The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 24, 2007 #3,048 Editor-Barry Block, DPM, JD

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Worn Out Shoes Can Lead to Heel Pain: PA Podiatrist

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Outgrowing shoes is not the only reason to purchase new footwear for your growing child. "The main thing is to be sure last year's shoes aren't worn," said Dr. Steven Schwartz, a podiatrist with offices in Chambersburg, Waynesboro, and Dry Run (PA).

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Dr. Steven Schwartz

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The upper or top of the shoe shouldn't be stretched out, Schwartz said. A stretched-out shoe will allow excessive motion of the foot. This can create foot fatigue, ingrown toe nails or toe irritation, which may result in blisters.

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Hold each shoe at an angle and push down to make sure the shoe bends at the ball of the foot where the foot naturally bends. Also, make sure the shoe shank, or middle of the sole, remains rigid when gently squeezed. The shank may break down over a period of time, which can lead to heel pain. Schwartz said that a firm heel counter helps to stabilize the heel of the foot. Shoes should not be too flimsy.

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Source: Iris Hersh, Public Opinion - Chambersburg, PA [9/21/07]

CO Hospital Honors Two Podiatrists

What gives a hospital life are its people, the caregivers who look after the sick, and Community Hospital is unveiling a new way to honor those people. Community Hospital has selected 21 of its own to recognize Saturday night at the Community Hospital Foundation Board Gala, which will be held at the Two Rivers Convention Center. The podiatrists to be honored are: Edward Behen, DPM and John Feild, DPM.

Dr. Edward Behen

All 21 medical providers that will be inducted into the Legacy Circle of Care have given Community Hospital more than 25 years of service and “have had a significant impact on the legacy of Community Hospital,” according to a hospital news release.

Dr. John Feild

These physicians, podiatrists and an oral surgeon have served in the roles of chief of staff; chairs of specialty departments; participants on education, compliance, and bylaws committees; board of trustee members; and board members for their state and national professional societies.

Source: Le Roy Standish, The Daily Sentinel [9/21/07]

E-mail Remains a High Risk When Safeguarding Patient Privacy Under HIPAA

E-mail has become an indispensable tool in every industry, and health care is no exception, as busy professionals use the technology to quickly communicate with colleagues and patients. But for those who deal with protected health information (PHI), pressing the "send" button can be fraught with compliance dangers. As hospitals and covered entities (CEs) see their peers victimized by damaging electronic PHI breaches, more and more are installing filtering technologies that not only scan outgoing e-mails for PHI, but also can encrypt the messages.

While hospitals grapple with the e-mails of thousands of employees, more and more doctors, even in small practices, also are using this method. In 2007, 31% of physicians reported using e-mail to communicate with patients, up from 24% in 2005, according to a survey released this spring by health care research firm Manhattan Research, LLC.

David Ermer, managing partner at Washington, D.C.-based Gordon & Ermer, says there are two major problems with e-mail: misaddressing and forwarding. "E-mail is very convenient, but address errors can occur and the problems associated with address errors are magnified if protected health information is included in the message," he says. "Internal controls can address this problem," Ermer adds. "My concern about using e-mail for legally privileged discussions is that they are so easy to forward to others, and forwarding can destroy the privilege."

Source: Report on Patient Privacy [9/20/07]

Query: Sclerosing ETOH Injection for Tarsal Tunnel

I have a patient that has a chronic tarsal tunnel condition. There is pinpoint pain overlying the posterior tibial nerve and a positive Tinel's sign. He has had a previous steroid injection and a previous surgical release. He has this pinpoint pain remaining. Has anyone used a sclerosing ETOH injection in this situation? Any other treatment recommendations? I really do not want to perform surgery again.

Alan K. Mauser, DPM, Louisville, KY

Query: Aquaspray Nail Drill Repair

Our office is currently using a Aquaspray [cabinet unit] nail machine. The handpiece is in need of repair, and we are having difficulty finding a vendor that can repair. The original manufacturer is no longer in business, and can no longer service or provide parts. We would appreciate any input on a vendor that can repair handpieces.

Kandy Inskeep, Munice, IN

RE: Abnormal Osteoproliferative Changes in Toes (Greg Caringi, DPM)
From: Multiple Respondents

With toenail changes and periostitis of the terminal tufts of the distal phalanges I would consider the possibility of an underlying Psoriasis or a seronegative arthropathy. The T. rubrum positive cultures may be coincidental.

Donald Jay Arenson, DPM, Elmhurst, IL, darenson@pol.net

Dr. Caringi presents an interesting case involving digital phalangeal tuft abnormalities in the hallux and fourth toe with a possibly lytic process of the fourth middle phalanx in an otherwise healthy 50 year old male with dermatophyte culture positive nail changes.

The differential diagnosis of tufting like this is EXTENSIVE and transcends several body systems and genetic possibilities. I believe he should do some more studies before initially referring to a musculoskeletal oncologist. The first thing I would do is get as detailed a history as possible to see if the patient himself has not overlooked anything. This should include occupational history as well. Perhaps he is a martial arts enthusiast? A detailed family history of all first-degree relatives to rule out anything genetic may help. An MRI with contrast to rule out soft tissue issues, especially with the "vanishing" appearance of the middle phalanx would be next.

If that study proves negative, and endocrine work-up would be prudent. An endocrinologist specializing in bone metabolism can be very helpful. Even though the nails cultured positive for dermatophyte, a nail bed biopsy just might reveal psoriasis, which can cause distal bone changes like this without characteristic skin lesions elsewhere. Lastly, a rheumatologist may be helpful in ruling our spondyloarthropathies and other such conditions which may present with distal phalangeal changes. The patient's primary care physician can do a screening for malignancy if these other investigations all prove negative. If so, a bone biopsy would be my next step.

Bryan C. Markinson, DPM, New York, NY, Bryan.Markinson@mountsinai.org

Editor’s Note: An extended-length reply by Dr. Mullen can be read at:
http://www.podiatrym.com/letters2.cfm?id=15802&start=1

RE: Cosmetic Foot Surgery Prevents Future Structural Problems
From: Ivar E. Roth DPM, MPH, Daniel Tellem, DPM

I think there is room for some of us to do “cosmetic” foot surgery. If the patient wants a better looking foot and you are honest and tell them the pro’s and cons of having this surgery and you CAN deliver the goods why not? Unfortunately for those Dr’s that try to do this surgery and are unsuccessful, the system has a way of weeding them out i.e., malpractice suits.

The bottom line here is that it is human nature to try and beautify one’s body. Podiatrists are the specialists with the most knowledge of the foot, so again why not make someone’s dreams come true.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

I am assuming that if this is considered "cosmetic" podiatry, that these patients are probably paying out-of-pocket? I guess patients in the big cities (e.g., Los Angeles, NYC, etc.) will pay for these treatments. In Rochester, NY, a "toe tuck" is usually considered an arthroplasty of the 2nd toe, and although an unintended benefit might be ease of shoe fit, the people undergoing the procedure come in with pain... Now, I have no clue what the "Cinderella procedure" is, but I am pretty sure my patients would not pay for it, they barely like paying their co-pays!

Daniel Tellem, DPM, Rochester, NY, liadant@frontiernet.net

Editor’s note: This topic is now closed.

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

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 -- www.homephysicians.com

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

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