The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 08, 2009 #2,643 Publisher-Barry Block, DPM, JD

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Congratulations to Keith Daniels , DPM of Flint, MI , winner of PictZar® Digital Planimetry Software - Wound Measurement on Digital Photographs (Value $850).

We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2010 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

This week's prize is registration to the 2010 Alaska Practice Management Cruise.  Learn about this once-in-a-lifetime adventure seminar by going to www.podiatrym.com/alaska (Value $495).

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame. 

Worn Shoes Are Major Cause of Running Injuries: DC Podiatrist

The American Academy of Podiatric Sports Medicine has devoted an entire article on its website to selecting the best running shoe. According to the article, written by podiatrist Dr. Stephen M. Pribut, this is a task of the utmost importance. The factors Pribut suggests considering when shopping for a running shoe are shoe experience, any foot problems, the body's own and environmental factors and exercise requirements.

Dr. Stephen Pribut

For those who haven't experienced any problems due to shoes, Pribut stated it can be hard to recommend a change. When trying on running shoes, be sure to run in them, he advised. Try both shoes on, and leave them on for a good 10 minutes before making a decision.

Pribut stated that worn shoes are a major cause of running injuries and advised replacing them at between 350 and 550 miles. Looking at wear patterns on old tennis shoes can help athletes identify where their strides are putting the most stress on their feet. Look for shoes that accommodate and support these patterns, Pribut advised.

Source: Annie Getsinger, Herald & Review [9/2/09]

Steinberg Family Kicks Off Barry’s 25th Anniversary Campaign

The Barry University School of Podiatric Medicine will celebrate its 25th anniversary in January 2010. In honor of this milestone, the Dr. Lloyd Steinberg family, including Drs. Paul and John Steinberg, has donated $6,000 to the Dr. Marvin and Ruth Steinberg Podiatric Alumni/Student Scholarship Fund. The donation is helping to kick off an anniversary fundraising drive to raise $25,000 that will benefit podiatric medical students at Barry who are academically qualified and selected by the faculty.

Dr. and Mrs. Lloyd Steinberg, Dr. John Steinberg (center)

The Steinberg Scholarship fund was established in 1994 by members of the Steinberg family and the Barry University Podiatric Alumni Chapter to provide academically qualified students with support for the financial demands of their medical education. The fund, a major source of scholarship assistance at the school, is a memorial to Dr. Marvin D. Steinberg, pioneer and leader in the field of podiatric medicine. His influence and involvement in both podiatric practice and podiatric education earned him the name, “Father of Modern Podiatric Medicine.”

White House Shifts on Public Health Care Option

President Barack Obama's top political adviser is backing away from having a government health care plan compete against private carriers. David Axelrod says Obama believes a public option would be a good tool. But Axelrod says "it shouldn't define the whole health care debate."

The president is trying to refocus the debate on proposals to help the majority of people who already have insurance - for example, limiting out-of-pocket costs. That's part of the legislation in Congress, but hasn't gotten a lot of attention. Axelrod says it's essential to create a competitive market for self-employed people and small businesses to get affordable coverage. But he's suggesting a government plan may not be the only way to do that.

Source: Associated Press [9/6/09]

Query: Leg Pain

I had a 39 year old female who presented to the office with a mildly swollen leg. She stated that she had had been on a transcontinental flight from Europe for eight hours, and then drove 22 hours to Florida.  When she got home, her leg was swollen and very painful. She went to the ER and had a negative venous Doppler and negative D-dimer test. Treatment was aspirin. She also had an MRI later which revealed possible anterior shin splints. However, all of her pain was posterior when she presented to the office. She has minimal swelling and hyperestesia with any light touch to her skin. I could not find anything wrong, so I thought maybe she had a superficial DVT and gave her NSAIDs, compression sleeve, and instructed her on heat to the area. Any other suggestions for a possible diagnosis? 

Brent Rubin, DPM, Bradenton, FL

Query: TENS Units

I have been contemplating ordering some TENS units for patients so that they can perform some physical therapy on themselves at home. When I looked through my distributor’s catalogue, I was inundated with all the various kinds, prices, etc. Can anyone give feedback on a particular brand or model they feel is good? Any feedback would be appreciated.
 
Jeffrey Kass, DPM, Forest Hills, NY

RE: Verapamil for Plantar Fibromatosis (Greg Caringi, DPM)
From: Rick Wittock, DPM, David Cauthon, RPh

I use 15% compounded verapamil in my practice, and have found that after a 3-4 month treatment course of daily or nightly application under occlusion that the lesions do become smaller in about 40- 50% of cases. I have not had the success that some of the literature states with this treatment, but it is a good option to offer your patients. I have not had any lesions go away completely, but smaller lesions have reduced my patients’ complaints. This. combined with a good orthotic, has been a good alternative for patients who do not want to have surgical excision of the lesion. The verapamil will cost about $80-100 for the treatment course.

Rick Wittock, DPM, St. Louis, MO, wittockr@sbcglobal.net

While I do not know of any research on the use of verapamil for fibromastosis, PDL labs has a patent on topical 15% verapamil gel and is promoting it for plantar fibromatosis, Dupuytren's disease, and Peyronies disease. This does not mean that it has been FDA-approved for any of these conditions. Other pharmacies have received patent infringement letters for trying to compound it. This whole situation, including the advertising of unapproved compounded products, seems questionable to me, and so far the FDA has not commented about it.  

David Cauthon, RPh, AzPOD Class of ‘12, david.cauthon@azwebmail.midwestern.edu
 

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

Thanks to all for your helpful comments. I intend to work with her internist and get a rheumatoid panel, thyroid profile, as well as standard chem panel with Ca, alkaline phosphatase, and kidney function.  The question about low estrogen is very interesting, however. She is a track coach, exercises regularly, and is in the Air Force reserve. Although I can't recall the reference, I remember reading about the increased incidence of amenorrhea in slender, athletic young women. This did not come out in our pre-op H&P, but I will look into it.
 
For clarification, the subchondral microcysts were present prior to the surgery. The cysts were evident intra-operatively and confirmed by pathology. It is therefore impossible for the Orthosorb fixation to have caused the microcysts. On the other hand, the doctors in my group have used Orthosorb almost exclusively for our distal first and fifth met osteotomies for many years, and we have seen the "normal" osteopenia from hydrolysis many times, sometimes called osteomyelitis by our local radiologists - even though I have, several times, pointed out this reaction to the "invisible pins" to them. For some unknown reason, two pins in the first met never stimulates as strong a reaction as a single pin in the fifth. 
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

RE: Help For Israeli Podiatric Medical Association
From: Jonathan Rosenblum, DPM

The Israel Podiatric Medical Association is at a crossroads. Today, we sat in Parliament in a meeting trying to outline a law that would grant us licensure, as well as guaranteeing a scope of practice. We came up against significant resistance both from the orthopedists and the  the Ministry of Health. One of the decisions that was made was that our association would review the official scopes of practice for each individual U.S. state, as well as any defining documents on a national/ federal level. Is there also any document that defines what a DPM can do straight out of podiatry school?

I appreciate any help on the matter.

Jonathan Rosenblum, DPM, Jerusalem, Israel, jrosenb@bezeqint.net

RE: Prescribing Pain Medicine to an Addicted Patient (Name Withheld)
From: Paul Kruper, DPM, Elliot Udell, DPM

It is my understanding  that in CA doctors are allowed to prescribe narcotics to an addict to treat a pain problem. Docs are not allowed to prescribe narcs to an addict to treat his addiction. That can only be done by specific docs treating the addict at specific clinics. It sounds like the pain management specialist has acted as a consultant to the DPM to recommend a prescribing plan to treat his pain, not his addiction. The higher than normal dosage would be expected in an addict who has a high tolerance to narcs. This sounds like an appropriate sequence of events to treat the patient’s pain and would probably pass the regulatory smell test.

Paul Kruper DPM, Kingsburg, CA, prkruper@yahoo.com

Prescribing narcotic analgesics, other than for patients who are post-op, can create serious problems for podiatrists. Law enforcement authorities are eager to bring the wrath of the law down on physicians who prescribe opioids for pain management. A friend of mine, who is an MD specializing in hematology, prescribed narcotic analgesics for a patient he saw in the hospital who was suffering with severe pain associated with sickle cell anemia . The local authorities got wind of it and pressed charges against him. He won the case, but his legal fees, as well as the toll it took on him and his family, taught him a lesson.

I know pain management specialists in this area who prescribe oxycontin and similar drugs with impunity to patients suffering with chronic pain conditions. There is a double standard. So, if a patient comes to me who has seen another doctor in a different locality, and wants a refill for narcotics, I refer them to one of the pain management centers in this area. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Standard of Care (Michael A. DeVito, DPM)
From: Allen Mark Jacobs, DPM, Richard W. Boone, Sr.

Increasingly, we are being told that "standard of care" is a legal concept, and that, as doctors, we can comment on "standard of practice", not standard of care.

A wise older general surgeon once defined "standard of care" best to me. He told me "Jacobs, the standard of care is whatever the expert tells the jury it is." That is, practically speaking, and in reality, the truth.

Allen Mark Jacobs, DPM, St. Louis, MO, sbcglobal.net

With all due respect, the term "Standard of Care" is NOT a term that any podiatrist should ever use. It is a legal term and not a medical term.  Using it to describe or define the universal boundaries of good clinical practice will certainly lead your entire profession into a world of pain and heartache.
 
Published guidelines for clinical practice, such as those espoused by the ACFAS, may or may not be a good thing. That is a different discussion for another day.  But the one thing they ARE NOT and should never even be considered to be is the "Standard of Care."
 
Dr. DeVito got it absolutely correct when he noted that "Standard of Care is always case-specific, and in many instances it may also be location specific. But the one thing that "Standard of Care" isn't, and shouldn't be, is uniform or universal. What constitutes good clinical practice for one patient may well be absolute malpractice on another patient with the same apparent presentation.
 
So, argue to you hearts content about what is or isn't good clinical practice. But leave the question of "Standard of Care" to the courtroom, which is where it belongs. As far as I'm concerned, the "Standard of Care" in any case is what the jury determines it to be. And hopefully, that determination comes after I have educated the jury to the issues of proper clinical practice, using outstanding experts who know what they're talking about. It cannot ever be something determined by a committee of doctors, and frankly, you really don't want it to be that way in any event.
 
Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

HELP WANTED! NEW JERSEY
 
Busy podiatry practice located in northern New Jersey looking for a full time associate for an excellent opportunity for employment!
Please E-mail resume to njfootdoc@hotmail.com

ASSOCIATE POSITION - FREDERICK, MD
 
Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION – LONG ISLAND

Busy Wantagh, NY office. Motivated, preferably board certified, hard working, experienced in all phases of Podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.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 – 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 - 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

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

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