The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 07, 2009 #3,642 Publisher-Barry Block, DPM, JD

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Shoe Salespeople Not Qualified to Diagnose Foot Problems: GA Podiatrist

Podiatrist Dr. Jeremy Thomas, with Triangle Foot and Ankle, said many orthotics aren't actually custom-made, and shoes salespeople and physical therapists aren't really qualified to diagnose foot pain problems. Podiatrists can help with foot pain. A proper diagnosis requires an expert exam by a podiatrist, who looks at all the joints from the knee down to the toe. Thomas also takes a look at how the patient walks. "It really gives me a full idea of where her foot should be in a custom orthotic," he said.

Dr. Jeremy Thomas

In fitting for an orthotic, Thomas starts with a plaster mold, capturing the arch of the patient's foot in a neutral position. The mold hardens in minutes. A real custom orthotic made from a cast will keep a patient's foot in the neutral position. Unlike the over-the-counter version, the custom orthotic provides support and relieves pain. Most insurance policies will cover custom orthotics.

Source: Allen Mask, M.D., WRAL [9/2/09]

OCPM Provides Treatment at Burning River 100 Mile Run

Kathy J. Siesel, DPM, Class of 1989 and associate professor in biomechanics, supervised evaluation and treatment of ultra-runners at the Burning River 100-Mile Run this Summer. This ultra-marathon had an international field, and 156 runners started the 100 mile course. The runners have 30 hours to complete the 100 mile course and 103 runners finished the course.

OCPM Provides Treatment at the Burning River 100 Mile Run

Dr. Siesel was joined by 32 students working in 5 different shifts.  Students are from all class years currently enrolled at the Ohio College of Podiatric Medicine. The students worked in teams of two to four students per runner to make the treatment time as short as possible for the runners. The students participated in the evaluation, treatment, and basic charting for the runners who sought our assistance. 

The OCPM team discussed many items with the patients, including footgear types and fit, stretching exercises, training schedules, and follow-up treatment. It was a very busy two days at the Foot Aid Station, with 75 visits and numerous referrals to podiatrists and to the Cleveland Foot and Ankle Institute.

Source: Footsteps [August 2009]

ID Podiatrist, Former Pro Cyclist, Now Top Triathlete

Calling himself a full-time doctor and part-time athlete, Jonathan Fisher is nonetheless one of the top triathletes in the region, parlaying a background in professional cycling into new-found success at Olympic distance triathlons.

Dr. Jonathan Fisher in Competition

Fisher, 33, used to race bicycles with and against the likes of Lance Armstrong and George Hincapie, while competing on the U.S. professional circuit and racing in places like Belgium and France. He had numerous top 10 finishes, and said his biggest strength was racing over the rough cobblestone streets.

The Minnesota native eventually gave up competitive racing to attend medical school, recently completing fellowships at Detroit Medical Center, another in Baltimore, and finally at Harborview in Seattle. He’s currently the new foot and ankle specialist at North Idaho Orthopedics and Sports Medicine.

Source: Eric Prummer, Bonner County Daily Bee [9/3/09]
 

Most Docs Still Taking New Medicare Patients, Survey Finds

Nearly 75% of physicians were accepting all or most new Medicare patients in 2008, according to findings released by the Center for Studying Health System Change. The survey, A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Study Physician Survey also found that the vast majority of physicians (87%) are contracting with managed-care plans, and slightly more than half (53%) said that their practices were accepting all or most new Medicaid patients.

Almost three-quarters of U.S. physicians were men in 2008—but for physicians under age 40, “slightly more than 41% were women, signaling how the composition of the physician workforce may change in the future,” according to the survey. More than 80% of physicians surveyed worked full-time last year; more than half (53%) were 40 to 55 years old; and almost four in 10 had practiced medicine for more than 20 years. Fewer than six in 10 physicians provided charity care in 2008.

“Physicians' clinical decisions affect how up to 90% of every healthcare dollar is spent, so understanding how physicians are organized and practice medicine is critical for policymakers, especially as they engage in the most serious discussion of comprehensive healthcare reform in 15 years,” the center's President Paul Ginsburg said in a written statement.

Source: Jennifer Lubell, Modern Healthcare, [9/3/09]

Query: Verapamil for Plantar Fibromatosis
 
Other than anecdotal reports, has there been any research done on the use of Verapamil for treating plantar fibromatosis? What type of delivery system is being used for topical application? Is anyone using compounded 15% Verapamil gel?  
 
Greg Caringi, DPM, Lansdale, PA

Query: Prescribing Pain Medicine to an Addicted Patient

One of the doctors who has an ownership position in our practice is involved in the treatment of a patient who is addicted to narcotic analgesics. The patient has been referred to a pain management physician. The pain management physician has put the patient on a plan of decreasing dosage, which is currently in excess of the recommended maximum daily dosage. The prescriptions are being written by the podiatrist. There are two concerns. 1)Is the podiatrist legally and ethically permitted to write these prescriptions to treat an addicted patient. 2) If there are complications, such as overdosage by the patient, are the corporate entity and the other physician shareholders liable both legally and ethically.

Name Withheld

Editor’s comment: PM News does not provide legal advice. Podiatrists are licensed to prescribe narcotic analgesics for the treatment of foot or ankle-related conditions. From your described scenario, these prescriptions are being prescribed for a condition not within the scope of podiatric licensure. The prescriptions should come from the pain management doctor, not the podiatrist. Thus, your concerns are real and should be related to a healthcare attorney in your state.

RE: Subchondral Microcysts (Greg Caringi, DPM)
From: Multiple Respondents

I would make sure that the radiologist knows that you used absorbable pins. Although it is a little early at 6 week, cystic lesions are very common when using absorbable material for fixation. I would suggest that you formally send a note to the radiologist, suggesting that he/she review the x-ray, and evaluate the possibility of this common Rx, and of course documenting it! This may be an opportunity to teach the radiologist something, if it is done in a diplomatic and personal way.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

I used Orthosorb on occasion until I had two complications. In one case, the entire metatarsal head disappeared from a reaction to the product. In the other, I had a long, draining sinus that eventually resolved from what I feel was a very similar reaction.   
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

We have seen and studied this phenomena in patients at the Weil Foot & Ankle Institute. These microcysts are probably signs of a form of temporary osteonecrosis (a low level AVN). These can occur with possible injury to the vascular supply to the 1st metatarsal head during surgery or from inadequate fixation of the osteotomy.  The condition of AVN was widely reported in the orthopedic literature following the Austin procedure, and was blamed on the concomitant use of a "lateral release." The early cases of the Austin did not use internal fixation, and we opine that this lack of stable fixation resulted in movement of the osteotomy and a temporary interference with the blood supply, resulting in the AVN appearance (microcysts or osteonecrosis) of the metatarsal head.

Kenzora reported a large incidence of mini-osteonecrosis in foot surgery osteotomies 30 years ago, and although many went on to complete and uneventful healing, this piqued my interest. In a pilot study done by us, using Osteofix absorbable pins for an Austin bunionectomy, we saw an inordinate number of cases that developed microcysts that I attribute to the less than ridged internal fixation that the absorbable pins provided.

The bottom line is that most of these get better with time as the bone revascularizes. (I would not allow any sports activity for about 3 months) Some, over a period of time (years) will develop some arthritic changes in the metatarsal head that do not seem to be symptomatic, but just a little scary when compared to the pristine looking pre-op radiograph.
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL,  weil4feet@aol.com

RE: Clarification on ACFAS Clinical Practice Guidelines (Bob Hatcher, DPM)
From: Chris Mahaffey, CAE

Dr. Hatcher refers to discontinued ACFAS Clinical Practice Guidelines.  Please refer your readers to our new Forefoot Clinical Practice Guideline that covers the procedures Dr. Hatcher described.

Chris Mahaffey, CAE, Executive Director, ACFAS, Mahaffey@acfas.org

RE: Removable Walking Casts (Arden Smith, DPM)
From: Robert Wunderlich, DPM

In regard to Dr. Smith's query about billing/reimbursement for removable cast walkers as offloading for diabetic foot ulcers, these are indeed non-covered DME under Medicare for that diagnosis. So, the answer is to consider using offloading modalities that ARE covered under Medicare, and you have 2 options: 1) total contact casting, or 2) diabetic shoes and insoles. Obviously, neither of these options will be appropriate for every patient, but these are the options that Medicare will reimburse us for. When faced with this issue, I typically explain the situation to the patient and we have a discussion of various offloading modalities. I think you'll find that most patients prefer to pay out-of-pocket for the convenience of having a removable cast walker when given the alternative of serial total contact casting, as an example.

In my experience, Medicare is one of the few payers that restricts use of removable cast walkers in this way (i.e., coverage being diagnosis-dependent). Even Medicare-replacement HMOs will usually pay for them.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Standard of Care (Jeffrey Kass, DPM)
From: Michael A. DeVito, DPM

In response to Dr. Jeffrey Kass’ position that an organizational group such as APMA, ACFAS, etc., should actually make a list of procedures deemed "standard of care"; or have a panel of doctors do the same, I would be very cautious with that position and not like to see that occur. This is exactly what the legal system would like us to define. Then, they will be able to say anything outside of this is a breach and you will be stuck defending continually why you did not apply the standard of care. We all cannot practice every day within these boundaries, and we would be placing ourselves inside a difficult box with limitations on what we do.
 
"The standard of care is what any reasonably careful podiatrist would do in the same or similar circumstances." It will differ from state to state, region to region, and person-to-person, and in some cases, it is a significant benefit for it to be this way.
 
 Michael A. DeVito, DPM, Oak Lawn, IL, devitodr2@sbcglobal.net

RE: MD Buying Group (Arden Smith, DPM)
From: Joel Lerner, DPM

I am writing in response to Dr. Aldrich's question on MD Buying Group. It was started by me approximately 5 years ago in order to save money for my own 3-office practice. I never had any intention to do anything like this until I stopped purchasing our supplies from a particular company. They called me up asking why I stopped buying from them and what could they do to get my business back. I said give me a discount on my supplies. They immediately said “yes” , so I asked them how much discount if I get 100 offices to purchase from them.

After negotiating to get what I wanted, I went out to recruit 97 more offices. We now have 1,600 podiatric offices in our purchasing group and are rapidly growing. We save between 17 and 60% on all products. We purchase x-rays film in bulk, which allows our members to purchase Fuji film for wholesale prices. We buy CAM walkers, night splints, and various DME products at wholesale prices. We have a contract with Staples that allows us to purchase office products approx. 47% cheaper than store prices. There is no fee to join and absolutely no obligation to use the companies we purchase from. I am hoping we all stick together in order to help each other with more work and less reimbursements.
 
Lastly, ACFAS has never endorsed our group, but being part of the ACFAS, I limited our membership to active ACFAS members only. 
 
Joel Lerner, DPM, Union, NJ, Njdoc2@aol.com
 

ASSOCIATE POSITION - NY (MID-TOWN MANHATTAN & WESTCHESTER COUNTY)

Multi-office, well-established medical/surgical practice with on premises OR, digital x-rays, vascular testing, sonogram, F-scan, bone density testing, fluoroscopy & NCV. Additionally, EMR with voice recognition charting coming soon, and many other perks are available. We are looking for personable, well-trained & well-motivated individual. Patient base available for immediate in-office productivity. If you are new or ready to change locations, contact us ASAP to discuss opportunities. Send resume and cover letter to terri.bobson@verizon.net

POSITION AVAILABLE IMMEDIATELY - IOWA

Looking for Board Certified/Board Qualified Foot and Ankle Surgeon to join a very busy hospital-based practice. We see over 6000 patient visits per year in the county hospital and take all lower extremity trauma call. Must be 2yr residency trained minimum, with trauma experience or willingness to learn. You will be joining a group of 4 dynamic, hard working podiatrists who enjoy great benefits, pay for performance options and a great Midwestern lifestyle. Please send your CV and letter of interest to: Dr. Denise Mandi, Section Chief, Foot & Ankle Surgery, Broadlawns Medical Center, dmandi@broadlawns.org

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

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 - 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 – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

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.

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.

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