The Voice of Podiatrists

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September 07, 2007 #3,034 Editor-Barry Block, DPM, JD

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NY Podiatrist Uses Coblation Therapy for Chronic Plantar Fasciitis

According to Dr. Joseph Fox, podiatric surgeon with Gramercy Surgery Center and 20+ years of experience in treatment of musculoskeletal conditions of the foot, "If you experience nagging heel pain when you wake up in the morning or after spending a significant time on your feet, you're not alone. While invasive surgery has been the primary option to treat chronic plantar fasciitis, a new, minimally-invasive technique called coblation therapy promises pain relief and resumption of normal activities with fewer side-effects.

Dr. Joseph Fox

"Coblation therapy is a relatively new procedure that uses low-temperature radiofrequency to destroy the nerve fibers in the inflamed tendon," explains Dr. Fox. "The destruction of those fibers in the plantar fascia allow for immediate pain relief following coblation therapy, and we believe that new nerve fibers regenerate within about three months post-operative," Fox continues.

Recent back-to-back studies published in the American Journal of Sports Medicine confirm this theory. In the first study published in May, researchers at the University of California San Diego found that nerve fibers were significantly decreased, scarring was non-existent, and pain relief was evident within two weeks of coblation treatment. The same researchers published a follow-up study in July, noting evidence of full nerve regeneration at 90 days post-treatment, and pain relief remained evident. The studies used a new coblation therapy device called Topaz, which allows surgeons to remove small amounts of dead nerves and/or tissue in the tendon (debridement) without affecting healthy cells.

IL Podiatrist Inducted as President of Cosmopolitan International

Walter A. Alm, DPM, of Elgin, IL has been inducted as the President of Cosmopolitan International. Dr. Alm was officially installed on August 10, 2007 at the club’s international convention in Omaha, NE. Dr. Alm is a 1976 graduate of the Illinois College of Podiatric Medicine and has been in private practice in Elgin since 1978. Dr. Alm relates that the complications of diabetes play such a large role in his practice that joining and volunteering for the club is a perfect fit.

Dr. Walter A. Alm

Cosmopolitan International is a service club originally chartered and incorporated in 1918 in Kansas City, Mo. The club today is made up of some 70 local branch clubs located throughout the United States, Canada and Mexico with headquarters in Overland Park, KS. Since 1970 the international organization has been committed to the fight against diabetes as well as civic projects in member communities.

Dr. Alm, who has been a member of Cosmopolitan International for seven years, has served his local club in Elgin, Ill, his area clubs as their Governor and has been an international board member for the past four years. As President, Dr. Alm will direct the operations of 70 clubs in their philanthropic programs and events during the current fiscal year

IL's Malpractice Law Nears First Court Challenge

The second anniversary of Illinois' landmark medical malpractice legislation passed quietly last month, in part because not everyone is sure the package of reforms should or will last. Later this month, the law will be tested before a Cook County judge. The question before the court will be whether caps on the damages for pain and suffering in a malpractice lawsuit are constitutional.

Only a few years ago, skyrocketing medical malpractice insurance rates caused a political and medical crisis in some parts of the state and the Metro East area in particular. Dozens of doctors faced with rising bills simply closed shop or moved. Insurance companies blamed the area's aggressive lawyers for oversuing. Plaintiff attorneys said insurance companies were just looking for a scapegoat to justify their rates and profits.

Lawmakers eventually came up with a compromise — the legislation now being challenged — which bolstered competition in the insurance industry and capped non-economic damages in medical malpractice cases to $500,000 for a doctor and $1 million for a hospital. Malpractice insurance premiums have stabilized or even fallen for many doctors, anywhere from 5 to more than 30 percent. At the same time, the insurance industry's profits generally have risen. However, in about two weeks, one challenge will finally go before a Cook County judge to test the law. A Chicago lawyer, Jeffrey Goldberg, has challenged the caps on behalf of an infant who was born with severe brain damage. Goldberg alleges a botched delivery and argues the caps simply don't allow a jury to award enough money.

Source: Adam Jadhav, St. Louis Post-Dispatch, 09/04/2007

Query: Accommodative Device Ulcer on Malleolus

I have an elderly patient who has a recurring ulcer on the lateral malleolus. All causes have been medically ruled out. My suspicion is that it is caused by pressure at night when she is in bed. I know there are devices to prevent heel sores at night. Is there anything commercially available that can take pressure off the lateral malleolus when she is in bed?

Elliot Udell, DPM, Hickville, NY

Query: Outcome Studies for Subtalar Arthroerisis

Coventry insurance has denied coverage for a subtalar arthroerisis procedure that I performed on a child. They indicated that it is "experimental and investigational." They have asked for outcome studies on this procedure. Does anyone know of any articles discussing outcomes?

Arthur Weisman, DPM, Independence, MO

RE: Digital X-Ray Equipment
From: Kenneth Meisler, DPM

I purchased an Air Techniques Scan X digital x-ray system four months ago. We have installed it on our network with no difficulty (10 monitors, 5 treatment rooms). The price of the unit was much less than any I have seen quoted in PM News. The entire staff loves using the unit - from the doctors, staff trained to take x-rays, people who used to have to file the x-rays, and especially the patients. I prided myself on the quality of my traditional x-rays, however now patients are very "impressed" to see their x-rays on the monitor in their treatment room.

The unit is very easy to use and the quality of the images are excellent. I think the unit will pay for itself in a very short period of time because of decreased developer, cleaning, film, costs etc., however the greatest savings are in saving the labor involved with filing x- rays. I also think the digital x-rays lead to more patient referrals.

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

RE: Uncontrolled Gout (Richard Rettig, DPM)
From: Kazu Suzuki, DPM, Tip Sullivan, DPM

I would consider the tophi within the joints as "foreign body"; I think you can excise it or debride it surgically, and fuse the joints if needed. To my knowledge, and with my search on the Medline, there is no medication or solution that would "dissolve" the uric acid crystals, besides lowering the serum uric acid levels.

I have to agree with Dr. Rettig, and I believe that judicious uses of intra-articular steroid injection may be helpful for symptomatic inflamed joints; although I understand Dr. Mullen's concern, which is not to inject more steroid "crystals" within the joint.

There is a newer alternative to allopurinol called Febuxostat, that is also an xanthine oxidase inhibitor. This agent is more efficacious than allopurinol, and the chemical structure is different. Your patient may be a perfect candidate, but Febuxostat is on the phase III trial, and is not on the market yet. Ref: N Engl J Med. 2005 Dec 8;353(23):2450-61.

Nonetheless, I would manage this patient along with a rheumatologist. There is no reason that you have to manage this patient by yourself, especially when there are many competent rheumatologists within the University of Texas health systems.

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

The only way that I have found to decrease gouty tophi is to use a uricosuric agent IN COMBINATION with alkalinization of the urine and significant hydration. In this case the patient is allergic to the uricosurics and looks like you are stuck with simply alkalinization of her urine and hydration.

The goal urine pH>6.5. I use potassium citrate 30 -90 mEq per day in divided doses. Note: do not use sodium citrate or you might induce calcium oxalate renal stones. The patient should drink 6-8 full glasses of water each day.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Editor’s Note: This topic is now closed.

PODIATRY ASSOCIATE WANTED – YONKERS, NY - ASAP

P/T-3 days per week for busy Yonkers and White Plains location-
Surgical training a plus, but not mandatory. Please fax resume to 9149939031 or call 914 325-9198 for more details.

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

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

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