The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 11, 2008 #3,345 Editor-Barry Block, DPM, JD

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CA Podiatrist Uses Titanium Stents to Treat Flatfoot

About 25 percent of the population has a condition called flat foot, a collapse in the arch of the foot. It can cause pain in the ankle, heel or leg and eventually the knees, hips, and back. But now some doctors are recommending a controversial fix.

Dr. Ivar Roth

Brian Horn is shooting in the 70s, and it feels good from his feet all the way up - a first after years of pain. Horn has flat feet. With no arch, Horn's weight fell on the inside of his foot, throwing off his body's alignment.

Doctor Ivar Roth rebuilt Horn's arch with this titanium stent. Through an incision in the ankle, the stent is placed inside the foot. It forms an arch by holding the bones in place. "It's instantaneous," said Roth, podiatric surgeon in Newport Beach, CA. "So, as soon as the implant is put in, the first step down, they notice that their knee pain has gone away because it corrects the position." He's now back in alignment. No more knee and back pain.

Source: Jean Enersen, KING 5 News [9/8/08] View video by clicking here

Its Running Marathons and Running Practice for ME Podiatrist

Who would have thought running the Boston Marathon would be a major factor in determining a career path? For Dr. Brad Samojla, it was. Samojla was considering a career in molecular genetics but in graduate school decided it wasn’t for him. “I took one year off, trained for and ran the Boston Marathon and (after completing the 26-mile run), I decided that I would become a podiatrist,” said Samojla.

Dr. Brad Samojla

Samojla is passionate about running — he has completed 40 marathons, numerous 5- and 10-kilometer races and triathlons, and has a goal to participate in an ultra-marathon (a 51-mile course). In addition to running, he likes hiking, painting, skiing and surfing.

Samojla and his wife, Dr. Christiane Gardner, also a podiatrist, came to Maine in 1994 to work in private practice. They were sole practitioners of Mid-Coast Foot & Ankle Center in Rockport, ME, which they closed in February. After closing the practice, Samojla worked for a practice in Windham until opening his Belfast practice, Waldo County Foot & Ankle. His practice is devoted to surgical management of foot and ankle problems and comprehensive diabetic foot care including preventative care, education and treatment of severe complications (limb salvage).

Source: Andy Kekacs, The Republican Journal [9/9/08]

We Need to Educate People About The Procedure We Perform: NY Podiatrist

“The health industry will be a great booming industry in the near future and there is an initiative through the APMA to bring more podiatrists into the career ASAP to prevent a huge shortage as the baby boomers age” , says Dr. Daniel Thomas Smith. Smith, a Cornell University graduate, continued his post-graduate education at the William M. Scholl College of Podiatric Medicine and then Framingham Union Hospital for a combined primary podiatric medical residency and podiatric surgical residency. He was board certified in 2004 by the ABPOPPM and additionally certified in 2007 by the ABPS.

Dr. Daniel Thomas Smith

Smith says the most rewarding part of being a podiatrist is “Seeing my patients return to activities they enjoy doing.” And the most challenging part is “Trying to help someone who will not participate in their own care - the non-compliant patient.” Smith says that the most common misconception about podiatry is that 'we only trim toenails.' We need to educate more people about the many foot procedures we perform and the various admitting privileges at hospitals in the area.”

Source: Auburn Citizen [9/8/08]

Some Ways to Avoid Failure - Part 2

Psychologists are finding more evidence suggesting that some people behave in ways that consistently result in failure. Some symptoms:

• Being surrounded by negative people. Analyze the people around you. Do they trust and believe in you? By surounding yourself with positive, uplifting people, you'll lift your own spirits and motivational level.
• Expecting failure. There is truth to the adage, "You get what you expect." Learn to expect the best.
• Being stopped by failure. Life is full of failures. Does failure make you stop or challenge you to work harder to reach your goals?

Source: Dr. Charles Dickson, Hickory, NC

Query: Verapamil for Plantar Fascia Nodules

At a recent seminar someone suggested using verapamil topically to treat plantar fascia nodules and they claimed it was beneficial. Has anyone tried this? How would it be formulated for topical use?

Jim Clark, DPM, Salinas, CA

Query: False Testimony by Expert Witness.
From: John Doolan, DPM

In a recent malpractice case in which a defendant's verdict was rendered, the expert witness, Gary Saphire, DPM testified under oath that I deviated from the standard of practice because I should have attempted conservative treatments before operating on a patient with hammertoes and a neuroma (see http://www.podiatrym.com/pmarticle.cfm?id=120 page 179, lines 24-25, page 180, lines 13-16, page 181, lines 4-7, and page 216, lines 4-7.) He then admitted that, in fact, the patiient had tried conservative treatments (page 219, lines 8-25, page 265, lines 17-18).

In addition, his testimony contains additional false statements and contradictions. What recourse is available to deal with experts who lie under oath?

John Doolan, DPM, NY, NY

RE: Pre-op Screening for MRSA (Howard Schultheiss, DPM)
From: Lee C. Rogers, DPM, Thomas A. Graziano, DPM, MD

We did nasal screens for MRSA on every podiatry pre-operative patient for the month of Nov 2007. Our intention was to direct our pre-operative antibiotics. Positive patients were prophylaxed pre-op with linezolid or vancomycin. We only had a couple of patients that were positive, despite several which I predicted to be positive based on past history of MRSA wound cultures. There is variation in the literature on the concordance of nasal swabs for MRSA to wound cultures. It is important the technique used to collect the swab specimen is appropriate, deep near the turbinates. What also must be considered are the different methods to identify MRSA, standard culture vs. PCR.

Dr. Robert Frykberg has been using nasal screens as part of the VA protocol in Phoenix to compartmentalize those with positive screens (regardless of diagnosis - open wound, infections, or not). So the two important questions are, 1. Are nasal screens for MRSA helpful in the pre-op patient? and 2. What do you intend to do with the data? I'm not sure we've proven that nasal swabs are helpful in the treatment decision. It might be more prudent to decide to use anti-MRSA prophylaxis if there are positive risk factors for MRSA (previous history of MRSA, multiple recent antibiotic use, recent hospitalization).

Lee C. Rogers, DPM, Des Moines, IA, Lee.C.Rogers@gmail.com

Dr. Schultheiss poses an interesting question. Studies do show that 25 to 30% of the population is colonized with MRSA either in the skin or nasal passages. What about the other organisms that inhabit our skin? The point is that there is no evidence-based medicine out there to support pre-operative screening for any skin flora. I believe if we ever even entertained the idea that there was a link between bacteria in one's nose and the possibility of a post-operative wound infection in the foot, we would be opening up a can of worms for the members of our esteemed legal profession to dine on.

After a thorough medical history, the most important parameters in preventing a post-operative infection involve excellent pre-operative surgical prep and surgical technique. Our patients with immunosuppression (diabetics, rheumatoid arthritics, alcoholics, HIV, etc.) certainly deserve special attention and should receive pre-operative prophylaxis.

Thomas A. Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: GA Podiatrist Ordered to Jail By Federal Judge
From: Gerald Mauriello Jr., DPM, MA

I was saddened to learn of Dr. George Vito's legal trouble. We should give this individual the benefit of the doubt before we persecute him in the court of public opinion. I am sure we are not privy to all the facts surrounding this case. Dr. Vito has done great things to advance our profession. It would be, in my opinion, a real black eye to podiatry if these allegations are in fact true. Let us hope for Dr.Vito and his family that they are not.

Gerald Mauriello Jr., DPM, MA, Toms River, NJ, mauriellodpm@gmail.com

RE: Patient Cell Phone Policy (Dale Shrum, DPM)
From: Multiple Respondents

Although we have a sign posted, “Please turn your cell phones off,” patients still use them in the treatment rooms. What are the policies/responses by my colleagues when;
1. Cell phone rings while taking a history or performing treatment?

a. patient answers and begins a conversation: I’ve only had this happen once. The patient waved me off so she could have her conversation. I left the exam room, told the staff to send the patient home and block them from the computer. I thought about sending her a bill, but ultimately decided against it.

b. patient answers and says, “ I’m at the doctor’s office. I will call you back.” This happens all the time; it doesn’t bother me at all.

Eric Edelman DPM Syracuse, NY, ericedelman@gmail.com

We also have notices posted that request that patients turn off cell phones in the office waiting rooms and treatment rooms. If a cell phone rings while the patient is in the office, a simple "please turn your phone off" works well.

Michael J. Schneider, DPM, Avon-Frisco, CO, MJS10Vail@aol.com

While patients wait for me I'm OK with short calls. Signs are in each room, asking patients to silence their phone's ring (or whatever the heck rap tune they uploaded).

A while ago a patient was in the exam room talking on her cell phone and despite my opening the exam room door a few times she kept yapping away. Looking in her chart, I noted her cell phone number. I went to my office phone, called her and asked if she wanted to reschedule her appointment. She got the message and ended her call. When I came into the room, her face was red but we both had a good laugh.

Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com

RE: Podiatrists With Outside Interests (Daniel Mendoza, DPM)
From: Karen Malley Banks, DPM

In response to the email regarding not wanting to read about podiatrists with outside interests... I strongly disagree. This newsletter is about podiatry management. One of the best management suggestions I have ever received is .."Get out a lot!!" Now this isn't a weakness I have, but I know some of my fellow physicians struggle with this. I love hearing about podiatrists who manage to be more than just a workaholic. Keep up the good work. If you don't want to read something.. use your mouse to scroll down past it. That is what I do with a topic that I am not interested in.

Karen Malley Banks, DPM, Thomasville, GA, kmbwwjd@rose.net

ASSOCIATE POSITION - CALIFORNIA

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

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

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

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