The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 13, 2011 #4,278 Publisher-Barry Block, DPM, JD

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Improper Footwear Contributes to Back Pain: CA Podiatrist

High heels, shoes without enough arch support, or physical problems like flat feet or high arches all can contribute to back pain. For example, patients with exaggerated arches often experience pain throughout the body, including the back, because their feet don’t absorb shock well, says Dr. Mark Wolpa, a podiatrist in Berkeley, California.

Dr. Mark Wolpa

Also, a surprising number of people have legs of slightly different lengths. Wolpa says about 80 percent of his patients show signs of “limb length discrepancy,” some caused by uneven bone length and others due to long-term positioning problems, where muscles have developed unevenly, shortening one side of the body. This uneven stance throws the whole body off balance, causing one part to compensate for another, often resulting in pain.

Source: Caring.com [10/11/11]

Foot is a Mirror of Overall Health: APMA President

Forget aging gracefully. For today's baby boomers, it's more important than ever to stay healthy and active as they age. While growing older causes some unavoidable body changes, more boomers are focusing on healthy lifestyles that can help them prevent problems associated with aging - like mobility issues related to the feet and legs. Impairment of the lower extremities is a leading cause of activity limitation in older people, according to the U.S. National Center for Health Statistics (NCHS).

Dr. Michael King

"Foot problems are a health concern that can lead to further complications like knee, hip, and lower-back pain, all of which undermine mobility," says Michael King, DPM, president of the American Podiatric Medical Association (APMA). "The human foot has been called the mirror of health. Systemic problems often related to age, such as diabetes, arthritis, and circulatory disease often can first be detected in the feet."

Source: Baltimore Times [10/7/11]

FL Podiatrist is an Ironman

Dr. Matthew Werd, a Lakeland podiatrist, competed Saturday in the Ford Ironman World Championships in Kona, Hawaii.

Dr. Matthew Werd (R) (Photo: James Borochock)

Werd finished the 2.4-mile swim, 112-mile bike, and 26.2 mile run in 14:12.22. He finished 204th in the men's age 40-44 group, taking 1,217th overall.

Source: Lisa Coffey, The Ledger [10/10/11]

Make a ‘Thank you’ Meaningful

Even if you are polite enough to say “Thank you” throughout the workday, you can turn those two words into powerful recognition for your employees. Spend a few minutes this month showing staff members how much you truly appreciate them. Say “Thank you” with actions like these:

• Put it in writing. Send your staff member a letter on professional looking stationery. You don’t need to write much, just a few lines saying specifically why you are glad that this person works with you. Mention details such as the actions, skills, or attributes that the person brings to the workplace.
•  Reinforce the behaviors you value. Note progress that the person has made over the past few months or well-established actions that you value. Example: “Rita, your positive attitude always raises the team’s morale. I recall just last week when …”
•  Make the delivery special. Hand the note to the person with a few brief remarks, such as “I want to tell you how much we value your contributions.” Or mail the letter to the employee’s home, where the recipient can savor the praise with his or her family.
•  Ratchet up the praise. Instead of thanking the staff member yourself, ask your boss or another executive to deliver the words with a call or note. Knowing that you have told others about the person’s good work will make it more meaningful.

Source: Communication Briefings

Query: Medisoft Clinical

What experiences have podiatric physicians had with Medisoft Clinical, a combined EMR and Medisoft billing program?

Mark K Johnson, DPM, West Plains, MO

RE: Plating System for Fractured 5th Metatarsal
From:  Vince Marino, DPM, Dennis Shavelson, DPM

Look into the A.L.P.S. Hand plating system from DePuy. I have had excellent success using the “T” plate, and it is small enough for metatarsals. I routinely use it to fix metatarsal fractures. The “T” portion fits nicely around the metatarsal head. You can also incorporate an interfrag screw in the plate. You can use both locking and non-locking screws with it, and both screw types come in the set.
 
Vince Marino, DPM, San Francisco, CA, drmarino@marinofootandankle.com

This case becomes different when we think biomechanically and not orthopedically. I am considering this 45 year old neuropathic patient with poor bone quality and a flat 1st MP joint to be in his 60’s physiologically. I am thinking about the patient avoiding future trips to the OR and would like to avoid plating and iatrogeny.
 
1. We need a second x-ray view because it looks as if this may be an old fracture that is united. The inflammation may be from the sharp edge jutting out laterally which would involve reshaping the bone and not plating.
 
2. If not, after foot typing the patient (this plan is contra-indicated in the rigid forefoot types), I would consider a fifth met head resection which would eliminate the 5th ray problem and have a positive biomechanical effect on the forefoot type by reducing the Forefoot SERM position in closed chain post-op and greatly reduce the post-op downtime at work.
 
3. In any case, I would cast the patient, foot type-specific pre-op for Foot Centrings and dispense them into the post-op shoe, immediately post-op, to promote quicker and more mature healing.

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: Pass/Fail for the First Three Semesters of Podiatry School
From: Al Musella, DPM

I just took a look at the curriculum for the New York College of Podiatric Medicine. In the first 2 years, there are 90.5 credits worth of classes given. Of this, there is 1 credit in biomechanics, and 2.5 credits in functional orthopedics. In the 3rd and 4th year, there are 7.5 credits (out of 91.5 credits) of courses involving biomechanics and orthopedics.

The students are put into a learning situation where they are not encouraged to take an interest in the more important courses. I know all courses are important, but if you put a sleep-deprived student into a situation where...

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

RE: A Simple Way to Track Accounts Receivable (Hal Ornstein, DPM)
From: Lynn Homisak
 
Great advice by Dr. Ornstein on having staff markup EOBs! Why not make it one step simpler? Instead of using numerics - consider attaching meaning to the system by using:

"W" for Write offs,
"P" for patient Paid and
"B" for patient Billed

Clearer communication = less chance for misinterpretation and error.

Lynn Homisak, Renton, WA, lynn@soshms.com

RE: Is Podiatry Turning Away from Biomechanics? (Michael Turlik, DPM)
From: Narmo L. Ortiz, Jr., DPM

With all due respect to Dr. Turlik, would he be so kind as to expand on what he meant by a hidden curriculum? As far as I can recall, when I attended podiatry school, the "exposed" curriculum we were "subjected" to followed a model resembling adult pedagogy since it outlined a set of programmed lectures, teacher-directed instruction, testing, monitoring, evaluation, and even discipline. Isn't that more of a pedagogical model?
 
A true andragogy model was started at Harvard and Johns Hopkins medical schools back in the 1980s, immersing freshmen right into clinical work as they took their didactic courses. Presently, many medical schools now follow that model.
 
Now, can we get back to the subject of biomechanics?
 
Narmo L. Ortiz, Jr., DPM, Marietta, GA, nlortizdpm@embarqmail.com

RE: Insurance Company Did Not Discriminate by Paying Podiatrists Lower Fees: CT Court
From: Edward R. Nieuwenhuis, Sr. DPM

The recent decision by the Connecticut Supreme Court allowing insurance companies to discriminate in their billing practices is troubling, to say the least. The doctrine of equal pay for equal work is one which has long been promoted in our nation. and this decision runs 180 degrees counter to this doctrine.

I am not familiar with the laws of the State of Connecticut which would allow such a practice, but in the interest of all podiatrists, and also other professional disciplines throughout this nation, I hope that this decision will be appealed quickly, if that is at all possible.

Edward R. Nieuwenhuis, Sr. DPM, Hawthorne, NJ, Edfeet@aol.com

RE: Not All Bunions Require Surgical Correction: IL Podiatrist
From: Ray McClanahan, DPM, BS Ed

Dr. Reid is correct when she suggests that not all bunion deformities need surgical correction. However the treatment recommendations offered by her for conservative care are ineffective at addressing the cause of the deformity, and will not provide long-term relief.

Anti-inflammatory medications are notorious for their systemic side-effects, and have negative effects on bone and cartilage. I am curious about what types of physical therapy modalities Dr. Reid is prescribing for a patient with a bunion, as I cannot envision any physical therapy modality that will have a lasting effect on a subluxed 1st MPJ that is caused by footwear with tapering toeboxes.

How will rest help a bunion, when...

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

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

SPACE AVAILABLE - NYC & LI

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 - MICROVAS UNITS

2 lightly used Microvas units (2010) for sale at $7000 each plus shipping. Paid $1600 for each machine. Great way to add therapy modality to your practice. Contact: klamdpm@hotmail.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-mailcontactus@podiatrypracticeconsultants.com

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 - TEXAS (HOUSTON AREA)

Become a “SUCCESS”! Multi-professional podiatric practice seeks personable, talented, enthusiastic physicians with expertise in any of these areas: 1. Biomechanics 2. Geriatrics 3. Pediatrics 4. Trauma. Send CV and letter of intent to: sierrajip@gmail.com

ASSOCIATE POSITION    - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA
 
Home of Florida State University. Great university town!  Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION – IOWA CITY AREA

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 tocontactus@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.

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

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