The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 04, 2010 #3,974 Publisher-Barry Block, DPM, JD

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We've just mailed the October 2010 issue of Podiatry Management. This special footwear issue includes a variety of  articles on this timely topic. In addition, you'll  find our usual assortment of features, including our columns, and a CPME-approved CME.

October 2010 Podiatry Management

Heel Spur Could Result from Untreated Plantar Fasciitis: NY Podiatrist

There's a new theory out there that going barefoot is the best way for humans to get about. Dr. Craig Campbell disagrees, saying that, theoretically, the foot may be designed to bear weight without a shoe, but not in areas where cement and concrete predominate. Sneakers are great, he said. "They provide compensation for hard surfaces."

Dr. Craig Campbell

If you suffer from plantar fasciitis - inflammation of the thick fibrous band of connective tissue that leads from the bottom surface of the heel bone, along the sole of the foot toward the five toes - see a podiatrist. Left untreated, a bone spur could develop. Plantar fasciitis, often brought on by blunt force and/or exacerbated by excess weight, can take a long time to resolve. Stretching and application of ice on the injured area help, said Dr. Campbell.

Source: Marjorie Hack, Staten Island Advance [9/30/10]

OCPM Professor and Students Provide Relief in Haiti

Matthew DeMore, DPM, OCPM Associate Professor and Chair of Podiatric Surgery, along with fourth year students Evan Ross and Brian Gradisek, recently volunteered their time and resources in Haiti. In a continuing global effort of people providing relief to the Haitian people, the OCPM team spent five days in August as part of that spirit of human generosity. Dr. DeMore and his students treated numerous conditions such as soft tissue infections and abscesses. They also treated bone infections via amputation, incision and drainage. According to Dr. DeMore, "It was one of the most rewarding things I have ever done.

Dr. Matthew Demore in Haiti

I look forward to returning. In fact, I am in the process of formulating a plan to return with two deserving fourth year students from next year's graduating class." Dr. DeMore also stated, "I was emotionally drained after seeing the living conditions for most of the Haitian people. Everyone I talked to while we were there was so appreciative of our presence and treatment. There has been little effort to rebuild, and many of the people still live in 'tent cities'."  

Source: OCPM Footprints

Stretching and Appropriate Footwear Prevent Running Injuries: APMA Podiatrists

“Some of the most common running-related foot injuries that today’s podiatrists treat are arch pain, tendonitis, and blisters,” said APMA president Kathleen Stone, DPM. “However, if runners can take just a few minutes to stretch properly pre-workout, select appropriate footwear, and see a podiatrist immediately when foot pain occurs, many of these ailments can be avoided entirely.”

Drs. Kathleen Stone and Karen Langone

In order to get the most out of each run without falling victim to injury, APMA recommends that you select a good running shoe. According to Karen Langone, DPM, president of the American Academy of Podiatric Sports Medicine (AAPSM), the most important running tip is proper shoe selection. “A running shoe purchase is dependent upon the type of foot and function of the foot for the individual. Runners should research shoe construction and keep in mind that footwear can vary in size from one manufacturer to the other,” she said.

Federal Government Expands Grassroots Fraud Prevention Effort

The Centers for Medicare & Medicaid Services (CMS) today announced the award of $9 million in grants to help more than 50 Senior Medicare Patrol (SMP) programs fight Medicare fraud. This is part of President Obama’s mandate to educate seniors and other Medicare beneficiaries about how to prevent fraud in Medicare. 

The announcement to double the funding for SMP activities states that the grants will provide additional funds to increase awareness of Medicare and Medicaid beneficiaries of healthcare fraud prevention, identification, and reporting through expansion of SMP program capacity. Increased funding levels for states identified with high-fraud areas will support additional targeted strategies for collaboration, media outreach, and referrals. The Administration on Aging will administer these grants in partnership with CMS.

Source: CMS

Give Complaints The Benefit of the Doubt

Unless you have solid proof that a patient is lying or wrong, never treat any patient with suspicion. Assume that most patients are honest people instead of responding to them as if they are rogues working to exploit your practice. Consider the following example:

• A patient complains that she has been waiting for a half-hour. It’s easy to assume that the person is exaggerating. Even so, you should trust that she has been waiting longer than she reasonably expected to wait.

Benefit: When you give patients the benefit of the doubt, you create loyalty that delivers long-term gain to your practice.

Source: Adapted from The Buzz: 50 Little Things That Make a Big Difference to Serve Your Customers, David Freemantle, Nicholas Brealey Publishing via Communication Briefings

Query: Dealing With Medicare Carrier’s Incompetence

What is the best way to fight a Medicare carrier on issues of either severe incompetence or denial by design that is chronic? Does it help to go to my Congressman? How about contacting CMS directly to file a complaint and to point out issues of noncompliance of the contract?

Michael Lawrence, DPM, Chattanooga, TN

Editor’s comment: Individual podiatrists have little or no power to bring about changes in a bureaucratic system. This is why it pays to belong to APMA, an organization with the strength of 12,000 members. We encourage you to join APMA so that they can intercede on your behalf.

RE: Wound VAC with HBO (Doug Mason, DPM)
From: Frank Lattarulo, DPM

We see this scenario all the time. In a 12-person, multi-place chamber we rarely have a treatment without a patient on a VAC. By the very nature of what HBO does, you are expected to get vasoconstriction on decent (Boyle's Law) to 2.4 ATA (45 FSW). There is also some hyperemia during the 90-minute treatment and some vasodilation on ascent. If the wound VAC is applied properly, sealed effectively, and enough skin prep applied, this should not be a concern. Your wound VAC or NPT machines should not impact HBO treatments. Of course, remember to disconnect the tubing and cover the end prior to loading the patient. Simply reconnect after treatment, turn the machine on, and this will be fine.
 
Frank Lattarulo, DPM, New York, NY, doclatt@aol.com

RE: Rotation Flap for Squamous Cell Cancer (David E. Gurvis, DPM)
From: Bryan Markinson, DPM

Dr. Gurvis generated a lot of responses regarding coverage of a defect after wide excision of a squamous cell carcinoma. Most people seem to agree that a flap of some type would be appropriate. My suggestion was that the patient have Mohs surgery to achieve the stated aims of removing the lesion with clear margins while preserving as much tissue as possible. Although I agree with those advocating for a flap simply to cover the defect, we must remember that the lesion we are removing is a cancer. The defect is not... 
 
Editor’s note: Dr. Markinson’s extended-length letter can be read here.

RE: Midmark Repair (Paul Galluzzo, DPM)
From: Brandon M. Zuklie, DPM

I have used Global Intermed for Midmark parts. Contact Mark Hayes 440-610-1495. He is fair, honest, and knowledgeable.

Brandon M. Zuklie, DPM, Piscataway, NJ, zuklie@hotmail.com

RE: Ethical Dilemma (Ivar Roth, DPM, MPH)
From: Allen Mark Jacobs, DPM, Elliot Udell, DPM

Since when is an injury to the sural nerve res ipsa malpractice? How would Dr. Roth's actions by encouraging a negligence suit reduce the cost of care for this patient? The origin and course of the sural nerve is quite variable, and as a result, injury to this nerve is not uncommon. If, as suggested, the patient is doing well with a nerve stimulator, why endanger her current status with further surgery? On what basis does Dr. Roth conclude that, in this case, the nerve was negligently cut?

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

The interesting aspect of this ethical case presentation is whether a person can be forced to undergo additional surgery so that the public will no longer have to cover the patient's disability payments. Can a person be forced to undergo additional pain and risk associated with a new surgery on the chance that it will save the taxpayers' money? Is any surgery guaranteed to succeed?  It is possible that the patient would still have pain and would still not be able to work. Assuming for the sake of discussion that the reparative surgery would alleviate the patient’s pain, could anyone can be forced to undergo a medical treatment or be denied a medical treatment solely in order to save the government money?

Thank heavens in this country the answer is no, and hopefully it will stay that way forever. As to whether the patient should be resorting to litigation against the original doctor, that too is up to the patient. Many lawsuits have been averted because a patient likes a doctor even though the doctor was negligent. Another factor is that negligence can only be established in court. Dr. Roth's professional viewpoint is that the surgeon "goofed." In a courtroom, the surgeon's point of view would also be aired, and if he has good legal representation, the outcome could come out in his favor.   
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com   

RE: Extortion By Patient (Name Withheld)
From: Jeffrey Kass, DPM

Make sure everything is documented as you say. Speak to your malpractice carrier. I am not an attorney, so I can't give legal advice but I would inquire from the malpractice carrier if you can bring him up on extortion charges.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

This is an ugly situation. You have been put on the defensive by a patient when you "did no wrong." If you give the money back, even with a signed release, you would have to check with your own attorney or your malpractice company's attorney to see if that indeed releases you from liability. 

While I understand the "easy way out" is to pay the patient and be done with it, perhaps you should do some soul-searching and contact your liability carrier. Sometimes, patients do threaten, but then again, if your records are well documented, an attorney would be hesitant to take a case against a non-compliant patient who caused his own injury.  It's a game of who blinks first, but if you feel you were absolutely in the right, then you should not refund him simply because it's the easier way to go. Remember, a malpractice suit costs both sides money in the beginning.

Sloan Gordon, DPM, Houston, TX,  sgordondoc@sbcglobal.net

ASSOCIATE POSITION - NEW JERSEY

Ambitious podiatrist needed for part-time work in Bergen County office, nursing homes, rehabilitation centers and assisted living facilities. Hours are flexible. PRS 24 needed. Candidate should be hardworking and willing to travel throughout Bergen County. Please send CV to facnj@yahoo.com or fax 201-599-5960.

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a  very busy, well established, diversified practice in Clearwater, Florida. We are seeking an Associate who is BC/BE and highly motivated, minimum PSR24+. We offer a competitive salary and benefits. Please send your resume to Jaye@fdn.com

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

NORTHEAST OHIO PODIATRY OPPORTUNITY

Western Reserve Senior Care, an innovative home visit practice that makes visits to seniors in assisted living facilities and SNF’s, is recruiting for a Part-Time Podiatrist. Make a true difference as you make visits to homebound seniors while managing the full scope of podiatric disease. This opportunity offers a perfect balance of superb lifestyle and excellent compensation. Practice is affiliated with world class health systems in Cleveland, OH. Email CV to wmills@westernreserveseniorcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

PRACTICE FOR SALE - NORTHEAST COLORADO/SOUTHWEST NEBRASKA 
 
Practice is a good mix of biomechanics, diabetic care and surgery.  Revenue could be increased by well-trained surgeon. No HMO's. Low overhead. Only podiatrist in the area. Please contact mld9439@live.com for more information.

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com

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