The Voice of Podiatrists

September 19, 2006 #2,692 Editor-Barry Block, DPM, JD

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Price Not a Good Factor in Judging Athletic Shoes: Pribut

Can youngsters get high-quality, cool shoes for $15 in a world where basketball shoes often top $120? NBA star Stephon Marbury, a point guard for the New York Knicks who was in Detroit to promote the $15 shoe Friday, lent his name to the Starbury One. He has committed to wearing the shoes through the coming basketball season. Spokesman Howard Schacter said there are plenty of skeptics on the quality of the shoe, asking whether Marbury wears orthotics. He does, as many NBA players do.

Dr. Stephen Pribut, a shoe specialist and podiatrist in Washington, D.C., didn't dismiss the shoe outright. It's possible to sell a shoe for that price if the shoe is manufactured and the materials are purchased in China. They are.

Dr. Stephen Pribut

"I wouldn't consider price as a good factor in rating shoes," Pribut said. "Though I would be skeptical at the $15 mark ... when looking at the other end, shoes retailing for $250, I'm skeptical, too."

Source: Margarita Bauza, Detroit Free Press [9/16/06]

PA Podiatrist Receives 100K NIH Grant to Develop Math-Based Foot Model

Philip H. Demp, DPM, MA, MS, PhD, Adjunct Clinical Professor at the Temple University School of Podiatric Medicine and Adjunct Professor, Temple University Department of Mathematics has received a $100,000 grant from the National Institutes of Health for a the research project entitled," Development of a Geometric Forefoot Model: A Tool for Clinical Decision Making." This will be a collaborative study by the Gait Study Center of Temple University School of Podiatric Medicine and the Motion Analysis Laboratory of the Hospital for Special Surgery in New York City.

Dr. Demp's contribution will be a proposed geometrically-based forefoot model based on his pilot study, "Morphometric Evolution of the Metatarsal Length Pattern: Biomechanical Implications." Dr. Demp will also be involved in constructing the geometric models, interpreting final results and co-authoring manuscripts. It is the ultimate objective of this research team to develop a mathematical model of the foot structure that is sensitive to aberrant function and can be used to plan more effective conservative and surgical treatments.

Bart Gastwirth Elected to ACFAOM Board

Bart Gastwirth, DPM, FACFAOM, of Arlington Heights, IL, has been elected to the Board of Directors of the American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) . He will begin his first 3-year term on January 1, 2007.

Dr. Bart Gastwirth

Dr. Gastwirth has been active in podiatric and medical education since graduating from the Illinois College of Podiatric Medicine in 1977, and is currently a Clinical Assistant Professor in the Department of Pediatrics, Section of Rheumatology at the Pritzker School of Medicine of the University of Chicago. He is a former Chairman and Professor in the Department of Orthopedics at the Scholl College of Podiatric Medicine. As a member of the core faculty of the podiatric surgical residency program at Advocate Illinois Masonic Medical Center, Dr. Gastwirth places emphasis on the development of residents to include public service.

He has served as a member of the Board of Directors of the Illinois Podiatric Medical Association and as a member of the Podiatric Section Council of the American Public Health Association. Dr. Gastwirth has authored numerous peer-reviewed publications and has lectured nationally and internationally.

Query: Cold Sterilization Mixture

When mixing solution for instrument trays, must you use distilled water or is tap water fine? Are there are any regulations governing this?

Cynthia Ferrelli, DPM, Buffalo, NY, drfoot@adelphia.net

RE: "Worst Jobs With Best Pay"
From: Earl L. Cherniak, DPM

It is the same prevailing problem that our profession has had and will have unless we remove the stigma of podiatrists "not being real doctors." It is an insult to be classified in this category. The optometrists and chiropractors do not do surgery and, to the best of my knowledge, only prescribe few if any internal medications. We must be classified as physicians and the only way that our profession will achieve this is by changing the curriculum of our colleges to enable our graduates to attain a medical or osteopathic degree.

Earl L. Cherniak, DPM, DSc.(Hon), Los Angeles, CA
drearlcherniak@aol.com

RE: Lamisil for 12 Year Old (Multiple Respondents)
From: Bryan C. Markinson, DPM

Dr. Howard Fox's response and experience with a child suffering emotionally is the appropriate reply to Dr. Smith. He can probably see better examples of unfit parents during a trip to the local supermarket. Dr. Spielfogel marches in step to the PDR recommendations, which of course is generally prudent advice. I am sure however, that if one of his kids needed a tonsillectomy, he would not balk at the post-operative injection of Marcaine, even though that too "should not be used in children." Regarding "lack of clinical evidence in children," there is in fact plenty of evidence.

Gupta, et al., published an important paper entitled "Onychomycosis in children: prevalence and treatment strategies. J AM Acad Dermatol. 1997;36:395-402." The main points of the article were:
1) Onychomycosis is uncommon in children
2) Diagnosis should be confirmed before treating with oral agent
3) Important to inquire about onychomycosis, tinea pedis, and other superficial fungal infections in patient, siblings, parents, and other family members
4) Although not approved for use in children with onychomycosis, oral agents have been shown to be safe and effective.

The article recommends the following 90 day dosing schedule based on kg of body weight:
Terbinafine
<20 kg: 62.5 mg/day
20-40 kg: 125 mg/day
>40 kg: 250mg/day
Duration of treatment: Toenails - 12 weeks, Fingernails - 6 weeks

I have been using this dosing schedule for about 7 years, on approximately 3-5 kids per year. I have treated no patient younger than 9 years old. It is definitely off-label use and I have all of the pertinent informational discussions with the parents. Lately, I have started using off-label pulse-dosing of Lamisil in both adults and children with spectatcular clinical results. This dosing uses 70% less drug, and due to an 11-week drug holiday between pulses, the risk of hepatic injury is virtually nil. For the definitive study, see: The Successful Treatment of Trichophyton rubrum Nail Bed (Distal Subungual) Onychomycosis With Intermittent Pulse-Dosed Terbinafine, Nardo Zaias; Gerbert Rebell. Arch Dermatol 2004; 140: 691-695.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@msnyuhealth.org

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

FOR SALE - ORTHOTIC LAB EQUIPMENT

Supreme Dual Vacuum Press from Gateway with Gast Vacuum Pump, silencer and filter. full description of features upon request. Originally $1200, Like New $ 750 drmorse@northpod.com

PRACTICE FOR SALE - BERKELEY CALIFORNIA

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

ASSOCIATE POSITON - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

EQUIPMENT WANTED - X-RAY Machine

I am looking for a used x-ray unit, preferably no older than 15 years. EXCEL units or units of this type are appropriate for my needs. If you have a unit, with or without the stand, please e'mail a picture and relevant information to me at drkarendpm@aol.com I can also be reached at 619-892-3549. Shipping would be to Southern CA.

ASSOCIATE POSITION – NEW ENGLAND

Opportunity in growing New England practice. Well established and respected practice with large office and surgicenter, latest technology, great staff, loyal patients and solid referral base. Close proximity to hospitals, full scope practice. Opportunity for partnership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and contact info to: Footdoc-office@usa.net

ASSOCIATE WANTED - SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

SEEKING ASSOCIATE POSITION IN TEXAS, DFW AREA

PSR-24 trained podiatrist seeking a FT associate position with possibility of future partnership. Trained in all aspects of podiatric medicine including forefoot and rearfoot surgery, and diabetic limb salvage. Email: fixfeet@hotmail.com

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