The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 19, 2007 #3.070 Editor-Barry Block, DPM, JD

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IL Podiatrist Uses Subtalar Arthroereisis to Correct Hyperpronation

For Margaret Coppejans bunions and knee pain were a fact of life for the past 71 years. “I’ve been flat-footed since I was born,” she said. “I had bunions so bad so I went to see (Dr. Elie Daniel).” In her case, the bunions and knee pain were the result of hyperpronation. Daniel, a podiatrist, had performed several other surgeries for her and when a new procedure for hyperpronation became available, he also advised her to try it. Daniel said the motion of the bones in the ankle take place surrounding a small space called the sinus tarsi. If the foot is hyperpronated, the sinus tarsi space gets compressed. Bunions, heel pain, ankle pain and other ailments are all symptoms of that compressed space.

Dr. Elie Daniel (Kemp Smith)

“The sinus tarsi have ligaments that hold the bones together,” Daniel said. “What happens then is when this bone moves forward, you obliterate that hole. The tissue in there gets squeezed so you start to get pain.” Coppejans expected a reduction in foot pain but what surprised her was the improvement in her left knee. She originally expected she would need knee replacement surgery but now her knee has improved to the point where she’s walking normally and pain free.

Daniel advises patients to have one ankle done at a time to lessen the impact. While Coppejans reports no pain from the 20-minute outpatient surgery, she did have to stay off her feet for a week and then slowly start back into her normal routine. Following the surgery, Coppejans said she has some exercises she needs to do in order to stretch out the tendons in her foot and leg. She said she still walks a little on the side of her foot and her big toe sticks up. With exercise, she expects to eventually stretch those tendons and walk normally.

Source: Source: Tamara Abbey, News Tribune [10/16/07]

Postal Exhibit at Scholl Highlights Domestic Terrorism

"The Devil's Mail," an award-winning collection of postal "covers" owned by Dr. Steven Berlin, traces the history of 20th century terrorism through the mail, including the 1994 Unabomber attack on American Airlines Flight 444 originating in Chicago. In that incident, passengers aboard a Boeing 727 heard a thud from the baggage area where an airmailed parcel rigged by Kaczynski ignited a mass of gunpowder which began to smolder and fill the plane's cabin with smoke. The plane made an emergency landing at Dulles International Airport where 12 passengers were sped to a hospital for treatment of smoke inhalation.

Dr. Steven J. Berlin With Stamp Cover

Berlin, a podiatric surgeon from Maryland and avid stamp collector, said that the 1979 cover -- or postmarked letter -- from a mailbag carried aboard the flight draws keen interest from those who never got any closer to the madman Kaczynski than their daily newspaper. Berlin's collection features about 30 other covers that survived assassinations and terrorist strikes around the world, those perpetrated by the Irish Republican Army, Palestinian hijackers and Columbian drug lords.

The exhibit, displayed inside the Feet First Museum of the Dr. William M. Scholl College of Podiatric Medicine at the university will be on display through Nov. 6.

Source: Judy Masterson, Chicago Sun Times, October 16, 2007

Medical Schools: Record Number of Students Apply

Medical schools in 2007 admitted a record number of first-year students, according to a study released on Tuesday by the Association of American Medical Colleges, Bloomberg reports. According to the study, 126 medical schools in 2007 admitted 17,759 students, a 2.3% increase over 2006, and 42,315 students applied to the medical schools, an 8.2% increase over 2006 (Sullivan/Keenan, Bloomberg, 10/16).

The study also found that the number of applications by black and Hispanic males increased by 9.2% in 2007, and the number of black men accepted and enrolled in medical schools this fall increased by 5.3%. Minorities account for 6% of practicing physicians in the U.S., even though blacks, Hispanics and American Indians comprise 28.8% of the U.S. population, CQ HealthBeat reports.

Source: Bloomberg, CQ Healthbeat via American Health Line [10/17/07]

Query: Charcot Dilemma

Over the past ten years or so I've been involved with a number of Charcot reconstructions. The majority of these patients, after long post operative periods filled with morbidity and complications, eventually ended up with major amputations, or expired with their bandages still on. In over twenty five years of practice, the patients whose condition was amenable to a palliative "lump and bump" fared somewhat better, also not without complications and recurrent ulcerations [also, brace or AFO-related wounds], but in general a better quality of life.

I'm beginning to wonder if I wouldn't be doing a greater service to these patients in need of a major reconstruction if I listened to some of my orthopedic and vascular colleagues and more strongly suggested a primary BKA with the goal of getting them into a good functional prosthetic and letting them have their life back again - a life without wound care and bandages and with real showers. The flip side is the very high potential for a contra-lateral major amputation and/or death in a relatively short period. What do PM News subscribers think?

Arden Smith, DPM, Great Neck NY

Query: ABPS Certification Preparation

Can anyone recommend a good ABPS recertification study guide or course?

Bruce Williams, DPM, Merrillville, IN

RE: Effect of Dropping Out of Oxford (Name Withheld)
From: Barry Mullen, DPM

We dropped the Oxford Liberty plan over 4 years ago and witnessed an increase in revenue because 1) it freed our multi-physician schedule to allow the doctors to provide care for patients with insurance carriers that reimburse more equitably and 2) we determined that after calculating the added work value units and paperwork associated with processing the majority of Oxford Liberty's claims, coupled with processing delays and the cost of tracking those outstanding claims, it wasted so many valuable billing department resources that it actually cost us money to see those patients. We'd like to think we're a very efficiently run office and couldn't derive an acceptable profit margin from Oxford Liberty, so I'd venture to guess that is one of the least desirable insurance plans to participate with. In addition, we've retained approximately 33% of those patients who continue to choose to see us out of network. Depending upon the quality of care provided and your local patient demographics, you may experience the same phenomenon.

With respect to de-selection vs. participation decisions with any insurance plan, first determine the your cost of service provision for each and every service you provide. Then, factor in any additional opportunity costs incurred with claims processing and reimbursement delays over and above your local insurance payor mix norm and weigh that against the total reimbursement you receive for those services from that plan. That is the only way one can determine whether it is profitable to participate with a given insurance plan or not.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Board Certification Requirements for Hospital Staff (Doug Milch, DPM)
From: Multiple Respondents

What many of our hospitals have opted to do to is to state that those applying must be either ABPS qualified/certified OR they must show that they are capable of doing the procedure. I was not able to finish my surgical residency and I showed that I should not be denied surgical privileges due to unforeseen events.

Brandon J. Hawkins, DPM, Bakersfield, CA, bjhawkdpm@hotmail.com

This issue was to have been settled when the Ambulatory Board was allowed to have some members certified as ABPS members. There will always be those who for whatever reasons can't, or don't want to comply with the rules form a new board. This profession has a representative, and its name is the APMA. The parent organization has two boards, and they should be the only boards that any hospital should accept.

The two boards have a valid time-tested examination process. You should not be allowed to send in two Wheaties box tops, and twenty-five cents in coin, and receive a certificate. Medicine has been confronted with this also, and there is only one acceptable board in plastic surgery, notwithstanding the fact that the ENT people have created the American Board of facial plastic surgery. If you have not been trained as a plastic surgeon, you are not a plastic surgeon.

Sheldon Marne, DPM, Hendersonville, NC, ncmarnes@msn.com

When I was chair of the privileging committee of our hospital in the Northwest, the issue of Board Certification came up frequently. However, it was in the area of SURGICAL PRIVILEGES, not hospital privileges themselves.

Our hospital was unique in at least two ways: First, we had podiatric residents in up to 3-year positions. Secondly, we had a system in place whereby even non-board certified surgeons had an opportunity to raise their surgical privileges if they followed a "specifically designated track" by our privileging committee. There were a number of podiatrists who actually availed themselves of that opportunity.

The place where board certification is relevant is in the extent of surgical and other privileges, NOT actual membership on the hospital staff. We encouraged both non-board certified and certified to apply for privileges. That had the effect of providing more patients for our residents, and an atmosphere where non-board certified individuals could improve their education and opportunities.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

Editor's Note: This topic is now closed.

POSITION WANTED PHOENIX METRO AREA

Office getting too busy with winter visitors? Young practitioner available for part time help. Seasonal or temporary OK. Surgically trained. Flexible schedule. Direct inquiries to dlmeb5@yahoo.com

HOME FOR RENT- CABO SAN LUCAS, MEXICO

For rent: 2 bedroom-3 full bath fractional home on the Sea of Cortez at Grand Regina Westin, Cabo San Lucas, Mexico. Week of December 29, 2006 until Jan 5, 2008. Sleeps 8, full kitchen with washer and dryer. Outside balcony with hot tub overlooking the water. Ideal for family vacation. $5000. Photos available. Contact Amogreg@aol.com

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in North Hollywood, California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

ASSOCIATE POSITION CLEVELAND CLINIC

The Section of Foot and Ankle Surgery at Cleveland Clinic is seeking highly qualified board-certified/ board-eligible podiatrists to join our faculty. High volume clinical practice consisting of general podiatric care, wound care, and diabetic foot problems, along with a research background in diabetic foot complications and/or clinical outcomes. Please contact: Joe Vitale, @ vitalej@ccf.org

THE PERFECT CHRISTMAS GIFT

Super Luxurious Custom Oceanfront Dreamhouse on Caribbean island of Bocas del Toro, Panama. FULLY FURNISHED 5000 SQ FT, 5 BED, 5 BATH, 2 KITCHENS, Infinity Pool, satellite TVs, wireless internet, Lush Tropical landscape, NEVER hurricanes. NO TAXES for 20 YEARS. $875,000. photos & info drritarae@yahoo.com

SALES REPS WANTED

Orthofeet is looking for independent sales reps to sell their line of shoes and orthotics. Orthofeet offers high end shoes and diabetic insoles that are covered by Medicare, along with competitive advantages and unique selling points. E-mail: mb@orthofeet.com

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