The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 13, 2007 #3,065 Editor-Barry Block, DPM, JD

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MD Podiatrist Comments on Running Shoe Study

When it comes to picking footwear, runners should follow Prince Charming's lead and consider a shoe's fit, not its price tag, new research suggests. Using high-tech methods, a team of Scottish scientists found no differences in either comfort or shock absorption between $80 pairs of running shoes and pairs made by the same companies costing more than $150.

Dr, James Christina

Podiatrists and footwear experts have their own views on the findings. "I don't think there's anything shocking in this article -- to find out that maybe some of the high-end running shoes really aren't necessary for the average person that's running," said Dr. James Christina, a podiatrist and director of scientific affairs at the American Podiatric Medical Association. Big-name companies "come out with a new model [of running shoe] every year," he said. "How much of an improvement has really been made?"

But he also pointed out that people who buy sneakers are paying for a shoe's longevity, not just its comfort and protection. The Scottish study is just a "snapshot of the cushioning ability of that shoe in time," Christina noted. "It would have been interesting to have the subjects run a certain length of time, a certain schedule of months or a year, and then compare how the cushioning held up."

Source: E.J. Mundell, US News and World Report [9/11/07]

WI Podiatrist to Compete in Iron World Championship

Dr. Maggie Fournier will spend part of this weekend swimming 2.4 miles in the ocean, biking 112 miles and running 26.2 miles in the warm Hawaiian sun. The Wausau, WI podiatrist will compete against the finest amateur and professional triathletes Saturday in the 2007 Ford Ironman World Championship.

Dr. Maggie Fournier

"It's surreal; I'm still pinching myself," she said of the chance to compete among the best in the world. Fournier, 31, qualified for this week's championship in Kona, Hawaii, by finishing the Wisconsin Ironman in Madison in 11 hours, 20 minutes and 31 seconds in September 2006.

Fournier began her training as a cyclist and said she now considers herself equally capable in all three triathlon stages. She started entering races about six years ago just to have a goal for her workouts. "I'm the type of person who needs challenges, and I like to set goals for myself and reach them, whether it's professional or personal," Fournier said.

Source: Carrie Hutton, Wausau Daily Herald [10/11/07]

McCain Announces Healthcare Plan

Arizona senator and GOP presidential hopeful John McCain outlined a multipronged platform for healthcare reform, saying that American families and not government or special-interest groups would drive the change.

Under McCain’s plan, individuals would have increased access to actual healthcare cost information and would receive much-more simplified bills for the care they receive—moves meant to bolster consumer awareness and spark providers to drive for higher-quality and better-managed care. He also said provider-payment reforms are needed.

McCain, who has built his platform on traditional conservative free-market principles and less dependence on federal dollars, said he would give individuals a tax credit of $2,500, or $5,000 for families, if they have health insurance.

Source: Matthew DoBias, Modern Healthcare [10/11/07]

Query: Wireless Inter-Office Phone System

I am in the midst of moving to a large office with 6 treatment rooms, and an "administrative wing." I am working with the architect in getting the phone systems wired. Has anyone used "wireless" office phones - (with a base-station) and multiple units that are used around the office, and if so, what has been your experience?

David Weiss, DPM, Richmond, VA

Query: Wound Care Debridement Codes

In a wound center where patient have multiple visits, when should one use codes, CPT 97597, CPT 97598 (removal of devitalized tissue from wound, selective debridement, without anesthesia) for debridements rather than the CPT 11040, CPT 11041, CPT 11042, CPT 11043 debridement codes?

Mitchell Glodowski, DPM, Camarillo, CA

Response: According to CPT Assistant (May 2002), the active wound care management codes were originally added to describe "how to report interventions associated with active wound care management, as performed by non-physician health care providers (e.g., physical therapists, occupational therapists and enterostomal nurses)." CPT 97597, CPT 97598, and CPT 97602 are non-surgical debridement codes.

Surgical debridements performed by physicians would be billed using the appropriate CPT 11040 - CPT 11044 debridement code. Typically, physicians would not perform non-surgical debridements (and active wound care management codes would not be billed along with surgical debridement codes).

Harry Goldsmith, DPM, Cerritos, CA

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RE: Transdermal Verapamil 15% Gel for Plantar Fibromatosis (Kenneth Jacoby, DPM)
From: Jeffrey Kass, DPM

I tried it on one patient who followed the recommended treatment protocol. There was no improvement in the condition. Since, my first impression wasn't positive, and the patient had to outlay all costs, I have not tried it again.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Painful Hallux IPJ Lesions in Diabetic (Michael J. Ryan , DPM)
From: Jeff Root, Michael B. DeBrule, DPM

Before treating this overweight 17 y/o’s abducted gait and related pronation, it is important to conduct a comprehensive biomechanical examination. While his pronation may be caused or exacerbated by his obesity, there may be other biomechanical factors which influence his path of treatment. For example, if he has a hallux rigidus or a non-functional hallux limitus (no or limited dorsi-flexion during open chain examination of the range of motion of the hallux), then an orthosis which reduces his pronation and increases the propulsive nature of his gait may be contraindicated because it could actually increase pressure on the hallux. In this case, surgical options may be worth considering in addition to functional or accommodative foot orthotic therapy.

Other biomechanical factors to consider are the ROM of the hip, ankle, 1st ray, and the range and axis of motion of the subtalar and midtarsal joints. I would not be surprised if this individual has developed a forefoot supinatus as a result of excessive subtalar joint pronation. If an orthosis is not contraindicated, then there are a number of prescription variables that can be tailored to improve function and protect the hallux. I would highly recommend that you consult with your orthotic laboratory about your options, as they are likely to have some good recommendations.

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

The hallux IPJ lesions you describe suggest increased hallux pressure from functional hallux limitus (FHL). Decreases in hallux pressure by treating FHL are reported by Paul Scherer in JAPMA 96(6) 474-481. Please consider casting for orthoses with hallux dorsi-flexed. Orthotics may require a 1st ray cutout, kinetic wedge, 2-5 met bar post with maybe small forefoot valgus correction, reverse Morton’s extension, etc. I would avoid the Cluffy wedge (pre-dorsi-flexes the hallux) because they generally increase hallux pressure. Also, look at other things besides the big toe. Look for equinus, psudoequinus, limb length difference, and other pathology that can increase forefoot pressure.

Michael B. DeBrule, DPM, Marshall , MN, drdebrule@starpoint.net

RE: Podiatric Biomechanics: Was Schuster Right After All? (Robert Scott Steinberg, DPM)
From: Bruce Williams, DPM, Kevin A. Kirby, DPM

Dr. Steinberg is correct that podiatrists should set the standard in the use of functional foot orthoses. Dr. Root, by setting down his system of evaluation, created a great basis for evaluation of foot function, especially from a frontal plane mechanical standpoint.

I do disagree with Dr. Steinberg regarding his statement, “that anything less than plaster casting is cheating the patient.” Plaster casting can be just as bad as any other form of casting whether it be use of a foam box, or digital scanning of any type. What it comes down to is what you want the foot to do and how you capture the foot when “casting.”

Bruce Williams, DPM, Merrillville, IN, bwilliams@airbaud.net

Even though I realize that Dr. Schuster was a bright clinician, from my viewpoint, Dr. Schuster's impact on the podiatric profession is relatively minor compared to the impact of Dr. Root's contributions to our profession. The main reason for my opinion that Dr. Root's ideas have had a much greater impact on the podiatry profession than Dr. Schuster's is because Dr. Root had the vision and took the time to co-author and publish three textbooks on podiatric biomechanics. His textbook, Normal and Abnormal Function of the Foot, is still my favorite podiatric biomechanics textbook and will be a classic in the field of podiatric biomechanics for years to come. Dr. Root also performed and published cadaver research on subtalar joint and first ray function that are still referenced by scientific researchers to this day.

Even though Dr. Schuster may have been brilliant man and a great clinician who had many wonderful ideas, he didn't even come close to publishing the amount of quality work that Dr. Root and his coworkers did for the podiatry profession. This should serve as a valuable lesson to those who are well-known as lecturers in podiatry, but have not yet published their work in scientific journals, contributed chapters to textbooks, or written books. History has shown repeatedly, that if you have not preserved your thoughts in the written word, when you leave this world, your ideas and your name will be gradually forgotten. However, publishing quality papers, quality research or quality textbooks will allow one’s ideas and name to live on for generations after they pass away, just as will the name of Dr. Merton Root.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

Editor’s Note: This topic is now closed.

RE: Obituary J. C. Littrell, DPM

Dr. J. C. Littrell, 87, of Waco, Tx passed away Friday, Oct. 5, 2007. Dr. Littrell was a faithful Life Member of TPMA and APMA. He will be greatly missed by the podiatric profession."

On a personal note, he was just an incredibly, helpful doc, who was way ahead of his time. He will be missed.

Sloan Gordon, Houston, TX

RE: Mass for David Gutierrez, DPM

A funeral mass is scheduled for David Gutierrez has been scheduled for Saturday October 13, 2007 at 10:30am at Immaculate Concepcion Church, 55 Winterhill Road, Tuckahoe, NY, 914 961 3643.

Enid Goris, DPM, Bx Division Vice-President

RE: Mac-Based Podiatric Billing Software (Len Sanchez, DPM)
From: Mike McCormick, DPM

As an avid Mac user, I also was a long time user of Softeasy. About four years ago our group migrated to X-MED which is a Linux-based software. We use twenty or so G3 and G4 Imacs with a freeware called macssh to emulate Linux OS on a Mac. The program is very fast across multiple offices as it is character based instead of screen redraw. It has a basic medical records module as well that can be easily refined by the user. For a multi-office fully networked practice, the price and capabilities have suited us well. You can contact alex@x-med.com for additional information. I believe Bart Segal is still in the Atlanta area and can help former users of Softeasy migrate the patient demographics to X-MED.

Mike McCormick, DPM, Venice, FL, mmccormick@cyberstreet.com

We have used DBC since 1992 and are satisfied with the software. However, we are not happy with their support consultant for our area. If you want a lot more info, call my wife/office manager Linda at 978-6820382. Specific questions for her will help her to help you more.

Marc Klein, DPM, Methuen, MA, MAILKlein@aol.com

ASSOCIATE POSITION - SOUTH CENTRAL ILLINOIS

Multi-faceted 3-office practice needs motivated podiatrist. Opportunity for future partnership, buy-in, or purchase of an office. Willing to train practice management and surgery. Multiple hospital and surgical center privileges available. Forward CV to nolendpm2@yahoo.com or call (618)548-0057.

PODIATRY OFFICE FOR SALE – LONG ISLAND, NY

Fully equipped podiatry office for sale in Suffolk County Long Island NY. Very reasonable asking price $60,000. All equipment and patient files are included. Write bikerpod@optonline.net, or call 631 253-2046 Tue, Fri, Sat.

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