The Voice of Podiatrists

September 25, 2006 #2,687 Editor-Barry Block, DPM, JD

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There are more risks involved with wearing flip-flops than the accidents caused by the footwear’s lack of support and stability, said Dr. Jerry Lamendola, a podiatrist in Lakewood, OH. He has seen an alarming growth in the number of high school athletes suffering foot, ankle and shin problems that could be caused by frequently wearing flip-flops. The problems tend to show up when the athletes begin a new training program.

“What I’m seeing as a sports medicine physician, come early August, is the student athlete in soccer, cross country and football is having pain in the arch and the back of the heel,” Lamendola said. “I find this to be directly related [to wearing flip-flops]. I do ask them what kind of shoe they wear.”

The pain usually subsides in a week or two by giving up flip-flops and treating the condition with rest, ice and, if needed, anti-inflammatory drugs, Lamendola said. But there could be cases, if athletes ignore the pain and allow the condition to worsen, where they could miss a substantial amount of playing time. Plantar fasciitis (heel pain), shin splints and tendonitis are conditions that could be caused or aggravated by wearing flip-flops, Lamendola said.

Athletes and their coaches might never make the connection between the injury and their footwear choices. “When used moderately, I feel they have their place,” Lamendola said. “But long-term walking, you just don’t get the support of the shoe and you have misalignment of the muscles and bones.”

Source: Bob Migra, Cleveland Plain Dealer, [9/21/06]

VA Podiatrist Helps Raise Money For Diabetes Research

Dr. James R. Arnold tells some horrific stories about complications from diabetes. A podiatrist, Arnold has treated diabetic patients who didn’t realize they had an insulin needle embedded in a foot. One patient didn’t feel a nail in his foot until he took off his boot and saw the blood. Another didn’t experience any pain when he burned the soles off his feet.

“Even in well-controlled diabetes, there’s still nerve damage and vascular trauma,” said Arnold, who practices with the Foot Care Center in Winchester. “We see a lot of people with diabetes.”

On Saturday, Arnold put his best foot forward during the Walk for Diabetes, an annual event that raises money for the American Diabetes Association. Ideally, walkers obtain pledges from contributors beforehand. Single walkers this year are more motivated to get a team together next year and raise big money, Arnold said.

Source: Robyn Fontes Taylor, The Winchester Star [9/21/06]

Luring Customers From Medicare a Growing Business

For years, private insurers have offered alternatives to the federal Medicare program that are meant to give patients lower-cost options than the government coverage provides. More than 7 million people now subscribe to such plans, out of a total Medicare population of 42.5 million. But suddenly a type of private insurance plan is gaining ground that looks very similar to the basic coverage long available to anyone with a federally issued Medicare card. And the government is paying the private insurance industry a subsidy of 11% per patient, on average, to provide it. Since the government substantially increased the subsidies two years ago for these most basic private industry plans -- known as private fee-for-service -- enrollment in the plans has grown tenfold to 820,000. And some analysts expect enrollments to double or even triple by 2009.

Source: Milt Freudenheim, New York Times via Modern Healthcare [9/22/06}

Query: Synvisc For Ankles

Does anyone have experience or heard of using Synvisc for painful ankle joints?

Michael Zapf, DPM, Thousand Oaks, CA, mazdpm@gmail.com

RE: Fungal Transmission in Nail Salons (Neil H Hecht, DPM)
From: Cynthia Ferrelli, DPM, Adam Cirlincione, DPM

I recently read an article in a health magazine that stated many fungal nail infections are spread through the motorized foot baths that patrons soak in. Although the basins are cleaned after each client, fungus collects in the filters of these units which are never addressed. If patients must have pedicures, suggest that they go to a salon that just uses a personal little tub that vibrates. RE: the polish, it certainly could be a possibility-easy enough to just bring their own polish with them. Most women have several bottles around anyway.

Cynthia Ferrelli, DPM, Buffalo, NY, Drfoot1@adelphia.net

I am not sure if the literature supports or is present to prove fungal infections can be spread during a visit for a pedicure. I will always tell a patient to use their own instruments and polishes.

I do know that a majority of the nail polishes contain formaldehyde, toluene, and DBP. These chemicals have been linked to cancer and birth defects. California has placed them on their list of chemicals known to cause cancer or reproductive toxicity and the European Union has banned DBP altogether. I think a study would be prudent to see if any of these chemicals are related to fungal infections.

Adam Cirlincione, DPM, Glen Cove, NY, pittpod@aol.com

RE: OR Podiatrist First to be Appointed to OR Board of Medical Examiners
From: Steve Wan, DPM

Congratulations to Dr. Lisa Cornelius on her appointment to the Board of Medical Examiners of Oregon.

I read with interest that Dr. Cornelius can only vote on matters pertaining to podiatric medicine and surgery, though she may participate in discussions on all other matters. A quick glance at the Oregon Board's makeup revealed that there are two public members who have no medical credentials (this was so stated on the Board's own website). One wonders if those 2 public members are allowed to vote on all matters appearing before the medical board and if so, what criterion/criteria would be applied to limit Dr. Cornelius to vote only on podiatric issues.

Steve Wan, DPM, Torrance, CA, scwref1@aol.com

RE: Legal Implications of Off-Label Use of Drugs (Ken Malkin, DPM))
From: Elliot Udell,DPM

Dr. Malkin makes some very good points with regard to the use of off -label medications. I too would never recommend prescribing off label medications unless there are considerable papers published supporting both its use and safety. Three examples that immediately come to mind are 1)Off-label use of tricyclic antidepressants for the treatment of neuropathic pain. 2) Off-label use of gabapentin for the treatment of neuropathic pain 3) Off-label use of certain calcium channel blockers for the treatment of Raynauds phenomenon. In all three cases there was a wealth of literature in peer-reviewed journals, such as JAMA, before I dared prescribe any of these medications for my patients. When I was a student at NYCPM one of my esteemed professors advised us never to be first on line to prescribe any medications. He meant on or off-label medications. Even with this precaution, it is possible to err. Remember what happened with Vioxx?

The point Ken makes regarding risk/benefit ratios being different with regard to different conditions makes sense. A hypothetical drug with many known side-effects might be an option for the treatment of metastatic cancer, but would be a poor choice in the treatment of warts in healthy children even if it was effective. Once again this problem becomes moot if there is a preponderance of medical literature supporting what and how you are prescribing the off-label drug. I've also never had a patient tell me that his or her drug insurance plan rejected a medication prescribed because it was off-label. I hope they don't get any ideas.

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

RE: Heel Pain in Obese Patient (Charles Ross, DPM)
From: Joel Lang, DPM

I would suggest you try an M-F Heel Cup with a dense foam heel pad as an interim measure . . . providing the condition is an inferior calcaneal bursitis. This is usually not relieved by the average orthosis which is better suited to relieve fascial strain (spur) symptoms.

But the real solution is 60 pounds. Why are we so fearful of confronting the real issue - "obesity," It is almost guaranteed that if this patient lost 60 pounds, reducing his weight to 180 pounds, the measures already tried would be successful in reducing his pain. It is unconscionable to subject this patient to expensive, invasive treatment when the real cause is his weight.

As the doctor, Dr. Ross has done most everything he can do to relieve this problem. Now it is the patient's responsibility to do everything he can toward the same end.

Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

Established busy practice for sale in hospital's medical building. Fully equipped. All aspects of podiatric medicine/surgery. Large diabetic practice with wound care clinic. Large referral base. Hospital to be renovated and expanded. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving - will stay for transition. Associateship until purchase. Unbelievable potential to expand. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

PRACTICE FOR SALE – 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

IMMEDIATE ASSOCIATE NEEDED - PHILLY SUBURBS

High volume office-based practice suburban Philadelphia. Full-time office, near hospitals for surgery, consults, and in-house pt. care. Candidate must be hard-working dedicated to pt. care and well-trained. Needs to be personable. PSR12/24/36 Board Certified/Eligible required for a fast-paced, fun atmosphere to work. Email CV and contact info to: mrgpod@hotmail.com Or fax CV to 610-668-5175.

NURSING HOME ASSOCIATE NEEDED- PHILA AREA

Extremely high volume nursing home and home care practice. Well-established and respected Suburban Philadelphia practice seeking an associate who is hardworking. Full-time or part-time available. Very busy practice which can be worked every day and be very lucrative for a hard-working individual. No nursing home further than ½ hour away from office. Email CV and contact info to: mrgpod@hotmail.com or fax CV to 610-668-5175

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

EQUIPMENT FOR SALE - Computed Radiography System

SCANX 12 digital imaging system is a computed radiography system (CR). Replacing film and plates can be reused thousands of times. Saves images to your computer. CPU and monitor included. Purchased 2004. Asking $15, 000. Call 970-232-1717 for additional information. Product information found at www.allproimaging.com

ASSOCIATE POSITION - ARIZONA

Excellent opportunity for an experienced DPM looking for a change or young podiatrist looking to jumpstart their practice. Practice is well- established over 25 years, successful and a large volume in the Phoenix metro area. Current AZ license preferred as position is available immediately. The right person will join as a salaried associate leading to partial ownership in the group practice. Email CV and inquiries to: scfcs@cox.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

PRACTICE & BUILDING FOR SALE – SOUTHERN CALIFORNIA

30 year established practice in southern California. Includes Medicare certification, modern surgery center building, attached office and treatment rooms, equipment. 2.5 days office hrs per week –gross 240K per year. Can expand to 5 days. $1.5 Million. Contact Dr. Beal (951) 780-4782 or email rbeal10269@aol.com

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

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

High Income position for ethical hard working podiatrist, great for semi-retired or to supplement office practice, part time. Must have Florida license and active Medicare/Medicaid numbers. FAX CV or Resume to 727-785-4697

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

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