The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 11, 2011 #4,275 Publisher-Barry Block, DPM, JD

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Canadian Podiatrist Uses Radio Soundwave Therapy for Plantar Fasciitis

Plantar fasciitis is a painful condition in which the plantar ligament of the foot tears away from the heel bone, says Toronto podiatrist Dr. Hartley Miltchin.

Dr. Hartley Miltchin

Miltchin has intoduced a new treatment for this condition called radio soundwave therapy. "It's a 3-minute treatment once a week for three weeks that brings new bloods vessels into the area of the tear," says Miltchin.

Source: Nelson Hudes, Breakfast Television (Toronto)

Podiatry is an Ideal Profession for Women: NJ Podiatrist

Dr. Gina Lagnese didn’t dream of becoming a podiatrist when she was young. In fact, she didn’t dream of being a doctor at all. she thought that was for people like her brother, who wanted to be a doctor since he was a boy, and today is a successful pulmonologist. No, not her! In college, though, she scheduled multiple visits with local doctors to see if anything would strike her interest, and the one who did was a female podiatrist. "I was intrigued with the fact that podiatry has its own schools, and from day one, you know what you are going to do. Also, she told me of the shorter residency time, which is ideal for a woman who wants a family," said Lagnese.  

Dr. Gina Lagnese (Photo: Tom Spader)

After graduating from the Temple University School of Podiatric Medicine, she was fortunate to obtain a coveted two-year surgical residency at Franciscan Health System of New Jersey in Hoboken, which brought her to New Jersey. "When I graduated, I took a job with a podiatrist who had five offices in North Jersey and Queens. It was a great starter job, but ultimately the traveling did me in. I worked for him for five years, during which time I got married, and eventually left to have my first of two daughters. Being a podiatrist has been one of the most rewarding things in my life, and as a woman, I feel I am a role model for my girls or any girl who questions what in life they can achieve," says Lagnese.

Source: Asbury Park Press [10/5/11]

OH Podiatrist is Apparent Suicide Victim

The death of a man whose body was found in his car Friday morning behind the former Big Lots building was caused by what is believed to have been a self-inflicted gunshot wound, according to the Huron County coroner. The body of  Dr. James Revelas, a Norwalk podiatrist, was discovered in a parked car by a man who was doing work at the site. The body had a gunshot wound to the chest. 

Dr. James Revelas

Coroner Dr. Jeffrey Harwood said there were no signs of foul play and that all the evidence suggests Revelas' death was a suicide. Revelas was a virtuoso violinist and was a former member of the Youngstown Symphony, the Bellevue Symphony, and the Heidelberg Orchestra.

Source: Aaron Krause, Norwalk Reflector [10/7/11]

Insurance Company Did Not Discriminate by Paying Podiatrists Lower Fees: CT Court

The Connecticut Supreme Court says an insurance company did not discriminate by paying lower reimbursements to podiatrists than to other doctors. In a 6-1 ruling released Friday, the justices said state law prohibits insurers from denying reimbursement, but does not forbid them from paying varying amounts to different specialists.

The justices upheld a Waterbury Superior Court ruling that said reimbursements by Health Net of Connecticut did not violate Connecticut's Unfair Insurance Practices Act. The Connecticut Podiatric Medical Association appealed the decision. Justice Richard N. Palmer dissented, saying state law forbids insurers from denying reimbursements and discriminating based on how much it reimburses different specialists.

Source: Associated Press [10/7/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: Podiatrists often construct an orthotic with a rearfoot varus post, while orthopedists order one with a rearfoot valgus post. What are your thoughts?

Dr. Amol Saxena

Amol Saxena: Valgus in the rearfoot helps with medial knee DJD. If you limit the pronation, then the femur will dig into the medial meniscus and that is something that needs to be considered in runners. If a patient has a varus knee and wears motion-control athletic shoes, a varus rearfoot post is something that will cause problems.

Dr. John Giurini

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is podiatric surgery authority Dr. John Giurini. You can register for future events by clicking here

Lawmakers Call for SGR Repeal

A "dear colleagues" letter that was circulated in the U.S. House of Representatives urging repeal of the sustainable growth-rate formula for Medicare payments to physicians garnered 114 signatures before being sent on to the Joint Select Committee on Deficit Reduction. Rep. Allyson Schwartz (D-PA) circulated the letter, which was signed by 92 Democrats and 21 Republicans, including Dr. Phil Roe (R-TN).

"Physicians are currently threatened with a 29.5% cut in their payments unless Congress can end these budgetary games," Roe said in a news release issued by Schwartz. "Fixing the SGR will help bring stability to our medical system." The 29.5% cut is scheduled to take effect in January, according to the SGR formula that was included in the Balanced Budget Act of 1997. In December, President Barack Obama signed the Medicare and Medicaid Extenders Act of 2010 that postponed a scheduled 25% pay cut and froze rates for one year. Since then, physicians have been lobbying Congress to come up with an alternative reimbursement system.

Source: Andis Robeznieks, Modern Physician [10/7/11]

RE: Plating System for Fractured 5th Metatarsal
From: Multiple Respondents

Do not operate on a smoking diabetic who will not stay off his foot.  Dictate well, and cast.

Timothy Henne, DPM, Clermont, FL, tjhennedpm@hotmail.com

We have been using the Ortholoc Polyaxial fixation system (wmt.com/footandankle/FA251-409.asp ). A T plate would work well for this. Multi-direction locking screws placed into the plate will give it extra stability. Variable angle locking as well as the small screw size of 2.7 will fit perfectly in the 5th metatarsal.

Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

I would not be so quick to operate on your "non-compliant" patient. My experience dictates that fracture has the ability to heal without surgery as the bone segments are approximated enough. Your bigger problem is that you have a non-compliant patient with co-morbidities.

Patients with neuropathy often have a type of passive behavior regarding their own disease process. They oftentimes just don't seem to "get it." Likely it is because they don't feel anything. The concern here is that if the patient didn't "get it" before - what makes you think he is going to "get it" after the surgery? There is enough evidence-based medicine showing the ill effects of smoking on bone healing. You can use the strongest plate and screw in the world, but it won't matter if the bone can't hold it.

I would try to stay away from Unna boots in a patient with neuropathy as well, particularly in the case of a fracture. These can become too tight, and if the regions swells, as in your case, the patient can't feel anything. From a practice management standpoint, I don't believe an Unna boot is reimbursable without an ulcer, so why not go with a CAM walker that can immobilize the foot, offer stability, and is reimbursable? 

I would observe the patient, and try to get him to stop smoking and to lose weight. I would also check his Vitamin D levels which are likely low, and consider a bone stimulator if the timeline since injury dictates.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Painful 1st MTPJ (Brian Timm, DPM)
From: Greg Caringi, DPM

I have always been very interested in both the surgical and non-surgical treatment of painful hallux rigidus. When the joint is unable to be salvaged, I generally perform an interpositional arthoplasty - Keller procedure with modifications shown to me by Dr. James Ganley. In my hands and with 30 years of practice, I have had excellent short and long-term results. There are, however, times when an arthrodesis is more appropriate.
 
What is the consensus opinion for the best surgical technique - fewest complications and best durability - for arthrodesis of the 1st MTP Joint?
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

RE: Is Podiatry Turning Away from Biomechanics? (Jeffrey Kass, DPM)
From: Doug Richie, DPM

I would like to respond to the posting by Jeffrey Kass, DPM, who believes that the article by Jason Kraus was perhaps an insult to professors at the current podiatry colleges. As one of the individuals interviewed by Jason for his article, and given the fact that I teach biomechanics at two of the schools of podiatric medicine here on the West Coast (CSPM and Western University), I believe I am in a credible position to comment on this allegation.

What Jason was appropriately reporting is the fact that the total time spent studying biomechanics in the classroom and clinic by today's students of podiatric medicine is significantly less than what it was 10-15 years ago. He was in no way speaking about the quality of the instruction. While many of the same excellent professors are...

Editor's note: Dr. Richie's extended-length letter can be read here.

RE: OH Court Rules That Podiatrists Need ABPS Certification for Staff Privileges
From: Bryan C. Markinson, DPM

I have no quarrel with a hospital requiring ABPS certification within 5 years of being credentialed for surgical privileges. My quarrel is with the fact that NO HOSPITAL comes to these decisions without advice and input from podiatrists. Some try to act fairly and have levels of credentialing. Why should a DPM who graduated thirty years ago with a PSR 12 who has practiced successfully at any institution competently within his or her level of training be refused re-appointment based on ABPS certification or any other sole criteria?
 
My hospital, and the orthopedic surgery department that I function in, is second to none on the planet. Anyone around here demonstrates their worth by doing, not flashing certificates. I dare say I have done more to advance the perceived value of podiatric physicians in this hospital without a scalpel than any of my colleagues with a scalpel. Based on my input for the past 14 years, we have had a fair and equitable credentialing system. Some are certified by ABPS. Some are not. Those certified by ABPS as a class may do a wider variety of procedures, but whatever level of “trust” the credential offers over any other has yet to be solidified in my mind.
 
For those among us who feel thumping your chest with the “credential you can trust” is an excuse for fratricide, SHAME ON YOU! These terrible rulings are the results of us killing each other. Period. We have only to look inward.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Moroccan Man Has World's Biggest Feet

As Brahim Takioullah strolls through downtown Paris, people gasp, stare, take his picture and ask: "Are you the tallest man in the world?'' He's not, not quite, but he does have the biggest pair of feet on the planet - and that's official. Judges from Guinness World Records came to France to measure him and confirmed his suspicion that he had record-breaking feet - his left measuring 38.1cm in length and his right, 37.4cm. 

Morocco's Brahim Takioullah has the largest feet of the world according to the Guinness Book of Records (Photo: AFP)

Even getting a pair of shoes stretches his budget - he takes a European size 58, which no shop has ever stocked. "I always need them made-to-measure and they're very expensive. I once asked a cobbler to make me some shoes and he said it would cost 3500 euros ($4851),'' he sighed. He recently met with an orthopedic podiatrist to be fitted with a specially made pair of shoes designed to support his huge weight.

Source: Herarld Sun [10/10/11]

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

EQUIPMENT FOR SALE - ULTRASOUND, CRYO-PAC, FLOUROSCAN

Ultrasound w/printer, Cryo-Pac w/two probes, Flouroscan w/printer. There may be other surgical equipment as well. Please contact Jolene as young_jolene@yahoo.com

PRACTICE FOR SALE - SOUTHERN OH

Busy, well-established, full-time home visit practice. 100% referral-based. Wound care, pain management, routine care & DME’s. Excellent income, low overhead. Great opportunity for husband/wife business team. DPM relocating out-of-state for family. Contact:nanetter@zoomtown.com

PRACTICE FOR SALE - MOUNT KISCO, NEW YORK

Great opportunity in well-established, turn-key practice (or buy in option available) near Northern Westchester Hospital. Updated office includes four treatment rooms, two private doctor's suites, large waiting room with option to buy co-op. Excellent opportunity for growth. Contact  bbrick2@yahoo.com

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA
 
Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480 M per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

PRACTICE FOR SALE - ARKANSAS

Busy, well established practice of 13 years grosses 160K/year for the past 5 years, while working 3.5 days/week. Nursing homes available. 50% Medicare, average of 15 new patients/week. Doctor retiring. Please call 800-983-4194 for more details, or e-mail contactus@podiatrypracticeconsultants.com

FULL-TIME ASSOCIATE POSITION - SOUTHERN NEW HAMPSHIRE

Well-established, rapidly growing practice. Motivated, ethical and personable with well-trained PSR-24/36. Modern office with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package. If interested please email your CV, letter of intent and references to: NHFootDoc@yahoo.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to potential partnership available for a surgeon that is BQ/BC by ABPS. Must be a PSR 24 or PM&S 36 graduate. Salary with bonus. Email CV and samples recent cases done recently to: susmitad86@yahoo.com

SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking associate physician to join practice to cover nursing home facilities. Comprehensive package including Salary, Travel and Bonus benefits. Email cover letter and CV tomelissafoot@pol.net.

ASSOCIATE POSITION - DAYTON, OH

Join a Well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and current photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTH WEST FLORIDA

Full-time associate positions for an established group practice in Southwest Florida. Willing to train the right new graduates. Job will involved all aspects of podiatric care. You must be ambitious, hard-working and should have good people skills. Please e-mail your resume/CV to contactus@ankleandfoot.net

ASSOCIATE POSITION - NASSAU COUNTY, NY

Podiatrist needed in Nassau county to start immediately. Flexible hours 2 days a week. Please email pittpod@gmail.com with inquiries.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - NORTH CENTRAL NJ

Well established busy solo physician seeking a well trained podiatrist (PMS 36) to join our growing practice. Bilingual English Spanish a big +. Competitive salary/benefits package. Send CV to fax 732-520-6468 or send to fjr20032003@yahoo.com.

ASSOCIATE POSITION – IOWA CITY AREA

SEEKING ASSOCIATE POSITION - SUBURBAN DETROIT

ABPS certified podiatrist with several years experience seeking part-time position in suburban Detroit. On staff at area hospitals. Excellent clinical, surgical, and practice management skills. Please respond to michpod@hotmail.com

SELL OR MERGE YOUR PRACTICE - SOUTH FLORIDA

Looking for an exit strategy? If you would like to discuss options such as phasing out, selling your practice, or merging with a larger group in South Florida, please email your interest and contact info to foot369@yahoo.com

SPACE AVAILABLE - NYC & LI

PM News Classified Ads Reach over 13,500 DPM's and Students

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