The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 09, 2007 #3,061 Editor-Barry Block, DPM, JD

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Nike Air Native Shoe Could Benefit Those With Wide Feet: SD Podiatrist

Air Native or N7 is Nike's new shoe that has a culturally specific look, and is supposed to fit a Native American's foot more comfortably. Nike did their research. It turns out, in general, the foot shape of Indians and Blacks for that matter are different. "They have a wide foot and it tends to flatten out more as you step down, on a general basis," said podiatrist Tom Ries.

Dr. Thomas Ries

Ries admits a lot of people from all cultures could probably benefit from the N7. The shoe is supposed to have a wider and larger toe box, which could be less irritating to a flat foot. "You have more of a tendency to get bunions and hammertoes when your foot widens out, and so those areas rub. And that's common in a diabetic population which is increased in the Native American population, so I think they're on to a good thing here."

Source: KOTA-TV [10/5/07]

OH Podiatrist Follows in His Father’s Footsteps

Podiatrist Michael Moran of Lebanon, OH spends his day on feet — his and yours. "We see all kinds of things in this small-town practice but it's been a lot of fun for me," he said. "Everyday is different, you just never know what is scheduled but just when you think you've seen it all something worse comes in," Moran said.

Dr. Michael Moran (Photo: Linda Weisenborn)

Moran followed his father's steps into podiatry after seeing a dad who could be dedicated to home life as much as he was to his job. Raising five kids as a widower, the senior Moran was home every day at 5 p.m. "He never got called out in the middle of the night for an emergency," he said. "It was a nice lifestyle and it swayed me." After graduating from Xavier and the Ohio Collage of Podiatry Medicine in Cleveland, Moran got his feet wet in heel pain, diabetes, ingrown toe nails and fungus.

Moran hopes to continue treating feet for a long time — just like his father who has been working for 52 years. "It's been a lot of fun and I hope to do this for another 22 years," he said. "My dad will be 81 years old in November and he's still working at his practice in Hillsboro."

Source: Danyrae Lockwood, The Western Star [10/3/07]

Medicare Pay Hike on Tougher Road After Being Stripped From SCHIP Bill

Hopes that a two-year Medicare physician payment increase would head to the White House on the back of a popular children's health insurance measure were dashed late last month. Lawmakers decided to remove the Medicare language from the bill.

Lawmakers said they were not dropping physician payment as a priority. But the campaign to preserve access to care by boosting doctors' rates will not be able to rely on the strength of children's health coverage as an issue to achieve legislative success.

Physician organizations now must change gears to push a Medicare-only bill that can move through Congress on its own or attached to another piece of legislation. Because the House already has approved the two-year payment increase, as well as the reductions to Medicare Advantage plans to help pay for it, the focus will be on gaining enough support in the Senate for passage.

Source: David Glendinning, AMNews [10/8/07]

Query: Mobile X-Ray Unit

Can anyone recommend a mobile x-ray model?

David Zuckerman, DPM, Woodbury, NJ

Query: Practice Advisors

I am a new podiatrist (out of residency just over 1 year) and have begun the talks of a buy-in with my employer. I would like to know how many different advisors I need for the various aspects of this new road in my life. More specifically, who do I need to talk to regarding personal and business taxes, personal wealth and estate planning, need to form a separate business entity for myself and how to do this, asset protection, etc. Is there one individual that I can start with? Or do I need several different professionals now that my situation is about to become more complex? If so, who should I start with, and how do I locate someone?

Robert Lagman, DPM, Mandeville, LA

Editor’s comment: PM News does not provide legal advice. Today’s complex practice environment is full of “land mines” for the unprepared new practitioner. Since there is no single individual qualified to deal with both legal and financial issues, you need to build a support team. From the outset, you need an attorney to protect your interests and review any contracts you sign, especially your employment contract.

A good accountant can help you through the maze of tax issues, as well as help you prepare your taxes. Consulting a financial planner is a smart move because setting up an investment plan early will result in big dividends 30 years down the road. You’d be surprised just how fast those years go by.

RE: Choice of Bunionectomy (Dennis Shavelson, DPM)
From: Multiple Respondents

I do not believe a Keller procedure would address lateral transfer pain since this is due to metatarsal problems. In fact, a Keller might worsen it especially with long 2nd and 3rd metatarsals. If DJD exists of the medial head and plantar plate, a joint preserving procedure might cause more pain at the 1st MPJ (currently this is not a symptom).

A good or better cosmetic and functional result could be obtained with a 1st MPJ fusion, followed by biomechanical control via A Morton’s extension if elevatus exists, and/or short 1st metatarsal. Medial drift of MPJ's 2 and 3 might also be reduced.

Academically, we can consider Cotton cuneiform osteotomy to correct an elevatus, Modified Javara, "Z" distraction osteotomy to plantar-flex 1st met. head, distraction via bone graft, "Z" osteotomy, or with external fixator for length or Weil-type procedures for the metatarsalgia.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

My question is whether a Keller procedure is enough to establish relief and shoe cosmesis or do I need a reverse Austin incorporated or is (are) there another procedure(s) that would be better (but not more heroic)... After ten years those medial structures are going to be VERY tight. A 1st MTP joint arthrodesis would resolve the problem with the greatest degree of certainty and stability.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

Given the negative IM and severe hallux varus, it may be necessary to do an opening wedge to increase the IM and preserve length. I believe that a Keller may realign the hallux temporarily but will fail as insufficient metatarsal head will be available to stabilize it.

Mark Gresser, DPM, Mt. Sinai, NY, doctorblues@optonline.net

RE: Service Dogs and the ADA (Michael Cohn, DPM)
From: Michael J. Schneider, DPM, Elliot Udell, DPM

In regard to the "service dog" issue. Attached is a quote from the ADA. What service includes separation anxiety? Would the same apply to a canary or a gecko? Maybe a phone call to the proper authorities would remedy the situation.

ADA Business BRIEF: Service Animals: Service animals are animals that are individually trained to perform tasks for people with disabilities such as guiding people who are blind, alerting people who are deaf, pulling wheelchairs, alerting and protecting a person who is having a seizure, or performing other special tasks. Service animals are working animals, not pets.

Michael J. Schneider, DPM, Vail-Aspen-Frisco CO, MJS10Vail@aol.com

As an allergy sufferer, I side with Dr. Cohn. When most people think of allergy sufferers they think of a man, woman or child sneezing and then popping an over the counter pill and feeling all well again. TV commercials for allergy pills reinforce this image. This way of thinking might lead to the gut response. "Sorry, allergies don't count, put up with the dog in your office."

The reality of allergies is that in severe cases they can lead to debilitating asthma, sinusitis, infections and very severe cases can lead to anaphylaxis and death. If you have severe allergies to dog dander and it's more than just a mild response, by no means should you allow a dog into your office and be grateful that you have an allergy that can be remedied by avoiding a specific antigen. Many of us are not that lucky.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Restrictive Covenant (George R. Vito, DPM, MBA)
From: Robert Lagman, DPM , Howard L. Lazar, DPM, JD

As a fairly new podiatrist I take exception to Dr. Vito’s statement that new podiatrists lack simple logic when it comes to simple rules of signing a contract. I agree that most of us are naïve due to lack of any type of training in school or residency when it comes to business or legal aspects of medicine. But I do believe that many newly hired podiatrists are signing contracts with very restrictive non-compete clauses. I understand the principle behind one, however many doctors are hiring for subpar salaries and when it comes to renew the contract, no adjustments are made. The young podiatrist is now forced to accept this deal or leave and be forced to move in order to be able to practice.

I know several of my classmates that have been affected by unscrupulous doctors that take advantage of new graduates for their own personal gain. By the time young podiatrists “wise up” it has cost them dearly because they are unable to practice where they currently live. So while this contract seems to protect the interests of the practice, who is looking out for the interests of new podiatrists? I know the real answer is to do your research and hire a lawyer to review your contract, etc…but as I pointed out before, we are not up to speed on the business aspect of medicine.

In response to Dr. Vito’s statement I would like to say that many young podiatrists don’t lack common sense usually…it’s more of a lack of business sense, so cut them some slack on that. So to anyone that works with students or residents - please help educate them on many of these principles, so all of us can continue to improve the field of podiatric medicine.

Robert Lagman, DPM Mandeville, LA , Robert.J.Lagman@dmu.edu

Attorneys may, for their physician clients, draft employment and partnership agreements which contain restrictive covenants prohibiting a departing employee or partner from practicing their profession within a specified distance of that practice. It is interesting to note that attorneys are themselves forbidden to be a party to, or participate in, any partnership or employment relationship conditioned on such a covenant. An attorney who violates this rule may be professionally disciplined for doing so.
DR 2-108 Agreements Restricting the Practice of a Lawyer.

1. A lawyer shall not be a party to or participate in a partnership or employment agreement with another lawyer that restricts the right of a lawyer to practice law after the terminations of a relationship created by the agreements, except as a condition to payment of retirement benefits.

2. In connection with the settlement of a controversy or suit, a lawyer shall not enter into an agreement that restricts his right to practice law.

Such covenants are viewed as "clear violations of the explicit prohibition against attorneys entering into an agreement restricting the right of an attorney to practice law, which recognizes no exceptions for limitations of geography or time. Secondly, they violate a basic tenet of the professional responsibility of all lawyers that every person have ready access to the independent professional services of a lawyer of integrity and competence. In order to accomplish this, a potential client must have free access to the attorney of his choice." American Bar Association (ABA) Model Code of Professional Responsibility and Model Rules of Professional Conduct.

The ABA rule is intended to preserve the rights of lawyers and their clients. Restrictive covenants used by physicians are intended to impede competition (a good physician should not have to worry about this) without regard for the welfare of patients.

Howard L. Lazar, DPM, JD, Bloomfield Hills, MI, howardlazar@comcast.net

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