The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 14, 2008 #3,373 Editor-Barry Block, DPM, JD

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Technical Problem Prevented Some Readers From Receiving PM News dated 10/13/08

Due to technical difficulties, some subscribers did not receive yesterday's PM News. If you did not receive this issue, we encourage you to click here to read it. We apologize for this inconvenience.

Beware of “Boomeritis” AZ Podiatrist

With new treatments and new attitudes about remaining active in the face of physical setbacks, staying fit in your 40s and beyond needn't be a pain. Instead of throwing in the towel, you may be able to set things right by easing off a little, modifying routines and practicing preventive measures. That's welcome news for Boomers who exercise to bolster health and slow aging, only to find themselves with joint injuries from their shoulders to their feet. Orthopedic surgeon Nicholas DiNubile of the University of Pennsylvania Health System coined and trademarked the term "boomeritis" when he noted a surge in such injuries in people born between 1946 and 1964.

Arlene Polakof, a podiatrist and medical director of specialty care for Cigna Medical Group in Phoenix, says she knows what's behind the surge. She sees it in some of the 40-and-older patients who show up in her office complaining of foot or ankle pain.

Dr. Arlene Polakof

"People who are no longer very athletic dig an old pair of shoes out of the back of their closet," she says. "The shoes may not fit anymore, or they may be worn out. Then they go out and try to cram several years' worth of athletic activity into a short period of time." The result often can be an ankle sprain, strain or fracture. It also could be plantar fasciitis or a stress fracture.

Source: Gannett News Service [10/13/08]

FL Podiatrist Lectures at CILAD in Ecudar

Bret Ribotsky, DPM of Boca Raton, FL recently straddled two hemispheres to lecture at the 16th CILAD (Colego Ibero Latino Americano de Dermatologia) International Congress of Dermatology in Quito, Ecuador. Held every two years, this is the largest international Latin American congress.

Dr. Ribotsky at CILAD

“This meeting is a tremendous opportunity to become exposed to experiences of physicians practicing medicine in areas less developed than at home”, said Ribotsky, who presented recent research on onychomycosis and tinea pedis.

New FTC “Red Flag Rules” Also Affect Physicians

The Federal Trade Commission's (FTC's) "Red Flag Rules," which take effect on Nov. 1, may sound like they apply only to financial institutions and creditors, but they have implications for healthcare providers as well, says a Sept. 24 report by the World Privacy Forum.

The rules require that creditors that hold consumer accounts "for which there is a reasonably foreseeable risk of identity theft," to implement an identity theft prevention program. "The program must include reasonable policies and procedures for detecting, preventing and mitigating identity theft," the FTC says.

Where do providers come in? Medical identity theft and "creditors in the healthcare field" were singled out in the final rule published in the Federal Register in November 2007. "Some of the obligations affect creditors, a general term that includes some healthcare providers," the forum's report explains. "Essentially, if a healthcare provider extends credit to a consumer by establishing an account that permits multiple payments, the provider is a creditor offering a covered account and is subject to the Red Flag rules," it adds.

Source: Report on Patient Privacy [October 2008]

High-Tech Buying Tip

Before you buy that next expensive high-tech device or software package, call the manufacturer's toll-free help numbers. Reason: If you can't get through or must hold for a long time, you'll be better able to decide which companies you don't want to deal with.

Source: Bill Altier, Princeton Associates

Query: Orthotic Lab With Fast Turnaround Time

I am pleased with the quality of the orthotics from my current orthotic laboratory, but frustrated with the turnaround time and the lab’s bookkeeping. What great labs are there for me to try?

Loren Schneider, DPM, Manchester, CT

RE: OsteoMed Screws (Greg Caringi, DPM)
From: Jay Lieberman, DPM, Godfrey Viegas, DPM

These screws are ideal for cases in which the patient has a flexible forefoot equinus. In this particular case, I did fusions of the PIPJ of the second, third, and fourth toes and a standard arthroplasty of the fifth toe. The patient had an IP fusion of the hallux five years before. The head of the screw was bulky and needed to be removed.

OsteoMed Screws

I did extensor hood releases along with transposition of the extensor tendons (Jones-Hibbs). The effect of the procedure is dramatic on this type of foot. I always use fluoroscopy because accurate pin placement is important. The screw must engage the proximal cortex of the proximal phalanx or it will have a tendency to back out. The availability of longer screws makes this possible. The compression is impressive even as the screw passes through the fusion site. Surgeons may be tempted to leave it in the mid shaft region. This usually does not affect the arthrodesis but a second procedure will be necessary to remove the screw later.

I have also used the screws in MPJ fusions to augment fixation with a tubular plate.

Jay Lieberman, DPM, Margate, FL, drjayl@prodigy.net

I have used the traditional Osteomed 2.0/2.4 “headed” screws as well as these sizes in the “headless” type. I feel that these implants are outstanding. I use the 2.4 mm. screws with heads for all lesser MT osteotomies (Weil-type), and I have used both the headed and headless for PIPJ fusions, as they are placed as intramedullary implants, and are available in long lengths. I do not remove the guide pin, but instead, advance the guide pin proximally across the MTPJ, as it acts as a traditional K-wire.

When a lesser MT osteotomy is performed simultaneously, I advance the guide pin just lateral to the MT screw. The screw driver for the “headless” screws engages better, so there is overall less stripping when compared to the “headed” screws. I have had only a few “headed” screws strip either when placing them or taking them out. If this happens when placing the screw in, you will need to pre-drill and use a new screw. If this happens when taking the screw out, use a heavy needle holder to clamp the head and then remove the screw.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

RE: Arthrosurface Hemi Cap for Frieberg’s Infraction.( William Sachs, DPM)
From: Alan MacGill, DPM, Jeffrey Kass, DPM

Arthrosurface makes a larger implant (15 mm.), which is commonly used to resurface the first metatarsal, and a smaller size (12 mm.), which is what we have used to resurface the second metatarsal. The 12 mm. implant has worked great to re-establish a congruent articular face, all while maintaining the weight-bearing surface of the metatarsal.

We've performed this procedure in 4 cases. All cases involved the 2nd metatarsal and the patient age ranged from 29 to 68. Our follow-up has ranged from 10-19 months in this small sample size but results have been good. All patients have had increased joint range of motion, decreased levels of pain, and a return to desired activity level. These results have been promising but we'll have to wait and see how these implants hold up long-term.

Alan MacGill, DPM, Orlando, FL, alanmacgill@gmail.com

I just recently had a discussion with a fellow colleague regarding this type of case. The thought for this type of procedure is that you have a damaged met head and the implant would take its place. The con is the met head is collapsing, this is the disorder. So, the concern would be whether or not the implant can hold due to the decreased strength and collapsing nature of the bone. I have not done a literature search on the topic, but decided the con was too much of a concern.

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

RE: Weil Osteotomy w Cheilectomy (Stuart W. Kushel, DPM)
From: Lowell Weil, Sr., DPM, Greg Caringi, DPM

When treating hallux rigidus, one must consider the different forms and degrees of the deformity prior to choosing a "favorite procedure". While the Weil osteotomy may have value in some cases of hallux rigidus (Malerba - Foot & Ankle International 9/2008), the cheilectomy with a Moberg (we have done this for years and called it a Bonney & Kessel) has had favorable results as reported by Coughlin in long-term studies. Finally, implant arthroplasty and arthrodesis have their place as well depending on the degree of deformity. So, let us not recommend our "favorite operation" without discussing in detail when it should be performed. Surgeries have much better results when they are performed for the proper criteria.

Lowell Weil, Sr., DPM, Des Plaines, IL, lswsr@aol.com

I have used both the Youngswick modification of the Austin procedure and the Green modification of the Watermann procedure in combination with cheilectomy & subchondral drilling with good results. As far as first met shortening, I always follow a simple principle that I learned from Dr. G. LaPorta many years ago at one of the original Hershey conferences -- always plantar-flex (or plantarly displace) the first met head an equal amount relative to the 1st met shortening. Shortening is highly desirable for decompression of hallux limitus. If you can plantar-flex in equal measure, the first ray will remain stable and functional. This all within reason, of course.

Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

RE: Abandonment of Nursing Home Patients
From: Daniel Chaskin, DPM

Regarding a nursing home patient’s request to have a non-staff podiatrist come to the facility and give podiatric care, that facility must honor that patient’s request or else risk violating that patient’s federal civil rights to request podiatry care from their own podiatrist. That patient is possibly disabled and cannot travel outside the home, so they have a right to choose a non-staff provider.

The facility has a right to verify licensure and the appointment time, but must honor that patient's request. Disclaimer: Please check with the office of civil rights regarding these opinions.

Daniel Chaskin DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: Hallux Pelvis, Anyone?

I recently received this report from a radiologist:

"Impression: No fracture or dislocation is seen. Interphalangeal joints are mildly narrowed consistent with mild loss to arthritis. Only a very minimal Hallux Pelvis deformity is present, but overlying soft tissues are swollen. Extensive atherosclerotic calcifications are present."

I’m not sure what hallux pelvis is and I’m not sure I want to know!

Duane Kratzer, DPM, Austin TX

EQUIPMENT FOR SALE – PAD SYSTEMS

2 SensiLase 3000 PAD Systems used for Skin Perfusion Pressure (SPP) & Pulse Volume Recording (PVR) tests for micro and macro-circulatory assessment. I’m selling because podiatrists no longer qualified to do studies and get reimbursed in Colorado. Paid $24,390. Sell for $20,000 each. Purchased from Vasamed. Call or e-mail Jack Burgin A Step Ahead Foot & Ankle Center 2001 S. Shields St., Bldg. F, Fort Collins, CO, 80526, (970) 232-1717 jack@asafoot.com

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

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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