The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 28, 2009 #3,660 Publisher-Barry Block, DPM, JD

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Feet are an Indicator of Overall Health: NC Podiatrist

Want to make a 10-second check on somebody's well-being without feeling their forehead? Sneak a peek at their feet. "You can detect everything from diabetes to nutritional deficiencies just by examining the feet," says Jane Andersen, DPM, president of the American Association of Women Podiatrists and a spokeswoman for the American Podiatric Medical Association.

Jane Andersen, DPM

Unresolved foot problems can have unexpected consequences. Untreated pain often leads a person to move less and gain weight, for example, or to shift balance in unnatural ways, increasing the chance of falling and breaking a bone.

Source: Paula Spencer, Caring.com [9/25/09]

Vascular Surgeons and Podiatrists in Historic Collaboration to Save Diabetic Limbs

The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) announced a historic collaboration to save limbs at risk from the complications of diabetes. Leadership of the two groups said their members would work together to identify clinical issues relating to critical limb ischemia and find solutions that will benefit patients.

Front (L-R): Anton Sidawy (President, SVS), Ron Jensen (President, APMA), Back: Richard Neville (Georgetown), John Steinberg (Georgetown), David G. Armstrong (University of Arizona/SALSA), George Andros (Los Angeles), Christopher Attinger (Georgetown)

The announcement was made September 25, 2009, by Ronald D. Jensen, DPM, president of APMA and Anton Sidawy, MD, president of SVS, at the Georgetown University Hospital Diabetic Limb Salvage Conference: A Team Approach at the JW Marriott Pennsylvania Avenue in Washington, DC. Drs. Sidawy and Jensen were joined by other leaders of the two groups, including George Andros, MD and Richard F. Neville, MD of SVS, and David G. Armstrong, DPM, PhD of APMA.

MA Podiatrists Use Hi-Tech Gait Analysis

Among the advanced technology systems Central Massachusetts Podiatry uses to assess patients' problems is a treadmill used in conjunction with hi-tech gait analysis software, which provides frame-by-frame whole-body video analysis. In addition, Dr. Neil Feldman uses a gait-plate pressure mat system that gives postural readings and walking readings, and shows how weight is distributed across the bottom of the foot.

Dr. Neil Feldman (Photo: Ken Powers)

"By using the gait analysis software and videotaping the session, we're able to present patients with a video that breaks down everything about their gait and provides explanations about why they may be experiencing some of the problems that they are experiencing," Feldman said. "And because they have it at home, they can refer to it, share it with their coach/trainer, and/or other medical professionals."

Dr. Feldman draws triathletes and runners from all over New England. He himself is a seven-time Ironman finisher, twice competing in the world championships in Hawaii.

Sources: Ken Powers, Community Advocate [9/4/09]

Dealing With Complainers

Thank complainers for caring enough to call. Their complaints mean they want to continue doing business with you, so tell them: “Thank you for taking the time to bring this to my attention. I will do my best to solve the problem for you.”

Source: Adapted from Time Management for Dummies, Jeffrey Mayer, IDG Books Worldwide via Communication Briefings

Query: Licenses and Red Flag Rules

In an attempt to comply with "Red Flag Rules", we have been copying driver's licenses with photos as a "government issued photo ID" source. However, in our state, anyone who renews online or is elderly will no longer has a photo on their license. Any ideas as to what else an average person would carry that might qualify as a source of a "government issued photo ID" to verify a person's identity?

Paul Somers, Jr., DPM, Nashville, TN

Query: Small vs. Intermediate Joint Injections?

With regard to cortisone injections, I have noticed some disagreement between practitioners as far as which injection codes, CPT 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa ) vs. CPT 20605 (arthrocentesis, aspiration and/or injection; intermediate joint), are proper to code. The CPT manual gives "ankle" as an example of the intermediate injection code, CPT 20605 - so that would be the reference. Is there another example of an "intermediate joint?"

I bill CPT 20600 when I inject the great toe. What code would I bill when injecting the midfoot or sinus tarsi?

Michael Munson, DPM, Columbia, SC

Response: I think of ankle, subtalar, talo-navicular and calcaneo-cuboid joints as intermediate joints (CPT 20605). Joints distal to those I consider to be small joints. I know of no official list. This is my opinion, and I've never been challenged.

Walter Pedowitz, MD, Linden, NJ

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

In podiatry school, we were always taught to examine if the lesion was distal to or directly under the met head. While the posting states that the lesion is "directly under", it looks like it is more distal; the difference being doing an elevational osteotomy for a lesion directly under the metatarsal, or a shortening if distal. If you chose the Weil osteotomy, I think you kill two birds with one stone.

Having seen a number of Weil osteotomies performed by other surgeons, I notice a large percentage with somewhat floppy toes. I, therefore, prefer a PIPJ fusion to accompany the Weil osteotomy. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

I would approach this in a global fashion, i.e., address the bunion by Austin procedure, try to maintain length of 1st metatarsal and plantarflex it at the same time. I would then address the hammertoes by arthrodesis 2 through 4. If there were a moderate degree of hyperlaxity at the MC joint, then consider an arthrodesis there instead. If not, then stick with an Austin. Assess  sagittal plane and transverse plane deformity at the MPJs, and hyperflexibility at the lesser metatarsals. 

I would be careful with any lesser metatarsal osteotomy and would consider it only if the hammertoe procedure does not adequately decompress retrograde forces. If the foot is a more rigid type, then possibly consider a Weil or reverse Weil osteotomy with adequate digital and metatarsal fixation. If the foot has a flexible forefoot equinus, then tread carefully, and continue to palliate. 

Angelo J. Bigelli, DPM, North Providence, RI,  toedocri@aol.com 

The radiograph shows a moderate sized bunion deformity. This bunion is probably hypermobile, altering forefoot WB pressures. This pressure is lateralizing to the next available joint, the 2nd MTPJ. In order to correct this patient's problem, you would have to address the bunion deformity in addition to the hammertoe. A plantarflexory Austin bunionectomy would probably do the trick along with an HT procedure of your choice, e.g., arthrodesis, arthroplasty, PIPJ implant. I would also take an axial view to look at the declination of the 2nd met. While it doesn't look too long in the parabola, it may be plantarflexed, requiring a Weil osteotomy with/without fixation.

I would way the risk/benefit profile carefully before performing multiple forefoot procedures to address a painful callus. The conservative approach of routine paring, orthotics, etc. may be best.

Todd Lamster, DPM, Phoenix, AZ, tlamster@gmail.com
 

RE: Cutaneous Larva Migrans (Steven Miller, DPM)
From: Narmo L. Ortiz, Jr., DPM, Jon Purdy, DPM

Whatever happened to good 'ole thiabendazole 3 grams, twice a day for two days?

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

Cutaneous larva migrans is caused by different species of hookworm. Humans are not a host because the larva cannot penetrate the basement membrane of the skin. Infestation in a human would be considered extremely rare. 
 
I found studies that show a 6% infection rate for travelers to tropical vacation sites with beaches. One study showed ethyl chloride to be 65% effective is killing the little guy. I did not find any studies that show Chinese herbal medicines to be effective. 
 
Since we are not hosts to the organism, it will die without treatment in a few weeks to months depending upon the species. One interesting note was a new imaging study called optical coherence tomography. This gives a real-time, three-dimensional view of soft tissue. The larva could be precisely located using this technique.
 
Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Update on CCHIT Certification and "Meaningful Use"
From: Michael Brody, DPM

CCHIT has published the criteria to get certified for 2011.  There are two types of certification that have been published: Full Certification and Meaningful Use Certification.

Full Certification is...

Michael Brody, DPM, Commack, NY, mbrody@cmeonline.com

Editor's Note: Dr. Brody's extened-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29141&start=1

RE: Localpodiatry.com
From: Ron Lavenda, DPM

I also had a bad experience with Yext Local Podiatry. I allowed them to put my name in their website with the promise I would be charged for only new leads. After two months and a review of all the phone calls, I discovered that I was paying for my answer machine and a patient asking for directions to my office. I was charged close to $500. After trying to contact them and just getting a massage server, I canceled my association with them and had the credit card company refund the money. I then immediately canceled my credit card to a new number.

Ron Lavenda, DPM, Clinton, MA, rglavenda1@verizon.net
 

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 - 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

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

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