The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 19, 2009 #3,678 Publisher-Barry Block, DPM, JD

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Flip-Flops Create Inflammation of Growth Plate: FL Podiatrist

Easy, breezy flip flops are all the rage. Kids love them and parents love their low price. But, like the other end of the shoe spectrum, spike heels, the fun flip flop is trouble afoot. "In the last year I've had a dramatic increase in the number of kids I'm seeing because of flip flops," says Spring Hill podiatrist Dr. Joseph Barta. "It can be anywhere from 9 to 16 years old where I'm usually seeing the increase. And it doesn't have to be an athletic kid or an obese kid. It's hitting all of them."

Dr. Joseph Barta

"It's typically a tendonitis and it's typically on the inside of the foot," says Barta. "The inside of the foot pronates (points toward the outside). Your medial arch collapses and the toes are actually pointing outward. It also creates an inflammation of the growth plate in the back of the heel. And that is very prevalent."

Barta explains, "Their growth centers have not finished closing. They're very vulnerable to a flat foot deformity which then leads to additional bunions, additional hammertoes and metatarsalgia, It's just a snowball effect. It can get bad enough at some point that their only hope is going to be a surgical correction."
 
Source: Virginia Diaz, Tampa Tribune [10/15/09]  
 

Dr. Comfort “Names” Office with a Donation at OCPM

Dr. Comfort recently contributed $10,000 to the Ohio College of Podiatric Medicine’s (OCPM) Stepping Towards the Future Naming Campaign. Dr. Comfort has named the “Dr. Comfort Secretarial Services Office” at the college. This office is the “main hub” for all OCPM Faculty members and the central location for students.
 

Dr. Comfort Secretarial Room at OCPM

Rick Kanter, President of Dr. Comfort stated, “Dr. Comfort believes that giving back to the podiatry profession is one of our core values.  We wanted to have our name associated with one of the best medical colleges in the country that shares our same vision of educating future podiatrists and the importance of quality footwear.  The future of the profession starts with the podiatry student.”

Start with as Little Debt as Possible: GA Podiatrist/Advisor

Be patient, prudent, passionate, and start with a spare office and as little debt as possible, advises Dr. David Edward Marcinko, MBA, the CEO of the Institute of Medical Business Advisors Inc., an online and onground business advisor to physicians that is based in Norcross, GA. "Patients are looking for passion from you, not lavish trappings," Dr. Marcinko says.

Dr. David Edward Marcinko

"When a banker or a loan officer sees $175,000 or more of debt, they are loath to give a loan, and it's hard to blame them. Purchase a home after you become a private practitioner. You need to be as close to debt-free as you can be. "Another thing bankers want to know is, 'If we give you a loan and you start a practice and it fails, how will we be paid back?' They want an exit strategy."

Source: Michael Gibbons, Healthy Aging [9/16/09]

HIPAA CEs Need to Update Policies on Use of Cell Phones and Cameras

Covered entities (CEs) should review and update their policies on cell phones and cameras and make the rules clear and highly visible to employees, patients and visitors, privacy experts tell RPP.

When photos are needed for treatment, the CE should give employees access to a digital camera and discourage the use of cell phone cameras. “That helps mitigate much of the potential for further unauthorized disclosure,” Frank Ruelas, privacy and compliance trainer for CEs, explains. “With a cell phone, you can e-mail the photo to someone. There’s no way you can do that with just a camera. It can’t happen by accident.”

Abner Weintraub, president of The HIPAA Group, a consulting firm says that CEs should make patients aware of their photography policy, and have them sign the policy to show that they’ve read it. “When a patient has to sign that he or she will not use their phone’s camera, audio or video, the signature carries a lot of weight,” he says.

Source: Report on Patient Privacy [10/12/09]

Personalize Praise

Add oomph by tacking on the words, “And so am I” when you pass along praise from another: “The patient was delighted by your actions, and so am I.”

Source:  Adapted from How Full Is Your Bucket? by Tom Rath and Donald Clifton, Gallup Press via Communication Briefings

Query: Short Toes

I have a 38 year old healthy woman who was born with short toes on her right foot 2-4 from amniotic band syndrome. She has already been to a prosthetic center and was told she could have something fabricated.

Short toes from amniotic band syndrome

Does anyone have any experience with this and are there any life-like toes available? Would there be benefit from de-syndactylizing the toes to allow a prosthetic to adhere better? 

Peter Bregman, DPM, Tewksbury, MA

Query: On-Site Medical Waste Destruction

We are looking for alternatives for medical waste disposal for our office. We have seen advertisements for on-site waste destruction offered by a company called Medical Innovations. Is anyone familiar with this product who could provide any information about their experiences?
 
Steve C. Jensen, DPM, Sonora, CA

RE: Treatment for Fusarium Onychomycosis  (Laura Lefkowitz, DPM)
Chuck Langman, DPM, Gene Mirkin, DPM

If you check a site called doctorfungus.org (weird name, good site) and look up Fusarium sp., it says itraconazole (Sporanox) and ciclopirox topical (Penlac) are effective. I've been seeing a lot of Fusarium in recent cuttings I have taken, as well as Scopulariopsis, which is also difficult to treat.

Charles M. Langman, DPM, King of Prussia, PA, footdoc66@verizon.net

Fusarium does not respond to Lamisil or Sporanox.  We have had some success with Diflucan 300 mg (use the 150 mg tablets, they're cheaper)weekly for 6 months. We monitor CBC and hepatic panel ever 6-8 weeks. The drug is well tolerated. Let your patient know there is limited success and keep them on the medicine until the nails culture negative (after 6 months of therapy). If not resolved after 9 months, I stop it.

Gene Mirkin, DPM, Kensington, MD, gsmirkin@comcast.net

RE: Routine Foot Care (Ronald D. Jensen, DPM)
From: Al Musella, DPM, Narmo L. Ortiz, Jr., DPM

Do the meetings with Medicare that Dr. Jensen mentioned include patient representatives? I think that is the key to winning. I run a patient advocacy group for brain cancer, and have taken part in a few meetings with CMS where drug companies tried to get Medicare to pay for their treatments. The attitude of Medicare seems to be that these rich drug companies (or doctors) are just trying to get more money for themselves. 

Having patient representatives shows the human side of why these services are needed. In both cases I was involved in, Medicare refused payment until the patients’ representatives got involved. Then CMS changed their minds and gave in. It was a lot of work, involving letters from thousands of patients both to Medicare and every U.S. senator, but it works. We could do the same thing.
 
Al Musella, DPM, Hewlett, NY, Musell@aol.com

In reading Dr. Jensen's response to the routine foot care issue, I fear that, after all of his explanations of the meetings and lobbying done by the APMA, the questions posted by many colleagues still remain unanswered. While the APMA prefers the term "At-Risk Foot Care", the fact remains that it still goes by routine foot care as defined by Congress. Did the APMA select the RFC term originally, and if not, who in Congress did?

Dr. Jensen stated that regional differences exist due to Congress allowing regional contractors to interpret their own Medicare guidelines on par with our profession having different scopes of practice in different states. What is the APMA doing to stop this nonsense? Is a diabetic patient from one state different than one from another? With all of the bureaucratic committees, subcommittees, staff, board members, Guild representatives, lobbyists, health policy consultants, and other physicians that Dr. Jensen’s referred to, it seems to me that other than shuffling papers, although we have achieved progress in advancing our profession, we still have not resolved the core of our problem: EQUAL scope of practice in all States of the Union.

After all, Dr. Jensen stated that he doubts that any requests for changes to RFC would result in increased reimbursement or decreased regulation. Until that happens, we will not achieve any progress in obtaining fair and just reimbursement for treating our patients. We will be like the children following the pied piper of Hamelin.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com
 

RE: Custom vs OTC Orthoses (Mr. Jeff Root, Robert Bijak, DPM)
From: Robert Bijak, DPM , Beth Jarrett, DPM, CPed

Mr. Root missed the point I made on the other website. That podiatrist was inquiring about a patient with suggestions of neurological disease as well as pain. I merely meant that a medical investigation (prior to giving out arch supports and see what happens) is a more scientific way to approach a patient. The negligence aspect refers to not running blood test or taking x-rays.

The insurance companies have pretty much determined if orthotics are medical devices. And their determination is pretty much that they are not.

Robert Bijak, DPM, Clarence Center, NY,  rbijak@aol.com

I have followed this thread with interest for the past several days, and although seemingly contradictory, I have agreed with most of what has been said…until this one. Yes, it is true that we need more research in the area of custom orthoses, and it is true that designing a research project comparing custom orthoses vs. off-the-shelf orthoses is very difficult.

It is also true that...

Editor's note: Dr. Jarrett's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29698&start=1

RE: Obama’s Healthcare Plan 
From: Alan Silverstein, DPM , John Mishasek, CPed

What proportion of their GDP do the Canadians spend on healthcare? That’s the measure of cost, not how it’s collected (taxes versus premiums). The bad news is that both our system and theirs have bad outcomes, inconveniences, and so on. The good news is that Canadians are pretty healthy at about half the cost. It seems to me there may be a middle ground. Maybe, if they spent 50% more than they do, their system would seem pretty good. Or if our system were revamped, it could be really good spending just 50%, and not 100%, more than the Canadians do. You’ll find very few Canadians or French or Brits who wish they had our system, but a lot of our folks who wish they had theirs.

Alan Silverstein, DPM, New York, NY, alel@optonline.net

Editor’s note: Mr. Mishasek’s extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=29699&start=1

PRACTICE FOR SALE- SEATTLE, WA

Beautiful office for sale in the heart of Seattle, WA. Newly renovated, 2,500 sf, new digital x-ray, vascular lab, state of the art physical therapy equipment, paper-less system, all new podiatric furniture and equipment, popular podiatric products store and beautiful diabetic shoe display. Office is located in the medical building and open 3 days a week. Great opportunity for expansion to full-time. Please send us a letter of interest to the: podiatrygroup@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, CA

Busy 2 office multi doctor practice looking for dedicated, dependable, honest doctor to work 3-4 days per week. Must be ABPS BC/BE. Send cover letter and CV to bkatzman2@earthlink.net

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

ASSOCIATE POSITION - AUSTIN AND SAN ANTONIO AREAS

Seeking well-trained ABPS board certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - MANHATTAN, KANSAS

Seeking full-time associate to start January 2010. Will start with full schedule. Must be dependable, honest, ethical individual. E-mail CV/resume to: mtrandpm@cox.net

EQUIPMENT FOR SALE - MINXRAY P200R24 X-RAY UNIT

Unit was bought brand new in 2003 and, in April 2009, we stopped using it because another doctor joined the practice with an extra x-ray machine. Asking for $4K, OBO. Pictures are available. E-mail: mtrandpm@cox.net
 

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com
 

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.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 a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

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