The Voice of Podiatrists

Serving Over 13,000 Podiatrists Daily

September 14, 2011 #4,259 Publisher-Barry Block, DPM, JD

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IL Podiatrist Discusses Flat Feet in Children

Flat feet, a condition involving the total or partial collapse of the arch, is not usually a cause for concern since most kids outgrow it. But if not closely monitored or treated in more serious cases, it can lead to aching legs, sore knees, clumsiness, and excessive muscle fatigue. "A lot of things start from the ground up," said Dr. Breck Tiernan, a podiatrist at the Advanced Foot and Ankle Clinic in Joliet. "If the feet aren't properly aligned, everything else can get messed up." 

Dr. Breck Tiernan

Tiernan estimates about 20 percent of his patients are younger than 18 with some as young as 3 years old, but most come in for ingrown toenails, warts or other unrelated ailments. Some, however, need help with flat feet. Typically, he said, parents start noticing flat feet in their children as they get more involved in organized sports. One patient, he said, was a runner in high school and noticed she had pain only when she ran. She tried physical therapy and eventually found herself in his office because of her flat feet. A simple custom orthotic corrected the problem.

Source: Alicia Fabbre, Chicago Tribune [9/14/11]

NY Podiatrist Collects 600 Backpacks for Needy Students

Dr. Kathy Reilly Fallon, of Armonk, is a physician in Manhattan, and she loves her job, but her real passion is her charitable organization called Heavenly Productions Foundation, which donated over 600 backpacks to Public School #23 in Yonkers Friday, September 9th. 

Dr. Kathy Fallon (L) with students

“I grew up in Yonkers,” Fallon said. “I just felt like I was done writing checks to these organizations and not knowing where the funds were going. It was great to physically collect the backpacks and go to the school so we knew that these kids were reaping the benefits of what we were doing.” Fallon, along with six youth helpers – including her son James, collected backpacks and donations from friends, family members, and businesses so that they could provide each student from pre-kindergarten to eighth grade with a new backpack.

Source: Dan Curtis, The Daily Armonk [9/13/11]

IL Podiatrist Joins Father in Practice

Dr. Adam Bryniczka has joined his father Gregory C. Bryniczka, DPM at The Center for Surgery in Naperville. Bryniczka began his studies at the University of Connecticut before earning his doctorate of podiatric medicine at Rosalind Franklin University of Medicine/Scholl College of Podiatric Medicine in 2006. 

Dr. Adam Bryniczka

Afterwards, he completed three years of reconstructive foot and ankle surgical training at the Yale University Hospital residency program. In his final year of training, he served as the chief administrative resident at Yale University Hospital/DVA Healthcare Systems in 2008-2009.

Source: Chicago Sun-Times [9/13/11]

AZ Podiatrist Delivers Key Message to Burn, Wound Surgeons in Bangkok

Dr. David G. Armstrong, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage (SALSA) delivered messages of hope and healing for people with diabetes at risk for amputation at a conference in Bangkok today. The 8th Asia Pacific Burn Congress and 3rd Congress of the Asia Wound Healing Association held a novel joint-symposium  that brought together more than 800 surgeons, physicians, and nurses from Asia and beyond. 

Dr. David Armstrong in Bangkok

"Seeing the sophisticated combination of technique, technology, and team proliferating throughout the Asia Pacific Region means good news for people with acute and chronic wounds," noted Armstrong. The symposium, held at the world-renowned Bangkok International Trade and Exhibition Center (BITEC), featured invited speakers from around the developed and developing world.

NuvoLase Inc. Acquires All Assets and Rights to the PinPointe FootLaser™

NuvoLase Inc., a Delaware corporation, announced today it has acquired from PinPointe USA all rights, assets, and intellectual properties associated with the PinPointe FootLaser. Pursuant to its agreement with PinPointe USA, NuvoLase also gains access to all current and future product development activities. As part of the transaction, NuvoLase also has access to all the regulatory clearances for the FootLaser, including the FDA clearances, CE Mark, TGA, and Health Canada.

NuvoLase Inc. also announced today that it has selected a seasoned veteran with significant medical, laser, and industry experience to take this business opportunity to new levels. Effective immediately, Mr. Steven P. Duddy has been appointed President and CEO of NuvoLase and will also serve as member of the company’s Board of Directors.

Rural Docs Sign on for EHRs: Sebelius

Tens of thousands of physicians have signed up for the federal electronic health-record system incentive payment program, and the federal push appears popular, in particular, with rural clinicians, the Obama administration's senior health official said Monday.

HHS Secretary Kathleen Sebelius told a gathering of health IT leaders in Washington that more than 80,000 physicians have registered for the EHR incentive payments authorized by the American Recovery and Reinvestment Act of 2009. Also, about 70% of primary-care providers in small rural communities have signed agreements with regional extension centers, which were created by the law to give providers advice in purchasing and installing EHRs, among other IT consulting services.

Source: Rich Daly, Modern Healthcare [9/13/11]

Query: Sending PHI Securely

I'd like to find out if there is a secure way to have patients complete new patient forms, including demographic and medical history information, and have this sent electronically from a private office's website to a host server in the office. Is there a way to ensure security for this information?

Steven Block, DPM, Owensboro, KY

Query: Digital X-Ray Processors

I am trying to decide on which digital x-ray processors to purchase and have narrowed it down to the following: iCR3600SF or the Fuji-film Prima. Has anyone had any experience with these companies or  products? The iCR3600 is sold through Henry Schein and Gill Podiatry and is a flat scan path technology with Tigerview software. The Fuji-film is sold through local x-ray servicing companies. Any input would be most appreciated.
 
Rhonda Eichenberger, DPM, Louisville, KY

Query: Extended Medial Column Arthrodesis

A surgeon performs an arthrodesis fusing the talonavicular, naviculocuneiform, and intercuneiform joints, as well as the 1st, 2nd, and 3rd tarsometatarsal joints. Is all of this work covered by a single code, CPT 28730 (arthrodesis, midtarsal or tarsometatarsal, multiple or transverse)?

Heidi Stout, CPC, New Brunswick, NJ 

Response: When reviewing the existing code options, CPT 28730 does fit the procedure description you gave, but certainly doesn't properly reflect the work done when so many fusion sites are performed. I don't think it would be appropriate to bill PCT 28730 multiple times; besides, it would in all likelihood be kicked out by the computer as duplicate billing.

You have, I believe, two options: 1) the addition of modifier "-22" to CPT 28730, indicating that the services were significantly greater than that usually required by the code or its value; or 2) code the entire surgery as an unlisted foot procedure, CPT 28899, and provide a detailed operative report and letter of explanation. Be sure, regardless of your choice, to request individual consideration by peer review.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: MTPJ Stabilization with AVN (Tip Sullivan, DPM)
From: Gerald Mauriello Jr., DPM, MA, Kenneth Meisler, DPM

If there is no pain, then what is your rational for surgery?  Like you said,"the x-rays look worse than the clinical exam."  A wise man once told me while I was a resident, "We don't operate on x-rays."  If it does't hurt and without any compelling reason to operate, why do it?

Gerald Mauriello Jr., DPM, MA, Freehold, NJ, drmauriello@gmail.com

Dr. Sullivan states that "The third MTPJ is not really painful. There is limited but pain-free motion at the third MTPJ- it looks much worse on x-ray than it is clinically." Why are you proposing surgery at this point? The patient may be worse off after the surgery, even if the x-ray looks better.
 
Kenneth Meisler, DPM, NY, NY, kenmeisler@aol.com

RE: Posting Cases On-Line (Barry Mullen, DPM)
From: Tip Sullivan, DPM

I always enjoy the contribution that Dr. Mullen makes to this forum, but I did get distressed regarding part of his last post which seemed to slam this forum.  He writes, "Every week, on this website, in one breath, I read some of our colleagues providing opinions on various medical conditions...some of which are just dead wrong...in some cases, laughable, especially when discussing conditions that mandate multi-specialty involvement, like CRPS as one example...while in the next breath, other colleagues ask opinions about certain conditions, or seek help in establishing diagnoses for given sets of signs and symptoms. If you have to ask...DON'T TREAT...REFER!"
 
One of the reasons that I participate in this forum is to get other opinions about some of the problems I see in my little world of feet. I do not find comments made here "laughable"--except for the ones intended to be so. I may not agree with some medical or foot-related opinions and I may think some are incorrect. This is a forum to share with our colleagues, the good, the bad, and even the ugly. I do not believe that listening to others' opinions on a difficult problem should be interpreted as "this person doesn't know what to do so he/she is asking for help." I will continue to post interesting cases here and ask for my colleagues' opinions as long as I am allowed, and would ask Dr. Mullen to do the same. I promise I won't laugh.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Professional Attire (Alan Mauser, DPM)
From: John Sherman DPM
 
In the last 10 years, multiple articles have been published concerning the harboring and transmission of pathogens on various items physicians carry and use, including pens, I.D. badges, lanyards and articles of clothing, most notably the necktie. Here is a link to one such article on the Internet:
 
Usually the tie is made of fabric that is not washed but must be dry cleaned, and this is not done after every wearing. Many will use neckwear without cleaning until a visible stain is noted and sometimes not even then.  However, scrubs, shirts, lab coats, and most trousers can be washed after each use.
 
In this regard, I wear a dress shirt without tie or turtle neck in the winter, cotton blend trousers and a lab coat. The coat is laundered by the service our group uses, while my clothes are washed at home after each use. I also recall a few years ago, Warren Joseph, DPM mentioned in one of his lectures that he has a similar practice of dress and even carries a bottle of hand sanitizer with him to apply after touching a hospital chart or keyboard.
 
John Sherman, DPM, Medford, MA, John_Sherman@vmed.org

RE: APMA Nixes MD/DO Referendum
From: Jon Purdy, DPM

I would add to the argument that our isolation and exclusion is harming the population in need of the expert care that only we can provide. Doctors of osteopathic medicine have maintained a degree equal in scope to that of the medical doctor, yet continue to educate themselves above and beyond that of the medical doctor prior to entering residency. It would be no different with a combined degree for podiatrists.

The argument based on the comparison of dentistry to podiatry just doesn’t hold water. Dentistry is an entity all its own. There are approximately 150,000 dentists in the U.S., which provides much stronger support in lobbying for their interests. Dentists have maintained a significant separation from insurance constraints, which we gave up long ago. Dentists do not struggle with competition from other medical specialties.

The word “dentist” has been around for well over 1,000 years, where the word “podiatrist” has been in existence since...

Editor's note: Dr. Purdy's extended-length letter can be read here.

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Priced for quick sale. Real estate available for purchase. Please call 800-983-4194, or e-mailcontactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - ARKANSAS

Busy, well established practice of 13 years grosses 160K/year for the past 5 years, while working 3.5 days/week. Nursing homes available. 50% Medicare, average of 15 new patients/week. Doctor retiring. Please call 800-983-4194 for more details, or e-mailcontactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - NORTH DALLAS, TX

Great opportunity; 26 year old solo practice, reasonably priced. General practice consisting of hospital surgery, office surgery, orthotics, children, adults, geriatrics. Turn-key office located in medical building inside Loop 635. Will consider owner finance with down-payment.dallasfootdr@yahoo.com

PRACTICE FOR SALE - SOUTHERN OH

Busy, well-established, full-time home visit practice. 100% referral-based. Wound care, pain management, routine care & DME’s. Excellent income, low overhead. DPM relocating out-of-state for family. Contact: nanetter@zoomtown.com

ASSOCIATE POSITION - MANHATTAN

Experienced podiatrist wanted – Position available for per diem podiatrist (weekly and vacation coverage) in Park Avenue office. Seeking experienced, kind and well-trained podiatrist with out-of-network capability. Starting at $50/hour. Please fax CV to 212-889-6150.

ASSOCIATE POSITION - PORTLAND, OREGON

Busy office with good steady referral sources looking to expand. Areas of expertise wanted: wound care, surgery of all aspects, knowledge of running an office. Please come with good personality and hard work ethics. New main and satellite offices. mail: office.pfac@gmail.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

ASSOCIATE  POSITION - LONG ISLAND, NY

Immediate Position Available for motivated individual in well established,  diverse office. South Shore of Long Island. New Graduates will be considered. Send CV to dsmith4177@gmail.com

FULL-TIME ASSOCIATE POSITION – NORTHEASTERN PENNSYLVANIA (LEHIGH VALLEY)

Well-established, rapidly growing practice with multiple offices. Motivated, ethical and personable with well-trained PSR-24/36. Modern office’s with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package with partnership opportunity. If interested please fax your CV, letter of intent and references to: 610-432-4887.

ASSOCIATE POSITION - SOUTH CENTRAL PA

Martin Foot and Ankle, largest provider of foot and ankle care in South Central Pennsylvania, is seeking a full-time associate interested in future partnership. Practice facilities and technologies include: Surgical Center, in-office Physical Therapy, six appointment locations, in-office MRI, digital x-ray, PSSD and PVR testing, diagnostic ultrasound, and Electronic Medical Records. We are looking to hire candidates with a minimum of a three-year surgical residency. Experience in rear foot and forefoot reconstruction, including complex nerve releases of the foot and leg, Charcot arthropathy, and arthrodesis is helpful. E-mail CV to mfatrans@aol.com

ASSOCIATE POSITION - CANADA 

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - NORTH OF BOSTON

Seeking part-time podiatrist for both office and nursing home work. North Andover, MA (North of Boston) Could lead to possible partnership for the right person. jmclaughlin19@yahoo.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume toddavidphawk@yahoo.com

OFFICE TO SHARE - NYC (GRAMERCY)

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com

PM News Classified Ads Reach over 12,500 DPM's and Students

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