The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 05, 2007 #3,058 Editor-Barry Block, DPM, JD

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TX Podiatrist Provides Shoe-Buying Advice

Many women walk around in shoes a size too small, says Dr. Marybeth Crane of Grapevine, TX. Either they don't realize their feet enlarge as they age, or they can't stand the thought of wearing a size 10, 11 or 12. The rule of thumb: A shoe that fits has one thumb's width of space from your longest toe to the tip of the shoe.

Dr. Marybeth Crane

If you must wear pointy shoes, buy them a half-size bigger than your actual size to give toes extra room. And, says Dr. Crane, "I'd rather you wore a sling-back than a slip-on shoe. And if you like the espadrille look, you're better off with the strappy type than a slip-on. For the shoe to actually function properly, it needs to be attached to your foot properly."

Good-for-you shoes cost, concedes Dr. Crane, whose dream shoe is not too squishy and has a square toe and an inch-and-a-half heel. Not everyone likes them. "I have 17- and 18-year-olds that come in with back pain," she says. "They look at my shoes and say they would rather die than wear them."

Source: Sophia Dembling, The Dallas Morning News [10/2/07]

Illinois Podiatric Medical Association Elects New Executive Council

The Illinois Podiatric Medical Association (IPMA) recently appointed the following podiatrists to leadership positions.

Dr. Theodore Polizos

• Theodore Polizos, DPM, Hoffman Heights, President
• Paul F. Brezinski, DPM, Arlington Heights, President-Elect
• Joseph S. Borreggine, DPM, Charleston, Vice President
• Marlene Reid, DPM, Chicago, Treasurer
• Ada Paolucci, DPM, Plainfield, Secretary

10-Min Procedure Resolves Soccer-Related Ingrown Nails: VA Podiatrist

Suffolk, VA foot and ankle surgeon Matthew Dairman, DPM, FACFAS, says that he sees a lot of children with ingrown toenails during fall soccer season. "It seems like every child is enrolled in a league,” says Dairman, "The young kids wear hand-me-down cleats that don't fit exactly right. The older kids like tighter cleats to get a better feel for the ball and the field.”

Dr. Matthew Dairman

Dairman says these tight shoes crowd the toes together. Combine that with repetitive kicking, and you've got a recipe for painful ingrown toenails. Dairman says many of these kids don't tell their parents about the problem because they're afraid to miss a game. "By the time they come to my office, they've got a good infection brewing,” he says.

Young soccer players sidelined by an ingrown toenail may be able to get back into the game pain-free thanks to a simple, 10-minute surgical procedure. During the short procedure, the foot and ankle surgeon numbs the toe and removes the offending portion of the nail. Various techniques can permanently remove part of a nail's root too, preventing it from growing back. Most children experience very little pain afterwards, and can resume normal activity the next day.

Query: Slides for Rheumatology Presentation

I need to make a presentation to rheumatology residents on rheumatological conditions of the foot and surgical and non-surgical treatment of such. I need to know the best way to come up with the photos for this presentation. Can anyone suggest a good source?

Thomas Brant DPM, Jefferson City. MO

RE: Measuring Device For Pad Placement (Frank DiPalma, DPM)
From: Robert I. Shor, DPM, CPed

Pad placement tends to be too proximal when a met pad or accommodative pad is applied to an orthotic from markings on non-weight-bearing casts. Orthotics typically allow some pronation and elongation of the foot during weight-bearing. Marking a non-weight-bearing cast to place a met pad or other accommodation may not be accurate in these cases. Using semi-weight bearing or full weight-bearing casting techniques can provide a more accurate foot position for accommodations, but may not be the desired casting technique. Providing a lab with a weight bearing Harris mat imprint when a non-weight bearing cast is taken, may be preferred in these cases. SureFit has effectively used weight-bearing ink imprints to place accommodations on custom diabetic inserts for years.

Robert I. Shor, DPM, CPed, Medical Director, SureFit, rshor@surefitlab.com

RE: Billing an E/M code for Recurring Plantar Fascitis.(Ken Meisier, DPM)
From: Ken Malkin, DPM, Simon Young, DPM

If what happened was that the patient said, “I was fine and now it hurts again,” you told them “look out for the needle”, and that is what was documented, an E/M would simply not be appropriate. Knowing you, I doubt that is what really happened.

What I describe next is clearly not medical record fluff, but medically justifiable and should be payable. However, if what you did was document the patient presented after calling the office for the visit was patient directed not physician directed....performed and documented an interim HPI: such as when the pain recurred, described the pain, asked if their training schedule was altered, if they purchased new shoes, were wearing their orthotics, recall any injury etc. and graded the pain 1-10. And you documented that was no change in their meds or allergies since the last visit by mentioning the specific date this was last reviewed, performed and documented a problem focused exam, and discussed with the patient a today's treatment and the future plan you sure are entitled to an E/M with a -25. That scenario perfectly defines a separately identifiable service above and beyond the procedure itself where both the procedure and E/M services had a common diagnosis..

Just because the diagnosis was "known" does not make it a slam dunk for procedure only. By the way, some payers will not pay for both, some will pay for the cheapest one, others the more expensive one. This is clearly in violation of CPT coding rules.

Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

I am truly perplexed with Dr. Meisler's response. Not all heel pain is due to plantar fasciitis or truma. I would re-assess my original diagnosis. I think an E/M code could be warranted since you need to re--examine the patient to see if the original diagnosis was correct. Was there any change in the patient’s medical condition, new meds, for example? Differential diagnosis to r/o tarsal tunnel, RA, psoriatic arthritis, or other rhem. type of disorder, gout, PTTD, change in footgear, change in activities among others. Would further testing be warranted: EMG/NCV, radiographs, US., MRI, bloods.

I feel Dr. Meisler’s opinion is inaccurate and sends the wrong signal to insurance carriers. He is truly simplifying a condition that oft times is more complex than it appears, which affects a large portion of the podiatric patient population.

Simon Young, DPM, New York, NY, simonyoung@juno.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

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

PRACTICE FOR SALE-BEAUTIFUL SOUTHERN COASTAL MAINE

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ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

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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