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| PM News | |
The Voice of Podiatrists
Serving Over 14,864 Podiatrists Daily
October 12, 2013 #4,887  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
written permission of Barry Block
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| IN THE COURTS | |
TPMA Wins Scope of Practice Victory
A Texas district court has granted the Texas Podiatric Medical Association, Cory Brown, DPM, and Martin V. Sloan, DPM (Plaintiffs) a declaratory judgment that certain surgical procedures are within the scope of podiatry as defined in Chapter 202 of the Texas Occupations Code. After considering the evidence presented at trial, the arguments of counsel, the parties' briefs, and the applicable law, the Court concluded that judgment should be entered in favor of the Plaintiffs on this claim.
“It is therefore adjudged and declared that each of the following procedures are within the scope of podiatry as defined in the Texas Occupations Code: (1) ankle fusion; (2) pantalar fusion; (3) open reduction - internal fixation (ORIF) of ankle fracture to treat unstable talus; (4) ankle arthrotomy to treat talus; (5) tibial/fibular osteotomy to treat talus; (6) calcaneal osteotomy; (7) cuneiform osteotomy with bone graft; (8) gastrocnemius recession; (9) tendo-Achilles lengthening; (10) detachment and re-attachment of Achilles tendon with resection of posterior calcaneal exostosis; (11) flexor hallucis tendon transfer; (12) tibialis posterior tendon transfer; and (13) decompression posterior tibial nerve.”
Source: Texas Podiatric Medical Association, Cory Brown, DPM and Martin V. Sloan, DPM, v. Hendrick Medical Center, NO. 25137-B, 104th Judicial District (TX) via Dr. Sloan Gordon.
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| PM NEWS QUICK POLL | |
THIS IS THE LAST DAY TO VOTE
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| PODIATRISTS AND SPORTS MEDICINE | |
Minimalist Shoes Can Cause Major Problems: GA Podiatrist
There's a growing concern about minimalist footwear. Runners like the shoes because they say it gives them that natural feel, as if they are running in their bare feet. But podiatrist Dr. Alap Shaw of Foot & Ankle of West Georgia says they should be worn only by the well-trained athlete. Those who wear them as simply the latest fad, are finding themselves with injuries.
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Dr. Alap Shaw |
Shaw says the shoes, with no cushion for the feet, increase the flexibility in the foot more than a regular shoe, and for the untrained athlete, that can spell problems "that causes all types of stresses in the middle of the foot, in the rear foot, in the front of the foot, and the biggest things we do see from this because of lack of support are stress fractures, plantar fasciitis, or heel pain, neuromas."
Source: Teresa Whitaker, WRBL [10/9/13]
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| HOSPITAL PODIATRISTS IN THE NEWS | |
DE Podiatrist Joins Hospital Staff
Beebe Medical Center has announced that Harry Tam, DPM of Delaware Podiatric Medicine has joined its staff. He graduated from The New York College of Podiatric Medicine and completed his fellowship in diabetic foot and limb salvage (diabetic foot wounds, infections, Charcot foot deformities) at the Tidewater Foot and Ankle Education & Research Foundation in Virginia Beach, VA.
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Dr. Henry Tam |
Dr. Tam completed his podiatric medicine and surgery residency at Staten Island University Hospital, Staten Island, NY. He has been published in several scientific journals for his research in the treatment and reconstruction of the diabetic foot.
Source: Cape Gazette [10/9/13]
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| PODIATRIC INVENTORS IN THE NEWS | |
UK Podiatrist Designs Brace for Arthritic Ankles
David Hallowell is a podiatrist and managing director of Footcare Northern Ireland. Recently, he designed an ankle brace which rocks inside the shoe and therefore reduces strain on injured or arthritic ankle joints. This was first used by a patient who, after an explosive injury to his ankle, was told that he would never again walk or run properly. With the help of the brace, he eventually was not only able to run but completed the Belfast marathon in under four hours.
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David Hallowell and Ankle Rocker Brace |
"The device has been so successful that I have been asked to speak about it at podiatry conferences at home and abroad. I am also working closely with Invest NI who are funding research into the rocker in order to establish further evidence for its use," says Hallowell.
Source: Ulster Star [10/9/13]
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| PODIATRISTS AND FOOTWEAR | |
Rainboots Not Healthy for Feet: NY Podiatrist
The weather forecast is for rain. Grab those rainboots? Not so fast, says Dr. Neal Blitz, Chief of Foot Surgery/Associate Chairman of Orthopedics at Bronx-Lebanon Hospital. Rain can cause a moist environment, plus rainboots tend to be made of latex or other thick, non-breathable materials.
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Dr. Neal Blitz |
"You sort of walk more like a stormtrooper, so you just might get more fatigue from walking in them," says Dr. Blitz. The top of the boot can also rub uncomfortably against your calf. Wearing these shoes can cause mold, fungus, bacteria, wart viruses, and blisters.
Source: Rebecca Adams & Ellie Krupnick, Huffington Post, [10/9/13]
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| QUERIES (NON-CLINICAL) | |
Query: Evacuation System for Lasers
For those with lasers to treat fungal nails, do you you use smoke evacuation systems with 0.1 micron filter masks and if so, are there any recommendations for the smoke evacuation system?
Charles Baik, DPM, Tustin, CA
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| CODINGLINE CORNER | |
Query: Oxford: Ankle X-Ray Denial
Our doctor stated that he read that Oxford Health Plans will now pay for an x-ray of the ankle (CPT 73610). However, when I submitted a claim for CPT 73610, I received a notice denying the claim stating "not privilege to perform this service." I called Oxford and they said that only podiatrists in the state of New Jersey can bill for taking and reading x-rays of the ankle. Oxford then informed me if I can find this article regarding covering the ankle x-ray, they will reconsider the claim for payment. If there is such an article, can you please email it to me.
Office of Joseph Fox, DPM, New York, NY
Response: As far as I know, this has been an ongoing issue with Oxford even prior to their consolidation into UnitedHealthcare. I personally know of no article where Oxford has admitted that they will now pay for ankle x-rays. I do know that much has been communicated to Oxford on why ankle x-rays would be taken and why this would be within scope of practice for podiatrists in New York. I am not sure if the New York State Board of Podiatry has ever submitted documentation. If they have, Oxford has not responded in any positive fashion.
Oxford has been intransigent about changing their position. With the new scope of practice scheduled to take place next year, this should change. I suggest you run this by the New York State Podiatric Medical Association and the New York State Board of Podiatry again and submit this to the New York State Attorney General's Health Care Fraud Bureau and New York State Insurance Department.
Paul Kesselman, DPM, Woodside, NY
Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription
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| RESPONSES/COMMENTS (CLINICAL) - PART 1A | |
From: Andrew Levy, DPM, Keith Gurnick, DPM
I think the key to the diagnosis is that the change has occurred over a 4-year period, and there has been altered gait muscle recruitment. My recommendation is to get a neurology consult before any other intervention or delay.
It appears from the brief video that the patient has some thigh adductor muscle overtone and a partial foot drop right and left side and possibly some peroneal muscle weakness. He requires at first a lower extremity muscle testing exam to determine muscle tone and strength for all groups, and then if there is any weakness, identify the muscle weakness and give each muscle a grade.
Next, consider neuro-muscular conditions which could include Charcot-Marie-Tooth, Freidreich's ataxia, spinal cord tumors, etc.. He may require a neuro consult.
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| RESPONSES/COMMENTS (CLINICAL) - PART 1B | |
From: Gary W Docks, DPM, Ron Raducanu, DPM
From what I can see (which is not sufficient), it appears that the patient has a "steppage" gait pattern. Did you do any muscle testing? Is the patient's gait getting worse over the past 4 years? Any abnormalities seen on x-ray?
The FIRST thing I would do is send the patient directly to a neurologist for a full neurologic exam. I would rule out muscular dystrophy, MS, Charcot Marie Tooth (CMT), Freidrich's ataxia, etc. In the meantime, please forward a new gait analysis with his pants rolled up.
This patient appears to be vaulting somewhat, which may be a LLD with the left being longer. I also guess that his pelvis is rotated in more of an inferiorward direction, and his internal hip rotators (obturators and quadratus femoris) are extremely tight. The combination of these three elements are potentially causing his abnormality in gait.
The first thing to do is to get hip-to-floor radiographs and perhaps have him return to the office wearing shorts and record his gait on a treadmill. If you could post that in slow motion, and then have another camera filming his posterior calcaneus during gait, that would be great. Have him see an occupational therapist, and perhaps even a neurologist.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2A | |
From: David Weiss, DPM, Joel Feder, DPM
I have put in hundreds of SmartToe implants, and typically have great success. However, sometimes they have fractured. I find it is imperative that a good bone-to-bone approximation is important to obtain good results. In addition, osteoporotic/osteopenic bone is not ideal for this fusion modality. It appears the problem here was a pseudarthrosis - fibrous union or possibly non-union. In order to repair this, I approach it typically as any other failed hammertoe fusion. Once the PIPJ is exposed, there would typically be significant fibrous material in the area. Pull the PIPJ apart, and grab the implants with hemostats. They should come out easily. Then revise the fusion site and use conventional pins. Sometimes I'll use cannulated screws form the distal phalanx to the proximal phalangeal base. If length is an issue, bone grafts could be used. Finally, a nice "compliancy" talk with the patient would be in order!
Unfortunately, we have encountered the fracturing of these implants several times in our personal and colleagues' cases, especially with dancers and runners. I don't think the SmartToe is perfected for use in active patients. Our solution has always required removal.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2B | |
From: Frank Lattarulo, DPM
This looks like a hammer lock digital implant by Orthofix (if not please check with the manufacturer of the implant itself for removal advice). Having recently spent a lot of time with my local rep and having put several of these in, I asked that very same question.
According to the company, since the implant comes frozen in dry ice and the "wings" in the "contracted" position, they recommend using Normal Saline Solution (getting it as cold as possible) and irrigating the area around the implant to try and contract the wings once again. Once the wings have contracted, the implant will hopefully (therein lies the operative word) slide out with some pressure. If not, I would take the same approach as you would normally use to take out any fractured internal fixation device.
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MEETING NOTICES - PART 1
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| RESPONSES/COMMENTS (BIOMECHANICS) | |
From: Stephen M. Pribut, DPM
This past weekend's seminar was excellent. It afforded the opportunity to see many people who were tremendous lecturers of yesterday and still are great lecturers today. As D'Amico said, you won't see everyone there on the same platform again.
Many topics were covered. Both simplicity and complexity were on display from studies conducted by Schuster to one of the most intricate discussions of computer assisted gait analysis by Dr. D'Amico. D'Amico far exceeded what most biomechanists and almost all of those using the F- Scan in their offices would...
Editor's note: Dr. Pribut's extended-length letter can be read here.
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MEETING NOTICES - PART 2
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| CLASSIFIED ADS |
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Fully equipped podiatry office in Buffalo Grove, Illinois is looking for a podiatrist to share a space. Please email: jdhr2011@yahoo.com.
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PODIATRIST WANTED - NEW JERSEY
Busy Northern New Jersey podiatry practice needs board certified podiatrist participating with Blue Cross/ Blue Shield to work in office one day a week to start. Email resume to minggao@optonline.net
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ASSOCIATE POSITION AVAILABLE – NEW JERSEY
Podiatrist needed for an expanding practice in Bergen County. Will be required to perform house calls. Very competitive salary plus incentives. Must be motivated and willing to build a practice. Please email resume to: medicinenj66@yahoo.com
PODIATRIST WANTED - MN
We are seeking highly motivated, experienced and enthusiastic associate’s to join our successful, well-established practice, we currently have 6 locations and plans to add more, throughout Minnesota. The practice incorporates surgery, wound care, sports medicine and general podiatry. This opportunity offers an excellent salary, bonus and % commission with benefits, also an opportunity to become an associate down the road. PPMR/PSR required. Email CV to: kpepple@midwestpodiatrycenters.com
ASSOCIATE POSITION – SOUTHWEST, FL
R U a SuperStar? PM&S36 or PSR24. Comfort W Recon surgery. Hardworking w/o Ego. Excellent salary, benefits, chance at partnership. ABPS BC/BQ required RRA. Send CV, Tell why you are a superstar. mny1029@gmail.com
ASSOCIATE POSITION - CENTRAL FLORIDA
Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to: cmedders@atlanticpodiatry.com
PRACTICE FOR SALE - BRIARWOOD, QUEENS
Part-time practice with potential for full time. practice located in the same building with a primary care doctor (great referral base). A block from Grand Central Pkwy and subway station. Serious inquiry only to specialtouchfootcare@gmail.com.
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