The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 20, 2008 #3,378 Editor-Barry Block, DPM, JD

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UK Podiatrist Warns Against Trendy Skyscraper Stillettos

Women of a nervous disposition ought to look away now. The latest trend for high heels is set to reach new heights with the arrival of stilettos almost 8 inches off the ground. Christian Louboutin, the French shoe designer, claims his killer heels will set a new benchmark in mainstream fashion – though it is likely to drive podiatrists to despair. Louboutin has been inspired to produce 8 inch heels after the success of a range of stilettos measuring 5.9-7.1 inches in height.

Emma Supple

Some doctors have warned patients to stick to a 3 inch heel limit. “High heels artificially alter our posture, causing spinal compression, joint problems and osteoarthritis in later life,” said Emma Supple, a consultant podiatrist. “It’s essentially teetering about on tiptoes, which forces the weight of the body onto the forefoot . . . and that can lead to bunions and painful calluses,” added Supple.

Source: John Follain and Brendan Montague, London Times [10/19/08]

PA Podiatrist Re-elected as PCA Board Chairman

Arthur E. Helfand, D.P.M., has been re-elected Chairman of the Board of Directors of the Philadelphia Corporation of Aging (PCA) a non-profit agency established in 1973 to improve the quality of life for older Philadelphians. Helfand is Professor Emeritus at Temple University, Adjunct Professor of Medicine at the Temple University School of Medicine, and consultant to Temple University’s Institute on Aging.

Dr. Arthur E. Helfand

FL Podiatrist Seeks Town Council Seat

Two residents have expressed interest in filling the Town Council seat left vacant by the recent resignation of Councilman Robert Gottlieb. Semi-retired podiatrist Donald Clayman and sales and marketing executive Brian Merbler have both submitted their qualifications to the town.

Clayman, 73, is an alternate member of the town's Planning Board. He is also a member of the Community Affairs Advisory Board. He received his education at the Ohio College of Podiatric Medicine and has 40 years of experience in the field in Boston and Winthrop, MA. He sees patients when he returns north several times a year.

"Erosion of our beautiful beaches is probably our biggest problem," Clayman said. He said it is his time to give something back to the community."I love the town," he said. "It's such a small town. Everybody knows everybody."

Source: Margie Kacoha, Palm Beach Daily News [10/17/08]

New CA Laws Increase Penalties For Privacy Breaches

Hospitals and other covered entities in California may have to beef up their privacy and security compliance programs in light of recently enacted state legislation that slaps stiffer penalties on entities and employees who violate patient privacy. The legislation, approved in mid-September and signed by Gov. Arnold Schwarzenegger (R) on Sept. 29, follows privacy breaches of several high-profile celebrities, including singer Britney Spears and California First Lady Maria Shriver.

Two laws, AB211 and SB541, include provisions that assess civil penalties of up to $250,000 on individuals or entities that improperly disclose private medical information.

Among other things, AB211 requires every healthcare provider in the state to "establish and implement appropriate administrative, technical, and physical safeguards to protect the privacy of a patient's medical information." It establishes the Office of Health Information Integrity to enforce the law and impose fines. Provisions in SB541 include a penalty of $100 per day — up to a maximum of $250,000 — on a healthcare facility that fails to report an unlawful or unauthorized breach of a patient's medical information.

Source: Neal Learner, Report on Patient Privacy [10/16/08]

Time to Revamp Your Website?

If your practice's website was launched years ago, it probably was designed primarily to act as an extention of your print brochure. More recently designed websites do much more than put your brochure online. Your website can attract more patients and make your practice run more efficiently. The key? Redesign your website around thse elements:

• Calls to action.Encourage online visitors to do something. Examples: to schedule an appointment, contact your office, or sign up for a free newsletter.
• Forms, scripts and programs that make the patient visit easier, such as having a downloadable patient input form.
• Downloadable information. Include answers to frequently asked questions and informative articles to give browsers the information they need to become patients.

Source: Adapted from Signs It's Time to Redesign Your Website by Erin Ferree

Query: Mid-Arch and Met Pain

My patient is a 36 year old female who has had "Root orthotics' since 2001. Her most recent pair was dispensed 9-08. The orthotics were made for a rearfoot varus of 2 degrees b/l and a forefoot valgus of 4 degrees b/l w/met bar added. The patient has an unremarkable PMH, min gastroc-equinus w/ Lf FHL. Her most recent pair is causing mid-arch and met pain b/l. I tried increasing flex, adding a dorsal arch pad, removing met bar, but there was no change. X-rays are normal. Any suggestions would be greatly appreciated.

Kel Sherkin, DPM Toronto, Ontario

RE: Monofiliments Not An Accurate Test of Neuropathy
From: Peter J. Bregman, DPM

It has been shown that the earliest indication for loss of ulcer threshold for the foot is around 4.3gms/mm2. The typical 5.07 monofilament only bends around 66gms/mm2, thus this "gold standard" simple test is not an accurate test, especially if trying to detect the earliest signs of neuropathy. If you don't think this is true, please use the filament on a few patients who already have ulcers and try it out. You will find they can still have a 5.07 monofilament positive test.

The PSSD machine is the best and most sensitive tool for detecting neuropathy. The reason I post this response is to hopefully alert the people who are still using this outdated means of testing to at least be aware of how inaccurate and crude the monofilament is. It is also not an exacting test; it is just a range of measurement.

Peter J. Bregman, DPM, Tewksbury, MA, Footdoc@painfreefeet.com

RE: Misrepresentation by Yogatoes (Joseph Borreggine, DPM)
From: Robert P. Thiele, DPM

In response to the Dr. Borreggine’s comment about Yogatoes, I agree that we should make a strong stand against these types of false advertisements. I can imagine a lawyer at a malpractice case stating, "Doctor, you did not try Yogatoes as a form of conservative care before hammertoe surgery?" That might be a stretch, but you all get the point.

Also, a point of interest that has been made by many of our colleagues is the fact that some shoe stores are technically prescribing orthotics. They have the patients stand on some computer-based device, then they run into the back of the store and magically an orthosis is created and dispensed to the patient. We all know these are pre-fab devices, but the patients are under the impression that the device was customized for their foot.

Furthermore, I had a patient 6 weeks s/p HAV repair, whom I sent to a shoe store to buy a new pair of sneakers. The patient told me that they recommended that she buy their orthotics. They told her that all post-op bunion patients should have them to prevent recurrence. Of course, she was going to get custom-molded orthotics, but only after I repaired her contra-lateral foot. Aren't these stores practicing a form of medicine? I certainly know that I have liability in prescribing orthotics. What would happen if that patient developed a stress fracture or some other complication after purchasing such a device. Who is liable? Is this a medical treatment?

Robert P. Thiele, DPM, Denville, NJ,drthiele@comcast.net

RE: Feedback on Staff (Barry Block, DPM, JD)
From: Lynn Homisak, PRT

I agree with Dr. Block. We often recommend patient surveys and have found them to be very revealing in determining the caring, courteousness and helpfulness of staff as seen through the patient’s eyes. Generally speaking, unless patients have encountered a specific (good or bad) experience with your staff, they will very rarely offer information about them…so it does pay to ask! If you are trying to determine staff’s “work performance” however, patients may not be the best source of information. For example, some people think being seen on time is the most important criteria (when, as we all know, patient flow can be reflective of both doctor and/or staff activities). From their perspective, your staff’s performance may be rated based on many factors, including their friendliness, attitude, cooperation, and attentiveness.

While these factors are important, performance in your eyes may relate to their ability to accomplish work assignments, attention to detail, proficiency in technical skills, etc. In short, patients would be more likely to judge your staff’s character and behavior rather than their performance. Consider also that when patients take surveys, they tend to group staff together…and is that really fair? So, it depends on what you are looking for and how you define staff performance.

If you are trying to ascertain the efficiency, productivity and capability of an employee, then you (or a qualified office manager/supervisor) would be the best judge of that based on your observations and outcomes of their work activity. I would recommend conducting regular performance reviews to discuss your expectations, measure their behavior and set their goals. If you are in need of a good performance review form, I would be happy to share one with you. I welcome anyone to contact me for a copy of an employee review OR a patient satisfaction survey.

Lynn Homisak, PRT, SOS Healthcare, lynnprt@comcast.net

HOSPITALIST POSITION - QUEENS, NY

Busy multi-specialty podiatry group looking to hire a motivated individual to work part-time, including weekends as a podiatric hospitalist. Immediate opening available. NYS license a must. Applicant should be well-trained in all aspects of surgical and wound care and have completed a 24-36 month residency. If interested please send CV to docbunion@yahoo.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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

SURGICAL EQUIPMENT FOR SALE

One Storz-Ergo Surgical Kit - Oscillating and reciprocating plus K-Wire driver. In very good operating condition. $4,500.00 Complete set of surgical instruments for any type of foot surgery. Includes osteotomes, implant prep osteotomes, hemostats, rongeurs, Allis clamps, retracters, bone forceps, etc, in excellent condition. Approximately 80 instruments. $1,500.00. e-mail Marstubass@aol.com

SURGICAL PODIATRIST - CONNECTICUT

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Board-Certified podiatrist to add to our four-physician podiatry division based in Hartford. This podiatrist will provide all aspects of podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and bc/be. Competitive salary and productivity bonus, partnership opportunities, excellent benefits, and reasonable overhead. Please apply online or via our website , or fax your CV to 860-524-2653. No phone calls, please. EOE

ASSOCIATE WANTED - SOUTH JERSEY

Part time/ Full time Full scope, well established group practice located between Phila. and the Shore. Digital X-ray, EMR, Diag U/S. Prefer PSR 24-36 individual with several years previous experience but will consider the right recent grad. Must be willing and able to provide quality palliative and surgical care. Medicare and NJ Blue Shield provider numbers is a plus. Competitive financial and benefits package. E-mail resume & references to: Toetrukr@aol.com

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

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

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

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