The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 20, 2009 #3,679 Publisher-Barry Block, DPM, JD

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MO Podiatrist Takes Conservative Approach to Foot Problems in Seniors

We may focus more on our bodies above the ankles while we’re young, but as time goes on, our feet become a lot more important. There’s nothing worse than walking around on sore feet, and seniors are just naturally prone to foot ailments.

Dr. John Holtzman

“I find that seniors’ most common complaints are bunions or hammertoes that have been untreated for some time,” says Dr. John Holtzman, a podiatrist with Missouri Foot and Ankle at St. John’s Mercy Medical Center. Fungal infections of the nails, dry skin and arthritis also appear more in older patients.

Holtzman takes a conservative approach in treating these common complaints. “Shoes should have wide toe boxes and be made of soft leather. A soft, over-the-counter orthotic also may help with some types of deformities. And it’s important to go to a shoe store where knowledgeable staff properly measure the feet.”

Source: Connie Mitchell, Ladue News [10/15/09]

NJ Podiatrist Fights FDA for Approval of Ulcer Treatment Product

Kathryn Cace was in such agony from foot ulcers that she couldn't sleep at night. An application of foot gel and an antibiotic was providing no relief, and walking was extremely painful. Desperate for help, Cace sought out the services of Dr. Leslie Aufseeser, a local podiatrist she had heard good reports about. In an August visit, Aufseeser thoroughly cleaned out the wound on the heel of Cace's left foot and then applied Regenicel, an ointment he invented 20 years ago. The results were very positive.

Dr. Leslie Aufseeser with patient Kathryn Cace (Photo: Bob Bielk)

Ten years ago, Aufseeser tried to get his discovery (a combination of A & D ointment, vitamins and antibiotics) approved by the Food and Drug Administration. He said he submitted numerous clinical studies, where the ointment proved effective over 90 percent of the time. But the FDA kept rejecting them. "I asked to go through the protocol for clinical testing they use, but they wouldn't allow me to do it," Aufseeser said. "It is very frustrating because I have had great results with my patients. There are so many ointments out on the market now that don't do a thing. Mine works. My feeling is the FDA doesn't want little guys like me to come aboard because they work with the big pharmaceutical companies."

Source: Michael Amsel, Asbury Park Press [10/15/09]

KS Podiatrist is Part of Hospital's Centennial Celebration

St. Francis Health Center marked a century of service Friday as employees and community members came together at the hospital for cake, punch and fellowship.

Dr. Priti Lakhani (Photo: Nick Krug)

Priti Lakhani, a doctor of podiatric medicine with St. Francis Podiatry, remembers working at the hospital as a candy striper at age 14.  "I have seen this hospital become more a part of the community," she said. "It's much more diverse. We have signs in Spanish now. The hospital is more technological savvy. And I think we are more aware of our history and mission."

Source: Ann Marie Bush, Topeka Capital-Journal [10/17/09]

How to React to Negative Feedback

Respond honestly to negative feedback. It is okay to express surprise at what you hear, as long as you do not immediately discount the feedback.

Examples: “I am a little surprised to hear you say that; you may have a point. Please tell me more.”

“I am not sure what to say. I have never thought of that, but I will from now on. What else do I need to know?”

Source:  Adapted from How to Make Winning Presentations, Paul Timm, Career Press via Communication Briefings

Query: Painful Hemangioma

I had a 45 y/o male patient with a hemangioma of his left big toe which is very painful. The patient feels that it is increasing in size.  This lesion has been surgically removed two times, the most recent was about 10 years ago by a vascular surgeon. On weight-bearing, the patient stands with the hallux toe dorisflexed off the floor by 1/4" (I think that this off-loading is contributing to his ankle pain). Visual exam reveals mottled purple appearance to the plantar surface of the hallux. The plantar surface is bumpy due to the hemangioma, and there are areas of decreased fat pad from prior surgery.

Painful Hemangioma of Hallux

1) What approach would you recommend surgically or conservatively? I have not ordered an MRI yet. 2) Does anyone have any thoughts on how to address the painful plantar aspect of the left hallux with an orthotic device? I added a reverse Morton’s extension to his old orthotic and asked the patient to get back to me if it helps.
 
Ayne Furman, DPM, Alexandria, VA

Query: PADnet+ and Aetrex Systems

I am a new practitioner and I have been entertaining the thought of adding a PADnet+ and Aetrex system to my practice. Are these two systems widely utilized in podiatry offices? Are these considered to be good investments? All insights will be greatly appreciated.

Tamara Allen, DPM, Annapolis, MD

RE: Evidence-Based Medicine (Patrick J. Nunan, DPM)
From: Elliot Udell, DPM,

The case described involves surgery, and it’s almost impossible to do double-blinded studies to determine if an operation is superior or inferior. To do a double-blinded study on a surgical procedure is to perform sham procedures as controls. There are serious ethical problems doing this, even with patient’s consent. There have been some sham procedures where incisions have been made, but the procedure being studied was not completed in total. There are problems with this because the surgeons and staff had to know who got what procedure. Unlike giving a sugar pill, which acts as a placebo, when you do something invasive, which is what surgery is, whatever you do might have clinical implications.
 
Medical research has its time and place, just as blood tests and radiographs do. In practice, we by and large, do not base our total clinical impression on films or blood tests, but on a whole picture, which includes physical examination findings, test results, as well as our years of training. Evidence from properly performed research is also a part of the picture. On the other hand, if evidence determines that a medication may have dire side-effects, such as celecoxib when taken more than 200 mg a day (which was found to increase the possibility of cardiovascular incidents), such studies should be taken very seriously from the onset and may trump other clinical input in treating a patient. The same would hold true if the pathologist calls and lets you know that the specimen you sent in was a melanoma. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

RE: Routine Foot Care (Ronald D. Jensen, DPM)
From: Samuel S. Mendicino, DPM

As I read all of the posts about routine foot care, orthoses, and healthcare, I must say that we tend to blame everyone for our problems except ourselves and our patients. Perhaps, if we eliminated all of the people who have been "covered" when they shouldn't have, prescribed custom orthotics only when less expensive options have failed, and charged a reasonable fee for these devices, they may have been a covered service. I practice in a southern state with a younger population. Retired winter Texans arrive from the northeast and show up with clear nail plates or onychomycosis without class findings, and proceed to explain to us why they are covered by their hometown podiatrist. When we offer care as non-covered, they disappear faster than Houdini.
 
How many people, who have never had heel pain, who at age 55 develop plantar fasciitis are told they have a genetic biomechanical problem and are told they need custom orthotics for the rest of their lives?  Let's not forget how many people develop vague minor foot pain on Monday, get an appointment the same day, have an MRI immediately, and are treated for some generic diagnosis (capsulitis) that would have gotten better without treatment. Finally, how about the asymptomatic bunion that gets inflamed from a pair of tight shoes and is surgically corrected within a week of the first visit, or the painless flat foot that gets a $500.00 pair of orthotics, or worse - surgery?
 
Crazy, simply crazy...
 
Samuel S. Mendicino, DPM, Houston, TX, DrSMendo@aol.com

RE: Obama’s Healthcare Plan (Alan Silverstein, DPM)
From: Scott Giaimo, DPM

I would respectfully disagree with Dr. Silberstein’s assessment that no Canadians or Brits would want our health system. In reality, thousands of Canadians and hundreds of Brits (those who can afford to come here from England) come to the United States each year to get health care services they are denied in their own countries due to government rationing. Is our system perfect? No. But when you need coronary bypass in this country, there is not a 30% mortality rate because you have to wait 18-24 months for the surgery. No, Dr. Silberstein is absolutely wrong. Many of our friends to the north and from across the ocean are grateful for our system, as we do not fail to treat those who need it.

Scott Giaimo, DPM, Toledo, OH, footman28@yahoo.com

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

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

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

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