The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 07, 2010 #3,951 Publisher-Barry Block, DPM, JD

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Running Shoes Often More About Marketing Than Biomechanics: MN Podiatrist

Historians might look back on 2010 and find puzzlement in what has to be among the more unexpected recreational trends of our time. After decades of product development and marketing hype, footwear companies are doing 180s to drop features like gel pockets, air pumps, and arch support in favor of “barefoot-style” shoes.

Dr. Paul Langer

“The phenomenon of cushioning in running shoes is a recent invention,” says Dr. Paul Langer, a podiatrist and marathon runner in Minneapolis. Langer says misinformation in the 1980s started a myth that cushioning in shoes is always better. “It became more about marketing and less about biomechanics,” he said.
 
Source: Stephen Regenold, Gear Junkie, [8/26/10]

IL Podiatrist Involved in Opening a Federally Qualified Health Clinic

Dr. Joseph Borreggine, a local podiatrist, participated in the recent opening of the Coles Community Health Program (CCHP). The clinic is located in Mattoon, IL and officially opened on September 1, 2010. CCHP is a Federally Qualified Health Clinic (FQHC) that will serve members of the local and surrounding community who do not have health insurance or are unable to obtain care from a primary care physician.

Dr. Joseph Borreggine is pictured (back row, far left) with staff and board members of the Coles Community Health Program

The clinic board first began to meet to develop this FQHC in 2006. With Coles County, IL having a large number of under-served members who are at or below the poverty level, this clinic will provide the necessary medical care for these members of the community.  

Source: Dave Fopay, Herald-Review [9/2/10] 

X-Ray Tech Arrested After Stealing Rx Pads From FL Podiatrist

Authorities arrested an x-ray technician they say wrote more than 100 fraudulent prescriptions in her own name to get hydrocodone. Jessica A. Rhodes, 27, was arrested Sunday on six counts each of obtaining a controlled substance by fraud and trafficking in hydrocodone. Jail records show she was released Monday after posting a surety bond.

Pinellas County Sheriff's deputies began an investigation Aug. 30 after getting a tip from a pharmacist at a Target pharmacy. The pharmacist had become suspicious of Rhodes, who was getting weekly prescriptions for hydrocodone from a local podiatrist. Detectives called the podiatrist, Dr. Bella Worman, who told them Rhodes had worked in her office for about three years ending in June. The doctor said she had not issued any prescriptions to Rhodes, who has an active medical license for certified podiatric x-ray assistant.

Source: Kameel Stanley, St. Petersburg Times [9/6/10]

Social Media Do's and Don'ts

Here are social-media experts' answers to ethical dilemmas physicians face when using Facebook, Twitter or similar sites.

Should I accept Facebook friend requests from patients? Probably not. Keep your personal profile only for friends, family and colleagues. Create a separate business page to share general health information with your patients.

Should I respond to personal medical questions on Facebook or Twitter? No. Refer questions to the patient's physician. If the question comes from your patient, handle it through an office visit, phone consultation or encrypted e-mail exchange.

Should I post any identifying information about my patients? Absolutely not. It is unethical and illegal.

Should I blog or tweet anonymously? Probably not. Anonymity can make it easier for doctors to post content that is disrespectful to patients or that undermines patient trust in the profession.

Source: AMNews [9/6/10]

Query: Unusual Congenital Metatarsal Abnormality

This is the left foot x-ray of a 73 year-old gentleman of Middle Eastern heritage who presented to my office with the clinical symptoms of a 3rd interspace neuroma. The films show a rather unusual osseous malformation arising from the lateral shaft of the first metatarsal, extending into the first-second metatarsal interspace. The patient can recall no injury to the area.

Unusual Congenital Metatarsal Abnormality

There is no pain or other clinical signs of a related problem. X-rays of the opposite foot show only a very small, rudimentary metatarsal at the first-second metatarsal interspace area. I have never seen anything quite like this. I am hoping for an opinion as to the nature and frequency of such a finding.

Greg Caringi, DPM, Lansdale, PA

Query: Non-Union Phalangeal Bone

I had a patient referred to me with a symptomatic non-union of the proximal hallux phalanx. The patient had undergone an Akin-type osteotomy which never healed. There is bony overgrowth at the site with slight plantarflexion of the distal portion proximal phalanx from the non-union site. Conservative treatment failed to resolve the problem or symptoms. I repaired the non-union by excising bone, applying allograft bone, and screw fixation.

When I went to code the procedure, I noticed there are codes for non-union of tarsal bones and non-union of metatarsal bones, but no code for repair of non-union of phalanx. How do I code the procedure?

Jon R. Goldsmith, DPM, Omaha, NE

Response: This is not a common procedure. There is no code for non-union of phalangeal bones. I think you have two options. First option: Since you are creating a surgical fracture of bone, and then fixating it, CPT 28505 (open treatment of fracture, great toe, with or without internal fixation) would be reasonable.

Your other option, of course, is to submit the unlisted foot/toe procedure code, CPT 28899, and provide an operative report with billing, letter of explanation...and request a peer review.

Howard Zlotoff, DPM, Camp Hill, PA

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RE: Cortisone Injection in Second Trimester? (Mark Stempler, DPM)
From: Neil A Burrell, DPM, JP McAleer, DPM

We will give a cortisone injection during pregnancy but we ALWAYS make sure it is okay with Ob/Gyns by personally talking to them. We have never been told no. I feel that it also shows concern for the patient from the patient's perspective as well as the Ob/Gyn's perspective. 

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

I have discussed steroid injections for pregnant patients with several local OB/GYNs. They have all stated that it is a completely reasonable form of treatment and will pose little or no risk to the fetus.

JP McAleer, DPM, NY, NY, jpmcaleer@gmail.com

RE: Manipulation Videos (Howard Dananberg, DPM, Robert Bijak, DPM)
From: Richard A. Simmons, DPM

Dr. Bijak discusses that podiatric medicine should have the same practice scope in every state in the United States and that full scope answers all of our problems. In the first place, full scope will answer many of those problems, but there will still be those podiatrists with old scope who will gradually be replaced by those new practitioners with full scope. I doubt that the medical community will allow podiatry to grandfather all podiatrists into full scope.  As we all should be aware, that is one of the objectives of Vision 2015 for those podiatrists who receive three years of post-doctoral residencies.

Second, but most important, is the fact that the United States is a republic, or more correctly, a constitutional republic.  As such, there are states' rights. Unless you can show something in the Constitution of the United States that guarantees podiatrists full scope of practice, then that decision is left up to the individual states. If you want something done in your state, it is solely dependent upon you to contact your state government. Ironic, is it not, that many of the southern states enjoy a greater scope of practice than the industrial north? It is not by accident, but perserverence that Atlanta, Georgia podiatrists enjoy the best practice of podiatric medicine in the United States. 

With all due respect to the residents of New York, Southerners shake our collective heads in disbelief at all of the taxes, laws, rules, regulations, policies, etc. that seem to govern most aspects of a New Yorker's life. As such, it is difficult for me to isolate the limited scope of practice of podiatric medicine in New York as a simple problem to be corrected.

Thank you, Dr. Dananberg, for taking the time to present and upload that fantastic video.

Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com

RE: Keller with Chondroplasty (Barry Mullen, DPM, Jeffrey M. Kittay, DPM)
From: Juan Góez, DPM

Dr. Mullen asks as to the rationale why hemi-implants designed to replace the phalangeal bases are ever utilized in 1st MTP degenerative joint disease surgery. He further questions if any of our colleagues has witnessed significant destruction of a phalange's base. The performance of a resurfacing hemi-arthroplasty of the base of the proximal phalanx resolves the most important issue at hand: it eliminates the pain at the MTPJ. 

Second, it allows maintenance of joint structures as there is only need to remove 2mm of bone... the objective is to resurface the base of the proximal phalanx. Third, although less significant destruction is noted at the base of the phalanx, damage and degeneration is usually present as this is the other 50% of the joint. Dr. Kittay's statement that phalangeal base hemi-implants are designed to articulate against damaged 1st metatarsal head articular surfaces is accurate when referring to metallic hemi-implants, which I think he was referring to.

I agree with Dr. Mullen that the joint must be rectus for resurfacing hemi-arthroplasty and that 1st MTPJ compression must be addressed by increasing the cubic capacity of the joint. I regularly perform an osteotomy of the 1st metatarsal to correct any angular deformity in combination with the resurfacing hemi-arthroplasty, as required: head, shaft, base or in some instances a Lapidus arthrodesis. The procedure must be followed by aggressive physical therapy to maximize ROM post-surgically. 

Additionally, bone wax is a great way to reduce dorsal capsular adhesions post-cheilectomy. In the event of procedure failure, removal of the hemi-implant leaves the surgeon with many options available: convert to a Keller arthroplasty, MTP fusion, total implant arthroplasty, Valenti procedure. Hemi-implantation of the 1st metatarsal head has yet to be proven effective, while resurfacing hemi-arthroplasty has been a proven method for treatment of 1st MTP degenerative joint disease, hallux limitus/rigidus, and has been performed since 1952. 

Juan Góez, DPM, Bellmore, NY, jgoez11520@yahoo.com

ASSOCIATE POSITION – NEW MEXICO

Enjoy the outdoors? Enjoy sunshine? Enjoy beautiful vistas? Come to the Land of Enchantment. Albuquerque position: Move into a ready-made practice, full ownership in five years when I retire. Board certification is necessary for hospital staff privileges. Recently renovated office with digital imaging, diagnostic ultrasound, EHR in process. Contact fitz@abqpodiatry.com

ASSOCIATE POSITION - BLOOMFIELD, NEW JERSEY

Part-time office, part of larger practice looking for associate with well-rounded podiatric skills. Board qualified a must. Ground position leading to partnership. Please email CV to doccapo@yahoo.com

ASSOCIATE POSITION - SW FLORIDA GOLF, BOATING & BEACHES

Great opportunity to join a well established podiatry practice. Excellent mix office/surgery, motivated experienced staff. Seeking full-time Associate PSR 12-36. Salary $100 Thousand + bonus package with benefits, early buy-in available to right candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

POSITION AVAILABLE - NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: podiatry2011@gmail.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

PODIATRY POSITION AVAILABLE – WISCONSIN

Affinity Medical Group, an integrated health care organization in East Central Wisconsin, is seeking a BC/BE Podiatrist for our Appleton location. This is a General Podiatric practice opportunity including routine care, sports medicine, and surgery. The Appleton area offers a unique quality of life, combining a family centered, university community with all season recreation, a nationally acclaimed educational system, and a diverse and growing economy and population. For information, contact or send your CV, to: Sara Roth, Affinity Medical Group, Physician Recruitment, Phone: 800-722-9989; Fax: 920-727-4350; E-mail: sroth@affinityhealth.org Visit our website at: www.affinityhealth.org EOE.

ASSOCIATE POSITION – KENTUCKY

Very well established podiatry practice in Louisville, KY seeks a motivated, ethical practitioner trained in all phases of podiatry including routine care, surgery and wound care to join 2 other podiatrists. By joining our practice you will receive a competitive salary with a bonus structure and benefits. Our practice is equipped with DME, PadNet, Gait Scanner and on site retail store. There is a huge potential to grow your practice with our ideally located facility that has strong affiliation with leading area hospitals as well as 2 local residency programs. For immediate consideration, please forward CV to Samuel10530@yahoo.com

MANHATTAN - FULL-TIME POSITION

Available for a Board certified/qualified podiatrist (PSR-24, PM&S-36 ). Located in Downtown Manhattan in a multi-specialty Orthopaedic office. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Contact fscudese@seaportortho.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

Full-time 38 yr old podiatry practice with state licensed surgical center. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network, and well-equipped surgical suite. Retiring owner will stay on as needed for transition. Email dpmpracticeforsale@yahoo.com

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

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