The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 19, 2009 #3,653 Publisher-Barry Block, DPM, JD

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HAPPY NEW YEAR - 5770

Rocker-Bottom Shoes Can Strengthen Muscles: CA Podiatrist

Shoes that reduce cellulite? It sounds too good to be true, but experts say those promises may not be too far-fetched, as basic fitness principles meet the latest in physiological technology.

Dr. Victoria Foley

But can Shape-ups, and the similarly designed MBT shoes, really deliver? Yes, said Dr. Victoria Foley, a Long Beach podiatrist. Rocker-bottom shoes such as Shape-ups and MBTs have been around for years, prescribed mainly as medical devices for people with heel pain and arthritis.

The design works the gluteal muscles and helps strengthen the lower back, Foley said. "It's like being on a wobble board. You're constantly contracting your muscles," she said.

Source: Renee Moilanen, Press-Telegram (Long Beach, CA) [9/17/09]

Western College of Podiatric Medicine Holds First White Coat Ceremony

Members of the inaugural class of the College of Podiatric Medicine (CPM) took their first step toward becoming podiatrists at the Convocation and white coat ceremonies as part of Western University of Health Sciences’ traditional start of the academic year. Thirty-eight CPM students in the Class of 2013 donned their white coats for the first time, symbolizing their entry into the healing professions and serving as a reminder of the powerful influence of the healer.

Students at Western University's White Coat Ceremony

“It was a moment of fulfillment, of joy and excitement,” said CPM Founding Dean Lawrence Harkless, DPM. “I came here with the faith that it would work out. Through our hard work and perseverance and the university’s support, we were able to see it to fruition.”

The white coat ceremony marked the beginning of a professional career, said Richard Gardner, ’13. “I chose to be a part of this inaugural class because this school will offer the best education and, I believe in the coming years, the most sought-after podiatry program,” he said.

PA Podiatrist Receives Lifetime Achievement Award for Philanthropy

The Pocono Mountains Chapter of the Association of Fundraising Professionals will honor Drs. Rose and Joseph Mattioli with the lifetime achievement award at its annual National Philanthropy Day dinner on Nov. 12.

Dr. Rose Mattioli

Rose Mattioli, a podiatrist, and Joseph Mattioli, a dentist, came to the Poconos more than 45 years ago to invest in real estate and ski areas. After settling in Bartonsville, they opened Pocono Raceway in Long Pond in 1968.

The Mattiolis have donated to Pocono Medical Center for the Mattioli Emergency Center, and to the Mattioli Scholar Program, which awards 10 scholarships each year to students at area high schools. Additionally, the Mattiolis have donated a million dollars to Stroudsburg for Main Street beautification.

Source: The Allentown Morning Call [9/18/09]

Query: Social Networking and Podiatry

I was just wondering what anyone's opinion was on social networking in relation to your patients. I currently have a page on Facebook that I share personal things with my family and friends like pictures, etc. Recently, I have had a couple of my younger and older patients "friend request" me. This would give them access to these personal things that I may not want them to see. I know this will come up more and more as the social networking thing continues to explode. It is just funny that in this day and age we have to worry about offending our patients' feelings by "rejecting" their requests in order to maintain a separation between our professional and private life.

Nicholas Pagano, DPM, Conshohocken, PA

Query: Performing CPT 11750 After CPT 10060

I saw a patient with an infection on her toe, and performed and billed for an incision and drainage of abscess (CPT 10060). When the patient returned 7 days later for follow-up, the toe was still infected. After discussing treatment options, I performed a matrixectomy (CPT 11750) on the toe.

What modifier would I use so that CPT 11750 does not get denied? It was performed within the global period for the I&D?

Michael Perlstein, DPM, Brooklyn, NY

Response: The "-58" modifier would be perfect. It implies a staged procedure because of progression of the disease.

Walter Pedowitz, MD, Linden, NJ

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RE: Burning Pain, Plantar (Chuck Ross, DPM)
From: Multiple Respondents

The cause of burning is myriad. Your description of inconclusive tread mill and "adequate" circulation does not give enough scientific information to fully understand the involvement of possible ischemia. His Beta blocker and HCTZ can cause burning as described in the PDR as paresthesias. HCTZ causes sub-clinical gout, which could be felt as burning. Many podiatrists state that the patient’s podiatric neurological status is normal. Because we’re not allowed to deal with the back, we feel if the reflexes are normal, the back is okay. This is naive. Occult disc herniations cause burning without back pain.

Consider an MRI of the back. Also, does anyone run blood tests anymore? So many causes of burning can show in the blood. Everything from anemia to Waldenstrom's macroglobulinemia. Get a serum electrophoresis along with a comprehensive metabolic panel and CBC. I wish those citing case studies in this listserve would indicate something about the lab tests.

Robert Bijak, DPM, Clarance Center, NY, rbijak@aol.com
 
I just had an elderly patient (over 80), who was diagnosed with diabetes only 2y ago... neuropathy is the first thing that comes to mind. Other than tinea pedis, some causes for burning feet are: hypothyroidism (75% of whom have anemia), pernicious anemia, polycythemia, and vitamin deficiencies that cause demyelination of peripheral nerves (such as in alcoholism). If it's just the lateral aspect of the feet, it could be a herniated disc. Interestingly, according to an article by Louis G. Pack, DPM, insulin can cause diffuse pedal burning!

Roody Samimi, DPM, Sacramento, CA, roody.samimi@gmail.com

I had a patient who had much the same symptoms. One day, he said that if I didn’t help him, he would shoot his feet off. Luckily, he had a savvy PCP who recognized the problem. He had his gall bladder removed and the symptoms stopped completely.  
 
Laurence Rogers, DPM, Rochester, IN, larrydpm@rtcol.com

RE: Implant Data (Charles F. Ross, DPM)
From: April C. Borchardt, DPM, Howard J. Bonenberger, DPM

I would recommend reviewing the following article: Cook, et al. Meta-analysis of First Metatarsophalangeal Joint Implant Arthroplasty. JFAS 2009; 48(2): 180-190.

It is a very interesting study, and in the era of evidence-based medicine, it is a Level-1 study. The results showed survivorship of implants to be 86% at 10 years and 82% at 15 years. They also noted patient satisfaction to be 94.5%. The study reviews not only metallic implants, but silicone and ceramic implants as well. 

In my opinion, success of the procedure comes down to proper patient selection, and this is discussed in the above mentioned study.
 
April C. Borchardt, DPM; Green Bay, WI, april.borchardt@yahoo.com

I cannot speak to the 'high pounds per square inch' that Dr. Ross' orthopedic colleagues cited, however, I have an observation that may explain their impression. I have had 10-15 cases over the past 25 years. I have seen post-op feet and x-rays after an orthopedic surgeon has implanted the joint with some form of silastic implant, sometimes an old style hemi-implant and in others it was a full-hinged joint implant. I have seen these patients because their pain or stiffness had returned or had never gone away after the orthopedic surgery.

I have re-operated on most of these and the absolute common denominator in every single one of these was woefully inadequate resection of bone at the time of the first surgery. Often, just a few millimeters of cartilage was removed and then replaced with an implant about 10 times thicker. As a result, the joint implant was under a constant compression load. This led to stiffness (from the decreased freedom of movement), peri-articular osteophyte formation, and ongoing pain.  I do not know how carefully or completely the associated tight soft tissues were released (although I have a guess). Ergo, the orthopedists' conclusion that these don't work. 

When they see the stiffness and osteophyte formation, they are assuming that it is from this excessive pounds per square inch load from weight-bearing and not from technique-driven failure. As most of the weight-bearing pressure in a normal functioning hallux/MTPJ is between the sesamoids and the metatarsal cartilage, I don't see that there is an overwhelming weight-bearing-related compressive force that would lead to implant failure if the soft tissues are properly released and the bone is adequately resected.

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: LocalPodiatry.com
From: Kyle J. Kinmon, MS, DPM

LocalPodiatry.com is an online advertising company represented by Bobby Narang, who claims advertising on-line for no up-front, out-of-pocket expenses, and no contract or commitment. He told us that we would be billed $20 per patient that made an appointment at our office through their service. He specifically said we would not be billed for calls that did not materialize into appointments.

We signed up in June for a $10 set-up fee. Our credit card was charged $1,330 in July, $1,150 in August, and $1,420 in September. A total of only 10-15 appointments were made through the service, at the most.

When I called to request credit back to my card and to cancel the service, we listened with Mr. Narang to calls that came through their service. There were multiple hang-ups, wrong numbers, wrong type of doctor, weekend calls to voice mail, etc. He agreed we should be credited, but said their company policy is to NOT issue credit to credit cards but to credit our account. That would be over $3,500 in credit! This sounds like quite a large out-of-pocket, up-front expense to me! Also, how could we end our relationship when he owes us that much money?

I am disputing the charges with my credit card company, and when we went back with them to listen again to the calls, Bobby had deleted everything. He also put the last charge through AFTER I called and asked to end our relationship.

Kyle J. Kinmon, MS, DPM, Boca Raton, FL, kkinmon@aol.com

RE: Congressman Shadegg's Apology
From: Patrick J. Nunan, DPM

After reading the apology letter to Dr. Stone, I still believe the congressman is mistaken about our profession. If you read it carefully, he seems to justify mentioning us in his speech because we are either a mandated or an optional service. He mentioned that what he was against were mandates that can make healthcare costs increase. In many states, we had to be mandated because of discrimination and lack of recognition as physicians by Medicaid. So, was his letter a true apology?

Patrick J. Nunan, DPM, West Chester, OH, pjndpmrun@aol.com

RE: Obama’s Healthcare Plan (Eliot, Udell DPM)
From: Robert Scott Steinberg, DPM, John Moglia, DPM

Three weeks ago, I had the opportunity to address Congresswoman Melissa Bean (D.IL 8th) on healthcare issues from the doctor's perspective at a local chamber of commerce breakfast. I touched on everything Dr. Udell did, and the fact that physicians are fed up and are quitting practice a much younger ages. I also added a suggestion. I asked the audience if they would call one of their physicians and offer to take them to dinner for the express purpose of learning what it is like to practice under the thumb of the insurance companies, and whether they are planning on retiring early do to this and the lack of tort reform. A year and a half ago, I had the opportunity to address Senator Richard Durbin (D.IL) and expressed the same message.
 
I just sent a fax to Senator Durbin regarding S.654. Everyone needs to send letters to their Senators, today!
 
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

Am I missing something? Why re-invent the wheel? Medicare is a program that already works for the retired but is in danger of being bankrupted. Why not extend the program to the relatively young and healthy who pay higher insurance premiums, but don't utilize services as the elderly? I pay $13,000/ year for my young family, and rarely use services.

John Moglia, DPM, Berkeley Hts., NJ, drjohnmoglia@aol.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - CHICAGO AREA

Well-established, state of the art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

ASSOCIATE POSITION – NYC

Expanding Joint Commission Accredited Surgical and state of art medical podiatry practice seeks part-time ABPS Qualified/Certified podiatric surgeon on two weekdays in Flushing, Queens and on Saturday's in Midtown, Manhattan. Email CV and cover letter to EcksteinDPM@AOL.com

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - HAMPTON BAYS/LONG ISLAND, NEW YORK

Growing Suffolk County podiatric practice seeking a part-time associate that could lead to a future partnership opportunity. The ideal candidate must be highly motivated, have excellent communication skills, be flexible and have exceptional clinical abilities. We are a 15+ year well-respected established practice. If you are interested, please fax your current resume in confidence to: Wendy at (718) 723-5627 or via e-mail: Wendymakarowitz@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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-  SOUTHERN CALIFORNIA

Looking for board certified/board eligible ABPS associate to join a multi doctor practice with 2 offices. May lead to eventual buy-in and purchase. Must have minimum 2-year residency and comfortable with rearfoot procedures and diabetic care, ER call. Must be dependable, honest, ethical individual. Send cover letter and CV to familyfootcenter@earthlink.net

ASSOCIATE POSITION – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

ASSOCIATE POSITION -  WASHINGTON, DC 

Interested in working in Washington D.C.? Our group is looking to add a highly motivated, hard working, well trained podiatrist to our practice. Must have surgical training. We have a very busy multi-office practice. We practice state of the art podiatry with EMR and digital radiography. Associate to partner on a fast track for the right person. E-mail CV and cover letter to Washingtonpod@aol.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

PM News Classified Ads Reach over 11,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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