The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 22, 2009 #3,681 Publisher-Barry Block, DPM, JD

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Skin and Bones are Compromised in Seniors: MO Podiatrist

“As we get older, the fat pads in our feet become thinner,” Dr. Anna DeSaix, a podiatrist with Ankle and Foot Surgeons of the Midwest, says. “This can lead to increased trauma and inflammation of the structures that are normally protected by the fat pads, such as the metatarsal heads (the ball of the foot).  Stress fractures can also occur in the bones of the feet, especially in patients with osteoporosis. Fortunately, these problems can usually be avoided by wearing supportive shoes at all times.”

Dr. Anna DeSaix

“Skin is thinner and more easily compromised; bones are not as strong and break more easily,” DeSaix says. “Therefore, protecting one’s foot with a good walking or athletic shoe is the most important thing a senior can do to decrease the risk of injuries or pain.”

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

ME Podiatrist Invents Niche Surgical Instruments

Somewhere within the confines of his Orono home are Todd O’Brien’s notebooks. Black-covered, about 150 lined pages apiece, the half-dozen notebooks are full of his sketches, ideas, proposals and unsolved problems dating back to 1992. “Most physicians are trained to be problem solvers. I think this is just an extension of that,” the 45-year-old podiatrist said Saturday. “You see something that needs improvement, and you write it down. That’s the way my mind has run over the years. ... I review them every once in a while, write things down, update them.”

Dr. Todd O’Brien with his invention, SutureSafe (Photo Kevin Bennett)

His notebook entries have helped him invent six surgical instruments since the 1990s, he said.  Two have been sold internationally. Three more are hitting the market shortly. O’Brien said he hopes that one new device, called SutureSafe, will be enough of a hit to allow him someday to create his own medical manufacturing business. Licensed to Xodus Medical Inc. of Pennsylvania, which sells surgical products in the U.S. and 30 other countries, SutureSafe is a patent-pending “sharps injury” prevention device that is being marketed nationwide now. Click here for a video demonstration of SutureSafe.

Source: Nick Sambides Jr., Bangor Daily News [10/19/09]
 

Bill to Provide Immunity to WI Podiatrists Who Treat School Athletes

Podiatrists would get a leg up against potential lawsuits under a bill before the Wisconsin state Senate. The measure to be considered on Tuesday would make podiatrists immune from civil liability if they voluntarily perform services on someone at an athletic event or contest at a school.

The protection currently exists for doctors, emergency first responders and dentists. Immunity would only be given if the care is administered at the site of the event or contest and the podiatrist isn't paid.

Source: Chicago Tribune [10/20/09]
 

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What do you think about new graduates with three years of residency training compared to older practioners who often have far less training?

RossTaubman: My father graduated in 1955 when there were no residencies. That was only 55 years ago and look how far we have come. In terms of board certification and the scope of practice, consider that Dr. Michael DeBakey, the famous cardiac surgeon in Texas, had only two and a half years of medical school in the 30s when he graduated. Two and a half years! He did a one and a half year residency, not in cardiology or cardiothoracic surgery. Nobody made him go back and take a residency in cardiothoracic surgery to be the pioneer that he was in that field and the well respected guy. 

Dr. Ross Taubman

So, as the profession moves forward, it does not mean that you leave people behind. So people like me, who are not three-year trained or did not have the residency opportunities, should be thrilled that the profession is moving forward because that is progress. 

Dr. John Mattiacci

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest  is Dr. John Mattiacci, Dean of Temple University School of Podiatric Medicine (TUSPM) and the President of the Physician Guild of the Office & Professional Employees International Union of the AFL-CIO, You can register for this event  by clicking here

Query: Traumeel or Zeel Injectable

I had a chance to listen to Dr. Ribotsky’s excellent interview with Dr. Subotnick this weekend. There is so much information packed into that interview that I had to listen to it a second time with pen and paper in hand. Are others using Traumeel or Zeel injectable for Achilles tendonopathy or peri-tendonitis, and if so what are the results? I have used normal saline in a brisement procedure (joint distension), but never the aforementioned.
.
John D Lanthier, DPM,  Wilmington, NC

Query: Source for Evaluating EMRs

What is a good resource to evaluate the many EMRs available? I am looking for a basic, no frills, no bells and whistles package that would qualify for the government subsidy.

John Moglia, DPM, Berkeley Hts. NJ

RE: Hemangioma (Robert Colligan, DPM)
From: Multiple Respondents

Strictly, from a surgical standpoint, if all other efforts fail and you want to get coverage for this, I would suggest using a first innerspace flap. This is technically an island pedical flap, and is not easy to do. You may want to send it to a podiatrist who has experience in this or to a plastic surgeon. You would need to at least partially syndactylize the first and second digits.

Tip Sullivan, DPM, Jackson,  MS, tsdefeet@msfootcenter.net

Try sclerotherapy or flash lamp pulsed-dye laser for the hemangioma.  I excised a painful recurrent cluster of hemangiomas on a patient's heel which another podiatrist had injected with steroids several times. A small section kept coming back and would form a callus and bled like crazy when debrided. I sent her to a local dermatologist who performed in-office flash lamp pulsed-dye laser, and after 2 treatments, it was gone.
 
Chris Browning, DPM, Nederland, TX, chrisbrowning@att.net

Dr. Colligan's remarks regarding chilblains in response to the case presented by Dr. Furman are totally correct. However, the photo presented looks nothing at all like chilblains; it is unequivocally the clinical picture of a hemangioma. The distortion of the soft tissues is clear, and the engorgement of supericial abnormal venous structures is very evident. These are in no way representative of cold injury, ischemia, cold rubor, cyanosis, or impending soft tissue breakdown, very accurately described by Dr. Colligan as chilblains.

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

RE: Short Toes (Peter Bregman, DPM)
From: Charles Morelli, DPM
 
I have absolutely no experience with prosthetics for short toes, but I have done my share of de-syndactylizations and they have all involved one interspace.  For me, those cases were always challenging and I held my breath for days after each case.  If I was presented with this patient who wanted to have this type of cosmetic procedure performed in addition to prosthetic enhancement (if that even exists), I would probably run (not walk) to the nearest exit.  Is it just me, or does anyone else see the possible avalanche of complications that can, and most likely will occur here?  Infection, scarring, swelling, disfigurement, poor result and possible vascular compromise leading to gangrene and eventual amputation?  Remember, this is a cosmetic procedure. 

In addition to that....after she has healed, do you want to attach, stick or glue prosthetic toes to a weight-bearing area in order to make her foot look better? Does anyone believe that 4 digits can be attached to a foot and it would look "better" than the foot she presented with?  That no one would know or even notice? A prosthetic that she would have to remove and replace daily in order to bathe? What kind of adhesive will be used on the skin day after day after day? Will she now wear flip-flops and sandals to show off her new rubber toes? What will happen when she bumps into a chair or when someone steps on her foot? Can she now go swimming?
 
Tell her that her foot looks lovely, refer to a psychotherapist, and move on.
 
Charles Morelli DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Evidence-Based Medicine (Patrick Nunan, DPM)
From: Arden Smith, DPM, M. Turlik, DPM
 
Let's not forget that "expert opinion" and "clinical experience" are also components of evidence-based medicine...weaker components, but still components.

Arden Smith, DPM, Great Neck, NY, digitiquinti@aol.com

Dr. Nunan provides us with a colorful anecdote (level V evidence) regarding a rare condition. Rare conditions are rare; therefore, there are unlikely to be sufficient participants available to perform a randomized controlled trial (level I evidence). Rare conditions usually are presented as a case report or case series (level IV evidence). The best study design for rare conditions is a case controlled study (level III evidence). Evidence-based medicine does not provide rigorous guidance for therapeutic decisions when conditions are rare. Evidence-based medicine is better suited to provide guidance for common conditions.

Not every therapeutic decision needs to be confirmed with a randomized controlled trial (1). Surgical therapies offer unique difficulties when performing randomized controlled trials (2-4). The Consort statement provides recommendations in reporting and evaluating surgical trials (5).

1. BMJ 334:349, 2007, 2. BMJ 324:1448, 2002, 3. BMJ 330:88, 2005, 4. BMJ 330:1401, 2005 5. (consort-statement.org/extensions/interventions/non-pharmacologic-treatment-interventions/)

M. Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Obama’s Healthcare Plan  (Jonathan Purdy, DPM)
From: Jason Kraus
 
I would like to respectfully disagree with Dr. Purdy's position regarding the healthcare reforms being considered by Congress. To equate a public option to socialism is an unfair characterization of the plans being discussed. I would like to emphasize the word "OPTION" in the public option. It couldn't be more apparent that we….

Editor's note: Mr. Kraus' extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=29807&start=1

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

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

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