The Voice of Podiatrists

October 16, 2006 #2,715 Editor-Barry Block, DPM, JD

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85% of Plantar Fasciitis Patients Don’t Need Surgery: MO Podiatrist

Plantar fasciitis is “an inflammation of the thick, fibrous band that runs across the bottom of the foot and into the heel,” says Dr. John M. Dailey, a podiatrist and head of the St. John Mercy’s Foot Center. Plantar fasciitis has many causes, including a slight length difference in the left and right legs, increasing your speed or mileage too quickly, or improper footwear.

Treatment varies. Dailey says it can be as simple as changing shoes or getting orthotics. Anyone with such problems should be evaluated to be sure there’s no heel spur. Surgery usually is not necessary; he says 85 percent of heel spur patients get better without an operation.

Source: Lori Shontz, Quad City Times [10/14/06]

CA Podiatrist by Day, Stand-up Comedian by Night

Podiatry is hard. Monterey podiatrist Dr. Scott Smith, a Carmel native, will attest to that. But even as Smith is busy in the operating room, he'll tell you straight up: surgery doesn't compare to the difficulty of performing stand-up comedy. "Comedy is harder to do," said Smith, 34, who regularly performs at nightclubs such as Planet Gemini and Doc's in Monterey, as well as The Improv in San Jose, mostly as an opening act and master of ceremonies.

Dr. Scott Smith

As he's comparing the difficulty between medicine for the foot and medicine for the soul, he's busy scraping away at a patient's exposed foot, trying to remove some serious warts. Smith performs the surgery at Monterey Surgery Center, a much different stage compared to the clubs he's played. "(Comedy is) difficult because it's in front of an audience," Smith said, his voice muffled by a surgical mask. His body, from the top of his shaved head to his tennis shoes, is covered in hospital scrubs.

When asked how he manages to balance his life as a doctor with his secondary life as a comedian, Smith said, "I just figured it would be easier to be a struggling podiatrist than a struggling waiter or something."

Source: Marc Cabrera, Monterey County Herald, [10/15/06]

Medicare Pay Revisions on Hold Until After November Elections

Congress left town to prepare for midterm elections without agreeing on a way to stop the upcoming Medicare physician cut -- a situation that doctors said must be rectified as soon as lawmakers come back to Washington, D.C., in November.

The last chance physicians will have to prevent the estimated 5.1% cut from taking effect in January 2007 will occur after lawmakers go back to Capitol Hill the week of Nov. 16 for a "lame duck" session. Competition among legislative priorities, including stopping the Medicare pay cut, will be fierce, because Congress also must approve a number of massive spending bills if it wants to keep the government running.

House Energy and Commerce Committee Chair Joe Barton (R, TX) has floated a legislative proposal that would guarantee physicians a Medicare pay update of at least 0.5% at the beginning of each of the next three years, instead of the roughly 5% annual cuts that they are expected to receive. Doctors also could receive an additional bonus payment of 0.25% in 2008 and 2009 if they participated in a local utilization management program and in at least one of a number of federally approved quality improvement efforts.

Source: David Glendinning, AMNews [10/16/06]

Query: Risks for HAV Repair W/ History of CP

What are the potential risks or complications for doing HAV repair in a patient who had a mild form of CP as a toddler or child? For example: pain out of proportion, prolonged or severe edema, soft tissue or bone healing issues, neurologic hypersensitivity or predisposition to RSD/CRPS? He is an otherwise healthy soldier on active duty in an army field unit? He reports having overcome some LE MSK issues as a child w/ physical therapy, bracing, etc., and compensates extremely well as a an adult.

Will Godfrey, DPM, Fort Polk (Leesville), LA
williamtrekkie@earthlink.net

RE: “Healthcare Professionals”
From: Arden Smith, DPM

We should be the last ones calling ourselves, "healthcare professionals." We are doctors, podiatrists, podiatric physicians and/or surgeons...maybe someday thanks to Barry Block, physicians. The people who work for us may be healthcare professionals, but I'll be damned if I refer to myself, or another doctor as one!

Perception becomes the truth and sometimes we just have to stand up to the insurance industry and health care economists and politicians and say that "We Are Mad as Hell and We're Not Gonna Take It Anymore!"

Arden Smith, DPM, Maspeth, NY, digitiquinti@aol.com

RE: Pediatric Melanoma (Larry Aronberg, DPM)
From: Multiple Respondents

I have been to several recent scientific and risk management lectures claiming the same. A biopsy may be unsettling for a child but the consequences of not doing a biopsy may be catastrophic. Consult a pathologist specifically trained in dematopathology for advice and if there is any doubt, do the biopsy.

Lawrence J. Sturm, DPM, lsturm@bellsouth.net

If you are in any way and I mean in any way suspicious of a skin lesion, simply biopsy it. Would you rather subject her to the alternative if you miss the lesion and she does in fact have a melanoma. Since the incidence of malignant melanoma has increased about 200% over the past 20 years, I think that should be "evidence" enough for you.

Thomas A. Graziano, DPM, Clifton, NJ, TGrazi6236@aol.com

Dr. Aronberg raises the question on whether or not to biopsy a pigmented lesion on an 8 year old black female based on one singular finding: That the lesion is located on the juncture of dorsal and plantar skin. He remembers some 15-20 years ago being told by a dermatopathologist that "a pigmented lesion in the band of skin between the dorsal and plantar surfaces of black people should be highly suspect for melanoma."

Suspicion for melanoma should rarely be based on any one singular finding, but rather on a constellation of findings. In my opinion, one exception to that would be lesions that are greater than 6mm in diameter where a patient reports definite change in any characteristic. (Technically, that is two findings, size and change). We need to know other characteristics, such as size?, macular or raised? homogeneity of pigment? symmetry? border characteristics? noted changes? and yes, location. It has been published that location on the foot alone may be an independent risk or prognostic factor for melanoma.

I have not heard or read of anything specific about the junction of plantar and dorsal skin. In the case of children, we need to know if the lesion is newly acquired or congenital. A complete family history and total body exam should be done. If one is not totally comfortable that what they are seeing meets criteria for a high index of suspicion, then I suggest a second opinion. Lastly, pediatric melanoma happens to be on the rise, so there may be more opportunities to see early lesions. A biopsy procedure, even on an 8 year old, is far too simple and atraumatic to spend any time contemplating why not to do it.

Bryan C. Markinson, DPM, New York, NY

Bryan.Markinson@msnyuhealth.org

RE: Vicks VapoRub
From: Multiple Respondents

As per the article that Brad Bakotic and I published in August 2006 Podiatry Management on onychodystrophy, there is more primary repetitive microtraumatic onychodystrophy than primary fungal onychodystrophy and etiological predisposing biomechanical pathology that is being left untreated. This explains why current fungal toenail care has such a poor cure rate as well as a high recurrence rate.

None of the antifungals (topical and oral agents) are effective short or long-term unless some shoe/orthotic modification is made after proper evaluation of foot type. I utilize keratolytics (I prefer 40-50% urea to VapoRub) and not antifungal agents when I have a negative PAS and/or by clinical presentation, the primary etiology is biomechanical and not fungal. Keratollytics have a more important place than antifungals in both short and long term care of dystrophic toenails and should be a more important part of our treatment protocol.

Dennis Shavelson, DPM, New York City, NY,

drsha@lifestylepodiatry.com

Vick's ingredients:
Camphor - readily absorbed through keratin into the skin, believed to be slightly antiseptic, possibly a mild antimicrobial
Menthol - biochemically behaves like an alcohol
Eucalyptus Oil - long believed to be antiseptic. Popular in non-western medicine and used topically in veterinary medicine, and I think its in urinary catheter ointment

Most interesting are what the manufacturer calls "inactive ingredients," particularly thymol, a phenol classically used in bookbinding to kill fungal spores. Supposedly they would seal old moldy books in bags with thymol crystals before binding.

Corey Fox, DPM, DRwdstk@aol.com

Fungi like things to be damp, dark, and warm. That's why humans are susceptible to fungal infections in the groin, the feet, under the breast. The old treatments, before we had fungicidal / fungistatic meds, all tried to disrupt the environment to make things cool, light, and dry. Therefore menthol, the drying agent in VapoRub, will have some success. I always let my patients know that modern medications have a better rate of success, but they are welcome to choose whichever method they wish.

Matt Connolly, DPM, Fort Thomas, KY, MJCDPM@FUSE.NET

Ed note: This topic is now closed

RE: Fischer Auto Tank X-Ray Processor (Scott Kissell, DPM)
From: B. Thomas Kempf

I bought the Fischer Auto Tank earlier this year. It requires a little bit of time (maybe 3-4 hours) to put it together. It's only partially assembled when it gets delivered, but it's quite easy to do. The customer support is excellent, and they can help you over the phone if you have any problems. Once it was up and running, I found that I was able to get excellent quality films without having to change the chemicals for 4 months. If you do a very large number of X-rays everyday, this might not be the unit for you. The manufacturer has a guideline for how many X-rays you can average per day (I believe it's 5 a day). Overall, I am very happy with the unit and I would recommend it for any practice that doesn't exceed the maximum number of X-rays per day that the processor is rated for.

B. Thomas Kempf, DPM, Sayville, NY, drftlong@optonline.net

Ed note: This topic is now closed

We all know how hard it is for some of our elderly patients to get rides to our office. Years ago I had one of my favorite elderly patients ask me if I would go to the funeral home for her wake when she died. I told her I do not do that routinely for my patients but would make an exception in her case when she passes. I then asked her if she would come to my wake should I die before her and without missing a beat she said "yes, If I can get a ride!" We both enjoyed a laugh.

When she passed away I owed her one and payed my respects knowing well she would have done the same for me. There are times with the hustle and bustle of practice and life that we forget the fun we have with our patients.

Vincent L. Travisano, DPM, St. Louis, MO

PODIATRY POSITION IN ALABAMA

Excellent opportunity for immediate opening with AL licensee. Practice is very busy, 2 locations in West AL. Opportunity of six figures first year with contract for stock ownership. Great place to practice and raise a family. Get started with no hassles of a start-up practice. Very modern offices with ongoing management. Fax resume to (205) 330-9920 and visit our website at www.myfeethurt.com

MEDICAL EQUIPMENT WANTED

MinXray P-200 Exposure Hand Switch with Timer Control (circa 1977). jim.fractal@gmail.com

SEEKING ASSOCIATE POSITION - NEW YORK

Hardworking, ethical and well trained PSR-24 trained podiatrist seeking a part-time associate position in Westchester county or surrounding areas. Please contact (206) 919-2832 or bbrick2@yahoo.com.

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

High Income position for ethical hard working podiatrist, great for semi-retired or to supplement office practice, part time. Must have Florida license and active Medicare/Medicaid numbers. FAX CV or Resume to 727-785-4697

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com
WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established podiatry practice in Mt. Airy, North Carolina that is either for sale or in need of an associate/partner to come on board to take over patient care. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3,500 patients without a podiatrist to care for them. This is a unique opportunity to be able to begin work in an extremely busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE – TEXAS

Practice for sale in fast growing suburb of Dallas, TX. Fully furnished office in medical building on busy street. General Podiatry, including routine care, orthotics, surgery, etc. Currently part-time office, can be full-time. Hospital privileges available. Excellent Opportunity. Must sell fast. Please respond to: cdinbigd@aol.com P.O. Box 796757, Dallas, TX 75379 or fax contact info to: (972)267-1815.

ASSOCIATE POSITON - FLORIDA

Well established, growing, multi-physician practice in central Florida seeks hard working, ethical individual with good interpersonal skills to replace retiring physician. Experienced support staff, generous salary, malpractice coverage and health insurance. Excellent start on a promising future, this position will provide for the possibility of partnership in the near future. Send CV to: jrdpm@bellsouth.com.

ASSOCIATE POSITION – UPSTATE NY

Podiatrist wanted for busy practice in growing community in mid-eastern New York State, near Saratoga Springs and Albany. Grow into and eventually own practice. New office building with 4 tx rooms, state-of-the-art surgery center available, privileges at three area hospitals and nursing homes. No limit to what you will earn percentage base. Call 518-692-9134 for more info.

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