The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 07, 2010 #3,977 Publisher-Barry Block, DPM, JD

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Unexplained Foot Fractures First Sign of Osteoporosis: OH Podiatrist

Unexplained foot fractures may be the first sign of osteoporosis, a bone thinning disease which affects over 28 million Americans and accounts for 1.5 million bone fractures a year. According to the American College of Foot and Ankle Surgeons, osteoporosis is frequently referred to as the “silent crippler” since it often progresses without any symptoms or isn’t diagnosed until a person experiences pain from a bone fracture. Georgeanne Botek, DPM, FACFAS, a Cleveland foot and ankle surgeon, explains that the porous nature of bones in people with osteoporosis makes them more susceptible to bone fractures, especially in the feet.

Dr. Georgeanne Botek

“Because the bones are in a weakened state, normal weight-bearing actions like walking can cause the bones in the foot to break,” says Dr. Botek. “In fact, many patients visit their foot and ankle surgeon suffering from foot pain only to find out they actually have a stress fracture, without having experienced an injury.” While osteoporosis is most commonly seen in women over age 50, younger people and men are also affected. Early symptoms can include increased pain with walking, accompanied by redness and swelling on the top of the foot. “Oftentimes, patients don’t seek treatment for their symptoms for weeks or even months, thinking the pain will pass,” says Dr. Botek.

Source: News-Medical.Net [10/6/10]

Some People Genetically Pre-Set for Barefoot Running: IL Podiatrist

As running has become an increasingly popular sport, podiatrist Lisa Schoene said she has seen barefoot running wax and wane. And right now, because of a new bestselling book called "Born to Run," there has been a resurgence of interest. Given her profession, she doesn't love the idea, and she believes not everyone is suited for it. "It's important not to put a blanket statement on it, like everyone should barefoot run. Our feet are genetically pre-set with a certain type of structure, so not everyone is going to be the perfect barefoot runner," she said.

Dr. Lisa Schoene

In fact, Schoene said running barefoot requires really good strength in the core, hips, and lower legs; and good flexibility, which for many may require some focused training. But whether you run with shoes on or off, Schoene said many people injure themselves. "They just strap on a shoe and out they go. They have not really been trained to run properly, so many people have very, very poor form."

Source: Nesita Kwan, NBC-TV (Chicago) [10/6/10]

PA Podiatrist Wins Goldfarb Foundation Residency Contest

Dawn Stein, DPM, Chief Resident at Heritage Valley Health System, Beaver, PA, was the winner of the Goldfarb Foundation’s first-ever Residency Contest. Her winning research topic “Application of Platelet-Rich Plasma with Tendon Repair in the Foot & Ankle” is a scheduled lecture at the upcoming Foundation Clinical Conference, October 28-31, 2010, at the Valley Forge Convention Center, in King of Prussia, PA.

Dr. Dawn Stein

According to Dr. John Marty, President of the Goldfarb Foundation, Dawn’s project stood out because of the significant advantages it could bring to podiatric practices. The contest was open to residency programs around Pennsylvania, and the Foundation received 12 applications from four different residency programs.

Query: Too Many Stress Fractures in High School Athletes

In the past three weeks, I’ve had four high school athletes from the same soccer team come in to the office with stress fractures. Patient 1: Stress fracture 2nd metatarsal, plain films. Patient 2: Stress fracture calcaneus, MRI (I thought this was a torn posterior tibial tendon). Patient 3: Stress fracture 4th and 5th metatarsal bases, bilateral, plain film and 3 phase bone scans (seemed too coincidental). Patient 4: Stress fracture 2nd and 3rd metatarsal, one foot, plain films.

The patients and their parents were all concerned that this might be a coaching issue, which I am inclined to agree with. I contacted our malpractice attorney for advice, and he suggested I contact the athletic director for the school and explain my findings, but not give out any patient information. I did that, and it really went nowhere. The athletic director didn’t view this as a problem. I’d like to help my patients, and on some level maybe help the coach not hurt any more kids, but I’m at a loss on where to go with this. The coach is also the math teacher for most of these kids, so the parents are reluctant to make waves. Any suggestions would be appreciated.

Eric Edelman, DPM, Syracuse, NY

RE: Flu Vaccine Injections (Elliot Udell, DPM)
From: David S. Wolf, DPM

Flu Shots? Why not drug screenings, allergy testing, school physicals, etc. Understandably, in today's reimbursement climate when patients have to think twice about medical care because of high deductibles and/or fear of job loss, we all need to be "lean and mean" in our overhead, but flu shots is not the answer.

Think about podiatric profit centers like in office PT, over-the-counter foot products, diagnostic ultrasound, diabetic shoes, and marketing to referral coordinators from local PCP, internists, pediatricians, pharmacies, chiropractors, etc.

David S. Wolf, DPM, Houston, TX, rebdovid@aol.com

RE: Hallux Pain (Darryl Burns, DPM)
From: Gino Scartozzi, DPM, Robert Bijak, DPM

I read the post by Dr. Burns and two main things came to mind. The "stabbing" or "sharp" pain appears in regions innervated along the hallucal branch of the medial dorsal cutaneous nerve. The symptoms that the patient requires "2-3 tequilas" or "Nyquil" at night leads me to suspect a nerve entrapment/neuroma formation at the medial aspect of the first MPJ bilaterally. This is possible IF there is an underlying orthopedic bunion deformity. Does the patient have a bunion deformity, and is wearing confining shoe wear and has a pressure or compression neuropathy? A cortisone injection at the point of compression neuropathy can be performed in combination with cyanocobalamin.

The other issue that comes to mind with the patient's own words is whether the patient demonstrates a neuropathy induced by alcohol intake and/or nutritional deficiencies. My suggestion is that you perform the following blood levels:  thiamine (B1), pyridoxine (B6), vitamin B12, folic acid, and niacin (B3). Ultimately, a nerve biopsy of the afflicted nerve can be contemplated if these tests/examinations are non-contributory to test for any other "demyelinating" nerve disorders. 
 
Gino Scartozzi, DPM, New Hyde Park, NY Gsdpm@aol.com

This sure sounds neuropathic, and there is more to consider than diabetes. When people say labs are normal, I cringe because they're usually talking about the most general types of tests. It would be useful to get a book of tests from your favorite lab, as they describe tests that most doctors don't know exist. I suggest a serum electrophoresis to rule out lymphoma, macroglobulinemia, or a cryogloubulin-type of neuritis caused by vasospasm. B-12 levels and ALT would be helpful. Of course, disc disease needs to be ruled out.

Whether the Nyquil or tequila is affecting the etiology or just dulling the sensorium, I suspect it is probably the latter. Nitrobid is a good idea and I'd like to know its effect. I look forward to hearing from the biomechanics gurus as to an EHL or hypermobility etiology. 

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: Sage Advice From a Podiatric Legend
From: Tip Sullivan, DPM

I had the pleasure of attending the recent Podiatry Institute meeting in San Diego, CA. One of our truly great podiatrists, E. Dalton McGlamry, DPM presented a history of "modern day" podiatry. He began back in the early to mid-1950s when he began to practice and basically discussed residency genesis and the change in the educational process our profession has been through. The efforts made by Dr. McGlamry and his cohorts are nothing short of miraculous. It was a pleasure hearing the history from one of the guys who made it.

As a profession and as individuals, I believe that it would do us all good to back off of our moaning, groaning, and bad mouthing, and listen to people like Dr. McGlamry who have contributed and changed our profession so much. My dad always said that if you wanted to learn how to do something (i.e. change something) go to the people who know the most about it. One of the statements that Dr. McGlamry made is "support and respect your fellow podiatrists" and the efforts they make to better our profession. We may have some different ideas regarding what "betters our profession" but I think if we will take the time to listen to the people who have been successful, they may have something to teach us all!
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Best Credit Card Service (Jeff Kass, DPM)
From: Multiple Respondents

I found the cheapest rates were through Sam's Club. By getting a membership, you can use a program through First Data to accept credit card payments.  The credit card terminals can be expensive to purchase new, as are costly lease programs. I purchased a used terminal off of eBay, and First Data reprogrammed it for me through the phone line. Also, if you get a terminal with ethernet, then you can perform credit card transactions through the Internet and not tie up your phone line, or have to purchase another phone line.
 
Brian D. Battles, DPM, Waco, TX, battlesbrian@hotmail.com

I recommend shopping around to various banks and credit card merchants in your area to get the best deal. Often your bank will give you the best rates since you are already a loyal customer. We use BBVA/Compass. We pay 1.87% of all charges plus a $0.25 fee/transaction and no monthly statement fee. I definitely recommend going with a company that provides the terminal machine for free in return for a 2-3 year contract. Some companies may charge $1,000 or more for the machine.
 
Judd Davis, DPM, Colorado Springs, CO, jtdavisco@yahoo.com

I have been using credit cards in my practice for years. I recently switched to National Payment Corporation out of Waterville, Ohio.  My agent for the company is a good friend of mine who will analyze your business needs - Bill Pories - BPORIES@aol.com. Billy gave me the best rates available. I have no financial relationship with National Payment Corporation.

Mark Sugar, DPM, Hyattsville, MD, MSugar8364@aol.com

RE: Dealing With Medicare Carrier’s Incompetence (Michael Lawrence, DPM)
From: Makabis Yousefpour, DPM

Although I respect the editor's comments, and in most cases agree with him, I have to say Dr. Arnold is unfortunately right. I have recently undergone a serious, non-sense major audit in which Medicare bluntly violated several of their own by-laws. I was a member of APMA, CPMA, LACPMA. I did reach out to all  of these organizations and no one really offered any help, advice, or even pointed me to the right direction. I went through a 10-month audit, with over 4,000 charts being audited. What really helped me was my knowledge of LCDs, and how to fight these audits.
 
I did call Palmetto, and they do not have a provider complaint department. Regardless of that, I called them every day and complained. I did call my congresswomen, senators, and even e-mailed president Obama three times. No one really helped, but at least they got my complaints. Finally, I got a lawyer through PICA, but the only thing he helped me with was the appeals. After 10 months, they realized that I was not doing anything wrong and finally let me go.  What I am trying to get at is that unfortunately our societies (APMA, etc.) really do not have too much pull and knowledge when it comes to Medicare issues, and unless you keep on calling Medicare yourself, no one else will do so.

Makabis Yousefpour, DPM, Los Angeles, CA, makdpm@yahoo.com

RE: Extortion By Patient (Name Withheld)
From: David Secord, DPM

I saw a patient, an ex-patriot from New Jersey who moved to the Gulf Coast to escape the snow or the Mob or something. He was a particularly poorly controlled diabetic and developed a wound at the PIPJ of his 3rd digit, primarily from the shoes he was wearing and neuropathy. I did a perfectly fine arthroplasty and he was fitted with a post-op shoe and crutches at the hospital and given oral and written instructions not to bear weight on the foot, and to use post-op shoe and crutch assistance.

My first post-op visit is usually on day 3 and, unfortunately for this patient, our office on the 1st floor gave a wonderful view of people coming from the parking lot to the office. No crutches. No post-op shoe. Wearing the...

Editor's Note: Dr. Secord's extended-length letter can be read here.

RE: PECOS Update
From: Paul Kesselman, DPM

CMS has released two PECOS updates within the past few weeks, neither of which has modified the January 4, 2011 implementation date. The first ruling expands the PECOS edits to Part A facilities in rural hospitals, delaying the phase II implementation (date of claims denial) until April 2011.

The second posting expands those eligible providers who wish to have their applications fast tracked. This literally expands the list to all providers who DO NOT bill Medicare for services (e.g. podiatrists who have opted out of Medicare), or are providers who usually do not bill Medicare (e.g. dentists). This new ruling is a positive development in reducing the amount of time the Medicare Carriers will need to spend on processing these types of applications. Hopefully, this will leave them ample time to process the longer applications for those going through the full arduous PECOS application process.

These memos have stated that CMS expects to process PECOS applications without any further funding as part of their contractual obligations and normal statement of work. CMS has also been silent on the January deadline with the issuance of these other PECOS updates. This leaves me very uncomfortable in assuring anyone that the deadline will be changed. There have also been no announcements from CMS with respect to any upcoming Open Door Forums on PECOS.

Therefore, if you have not submitted your PECOS application to Medicare, act on it immediately. With an average of a 90 or more day backlog on applications for most carriers, there is no assurance that applications submitted today will be processed in time to meet the deadline. If you procrastinate any further, your practice’s very financial survival may be threatened.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

ASSOCIATE POSITION - ST. LOUIS, MO 
 
Leading group practice looking to add one podiatrist to established location. Group's podiatrists enjoy incentive compensation plan (production and sharing group profits), benefits including health and malpractice, and supported with integrated practice management and EMR systems. Perfect opportunity for solo practitioner to join group setting. Could also be part time opportunity for the right individual.  Please forward CV to StlPodGroup@gmail.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

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.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

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

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

PM News Classified Ads Reach over 12,500 DPM's and Students

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