The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 09, 2008 #3,343 Editor-Barry Block, DPM, JD

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CA Podiatrists Comment on Grade-3 High Ankle Sprain

According to a news release from the (Golden State) Warriors, guard Monta Ellis sustained a torn deltoid ligament and a Grade-3 high ankle sprain and a syndemesmosis disruption (which is a tearing of the ligament that holds the fibula and tibia bones together). According to a couple of Bay Area ankle surgeons, speaking generally about the reports of what happened to Ellis, his ankle injuries are among the more severe one can sustain.

Dr. Catherine Cheung

"(Ellis') injury was an example of [abnormal] pronation," said Catherine Cheung, a doctor of podiatric medicine for Post Street Orthopaedics and Sports Medicine. "That's when you roll your ankle the other way and most of your weight is on your arch." The "Grade-3" category is the most severe of ankle sprains (there are only three grades).

Robert Verrette

Robert Verrette, a DPM for the San Jose Medical Group, said 12 weeks is the standard industry treatment guideline. He, like Cheung, said it is definitely possible for Ellis to make a 100-percent recovery with proper rehabilitation. But that doesn't lessen his sympathy for the Warriors star. "It's awful," Verrette said. "I wouldn't wish that injury on my worst enemy."

Source: Marcus Thompson II, Oakland Tribune & Inside Bay Area [9/6/08]

Haves Named New Barry Alumni President

Bradley Haves, DPM, is the new President of the Barry University Podiatric Alumni Chapter. “It is always a privilege for me to give back to Barry University in any capacity I can,” said Haves. “I am deeply honored to be appointed to serve as president of the podiatric alumni chapter.” Dr. Haves ’90 will serve a three-year term as president but it won’t be his first. Haves served from 1995-2000 as alumni president and replaces Marti Solomon, DPM ’95 who served since 2006.

Dr. Bradley Haves making alumni phone calls with Sister Linda Bevilacqua, OP, PhD

“I hope to encourage my fellow alums to take an active role in the alumni association,” Haves said. Working in private practice in Miami, Fl., Haves served as the president of the Dade County Podiatric Medical Society. Dr. Haves now serves as First Vice President of the Florida Podiatric Medical Association and will be installed as president in January 2009.

“Dr. Haves will give his all to serve the alumni chapter for the school and the university,” said associate vice president and School of Podiatric Medicine Dean Dr. Chet Evans. “We are proud and pleased to have him leading our alumni chapter as president.” Barry University recognized Haves as Alumni Volunteer of the Year 2001 as well as honored him with the distinguished Dr. Marvin D. Steinberg distinguished Podiatric Alumni Award by the School of Podiatric Medicine for his contributions to the school and the profession.

CFPM CEO Awarded National Conference Scholarship

The Canadian Federation of Podiatric Medicine (CFPM) has announced that Mr. Stephen Hartman, Chief Executive Officer has won the prestigious CSAE National Conference Scholarship. The Canadian Society of Association Executives (CSAE) is a national association that is Canada's "association of associations.” It consists of individuals who manage many of this country's most progressive associations.

Stephen Hartman

Each year Starwood Hotels & Resorts offers the National Conference Scholarship to CSAE executive members. The candidate for this elite scholarship must have demonstrated commitment to and involvement in CSAE at the national level. As a recipient of this award, Mr. Hartman will be attending the CSAE National Conference in Vancouver, British Columbia on October 2 to 4, 2008.

CFPM is a national association comprising duly qualified foot care practitioners who are committed to the foot health of Canadians. The CFPM represents chiropodists and podiatrists from across Canada in the provinces of British Columbia, Saskatchewan, Ontario, Quebec, Nova Scotia, New Brunswick, Newfoundland, and Prince Edward Island.

Practices Hit Medicare P4P Quality Targets, but Bonuses Still Fall Short

New results from the second year of a Medicare pay-for-performance demonstration project for large physician groups are both raising hopes and casting doubts about the concept's feasibility. Ten groups are participating in the Physician Group Practice Demonstration, a four-year effort that began in 2005. For each year of the project, the groups can receive up to 80% of the savings they generate for Medicare by preventing complications and hospitalizations. Practices' bonus payments depend on these savings and their quality scores.

All 10 groups hit performance targets on at least 25 of the 27 quality measures included in the project's second year, which ran from April 2006 through March 2007, the Centers for Medicare & Medicaid Services announced Aug. 14. Five practices achieved the goals on all 27 measures, which relate to treatment of heart failure, coronary artery disease, and diabetes mellitus.

However, only four groups qualified for performance bonuses, which totaled $13.8 million. After the first year of the demo, only two of the 10 practices did well enough to get back any money from Medicare.

Source: Geri Aston, AMNews [9/8/08]

Name Correctness Etiquette

Call patients what they want to be called. If a patient introduces herself as "Patricia Smith," she probably doesn't want to be called "Pat." Show the patient that you listened and call the patient by the preferred name.

Source: Adapted from Bottom Line Communicator

RE: Voltaren (Diclofenac) Gel (Richard A. Simmons, DPM)
From: Multiple Respondents

I wrote 6 prescriptions for Voltaren Gel 1% for the first time last week and about half of those required some sort of precertification from an insurance company. They want the patient to use an oral NSAID first! Go figure. This medication may be a very costly product to the patient and the doctor as well.

Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net

I have used the diclofenac gel, and especially like the Flector patch (also diclofenac). I have not seen results for neuropathy but have had excellent results for fasciitis, tendonitis, gouty arthropathy, injuries and capsulitis. Flector is better because there is a steady time-released dose throughout the day and night. I have used these in combination with NSAID oral meds but have seen no advantage. I believe that the strength of these medications is that they are local and have minimal systemic absorption, so you can use them without the oral medication. They can be used with blood thinners and in those patients with GI problems. It takes about three days to see improvement.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

There are a number of topical preparations of diclofenac on the market ranging from gels to sprays and patches. Some of these products are quite effective in the treatment of localized areas of pain and inflammation such as shoulder, knee and foot pain. In our office we have found Flector patches to be quite helpful in the management of plantar fasciitis and Achilles tendonitis. We also had some good results with off-label use of Solaraze.

We have not had good results with any of the topical NSAID preparations or oral preparations in the treatment of pain caused by neuropathy. As for systemic absorption, there have been studies cited by the manufacturers in their package inserts that the difference in plasma levels with the use of the topicals as compared to a single dosage of 75 mg. of diclofenac is 1:80. Another study I came across said that the difference is five-fold, the higher being the oral.

As for drug interactions, especially in patients taking Warfarin, I typed in one of the topical preparations into a drug interaction program along with warfarin and it did say that there is a possible drug interaction. The package insert, however, did not list warfarin as a drug interaction. My gut feeling is that there is probably minimal cause for concern, but I would advise monitoring a patient on warfarin closely for bleeding if you were using a topical NSAID.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Degenerative Changes in 3rd Met-Cuneiform Joint (Jeff Kass, DPM)
From: Rich Bouche', DPM, Robert S. Schwartz, C. Ped.

This is certainly an interesting though rare problem. Should all conservative measures not prove helpful, then surgery could be considered. Fusion of isolated lesser TMT's is difficult to accomplish so either you can fuse the first three TMT's or you could consider a unique procedure which I have had success with in dealing with intractable 4th TMT arthritis- a procedure I call "Keller of the 4th metabase." It involves removing the base of the 4th metatarsal making sure you are proximal to the adjacent intermetatarsal ligaments which must be preserved to maintain ray stability. You remove enough of the base to make sure there is no contact of the 4th metabase with the cuboid articulation when the foot is loaded. There is no need to interpose any tissue in the interval, as I have tried to interpose tissue (once w/ tendon autograft and once w/ tendon allograft) and both times wound dehiscence occurred, requiring graft removal.

This procedure has been excellent at relieving pain, and interesting enough, there has been no transfer pain or skin lesions on the adjacent metatarsals in the eight patients I have performed this procedure on. Clinically, the ray is stable with no excessive sagittal plane mobility appreciated. You could apply this procedure to the 3rd TMT as well though I have not performed this procedure on the 3rd ray. Hope this gives you another option for a difficult problem.

Rich Bouche', DPM, Seattle, WA, spmrtb@earthlink.net

Pedorthic treatment can prove extremely effective. Footwear modified with a Lisfrancs Rocker sole will provide the support while limiting painful motion during the propulsive phase of gait. MBT is well suited as a ready-made option.

Robert S. Schwartz, C. Ped., New York, NY, rss@eneslow.com

RE: Podiatrists With Outside Interests
From: Daniel Mendoza, DPM

I think it is wonderful that we can have a life outside of our busy practices and I wish I could cook a peanut butter caramel apple pie. However, I barely have time to keep up with PM News e-mails as it is and when I do I would like to read something constructive or informative to the practice of podiatry. I don't mind learning about great achievements or honoring those that we have lost but when I know that half of the information in PMNews is unusable, I begin to lose interest.

Let me apologize now if I have offended anyone with this statement. Perhaps I should lighten up.

Daniel Mendoza, DPM, Nashville, TN, mendozadpm@comcast.net

Editor’s comment: Yes, we agree with Dr. Mendoza that “it is wonderful that we can have a life outside of our busy practices.” PM News encourages our readers to share their interesting aspects of life outside podiatry. Think how boring it would be just to read about billing, coding, and clinical issues.

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – VIRGINIA

Well-established 2-office private practice in central Virginia, completely automated, modern, full scope of foot and ankle care. Position requires hindfoot/ankle reconstructive and trauma surgery experience. External fixation experience helpful. ABPS BQ/BC. Competitive base salary, incentive plan, malpractice, health insurance, retirement plan, vacation & other benefits. Partnership option available. Forward CV and letter of intent to: admin@vfasa.com

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

ASSOCIATE POSITION – NAPLES

Immediate opening for full-time associate position in SW FL. Surgical practice seeking PSR 24+ trained individual who is self-motivated and must be BQ/BC in Rearfoot and Ankle Surgery. Current FL license a plus for immediate start. Ilizarov or AO fellow a plus. Please email CV to: KLAMDPM@hotmail.com

ASSOCIATE POSITION AVAILABLE – OCEAN COUNTY, NJ

Seeking a full-time associate for well-established practice in Toms River. Searching for a hardworking, ethical and well-trained individual. MUST be willing to do all aspects of Podiatry. Competitive salary and benefits package. Immediate opening available. E-mail CV to NJFeet@aol.com

ASSOCIATE POSITION AVAILABLE- NEW YORK

Full-time associate position in our well-established Midtown Manhattan and Forest Hills practices. Well-rounded practice with hospital based surgery and all phases of podiatric care. We are seeking PSR 24/36 trained podiatrist with good surgical background. Compensation to also include malpractice expenses. Forward CV to slurie@papapc.net or Fax to # 212-753-3521

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net, fax to 410-486-2049, call Dr. Herbert Rosen 410-580-0255

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

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