The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 21, 2007 #3,046 Editor-Barry Block, DPM, JD

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Cosmetic Foot Surgery Prevents Future Structural Problems: CA Podiatrist

Podiatrist Dr. Ali Sadrieh of Beverly Hills Aesthetic Foot Surgery is giving women the best of both worlds: fashion and comfort. Known as "Dr. Footnomenal" by his celebrity and socialite clientele, Dr. Sadrieh leads the $3.5 billion cosmetic foot surgery industry with revolutionary techniques to correct flat, fat, and wide feet and provides extensive hours of comfort for women in high-heeled shoes.

Dr. Ali Sadrieh

Dr. Sadrieh's menu of commonly-requested treatments include: "Toe Tucks" (shortening of lengthier second toe), "Foot Sculpture" (eliminating excessive fat), "Cinderella Procedure" (narrowing of feet), "Footox" (Botox injection to eliminate excessive sweating); and, "Cushion Comfeet" (collagen injection or silicone implant into the bottom of feet for comfort).

In the past, podiatrists performed surgery in response to painful foot problems. Today, many of Dr. Sadrieh's patients undergo cosmetic foot surgery to change the appearance of their feet, which also prevents future structural problems. "Since 90% of women's foot deformities can be attributed to improperly-fitted shoes," explains Dr. Sadrieh, "correcting feet so they fit properly and beautifully into shoes is correcting a problem before it occurs."

Source: Bend Weekly (OR)

Steven J. Berlin, DPM Donates $250,000 to OCPM

Steven J. Berlin, DPM, OCPM class of 1966, has donated $250,000 to the OCPM “Stepping Towards the Future” Capital Campaign. Dr. Berlin’s gift will officially name the “Dr. Steven J. Berlin Auditorium” at the new OCPM podiatric medical education facility. Dr. Berlin is also the co-chair for the OCPM “Stepping Towards the Future” Capital Campaign and a member of the OCPM Board of Trustees. He is leading an effort to unite the podiatric community in financial support of the new OCPM building.

Dr. Steven J. Berlin

The Dr. Steven J. Berlin Auditorium can hold up to 300 students at one time or be divided by a sound-proof wall partition for two 150 seat classrooms. The auditorium comes equipped with “Smart Technology” which includes interactive whiteboards, screens, video, data projector, lights, and electronic window shades. The “sympodium” operates all media and electronic devices so each professor can control the exact teaching atmosphere from a touch of a button. Lectures can be viewed on-line and via new technology, OCPM has the capability of providing distance learning for students and podiatrists for continued medical education courses.

Dr. Berlin’s history of giving to OCPM also includes a $100,000 scholarship endowment to the college.

Study to Determine Value of Implanted Glucose Sensors

While thousands of diabetes patients are "switching from a few finger pricks a day to track their disease to new sensors that keep guard around the clock," some studies show that these advancements have "little impact" on users' ability to control their blood glucose levels, the AP/Los Angeles Times reports.

FDA has approved sensors that are implanted under the skin and monitor glucose levels for three consecutive days in children and seven days in adults. Scientists by November expect to complete enrollment of 450 diabetes patients in a study funded by the Juvenile Diabetes Research Foundation that will focus on the best use of sensors. Results will be published next year.

Source: Lauran Neergaard, AP/Los Angeles Times via American Healthcare [9/19/07]

Query: Discoloration of Nail

I have a female patient with darkening of her toenail x 2 yrs after dropping an object on the nail. She had initial darkening of the nail which was treated with Lamisil x 1 yr (no nail biopsy). The discoloration slowly improved, but remained. I saw her for the first time a few months ago. Her nail had a dark portion again. I cut out the corner of the nail and a part of the nail bed for biopsy. She has no pain and the discolored area is always confined to the area of the nail that is partially detached from the nail bed. Pathology suggested nail trauma without evidence of fungal infection and the skin biopsy was negative for malignancy.

Discoloration of Nail

The nail grew out improved without discoloration and she refrained from using nail polish. Once she started using the nail polish again, she noted the discoloration returning (photo). She is 43 years old with no significant past medical and family history and does not take any medications. On her nail biopsy, then entire thickness of the nail was deep red in color. I think this is due to a chemical in the nail polish. Any ideas on the cause?

Zeeshan Husain, DPM, Southfield, MI

RE: Management of a 5th Met Non-Union (Sandy Schustek, DPM)
From: Elliot Udell, DPM

Hypophosphatasia is a metabolic disorder which causes a lowering of alkaline phosphatase which the body needs for proper growth and maintenance of bone. It leads to fractures. Metatarsal fractures are high on the list. Fortunately it is a very rare condition but unfortunately there are few treatments for it. In the Journal of Clinical Endocrinology and Metabolism, April of 2007, Whyte MP, Mumm S, and Deal C. published a case report where they treated a patient suffering with hypophosphatasia and skeletal fractures with Teriparatide (TPTD) which is recombinant form of human parathyroid hormone and the patient did well and the fractures resolved over a relatively short period of time. You might want to contact these clinicians and see if your patient is a candidate for this therapy and then determine if it is possible to arrange for this treatment. Although this medication may be available it is wise to administer it only under with the guidance of experts in endocrinology.

There is a bone stimulator called Exogen, that is approved for fresh fractures. I have used it for all of my fifth met base fractures and to date I have not had a non union. I have no qualms about prescribing this ultrasonic stimulator for any patient I see with a new fracture and the manufacturer has tended to be very nice about providing units for people even if the patient’s insurance company gives them a hard time regarding reimbursement. I don't know if this would work for a patient with hypophosphatasia. If you did try it, your clinical findings would certainly make a most welcomed article for publication and if the outcome is positive your findings could help many people.

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

RE: Humana Settlement Check
From: R. Alex Dellinger, DPM

I just got my "settlement" check from the class action by DPM's among others. I thought it was a joke. I fit into the class of billed charges to Humana between $25,000 and $100,000. They calculated that I got the Base Amount x 2. Want to guess how much that amounted to? A whopping $37.54. So, for all the shenanigans Humana pulled with me, I got what amounts to a little more than ONE co-pay. I wonder what the attorney fees were in this case. I don't know what I'm going to do with my "settlement.” The APMA wants me to donate it to the APMA Educational Foundation. Okay, maybe that will buy one student a pencil and a notebook.

R. Alex Dellinger, DPM, Little Rock, AR

Editor’s comment: We recommend that you add another $63.46 and mail your check to 9312 Old Georgetown Road, Bethesda. MD 20814. If every podiatrist donated $100 to the Foundation, life would be much easier for our debt-burdened students.

RE: Low Insurance Reimbursement (Multiple Respondents)
From: Paul Bishop, DPM, Larry Zimmerman, DPM

I agree with Dr. Jacobs. My guess (including Dr. Hultman's advice) is that those podiatrists who "cherry pick" patients because of reimbursement do not have to deal with being on ER call, trauma call, or are part of a hospital wound care center, and in fact not really part of main stream medicine. In my community most MD's and DO's (especially orthopods) deny no accessibility to their services as being responsible to the community that they serve. Who do you think absorbs the cost when you go to a non for profit hospital who has to take everyone. If you want to be a part of main stream medicine and insure podiatry is a part of it we need to work to keep all avenues open to our care, not "cherry pick."

Larry Zimmerman, DPM, Mansfield, OH, zimmysuzie@earthlink.net

I couldn't agree more that there is benefit at regaining control of your practice, your finances and your pride. It seems that podiatry as much or more than any other specialty devalues its own importance in the medical treatment arena. For some reason, podiatrists are afraid of "losing" every piece of market share, instead of focusing their talents on QUALITY share of the market. We don’t worry about losing patients to the vascular surgeons and orthopods because we made a deliberate and focused effort for years and worked very hard at telling those competing and non competing specialties that WE are important to the patients and now we get the referrals from the vascular surgeons and orthopedic surgeons and work with them on the same patient because we made it very clear to them that the patient care is paramount, and market share is not a consideration. If we do lose a patient or see someone being referred elsewhere, we try to fix that and work hard to make ourselves available.

We recently dropped two of the largest commercial insurers in our area. We are limiting our Medicare patients and considering no longer taking new Medicare patients because of the drain it has put on the rest of our practice. As a hospital medical staff, we rejected all HMO penetration in to our area. We have gone in to business with the orthopedic surgeons building surgical facilities.

We have learned that being passive and letting insurance and other specialties dictate our lives and practice would no longer work. Be proactive, market yourself. Don’t be ashamed to be a "foot specialist", but be the best educated, well-informed, friendly, helpful and available "foot specialist" you can and don’t apologize for delivering the best care. Make patients be advocates for change with the insurance companies. Drop that last horrible plan and take a deep breath. You’ll feel a lot better at the end of the day.

Paul Bishop, DPM, Yorkville, IL, PBishop82@aol.com

Editor’s note: This topic is now closed.

PRACTICE FOR SALE - HARRISBURG, PA

Well established, very profitable, full time surgical and general podiatry practice available. Looking for a highly motivated individual for a turn key operation. Owner willing to stay on and to teach and train the right individual to run a successful practice. Multiple financial and employment options are available. E-mail blkdmddoc@aol.com

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual . Fax CV with hours available to (718) 458-0053.

ASSOCIATE POSITION – CINCINNATI, OH

This is your once in a lifetime opportunity to join one of the largest, most successful practices in the United States. Start immediately with a six-figure income. If you are motivated, and knowledgeable in practice management, your income is unlimited. Please fax resume to: 513-577-7261

IN-NETWORK PODIATRIST WANTED – MANHATTAN

Busy Manhattan Office (2 locations) needs IN-NETWORK PODIATRIST, Can start immediately-Do not reply unless you are in with all plans Please respond to gelus07@yahoo.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PAIN-RELIEVING DEVICE FOR SALE

Matrix pain device, upgraded with latest Sanexas software. Great working order, operating manual, and programs to treat nerve and muscle pain, edema, circulation, inflammation, and other health problems. $28,000 new, will sell for $12,000. Covered by Medicare, most all insurances, coding and billing information provided. Photo can be seen at http://www.outcomemedical.com/matrix E-mail don@outcomemedical.com

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