The Voice of Podiatrists

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October 11, 2008 #3,371 Editor-Barry Block, DPM, JD

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NY Podiatrist Uses Dermal Fillers to Treat Painful Corns

Corns are among the most common foot ailments. Previous remedies like shaving them down and wearing protective pads offer only temporary relief. Now podiatrists are raiding the dermatologists' medicine cabinet and using cosmetic fillers for feet. Podiatrist Dr. Johanna Youner explains: "The filler, Juvederm, is injected beneath the corn and fills up tissue volume that's been lost through years of wear and tear. It's an off-label use of filler that's been FDA-approved for areas on the face, the nasal-labial folds, for years, and we found it safe and effective in the feet."

Dr. Johanna Youner

The filler not only evens out and shrinks the corn; it triggers the body to replace its own worn-out tissue. This stops the pain and prevents the need for more drastic measures. "Using filler we can either delay surgery or halt it all together," Youner said.

Source: Dr. Holly Phillips, WCBS-TV [10/9/08]

ID Podiatrist Challenges for State House Seat

Rep. Jim Patrick, a Twin Falls farmer and single-term Republican legislator seeking re-election, faces Democrat Peter Rickards, a Twin Falls podiatrist best known for his anti-nuclear activism, for the District 23 House seat. Rickards has voiced concern for waste at the Idaho National Laboratory and is staunchly against the proposed nuclear power plant in Elmore County.

Dr. Peter Rickards

He often warns that the negatives of nuclear power outweigh the positives - he proposes alternative sources instead - and he routinely says farms, dairies and other agriculture will be destroyed by the effects of nuclear energy. "I just have so many issues that I need a legislator to speak up on and I keep asking them to speak on, and they keep speaking up for the nuclear businesses instead of other people of Idaho," said Rickards, who ran against Patrick in 2006 and as an independent for governor in 1998.

Source: Jared S. Hopkins, Times-News [10/9/08]

Guidelines for Brilliant Brainstorming

Follow these suggestions and you will never again subject your staffers to a creativity-killing, unproductive brainstorming session:

• Don’t look for one big idea. View brainstorming not only as a chance to harvest ideas but also to combine and extend them. The power of group creativity comes from inviting people with different ideas to share, blend and expand their diverse knowledge.
• Allow individual effort too. Ideas sprout from a blend of individual and collective creativity. Build in time for people to think and learn about the topic before the group brainstorming session, and allow time to reflect on ideas generated during the meeting—before agreeing on a final decision.
• Take action. Brainstorming is of little value unless it is combined with observing customers, interviewing experts and building prototypes that test the proposed ideas.

Source: Adapted from “The Truth About Brainstorming,” Robert Sutton, Business- Week

Query: Arthrosurface Hemi Cap for Frieberg's Infraction.

Does anyone have any experience using the Arthrosurface hemi cap for a degenerative 2nd metatarsal head as a result of a Frieberg's infraction. This patient is 27 yo and has a stiff, painful and arthritic 2nd MPJ. Also, is there literature supporting the use of implants in a 27 year old with Frieberg’s?

William Sachs, DPM, Shrewsbury, NJ

Query: Abandonment of Nursing Home Patients

My group provides nursing home coverage for some of the nursing facilities in our area. We have recently been notified that we are being replaced for providing podiatry services in one of them.

I know that a facility cannot sign an exclusive agreement for health care services, but we all know that if you are not wanted, it can be a very unpleasant experience remaining in that facility. What is our legal responsibility to the patients we have been treating? Do we need to contact them or their guardian explaining the situation, and offering to continue our care if they should so choose? Are the steps identical to a non-nursing home patient?

Cyril Gostich, DPM, El Centro, CA

Response: A similiar situation happened to me. We contacted the local primary care physicians who admitted to the facility, and knew us, and explained the situation to them. Many of them know what it's like to be squeezed, so, in our experience, they were more than happy to help. We asked them, if they wanted us to treat their patients, to specifically request us on their admit orders.

We also wrote a note to the families simply indicating that there was a new contract regarding podiatry care in the facility, but if they want us to continue to see their relative, they could still request us. We hit home the fact that we were local, and available for prompt care rather than from, in our case, a group of podiatrists not from the area.

In our case, we lost few patients...and gained those back once the outside podiatry group decided it wasn't worth their time to come in to see so few patients.

Tony Poggio, DPM, Alameda, CA

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RE: Weil Osteotomy w Cheilectomy (Stuart W. Kushel, DPM)
From: Stephen Kominsky, DPM, Douglas Pacaccio, DPM

Early on, I was an advocate for the double cut V osteotomy in the transverse plane. Sometimes, it was a double cut on the dorsal wing alone, and sometimes it was a complete double cut. In fact, we presented a paper years ago looking at the amount of decompression of the joint, and plantar displacement of the capital fragment based on the distance between the apices of the two cuts.

However, for the past 5-7 years, I have become an advocate for a modification to the Weil osteotomy of the first metatarsal for hallux rigidus/limitus. I strongly disagree with a previous post as to the dorsi-flexion of the capital fragment when this procedure is done correctly. One can achieve plantar displacement of the capital fragment (you can control that based on the angle of the cut) and decompression of the joint with shortening and laxity of the soft tissue structures surrounding the joint.

This is easily fixated with screws of your choice in a dorsal to plantar direction, angling them slightly distally. Patients weight-bear in a short leg cast immediately post-op for 2 weeks, and then transition into a surgical shoe to begin physical therapy.

Stephen Kominsky, DPM, Washington, DC, sjkom120@aol.com

I would think that if you performed an aggressive enough cheilectomy, a subsequent Weil on the 1st Met might degrade your 1st MPJ construct, putting the patient at risk for all kinds of hallux deviations. If you have not tried a sagittal Mitchell yet and are looking for plantar-flexion, decompression and ROM, might I suggest an article by Richard Derner and Keith Goss, both of whom I trained with and who are very credible. It is a very detailed article on the procedure itself as well as realistic pearls on post-op possible complications and pearls to control the degree of correction.

I have performed the procedure a few times myself and have found it to be very effective even in stage 3 limitus/rigidus. Also remember there is a study that showed the most important predictor of success in those procedures is 70 degrees of "intra-op" df ROM. I think it was done by Mann comparing Youngswick vs. cheilectomy vs. another osteotomy, but the take-home point they discovered was that it did not matter which procedure they performed, but post-op success was statistically tied to> 70 degrees df ROM on the table. The motion will decrease with healing, but the symptoms were also decreased.

Here is the citation for the Derner article: A plantar-flexor-shortening osteotomy for hallux rigidus: a retrospective analysis. J Foot Ankle Surg. 2005 Sep-Oct;44(5):377-89.

Douglas Pacaccio, DPM, Yorkville, IL, pacman25@hotmail.com

RE: Nail Dust Inhalation (Steve Bennett DPM)
From: Multiple Respondents

I use the HP-Sani Vac from Moore Medical. It is independent of the Dremel, but has an adjustable hose. It really works well.

Jennifer Ryder, DPM, Rapid City, SD, jenbenryder@yahoo.com

I recommend reading a series of three articles on this topic published in APMA Journal years ago by Carl Abrahamson, PhD, from Temple University College of Podiatric Medicine..

Joan Williams, DPM, Seattle VAMC, Joan.Williams@va.gov

Dr. Nicola McLarnon at Glasgow University in Scotland has carried out extensive research on the effects of nail dust. See: World at work: Evidence-based risk management of nail dust in chiropodists and podiatrists. J G Burrow, N A McLarnon, Occup Environ Med. Oct 2006 (Vol. 63, Issue 10, Pages 713-6).

Lorraine Jones, London, England, lorraine.jones@gmail.com

RE: VA Salary (Name Withheld)
From: Joan Williams, DPM

In reply to “name withheld” concerning VA salary for part-time work, consultants at Puget Sound VA hospitals are paid $100/hour. No benefits.

Joan Williams,DPM , Seattle VAMC, Joan.Williams@va.gov

RE: Inexpensive Vascular Testing System (William Alexander, DPM)
From: Kazu Suzuki, DPM

For an inexpensive set-up, I recommend Hadeco hand-held Doppler device (distributed in the U.S. by koven.com. It is a high-quality and durable device. You can combine this with a blood pressure cuff, create a simple print-out, and measure ankle pressure and ABI. I believe it is retailed for $1000-2000 range.

If you are willing to spend more, I recommend Sensilase (vasamed.com), which measures both SPP (Skin Perfusion Pressure) and PVR (Pulse Volume Recordings). It creates a nice PDF report, which can be printed out or e-mailed to your vascular colleagues. Sensilase does not measure ABI, but I don't rely on ABI anyway, as it is clinically meaningless in diabetic and dialysis patients that I see everyday. As far as I know, in most areas in the US, DPMs can perform and bill for "non-invasive vascular testing (CPT 93922/93923)," which reimbursement rate varies between $80-250.

Kazu Suzuki, DPM, Los Angeles, CA, kazu88@gmail.com

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

turn-key operation grossing $570,000 annually based on one full-time doctor; practice is in a growing retirement area in the center of the state. Option to purchase or lease real estate. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours, so it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725 for details and ask for Lee.

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

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 Visit our website

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

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