The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 21, 2009 #3,680 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Seniors Need Regular Podiatric Check-Ups: MO Podiatrist

Older people can develop systemic conditions like diabetes or vascular disease that cause problems in the extremities. Peripheral neuropathy, which can be a symptom of diabetes, causes loss of sensation in the feet and can affect walking and balance, making falls more likely, points out Dr. John Dailey, a podiatrist with The Missouri Foot & Ankle Institute in Washington, MO. Circulatory problems also can cause injuries to become ulcerated and painful because an inadequate blood supply slows healing.

Dr. John Dailey

“Usually, older patients see me when a problem has occurred, but preventive care would be better,” Dailey says. “Billions of dollars were spent last year on treating conditions of the lower extremities as a result of diabetes. Good preventive care could save money and help people avoid pain and suffering.”

Dailey’s preventive regimen includes regular podiatric check-ups. “I suggest everyone see a podiatrist for a preventive exam, just like you would see your primary-care physician on a regular basis,” he says. “Those who have health conditions should be checked twice a year. We may take x-rays, examine how you walk, and make sure you’re wearing appropriate shoes.”

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

Temple Student is "A Gentleman and A Scholar" Success Story

In 2007, Vandy Gaffney II, then a second-year medical student at The Medical University of South Carolina MUSC, looked at inner-city Charleston's predominantly black, predominantly low-income neighborhoods, and something clicked. Why not use his own experiences, and those of his fellow students, to help others? 

Gaffney, now a fourth-year medical student, started A Gentleman and A Scholar, a program that encourages young black males in the Charleston area to pursue careers in medicine or another health profession. Virtually every medical school has some kind of mentoring or diversity-building program, but A Gentleman and A Scholar may be unique for specifically reaching out to black males in the local community.

TUSPM Student Aaron Haire

The program can boast having put one student into a health professions school: former mentee Aaron Haire is attending the Temple University School of Podiatric Medicine. "I would not have gotten there as quickly without A Gentleman and A Scholar," said Haire, a native of Orangeburg, SC. "A lot of students don't realize how time-sensitive things are or how you need to have your records in order. Someone from the MUSC dean's office spoke to us once, about how he came from nothing, basically, and rose to success. I saw a lot of similarities between him and me."

Source: AAMC Reporter [October 2009]

Query: Hill Chairs

Does anyone have experience, i.e., service, performance, durability with Hill podiatry chairs? Also, from whom did you order the chair?

Gary Trent, DPM, Chicago, IL

Query: Z-Skin Plasty

What would be the appropriate diagnosis and CPT codes for a planned Z-skin plasty for a surgical scar contracture over the metatarsal-phalangeal joint?

David Sands, DPM, Great Neck, NY

Response: I would recommend the use of the CPT 14040 code series (adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less). The specific code would depend on the size of the defect.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Hemangioma (Ayne Furman, DPM)
From: Bryan C. Markinson, DPM, Robert Colligan, DPM

Dr. Furman presents a case of a painful hemangioma of the hallux that has had multiple prior attempts at resection. Hemangiomas are very difficult complex lesions. Once they grow to larger sizes, the ability to reliably completely resect is near impossible. At surgery, these lesions are interspersed in fatty tissue and it is difficult to know what is tumor and what isn't. If the vascular portion of the lesion in incised, the lesion literally shrinks before your eyes as it bleeds, further making the excision more difficult.

Painless lesions in the foot should always be left alone and observed. Painful lesions which go to resection should accompany large amounts of information to the patient beforehand such as the likelihood of recurrence, the possibility that the pain will not be relieved, and the possibility of nerve damage. When faced with patients with such lesions, which happens no more frequently than 1-3 times per year, I always refer to interventional radiologists first for evaluation of the possibility of embolization of the lesions. This is a painful procedure, but nonetheless avoids open surgery and can be done multiple times if necessary.

Lastly, surgical resection is the domain of the musculoskeletal oncology surgeon. Vascular surgeon back-up may be required depending on pre-op imaging. This procedure should always be done in a hospital operating room.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

I note that the appearance from the photo is very similar to what I see in the Midwest, particularly around the Fall/Winter/Spring, but especially mid- to late spring. And that would be chilblains. And the majority of patients who present with this, frequently have Raynaud’s. The first one I saw, I was concerned of a thrombolytic shower, small emboli breaking off from a more proximal origin. I referred that patient to a vascular surgeon. 

These lesions are frequently painful, itch, and may eventually break open and dry out, or scabs form that fall off. But they do eventually resolve, at least until the next episode. Despite efforts to warn patients of cold exposure, or rapid rewarming, they still go outside with sandals, etc.

I used to think that this had to happen on the coldest days of the year. But that has not been the case. They are much more frequent when warmer weather is almost here, perhaps in the 40's, and people begin to dress down prematurely, and it's wet, spring-like weather with prolonged exposure.

Robert Colligan, DPM, Norfolk, NE, rcolligan@cableone.net

RE: Treatment for Fusarium Onychomycosis  (Laura Lefkowitz, DPM)
From: Joel Morse, DPM

Fusarium is one of the most resistant fungi to cause skin and nail infections. The literature usually recommends amphotercin B but I have found that avulsion of the nail with either itraconazole - pulse dose approach or fluconazole (200mg/week for 32 weeks) is the  recommended approach.
 
Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

RE: PADnet+  System (Tamara Allen, DPM)
From: Frank Lattarulo, DPM

I have extolled the praises many times in this forum regarding the Biomedix PAD system. Good accurate testing. Many of my patients who have gotten tested have been diagnosed with moderate to severe PAD. They have then been referred to the vascular surgeon and have gone on to simple angioplasty or less invasive endovascular procedures. Had they not had this test and their symptoms and arterial evaluation not been done, they may have gone on to more costly lower extremity bypass surgery. Ease of use, good support, and extra revenue added to good patient care make this system an important part of my practice. It is highly recommended.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

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

I fully understand that there is an ethical difference between double-blind surgeries and medication treatments. My point has more to do with the dangers or problems that some physicians may face if they strictly go by studies, protocols, and insurance recommendations.  For instance, I currently have a 74 year old female patient in the hospital who is diabetic, has PAD, needs cardiac surgery (refuses) and now has a bleeding colon.  The chief of surgery was consulted on the colon.  He told her that he wasn't going to waste his blood bank on someone with so many other health problems. She was either going to get well or die! 

Doesn't this sound like the direction we could head in to with healthcare reform - insurance companies dependent  on statistics, rationing of care, etc.?  What if this were your mother?  And we wonder why patients have lost faith in their doctors? My point is that we need to remember we are treating human beings who deserve our best and most compassionate care. Yes, studies and research are vital, but we cannot depend on just studies without looking at the face of the patient. Thinking outside the box allowed Siamese twins joined at the head to be separated, even though similar attempts had failed before. The doctor who performed that  procedure did not care that it had failed before; he knew that it could be done. We must be careful not to lose the human side of medicine.

Patrick J. Nunan, DPM, West Chester, OH, pjndpmrun@aol.com

There is plenty of evidenced-based podiatric surgery occurring mostly in Europe. I just returned from the AAFAS cadaver seminar in San Juan, Puerto Rico Oct 15-17, 2009. Our colleagues in Europe, especially Spain are very advanced in their surgery and research. As minimally invasive foot surgeons, they have published two recent surgical textbooks. One is in Spanish called Estruturas anatomicas implicadas en la practica de la cirugia de minima incision del Pie, by Eduardo Nieto Garcia, published July 2009. (enietopodologos.com) 
 
The other is Minimally Invasive  Foot Surgery by Mariano de Prado, (minimallyinvasivefootsurgery.com), which is available in both English and Spanish translations. See also Clinics in Orthopedics, Oct 2009
 
It seems our colleagues around the world are slowly passing us. 
 
John Fenice, DPM, Wilmington, DE, jfenice@yahoo.com

RE: Custom vs OTC Orthoses (Robert Bijak, DPM)
From: Kevin A. Kirby, DPM

Dr. Bijack made the observation, “This stands the murky alchemy of podiatric biomechanics on its head and rightfully shows if we are to be doctors, let's let this type of treatment return to C. PEDS and shoe salesmen.” Unfortunately, over my last quarter-century of teaching foot and lower extremity biomechanics, I have met a few podiatrists who feel just as Dr. Bijack does: orthoses simply don’t work well enough in their own hands to warrant their use as a valuable therapeutic modality in their practices. Luckily, there are a number of very talented podiatric physicians who are highly regarded by their local medical communities since they are able to cure painful conditions of the foot and lower extremity simply by placing a properly designed pair of custom foot orthoses into their patients' shoes. To those who don’t understand the potential therapeutic value of custom foot orthoses, or who haven’t experienced their significant positive therapeutic effects on numbers of patients, they, like Dr. Bijack, believe the myth that custom foot orthoses are no better than pre-made in-shoe inserts.

The reality of the custom foot orthosis issue is that the podiatric physician who has been trained in the proper casting techniques, has been trained in the multitude of orthosis prescription modifications, and has devoted the time and effort to understand the biomechanics of the foot and lower extremity will be able to conservatively treat many foot and lower extremity pathologies better than any other medical specialty. Not only is there a wealth of scientific research that supports the fact that custom foot orthoses are effective therapeutically, but also a large number of scientific research papers have been published that show that custom foot orthoses positively alter both the kinematics and kinetics of gait. All podiatrists should be aware of this research.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
 

RE: Obama’s Healthcare Plan  (Scott Giaimo, DPM)
From: Richard Weinbaum DPM, Judith E. Rubin, DPM

Dr. Giamo’s claim that Canadians flock to the US in large numbers to have healthcare services, appears to be a myth. Click here.

Richard Weinbaum DPM, High Point, NC, Richard.Weinbaum@cornerstonehealthcare.com

Editor’s note:  Judith E. Rubin’ s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29767&start=1

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

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 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 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

PM News Classified Ads Reach over 11,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.