The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 26, 2009 #3,659 Publisher-Barry Block, DPM, JD

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FL Discusses Achilles Tendinitis in Star College Football Player

Florida linebacker Brandon Spikes is ambling around campus with tendinitis on his left Achilles tendon, causing him to miss part of last week's win over Tennessee. Chris Hubbard, a podiatrist with Podiatric Physicians of Kentucky out of Louisville, said the injury creates significant pain and, without proper rest, the risk of rupturing the Achilles. Athletes are "gone for the year" after a rupture, Hubbard said.

Dr. Chris Hubbard

Such tendinitis cases usually require at least 1-2 weeks of rest and treatment. "He's probably going to be timid out there reacting to the football because of the pain," Hubbard said. "And when an athlete isn't going full speed, that's when he's prone to injure something else."

Source: Jeremy Fowler, Orlando Sentinel [9/24/09]

NY Podiatrist Organizes Brain Cancer Research Coalition

Al Musella, DPM, of Hewlett, NY was a featured speaker this past weekend at the Advanced Brain Tumor Treatments Conference in Ashland, OR. Musella discussed the formation of the Grey Ribbon Crusade (greyribboncrusade.org), which is a new organization attempting to unite the brain tumor community in the fight against brain tumors.

Dr. Al Musella addresses Advanced Brain Tumor Treatments Conference

Musella, who is the president and founder of the Musella Foundation For Brain Tumor Research & Information, Inc, (virtualtrials.com) has been invited to present the Grey Ribbon Crusade concept to the combined meeting of the Society for Neuro-oncology and the American Association of Neurosurgeons next month in New Orleans.
 

Senate Opens Door to Longer Doc Pay Fix

A key Democrat has left the door open for a longer-term physician pay fix. Sen. Kent Conrad (D-ND), part of a small team of negotiators who helped shape a broad health reform package, said that he is “hopeful” that a two-year fix could be crafted before a final bill is voted on. As written, the reform package that emerged last week from the pivotal Senate Finance Committee contains a one-year measure, where a scheduled 21% cut would be replaced with a 0.5% increase.

The 2010 fix in the Finance Committee bill costs $10.9 billion, but leaves doctors on the hook for about a 25% pay cut in 2011. Conrad said that the original plan called for a two-year fix, presumably with slight increases along the way. Other lawmakers hinted that amendments still expected to come might deal with the pay formula.

Source: Matthew DoBias, Modern Healthcare [9/24/09]

Query: Podiatry Plus Insurance

I was approached by Podiatry Plus Insurance. They offered me a very competitive rate for surgical malpractice. I would appreciate any information on experiences with Podiatry Plus (Underwritten by Ace USA).

Mark S. Davids, DPM, Deland, FL

RE: Intractable Plantar Keratoma Sub 2nd Metatarsal  (Gary Gugliada, DPM)
From: Multiple Responses

Consider an arthrodesis of the PIPJ of the 2nd toe to  prevent the contracted digit from plantar-flexing the 2nd metatarsal head. 

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

I've had similar cases of Intractable plantar keratomas that had to be debrided every three weeks and even before the 21st day, the patients had a return of their painful symptoms. One device that has been a lifesaver for patients with this condition has been a type of orthotic called the balance inlay. It has been manufactured by Bergmann orthotic lab since its inception. The trick is to take the cast off-weight- bearing, using plaster, and holding the foot in neutral position. The lesion must be marked using a device supplied by the lab.

It's imperative not to deviate one iota from the casting technique recommended by the lab for this particular orthotic, and it is advisable to consult with them before taking the casts. Now with orthotics just as with surgical correction for IPK's, there is always the possibility of transfer lesions but with balance inlays, if the patient develops a transfer lesion a year or more down the line, simply recast and make a new device. Starting from scratch for this condition yields better results than modifying an old orthotic. This is far easier on both the patient and doctor than addressing transfer lesions from a surgical perspective.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I would not be surprised if Dr. Gugliada’s 67 y.o. female patient has a metatarsus primus elevatus, resulting in overload of the 2nd met.  In addition, I don’t agree that the patient has a normal metatarsal parabola. It appears to me that the 1st met is equal in length to the 2nd  met, which means that the 1st met is slightly long. A long 1st met can result in hallux limitus and may explain why the patient has hallux abductovalgus.

Although Dr. Gugliada indicated that the patient was treated with orthoses without apparent success, I can’t help but wonder if the patient’s orthotic prescription specifically addressed the morphology in the feet. If the patient does have an elevated 1st, then it may be necessary to correct (i.e., balance) the cast to the level of the 2nd met. I would also consider a precise sub-2nd accommodation in a 1/8 inch Korex forefoot extension to the sulcus, and possibly applying an additional 1/8 inch Morton’s extension to further off-load the 2nd and to address any potential hallux limitus. Perhaps a non-surgical solution still exists.

Mr. Jeff Root, President, Root Lab, Inc., jroot@root-lab.com

RE: Cutaneous Larva Migrans (Steven Miller, DPM)
From: Tim Quagliano, DPM, Ray McClanahan, DPM, BS Ed

Yes, indeed this is cutaneous larva migrans. I contracted this infection during a vacation to Jamaica and irradicated it simply by applying ethyl chloride and a good squeeze.
 
Tim Quagliano, DPM,  Dubuque, IA, Quagdbq@aol.com

While vacationing in Mexico a few years back, I contracted cutaneous larva migrans. I took 2 courses of oral mebendazole, as well as another oral anti-worm med, with no resolution. I tried spraying ethyl chloride on it, which was a recommended treatment. It didn't work. I eventually had success with Chinese herbs. I soaked my foot in them, and applied a paste to the affected area. In two weeks, I was better. 
 
Perhaps a consultation with the local Chinese doctor might help the patient? A phone call to Dr. Laura McGraw, in Portland, OR who treated me, might give more information about the specific herbs that cured my case.

Ray McClanahan, DPM, BS Ed, Portland, OR, footdr@nwfootankle.com

RE: Surgery Case Log Program Software (Mark Lambert, DPM)
From: Pete Harvey, DPM

The easiest way to log surgery cases is to use your current software in Word. Simply create a document called Surgery 2009 (2010, 2011). You can create a grid and label each case as you see fit as to type, category, date, location, etc.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Localpodiatry.com
From: Neil Levin, DPM

I, too, called to cancel my relationship with the company and was told I had a $330.00 credit that could only be applied to future calls. I told them there was no contract, no obligation, and no mention of their credit policy when I agreed to participate. I told them to either credit my card for the entire amount or I would file fraud charges with the credit card company and call my attorney. Later that day, I received an e-mail receipt from Localpodiatry.com for the full credit card refund.
 
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

RE: Barefoot Running (Ira Meyers, DPM)
From: Doug Richie, DPM

This fad regarding barefoot running will undoubtedly become a topic of conversation in every podiatric practice in this country over the next 12 to 24 months. I have already been deluged with questions by patients and from the media about Christopher McDougall's fascinating book. Whether you agree or disagree with his conclusions, this book is a must read for podiatric practitioners who treat active athletes. There is research published in the biomechanics literature which has validated and refuted the theory of the Pose running technique and barefoot training methods.  

It is fitting to note that the leading lower extremity biomechanists in the world will convene at the 12th annual International PFOLA Conference in Atlanta, GA on Oct 2nd-4th. It is not too late to register and attend the best podiatric biomechanics conference in this country, where the subject of barefoot running is sure to be debated from the podium: (nvo.com/pfola/pfola2008/)
 
Doug Richie, DPM, Scientific Co-Chair, PFOLA International Conference, DRichieJr@aol.com

RE: Med Students Found Misbehaving on Net (Paul Kesselman, DPM)
From: Michael Turlik, DPM

The recent article regarding inappropriate medical student Internet behavior can probably be generalized to the podiatric medical student experience. The development of values and attitudes during an educational interaction is usually described in terms of non-cognitive objectives. Medical education and medical educators are more focused on cognitive and to a lesser extent psychomotor objectives rather than non-cognitive objectives during the educational process.

I am confident that there is some area of instruction in any podiatric medical college which deals with medical ethics. However, instruction in medical ethics occurs for the student outside the classroom every time he or she interacts with a clinical faculty member or practicing podiatrist. This interaction is much more important and powerful  than any didactic instruction students receive in shaping their value system. I'm also confident that all podiatric colleges have a student handbook which lists appropriate and inappropriate student behaviors. I am very confident that students are only aware of this when they consult an attorney because of some serious breach in non-cognitive behavior.

How important is non-cognitive instruction in medical students? There are several articles in the medical literature dealing with this. How important is non-cognitive instruction in podiatric medical students? There is probably no published information regarding this topic.

Michael Turlik, DPM, Cleveland, OH, mmturlik@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

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

ASSOCIATE POSITION – LOS ANGELES

Well established Los Angeles-based practice seeking a surgically trained, highly motivated, well-trained podiatrist. We have a very busy multi-office practice with state of the art podiatric equipment. Must be dependable, honest, and an ethical individual. This position is available immediately. Send resume and your email address to desierec@kimfoot.com

ASSOCIATE POSITION - MICHIGAN

Seeking quality-oriented, patient-focused RPR or Surgically-trained associate for a fast-paced, established group practice in Southeast Michigan. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. If you are highly motivated, ethical, have a current Michigan License and have good communication and clinical skills, please forward your C.V. cfsdr@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

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 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 - 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

EQUIPMENT FOR SALE- ARTOSCAN EXTEMITY MRI

In excellent cosmetic and working condition. Originally an A model, upgraded to a model D. Looking to sell the MRI because additional space is needed in the office. Price to sell. Picture can be seen at by clicking here  Contact baileymeans@yahoo.com for any inquiries

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.

EQUIPMENT FOR SALE - AMFIT ORTHOTIC MANUFACTURING MACHINE

Includes digitizer, fabricating mill, new updates have been added and enough supplies to pay for the machine in the long run. At $200 per pair = about $28,000. Selling FOR $25,000, O.B.O, F.O.B. americanfoot@email.com or 405-733-2783.

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

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

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

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