The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 13, 2008 #3,372 Editor-Barry Block, DPM, JD

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TX Podiatrist Provides Tips on Keeping Feet Looking Young & Healthy

According to the International Council on Active Aging, adults are at higher risk for foot problems, with an estimated 87 percent reporting at least one foot-related problem. Dry skin and callused heels are, by far, the most common foot complaints. These conditions not only make feet look older and less attractive, but they can pose a significant health risk.

Dr. Glen Beede

Dr. Glen Beede, a podiatrist in Fort Worth, Texas, says that dry, cracked heels can fissure, causing pain or even tissue wounds. Left untreated, calluses continue to grow thicker and, if they become infected, they may require antibiotics. But, with a little know-how and some due diligence, you can keep your feet healthy and looking great, no matter what your age. Here are some important tips:

* Give your feet a bath. Soak your feet in lukewarm water mixed with moisturizing soap. This helps heal calluses and tender spots, and a warm footbath is so relaxing at the end of a day.
* Don’t use razor blades. The American Podiatric Medical Association warns that razor blades should never be used to cut corns or calluses.
* Keep an eye on your feet. Along with proper foot care, monitoring the condition of your feet is one of the simplest ways to ensure foot health and beauty at any age.

Source: The Intermountain.com [10/9/08]

ABPOPPM Announces New Board of Directors

The American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) has announced the newly elected 2008-2009 Board of Directors:

Dr. David George

President - David George, DPM (NJ)
Vice President - Michael Robinson, DPM (MA)
Secretary - Stephanie Baldwin , DPM (FL)
Treasurer - Gerard Saponara, DPM (NY)
Immediate Past President - Joseph Hogan, DPM (NY)
Directors - Charles Ross, DPM (MA); James Stavosky, DPM (CA); Michael DellaCorte, DPM (NY); and Steven Goldman; DPM (NY)

One Year Sentence for IL Podiatrist for Medicare Fraud

A West Peoria podiatrist was sentenced Friday to one year in federal prison for bilking Medicare out of thousands of dollars over the past decade by writing bills for medical procedures he didn't perform. Dr. Ernest Nwani, 57, also was ordered to repay $109,127 to Medicare and Medicaid for the bogus operations, some 400 of them in all.

Nwani, the sole medical provider for Footworld Medical Center, which he operated out of his house, admitted he defrauded the government by billing for services he didn't provide or didn't provide to the level that he charged Medicare. A company hired by the U.S. Department of Health and Human Services to combat fraud last year noted irregular billing practices by the doctor. An investigation revealed patients did not have procedures or even surgeries for which Nwani had billed Medicare.

From 2002 until 2006, Nwani submitted claims, which Medicare paid, for 539 surgical procedures of various types regarding 442 patients and claims for the permanent removal of 1,082 toenails from 394 patients, according to court records. Medicare paid $171,760 for the surgeries and $100,180 for the toenail removals. Thirty-three patients were interviewed and of those, "none of the surgeries billed for these 33 patients and for which Medicare paid, could be verified as having been performed," court records state.

Source: Andy Kravetz, Journal Star [10/11/08]

Orient New Employees for Success

When you bring new workers on board, follow these tips to lay the groundwork for success:

• Introduce the new worker yourself. That shows respect for both the new employee and your current workers.
• Review expectations. You probably spent time writing a job description and defining parameters. Don’t forget to share them.
• Don’t go it alone. No one said you had to handle orientation on your own. You may decide to cover the new worker’s goals and strategies yourself. But you still can assign other sections to seasoned employees.
• Schedule the orientation plan. Once you have developed a program
  and assigned “teachers,” assign dates for each part of the program. On
  the first day, give the new employee the dates and times for orientation. Then make it the new hire’s responsibility to follow through.

Source: Adapted from The Boss’s Survival Guide, by Bob Rosner, Allan Halcrow and Alan Levins

Query: OsteoMed Screws

I am interested in opinions on the OsteoMed ExtremiFix Headless Cannulated Screw System. The local rep brought in sawbones yesterday. We used the new screws for all of our regular forefoot procedures and were very impressed with ease of use and stability afforded by the fixation.

Greg Caringi, DPM, Lansdale, PA

RE: Arthrosurface Hemi Cap for Frieberg’s Infraction (William Sachs, DPM)
From: Howard Stone, DPM

Your options are limited if the cartilage surface is truly destroyed. The Hemi Cap is a perfect solution since the procedure is not joint destructive. You can drill out the cartilage surface and implant a 12 mm. Hemi Cap with the appropriate radius of curvature. If there is any impingement dorsally after you have remodeled the second metatarsal head, perform a phalangeal cheilectomy by removing the dorsal 10-15% of the base of the proximal phalanx.

The major advantage of the Hemi Cap in this situation is limited risk of transfer metatarsalgia since you are not shortening the metatarsal by doing a joint destructive procedure. You must inform the patient that the implant will last on average 15-20 years, and that additional surgery will likely be needed in the future.

Howard Stone, DPM, Glenview, IL, drstone@nspodiatry.com

RE: Weil Osteotomy w Cheilectomy (Stuart W. Kushel, DPM)
From: Daniel J. Tucker, DPM, Sloan Gordon, DPM

I have found that shortening the first metatarsal can lead to unwanted problematic ramifications. I have been utilizing the Moberg type proximal phalangeal osteotomy in patients with hallux rigidus and a well-preserved 1st metatarsal articular surface (well- described in the orthopedic literature) for a number of years now with very good results. The premise of the procedure involves "borrowing from Peter to pay Paul." The axis of rotation of the hallux at the 1st MTP joint is moved more dorsally so that dorsi-flexion is increased at the expense of some plantar-flexion. The joint is decompressed as well. If there is adaptive hallux interphalangeus, the osteotomy can be adjusted in a "bicorrectional" manner to allow for reduction to a more rectus position.

If the 1st metatarsal head has significant erosive change but the phalangeal base is preserved and the sesamoids functional, I have been resurfacing the head with an Arthrosurface implant, again with improved motion, joint decompression and pain reduction. Since only the remaining cartilage and a small amount of subchondral bone are resected, future salvage fusion, if required, is not difficult since no bridges are burned. This is in contrast to the more traditional implants that have been fraught with complications over the years.

Daniel J. Tucker, DPM, Newport Beach, CA, ReekaT@aol.com

I have been using a technique which works very well for hallux limitus/rigidus to shorten the first ray. I use two blades on an oscillating saw and make a fairly aggressive chevron cut, plantar-flexing the first ray and shortening it. This has worked very well for my patients. I fixate with two modular hand screws (Synthes), allow immediate weight-bearing in a fracture CAM boot, and find it relatively simple to do (although I recommend practicing with saw bones or cadaver bone first.)

I have not tried the Weil for first ray deformities, although it's my favorite for lesser metatarsals, and when accompanied with an MTF 2.0 bone pin for fixation, is quite simple and easy to fixate. I would consider a Weil for the first. In addition, I'm just starting to do the Arthrosurface procedure and hopefully that will work as well for the foot as it has for the hip & knee and should make for shorter healing time.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Inexpensive Vascular Testing System (William Alexander, DPM)
From: Frank DiPalma, DPM

Try the Smartdop 30 by Koven Technology, Inc.

Frank DiPalma, DPM, Athens, GA, fivetoes1946@aol.com

RE: Attack by Foot Powder

A disgruntled passenger on a U.S. Airways flight out of Las Vegas, angry due to a late take-off, allegedly shook a 7 oz. bottle of Dr. Scholl’s Foot Powder and threatened to spray other passengers with it. There is some indication that he made good on his threat.

He was held for disorderly conduct, but eventually released on his own recognizance, the sweet smell still in the air... I’m sorely tempted to submit puns on this, but out of consideration to fellow readers, will not. You’ll just have to take this story in fungus-stride.

Michael M. Rosenblatt, DPM, San Jose, CA

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.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

EQUIPMENT WANTED – AUTOCLAVE/CHAIRS

Wanted to buy – Used New Style (not pressure cooker) desktop digital autoclave (e.g. Midmark Ritter) and 2 waiting room chairs. Call 212-724-4457 or e-mail frottenberg@juno.com

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