The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 08, 2010 #3,952 Publisher-Barry Block, DPM, JD

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Congratulations to Richard A Simmons, DPM of Rockledge, FL, winner of a two-night stay at a Kimpton Hotel located in Atlanta, Aspen, Baltimore, Chicago, Denver, Los Angeles, New York, Portland, San Diego, San Francisco, Salt Lake City, San Francisco, Seattle,  Washington, DC, and Elsewhere (value $558).

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 2011 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 a copy of Reconstructive Foot and Ankle Surgery: Management of Complications: Expert Consult - Online, Print, and DVD by Mark S. Myerson, MD (Value $229).

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

Toronto Podiatrist Provides Tips to Keep Children's Feet Happy

Our feet are the foundation of our bodies. If they are not functioning properly, it can be the source of pain in places such as the knees, lower back and neck. Here are some tips, courtesy of Toronto podiatrist Dr. Hartley Miltchin, to help your children have the best possible foot health.

Dr. Hartley Miltchin

* Parents often confuse leg pains with growing pains when they can actually be a result of foot problems. Growing pains occur usually in the evening. If the pain is in the shin or calf area, a massage will make the pain disappear. If the pain doesn't subside, it's foot pain.

* You should take your child to see a podiatrist before the age of six. At this time, there is a better chance of correcting foot problems. 
 
Source: Maria Tzavaras, InsideToronto.com [9/7/10]

PA Podiatrist Discusses Burning Sensation in Diabetic Feet

Question: My friend was recently diagnosed with diabetes. He complains that his feet feel very hot from time to time. Is this related to diabetes?

Dr. Lee J Sanders

Response: Lee Sanders, DPM: A painfully hot or burning sensation in the feet, especially in middle-aged and older people, could be caused by small fiber neuropathy. Diabetes is the most common cause of this condition; symptoms typically start with burning feet and numb toes. Even though your friend was only recently diagnosed with diabetes, if it is the cause of the burning in his feet, then he has probably had impaired glucose tolerance for years now. Peripheral neuropathy and peripheral vascular disease, which can be caused by diabetes, are potential culprits, and your friend should see his podiatrist or medical doctor for a foot screening.

Source: Diabetes Forecast  [September 2010]

Malpractice Costs Pegged at Over $55 Billion

Medical malpractice costs average about $55.6 billion annually, or 2.4% of annual healthcare spending, according to a Health Affairs analysis. The estimate includes defensive-medicine activities, such as ordering tests or treatments by physicians in order to avoid lawsuits, which alone costs about $45.6 billion a year, the study found.

The real cost of medical liability has been widely debated, according to the study published in the September issue of Health Affairs. Some studies have shown that on one hand, healthcare “is rife with errors and avoidable injury to patients. On the other, doctors and hospitals fear frivolous lawsuits and resent high malpractice insurance premiums.”  Tort reforms such as capping non-economic damages could reduce liability costs, but are likely to have little effect on overall healthcare spending, the study found. In the meantime, reform proposals such as moving away from fee-for-service reimbursement could have a greater impact.

Source: Jennifer Lubell, Modern Healthcare [9/7/10]

Build Tolerance

Evaluating your tolerance for discord is the first step toward improving your ability to handle difficult conversations and situations with success. Think about your last difficult conversation. If it lasted longer than 30 minutes, you have considerable tolerance and others probably find you approachable. If the conversation lasted just a few minutes—or seconds— build up your tolerance.

Suggestion: Work on extending those conversations. When you spot an “exit” from a difficult conversation, bypass it and keep going until you spot another “exit.” Build that habit and you will build your tolerance over time.

Source: Adapted from The Practice of Adaptive Leadership, Ronald Heifetz, Alexander Grashow and Marty Linsky, Harvard Business School Press via Communication Briefings

RE: Osseous Malformation (Greg Caringi, DPM)
From: Eric Edelman, DPM

I had one very similar case as this. My patient was a healthy female in her mid 30’s who sought treatment for a bunion deformity, with no recollection of a foot injury. We took x-rays in the office to look at the bunion and found a similar malformation of the bone as Dr. Caringi's patient. The patient was sent for an MRI. The radiologist got a second opinion from a musculoskeletal radiologist, and I got a report back that said something like, “possible congenital or traumatic abnormality, correlate clinically, consider biopsy.”

Under anesthesia, I took a biopsy with a trocar, which promptly fragmented the whole piece, so I cut out the rest of the deformed bone. It looked like normal bone and bled like normal bone after I released the tourniquet, so I went ahead and did her bunion surgery at the same time. The pathology report came back as normal bone and the patient had an uneventful recovery from her Austin/Akin procedures.

Arguments could be made that the deformed bone was best left alone or that taking a bone biopsy and doing bunion surgery at the same session wasn’t the best practice. 
 
Eric Edelman, DPM, Syracuse, NY, ericedelman@gmail.com

RE: Manipulation Videos (Stanley Beekman, DPM, Robert Bijak, DPM)
From: Narmo L. Ortiz, Jr., DPM

Dr. Beekman's response is well appreciated and understood, but I respectfully think he is missing the point. Dr. Bijak referred to the current crisis of our profession's current inconsistency in training and definition of scope of practice. While Vision 2015 will be addressing standardization of training, will they also address equality of scope of practice in all states of the Union?

Narmo L. Ortiz, Jr., DPM , Cape Coral, FL, nlortizdpm@embarqmail.com

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

Thank you, Dr. Pressman for an eloquent rationale behind the use of phalangeal base hemi-implants. Until Dr. Mullen's post, I was unaware that anyone was still using Silastic implants, hemi or total, for the very reasons cited. Like my colleagues in the early 1980's, I implanted Silastic hemis for intractable hallux limitus/rigidus with pain and had very good results. In fact, I had occasion to x-ray one of those patients, for a different problem, about 12 years after her bilateral procedures (one year apart). The implant was no longer distinguishable as an entity but the "joint" remained pain-free.  Certainly, I am aware of the many complications reported with those devices, but I removed none. Perhaps I just did not do enough of them.

I subsequently changed to the BioPro hemi for its very long history of success and ease of implantation, and remain pleased with the results. I cannot claim 100% success with any procedure that I perform, from nail matrixectomies to pan met head resections, but the BioPro hemi-implant, in my hands at least, has a proven track record. 

The old adage "Whether the pitcher hits the stone, or the stone hits the pitcher, it's going to be bad for the pitcher" applies aptly here. The purpose of a hemi-implant, whether phalangeal base or metatarsal head, is to eliminate painful bone on bone motion. If the surgeon is more comfortable replacing a damaged metatarsal head than a less damaged phalangeal base, as long as the result is a pain-free functional joint, does it really matter? We certainly want our older patients to remain as active as possible, so let's just remember on whom we're performing these joint destructive/replacement procedures. These are generally not 25 year-old professional athletes.
 
Jeffrey M. Kittay, DPM, Boston, MA, twindragons2@verizon.net

RE: Keller with Chondroplasty (Martin Pressman, DPM
From: Michael Turlik, DPM

Cohort studies may be considered Level-2 evidence if properly planned and reported (1). Cohort studies can be defined as: “Involves the identification of two groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest.” (2)

After Dr. Pressman’s posting, I read the abstract of his article "A Retrospective Cohort Study of the BioPro® Hemiarthroplasty Prosthesis." A series of 76 patients were evaluated retrospectively after surgery and multiple outcomes were reported. There was not a comparison group reported in the abstract. With all due respect to Dr. Pressman, his co-authors, and the journal, I believe this is not a cohort study, but a report of a series of cases. As a result, this is a level-4 study. From an evidence-based perspective, it is important because the inference drawn from a level-4 study is much weaker than from a level-2 study.

1. cebm.net/index.aspx?o=1025
2. cebm.net/index.aspx?o=1116
 
Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Scope of Practice (Richard Simmons, DPM)
From: Robert Bijak, DPM

Dr. Simmons is confused on many points. First, No one is speaking of grandfathering.  Second,  The point of podiatry not defining itself is clear, where in Florida podiatrists can work on the leg. He lauds Georgia as being so progressive due to political diligence vs. New Yorkers who are apparently backward. He reinforces my point that they are not just happy with the foot. So, are limited New Yorkers real podiatrists and Floridians and Georgian DPM's MD wannabe's? I'd like to see them give back their leg privileges! What about the old adage we've always heard, Dr. Simmons, "if you wanted to work on more than the foot, you should have gone to medical school"? Dr. Simmons is wrong in the states' rights issue. Though states' rights apply to MDs, they ALL have full scope in ALL states by nature of their educational philosophy as being physicians.
 
My point is that we need to make up our minds.  Are we just FOOT doctors who don't feel we should prescribe allopurinol or work above the ankle, or are we more in some states than others, or should we ALL have a common denominator and all do the same thing? This philosophy has to start with the profession itself and that usually means the schools. Project 2015 will not change the varied definitions of a podiatrist in different states.  

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

ASSOCIATE POSITION - SAN ANTONIO, TX

Immediate opening for motivated podiatrist with good people skills.  Associateship leading to partnership for the right applicant to help develop fast growing Northside San Antonio Texas practice. Attractive office and beginning income. CV and letter of interest to sadpmoffice@gmail.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

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 – 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

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.

PM News Classified Ads Reach over 12,000 DPM's and Students

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