The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 25, 2008 #3,383 Editor-Barry Block, DPM, JD

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CA Podiatrist Offers Women’s Shoe-Buying Advice

The problem is, many of the shoes women are wearing, aren't right for their feet. This could lead to problems and injuries in the future. Dr. Claire Futenma, a Pasadena-based podiatrist, sees these issues all too often. "Coming off of the summer season, many of the women have been wearing flip-flops. They come in with arch-pain and pain in the ball of the foot," said Dr. Futenma.

Dr. Claire Futenma

Dr. Futenma says, the type of feet you have should determine the type of shoes you buy. There are three main types of foot structure: flat feet, feet with a medium arch, and feet with a high arch. For the flat foot, you are looking for a shoe that has a bit of an arch support to it. A ballet flat would not be very good for you," said Dr. Futenma. "For women who have a high arch foot they usually feel a bit more comfortable wearing a bit more of a high. If you have a medium arch you are pretty fortunate. You are able to wear more of a variety of shoes. Still to me, arch support is the key," said Dr. Futenma.

If you don't address issues like these early on, you could suffer from other problems in the future, such as pain in the ankles, knees and lower back. So, when you shop, you should try doing a certain shoe test. "I will feel the back of the shoe and then make sure the heel counter is very stiff. I make sure, though, that the shoe also bends right in the forefoot region. Then I'll also torque the shoe to make sure that it moves a little bit but we don't want it to twist too much," said Dr. Futenma.

Source: Denise Dador, KABC (Los Angeles, CA) [10/23/08]

AZ Podiatrist Sells Hollywood Script

"My Big Fat Greek Wedding" producer Gold Circle Films is heading down the aisle with another matrimonial comedy. The company has acquired Cathy McCarthy's spec script "Oh Brother." Peter Safran and Gold Circle head Paul Brooks are hitched to produce it. "Brother" follows a self-made woman who, ashamed of growing up as an orphan, hires actors to play relatives at her wedding to impress her fiancee's high-society family.

Dr. Cathy McCarthy

It's the first deal for Phoenix-based podiatrist McCarthy, whose script caught the eye of manager Tom Drumm. It also is the latest deal to emerge from Gold Circle's first-look pact with management/production outfit The Safran Co. A new writer will be brought in to work on the script.

Source: The Hollywood Reporter [10/24/08]

Former CMS Head: 2009 Will Be an 'Ugly Year' for Medicare

Former CMS Administrator Tom Scully predicts that 2009 will be "a big ugly year" for Medicare in general and Medicare Advantage (MA) plans in particular. He made that prediction during a "CMS Administrator Roundtable" discussion at the America's Health Insurance Plans (AHIP) annual Medicare and Medicaid conference in Washington, D.C. The panel, which included two other former CMS chiefs, offered their perspectives on the future of Medicare.

With the Medicare system expected to be insolvent by 2019, Congress has some time to revamp the way it reimburses physicians, former HCFA Administrator Gail Wilensky, Ph.D. said. A key problem under the existing Medicare fee for service (FFS) model, she told attendees, is that the quality of care that physicians provide has no effect on their level of reimbursement. "Nothing they do, good or bad, impacts their fees," she said. "It's a broken part of Medicare that urgently needs to get fixed." One of the problems with FFS Medicare is that when you pay a physician a fixed dollar amount for an office visit, you are not paying him or her to do chronic care management, she explained.

Scully agreed and said the traditional Medicare FFS system rewards providers and health plans for the quantity of services provided rather than efforts to improve health. CMS contracts with Blue Cross and Blue Shield plans to administer the Medicare FFS program. "They write the checks, and [CMS] pays them a 0.5% administration fee," he explained. "When you do that, you become incredibly fast at writing checks and don't care how many services or CT scans you pay for." Instead, Scully says, the contracted Blues plans should receive a flat, annual per-member fee for managing care. "You get a better performance when you put the third party at [financial] risk." "The fundamental problem with Medicare is price fixing….Hospitals and doctors get paid the same whether they do a good job or bad job," Scully contended. Wilensky agreed and said Medicare has traditionally focused on controlling the price of healthcare services rather than controlling spending.

Source: Steve Davis, Health Plan Week [10/14/08]

Survive in a Multi-Tasking World - Part 2

The pressure may be on to "get it all done," but if you do not take time to plan, you will never make a dent in your to-do list. Use these strategies to plan your approach:

• Add in reality checks. If you never cross anything off your to-do list, you will feel that you are merely spinning your wheels as you fall further and further behind. Instead of racing to do as much as possible, check your activities against your prioritities and make sure that you are doing as much as necessary.

Source: Adapted from Tips From a Multi-Tasking Mom by Robin Gorman Newman

Query: Cracking Sound of 1st MPJ

A 10 Y/O female complains of "cracking" of the 1st MTPJ while walking. It has been present only a few weeks. There is very mild pain in the joint only present post-static in the morning or after prolonged sitting. She hears cracking mainly while barefoot or with sandals, but it is not present with athletic shoes. No significant personal history or FH. No trauma - she plays soccer and ice skates. The cracking occurs during gait at heel-off and going onto the toes to push off. It is audible from about 15 feet away. It is only present with closed kinetic chain dorsi-flexion. She has a RF varus, ankle equinus with early heel-off. There is mild pronation during midstance. Open kinetic chain ROM 1st MTPJ is normal w/o crepitus or pain. I added a heel lift, but there was no change. Any thoughts to the cause/treatment would be appreciated.

Edward Orman, DPM, Perry Hall, MD

Query: Corticosporin Otic Suspension Discontinued

I have just heard that Corticosporin Otic Suspension has been discontinued by the King Pharmaceuticals. Does anyone know if there are multiple manufacturing sources for this long-generic medication often used for post-op P&A's, or whether King Pharmaceuticals is the only manufacturer? If so, then it will no longer be available by Rx once supplies are gone.

Rich Rettig DPM, Philadelphia PA

Query: Hallux IPJ Fusion with EHL Lengthening

I recently performed a hallux interphalangeal joint (IPJ) fusion for a rigid flexion contracture at the joint. The patient also had a severe extension contracture at the 1st metatarsal-phalangeal joint. This second area of pathology was corrected by an extensor hallucis longus lengthening with autogenous tendon graft. A dorsal capsulotomy was also performed. I am anticipating that Medicare is going to try to bundle these.

Any suggestions on multiple CPT and ICD-9 code combinations?

William Parker, DPM, Conway, SC

Response: My suggestion would be to use the following CPT codes:

CPT 28755 - arthrodesis interphalangeal joint, great toe
CPT 28210 - repair tendon, extensor, secondary with free graft [includes obtaining graft]

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found here

RE: Monofilament Not an Accurate Test of Neuropathy (Allen Jacobs, DPM)
From: Elliot Udell, DPM

Dr. Jacobs is correct in his assertion that Intraepidermal Nerve Fiber Density (IENFD) testing is a highly sensitive test for evaluating peripheral neuropathy. For sure it is a better evaluator of the status of a patient's peripheral neuropathy than the Semmes Weinstein Monofilament test, the PSSD or other nerve testing modalities that are available. Some researchers have written that IENFD should be an end point in future research studies involving peripheral neuropathy. There is one point however that must be made clear. Although IENFD is superior to other forms of testing for peripheral neuropathy, it is not a true alternative to these other tests. Why? It is invasive. It involves a 3 mm. skin biopsy. We can be cavalier and ask "why not take biopsies on all of our diabetic patients? After all, nothing beats an accurate test."

The problem is that all of us deal on a day to day basis with complications associated with peripheral neuropathy secondary to diabetes, mainly ulcers and infections. At this point in time, the risk of routinely inflicting wounds on all diabetic patients by doing biopsies on all of them, far outweighs the benefits that they would all get from the results. Hence, even though IENFD testing is more accurate than non-invasive nerve tests, I recommend that we do these other tests and leave IENFD testing to researchers, lest we violate our oath by causing patients unnecessary harm without the promise of greater benefit.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Digital Scanning System (Mark K. Johnson, DPM)
From: Tatiana Wellens-Bruschayt, DPM, PhD

We have 4 physicians in our practice utilizing Aetrex scanning system (we had it for about 2 years) and we love it. We have looked at many others but found quality, service as well as overall patient satisfaction to be the highest with them. We did try several others prior to purchasing this one.

Tatiana Wellens-Bruschayt, DPM, PhD, Winter Haven, FL, tanyafoot@aol.com

RE: Find Passion and Balance in Your Life (Mitch Cooperman, DPM)
From: Arthur Gudeon, DPM

Thanks for the super and inspiring article....I'm hoping, and betting that you've influenced many of our colleagues out there! It's great that you're apparently doing well health-wise now, and that you found your "calling." I'm still, part-time at least, continuing my own life-long passion ("corny" as it may seem) of podiatry practice....but also had a sort of double life-altering experience a few years ago, the first part being my totally emotional and satisfying eight months post 9-11 volunteering down at Ground Zero, and the second part being the now permanent serious health issues that have occurred because of it.

Luckily, the Mt.Sinai WTC/GZ Health Effects Program has improved my health situation to the extent that I can now continue my own passions of tennis-playing (now primarily doubles) three times per week, visiting my six grandkids in various locations weekly, and helping my professional artist daughter at her frequent exhibitions. Cutting back on my way-too-many-though-loved podiatry hours, and devoting them to my other passions has also given me more meaning and joy in life. Thanks again, for your story....it sort of reinforces mine for me.

Arture Gudeon, DPM, Rego Park, NY, afootdoc@ix.netcom.com

ASSOCIATE WANTED – NORTH CENTRAL PENNSYLVANIA

Excellent associate practice opportunity leading to a partnership for PSR 24-36 trained foot and ankle, surgically trained podiatrist. A well-established, ethical and academic, successful, solo, half-time and multi-faceted podiatric practice wishes to expand surgical services. No competition with foot fellows. Need diabetic limb salvage, plastic surgery techniques, strong surgical rear foot and ankle reconstruction, ABPS qualified certification required. Practice has state-of-the-art orthopedic surgical environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Excellent salary and benefits; no nursing homes. Present doctor is podiatric chief of three hospitals. Mail CV with current references to fgsddpm@verizon.net

ASSOCIATE POSITION - EAST CENTRAL FLORIDA

Full-time position available in large practice. We are looking for the right individual to service geriatric needs. Responsibilities include nursing home, wound care and general podiatry. Great salary with full benefits. Send Resume to cmedders@atlanticpodiatry.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

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

SUBLET SPACE WANTED - NORTHERN NEW JERSEY

I am looking to sublet space in the Tenafly, Teaneck, Fair Lawn or general area. I need the office two 1/2 days per week or 2 full days, whichever is available. I can supply equipment, if needed, but prefer a turn-key operation. 516 476-1815 podo2345@aol.com

PODIATRISTS NEEDED - CHICAGO -- NORTHWEST INDIANA & BALTIMORE

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

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

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 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

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