2005, prosecutors said. As part of the scheme, Hardy falsely stated in her treatment notes that 20 Lafayette Habilitation Center patients (who are unable to walk and confined to a wheelchair or geri-chair) cannot walk without pain and had pain when walking that restricted their activities, prosecutors said.

Source: St. Louis Business Journal [9/1/09]

Speak Positively to Improve Your Success Rate.

When you say: “I will do it” instead of “I will try,” you close your escape loop and commit to completing the task.

Source: Adapted from Thank God It’s Monday by Roxanne Emmerich, FT Press via Communication Briefings
 

Query: Subchondral Microcysts 
 
I recently performed a standard Austin bunionectomy on a healthy 31 year-old high school track coach. My standard fixation is crossed-tapered Orthosorb that I have used without complication for many years. I noted mild cystic degeneration in the medial prominence on her pre-op x-rays. No DJD. Intra-operatively, I noted benign-appearing cystic changes in the met head that did not compromise the bone integrity. The pathology report stated, "the exostosis also includes small subchondral microcysts."
 
The patient has experienced a very uneventful recovery. There is minimal pain and swelling. Her 6 week post-op x-rays were read as, "increasing osteopenia and concern for possible early osteomyelitis" by the radiologist. I disagree about the osteomyelitis, but recognize the development of mild diffuse (not just the met head) osteopenia. The patient has no symptoms or other issues.
 
The patient's medical history is unremarkable. No medications. My question involves possible causes for the subchondral microcysts and mild osteopenia in this patient. Are there underlying metabolic concerns that I should be addressing? A colleague suggested that subchondral microcysts might be a result of her athletic activity. Any thoughts will be appreciated.
 
Greg Caringi, DPM, Lansdale, PA
 

Query: Removable Walking Casts

"Modified" removable walking casts have become a standard of care in wound care. Many insurance companies, including Medicare, do not cover these walking casts for ulcer treatment. How are my colleagues dealing with patients who are in need of, but not covered for this needed service, and who refuse to pay [or can't] for anything not covered by their insurance?

Arden Smith, DPM, Great Neck, NY

RE: Non-Fixated Osteotomies (Arden Smith, DPM)
From: Multiple Respondents

It is my opinion that "non-fixated" osteotomies of the lesser metatarsals is an appropriate procedure under the correct circumstances.

We have had good success in relieving diabetic ulcers that were under a lesser metatarsal head with the minimally invasive procedure described in JAPMA 30 years ago by one of my residents and me. A percutaneous metatarsal osteotomy is used in this circumstance. Concerns about transfer lesions are present but it is much easier to accommodate a transfer than to heal an ulcer. We also use this procedure when there is a recurrence following a Weil osteotomy (5%). The procedure is certainly within the standard of care in these and similar circumstances.  

Lowell Scott Weil, Sr, DPM, Des Plaines, IL, WEIL4FEET@aol.com

Fixation is not required in carefully selected percutanous--minimal invasive metatarsal osteotomies. Non-fixation is within the standard of care and is documented by the Academy of Ambulatory Foot and Ankle Surgery, as well as the medical literature. This topic is sure to arouse many curious podiatric surgeons.

Stanton C.  Southward, DPM,  Colorado Springs, CO, sbsouthie@comcast.net

Dr. Smith raises a good question, one that I think about every time I perform "floating osteotomies." Based on my clinical experience and training, I find them to be very successful procedures ( I do them only on central mets). Who defines standard of care? I learned the procedure in my residency training. I know, in hospitals where I am on staff that other pods perform them. Having said that, I am well aware that there are podiatrists who, given a case of a met osteotomy gone bad, would love to be the "expert witness." "Of course, there is a case Mr. Lawyer: “Look, there was no form of fixation used. That's the way it was done years ago. The doctor should have done a Weil osteotomy with a screw, and this wouldn't have happened."

A plausible solution to this problem might be for an organizational group, e.g., APMA, ACFAS, etc., to actually make a list of procedures deemed "standard of care"; or have a panel of doctors from an organization who would stipulate that something was standard of care. Something like this needs to be done because the system that is currently in place is NOT working. Expert witnesses are being pitted against expert witnesses, and sometimes their opinion of standard of care may be influenced by the monies they are receiving for the case.
 
Jeffrey Kass, DPM,  Forest Hills, NY, jeffckass@aol.com

RE: Posterior Tibial Neuropathy (Frank DiPalma, DPM)
From: M. Turlik, DPM

The best article I have read regarding electrodiagnostic tests used in the evaluation of Tibial Neuropathy / TTS is: Patel A, et. al. Usefulness of Electrodiagnostic Techniques in the Evaluation of Suspected Tarsal Tunnel Syndrome: An Evidence Based Review. Muscle and Nerve 32: 236, 2005.

The value of a diagnostic test is determined by the estimate of the pre-test probability, and the measure of test effectiveness (I prefer likelihood ratios).

Pre-test probability x likelihood ratios = post-test probability
 
M. Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Podiatric Surgeons and Generalists (Arden Smith, DPM)
From: Dennis Shavelson, DPM,  David E. Gurvis, DPM

The shift to creating surgeons reduces the DPM patient pool to those opting for a surgical cure, effectively reducing foot sufferers wanting non-surgical options to second class. The podiatric “surgeon” will “offer general podiatry care” but if I am a surgeon, my CME’s and my philosophy is surgical and that would dampen my desire and ability to present non-surgical alternatives seriously to patients.

I can understand why surgically trained DPM’s are forsaking the therapeutic power of custom foot orthotics for a scanner or a foam box. More surgery. It explains the casual presentation of injection therapy, physical therapy, and medical consultations because more patients opt for elective, invasive care believing they have weighed the alternatives. Why work with shoe selection, motor control or manual therapy when they might reduce my OR bookings? Why practice prevention or attack performance enhancement or improved quality of life issues when that would reduce eventual surgical problems like fluoride has done to oral surgery?

I’ll offer a deal to any “surgeon” podiatrist:  I’ll stop doing surgery and refer all my surgical cases to you if you refer all those who opt for a non-surgical approach to me. That relationship would establish surgeon and non-surgeon podiatrists, and the foot-suffering public would have actual choices. Podiatry would then become an expanded, more successful marketplace.

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com      

Editor’s note: Dr. Gurvis’ extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=28589&start=1

RE: Addante Receives FIP Lifetime Achievement Award
From: Giulio V. Zanetti, Larry Dorman, DPM

Dr. Joe Addante is one of the first DPMs who came to Italy and Europe  to teach us  the essentials of  the podiatric profession. The F.I.P.  Award (International Federation of Podiatry) to Joe has been given to a great  man in love with podiatry,  medicine, surgery, and my country, Italy. Dr. Addante and the late Dr. Raymond Locke were the first DPMs who came to Italy from the USA, and gave us the gift of their great experience in the care of foot ailments.

Giulio V. Zanetti ( Podiatrist), Milano, Italy, giuzanet@tin.it

I, too, would like to congratulate Dr. Joseph Addante on his Lifetime Achievement Award. I was a resident of Dr. Addante from 1979-1980. Dr. Addante, together with his many colleagues throughout Massachusetts and New Hampshire, took my previous four years of podiatric medical education and helped me to make the transition from student to practitioner. After completing my residency, I felt immediately comfortable treating patients in the private practice setting. That feeling has never changed throughout my 29 years of practice. It was a privilege to have trained under Joe, and I applaud him for this well-deserved accolade. 
 
Larry Dorman, DPM, Miami, FL, drlid@bellsouth.net

ALASKA- ANCHORAGE- IMMEDIATE OPENING – DON’T HESITATE

One of state’s largest podiatric providers is looking for an associate to join the practice with becoming a partner as part of plan. Practice has modern office on the campus of Alaska Regional Hospital and opportunities for surgery, in-office care and ancillary services. Great place to live for the outdoorsman. Three-year surgical residency preferred. contact: mcrosby@providerresources.com  AK03.

ASSOCIATE POSITION – CENTRAL FLORIDA

ASSOCIATE POSITION - DALLAS/FORT WORTH AREA

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net.

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

EQIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

PM News Classified Ads Reach over 11,500 DPM's and Students
 
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.