The Voice of Podiatrists

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October 02, 2007 #3.055 Editor-Barry Block, DPM, JD

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IL Podiatrist Offers Advice on Heel Pain

Heel pain is one of the more common complaints people have when they visit a podiatrist (foot doctor). "Most people with heel pain have a heel spur on the bottom of their heel, but it isn't the heel spur that causes pain," said Dr. Todd Horak, a podiatrist at Advocate South Suburban Hospital in Hazel Crest. "A heel spur is a pointed bony outgrowth of the bone of the heel. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot." Causes can include tight calf muscles, lack of arch support, being overweight, sudden increased activity and/or general overuse.

Dr. Timothy Horak

"What people experiencing heel pain should know, is that there are several home remedies they can try before having to seek treatment from a physician," Horak advised. "The first step is to avoid activities that aggravate the symptoms. Rest should reduce severe pain and decrease inflammation. Icing will also help control heel pain and can be performed with a frozen water bottle."

In order to relax the tissues around the heel bone, Horak recommends stretching the foot by performing a runner's stretch can help, which is performed when the foot is flexed toward the knee at the ankle and the knee is extended. Night splints are another product that worn overnight to keep the heel stretched out and are available over the counter or online. According to the doctor, it is also important to avoid going barefoot, especially on hard floors.

Source: The Star-Homewood (IL) [9/30/07]

Armstrong Receives Inaugural Georgetown Distinguished Achievement Award

In ceremonies September 28, 2007, at the Georgetown University Hospital Conference on the Team Approach to Diabetic Limb Salvage in Washington, DC, David G. Armstrong, DPM, MSc, PhD, received Georgetown’s first Distinguished Achievement Award in Diabetic Limb Salvage.

Drs. Robert Goldberg, David Armstrong, and Christopher Attinger

“David Armstrong is one of the leading lights in research on diabetic foot disease and diabetic limb salvage,” said Dr. Robert Goldberg, executive vice president of Georgetown University Hospital, in presenting the award. As director and co-founder of the Center for Lower Extremity Ambulatory Research or CLEAR in Chicago, Dr. Armstrong and his group at CLEAR have produced more than 200 peer-reviewed research papers in two dozen scholarly medical journals as well as over two dozen book chapters.

Dr. Armstrong is professor of surgery and associate dean of the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago. He recently became the first podiatrist to receive tenure at Rosalind Franklin. An honors graduate of the California College of Podiatric Medicine, Dr. Armstrong also holds a master’s of science in tissue repair and wound healing from the University of Wales College of Medicine and a PhD from the University of Manchester College of Medicine.

NJ Podiatrist Sentenced to 5 Years for Healthcare Fraud

Attorney General Anne Milgram and Criminal Justice Director Gregory A. Paw announced that a Long Branch podiatrist was sentenced today for billing Horizon Blue Cross/Blue Shield more than $200,000 for medical services he never rendered.

According to Insurance Fraud Prosecutor Greta Gooden Brown, Martin H. Weinstein, 52, of Long Branch, NJ was ordered by Superior Court Judge Francis P. DeStefano in Monmouth County to serve five years in state prison and pay $200,695 in restitution to Horizon Blue Cross/Blue Shield.

The judge also ordered him to permanently forfeit his podiatrist’s license. The sentence was pursuant to Weinstein’s June 11 guilty plea to health care claims fraud, a charge contained in a 2003 indictment.

Source: NJ Department of Law and Public Safety [9/28/07]

Query: Foot Pain from MRI Contrast Material?

I recently had an 82 year old male present to my office with the complaint of bilateral foot pain primarily across the metatarsal heads, duration possibly a year or so. He told me that he had seen an ad on television for a personal injury attorney soliciting potential clients with the claim of foot pain as a result of MRI with contrast material. He claims that he had an MRI with contrast on his spine about four or five years ago, and because of this commercial he is convinced that this is the source of his pain. Has anyone heard of this side effect before and if so, what are the symptoms?

Leonard Kuzmicki, DPM, Spring Valley, IL

RE: Arthroereisis vs. Arthrodesis (Robert Scott Steinberg, DPM)
From: Lloyd S. Smith, DPM, Ivar E. Roth DPM, MPH

We have clearly entered an era where new procedures, technology, devices and even CPT codes must prove that they provide valuable patient health benefits at a reasonable cost. FDA approval does not address issues of cost compared to other options available to treat a particular condition. Our healthcare system is being managed by health care economists in both the federal and private payer systems. We are competing in a global economy and the cost of health care affects the ability of American industry to compete. Just look at the GM strike settlement for a lesson in that issue. As physicians we may not like that one bit but if we don't manage our patients with those issues in mind, someone else will (and actually probably is already) do so for us.

Lloyd S. Smith, DPM, Newton, MA, Lloydpod@yahoo.com

In the insurance industry there is the theory of equivalents. It goes that if there are similar procedures than use a code closest to the “correct” code. I keep reading the “dogma” put out by some coding experts that if the procedure is not “exactly” the same than the only code that fits is one of CPT 28899, i.e., unlisted procedure. Insurance companies routinely deny a code of 28899 with a, “take your pick of the week excuse for not paying”

Why are we podiatrists beating up on ourselves and denying both the patient a needed surgery and ourselves the ability to bill for a real therapeutic procedure that the insurance company should rightly cover? I will explain why a CPT 28725-52 procedure code is the correct code to bill unless a specific code exists for this procedure, which it does in at least one state I am aware of where the insurance carrier made a code to cover this procedure.

A subtalar arthrodesis is a procedure to eliminate unwanted motion in the subtalar joint, i.e. through boney fusion where as an arthroereisis is a procedure where unwanted motion is eliminated by means other than fusion. The procedures both eliminate motion, one more than the other, in the same exact area, but by two different methods. Therefore use of a -52 is the closest way to bill for this procedure. I would like to hear from the experts as to what their opinion is on this theory of equivalents.

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

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

ASSOCIATE POSITION – CENTRAL FLORIDA, ORLANDO AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well established multi-office practice. Applicant must be bilingual in English and Spanish, well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.com

PODIATRIST WANTED – RIVERHEAD, NY

Podiatrist needed in Riverhead, NY for an Article 28 Diagnostic and Treatment Facility with unlimited growth potential. Multidisciplinary site with much cross referral. Great opportunity. Call 631-981-1333. lakechiropllc@optonline.net

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

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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