The Voice of Podiatrists

October 26, 2006 #2,724 Editor-Barry Block, DPM, JD

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Obesity Accelerates Effects of Aging on Feet: OR Podiatrist

Heavier people amplify the hobbling effects of age by putting more pressure and stress on each foot with every step. "Obesity causes the same issues as aging, only accelerated," Dr. John Mozena said. And the obese are far more prone to diabetes, the nation's No. 1 cause of amputated feet.

Dr. John Mozena

The foot's arch is a good milestone of the twin burdens of time and weight. The arch is supported by the posterior tibial tendon, which runs from the calf past the inside ankle. Over time, stress can stretch the tendon so the arch sags, making the foot longer and wider. "When people say their foot doesn't grow, that's wrong," Mozena said. "It does grow, by the arch dropping." If you don't change shoe size to accommodate that middle-aged spread, he said, you risk pinched nerves, hammertoes or bunions from the shoe rubbing and squeezing the foot.

Source: Andy Dworkin, The Oregonian [10/25/06]

Healthcare Costs: Majority of Adults Dissatisfied, Survey Finds

Fifty-two percent of U.S. adults are dissatisfied with health insurance costs, compared with 33% in 2005, according to the ninth annual Health Confidence Survey released on Tuesday by the Employee Benefit Research Institute, the Los Angeles Times reports. The telephone survey included responses from 1,000 adults and had a margin of error of plus or minus three percentage points.

According to the survey, about 60% of respondents said that their health insurance costs – which include premiums, deductibles and co-payments -- had increased in the past year, and more than half said that they saved less as a result (Alonso-Zaldivar, Los Angeles Times, 10/25). Among respondents who said that their health insurance costs had increased, 36% said that they decreased retirement savings, compared with 25% in 2004, and 28% said that health insurance costs affected their ability to pay for basic necessities this year, compared with 18% in 2004, the survey found (Gerencher, Dow Jones Business News, 10/25).

Source: American Health Line [10/25/06]

U.S. Healthcare Lagging Behind Other Countries

There's lots of room for the U.S. healthcare system to improve on measures of health outcomes, quality, access, efficiency and equity, according to a national scorecard the Commonwealth Fund released last month.

The first annual scorecard examined how the United States' national average compared with the top 10% of industrialized nations, as well as states, hospitals and insurance plans here at home. Researchers looked at 37 indicators and found the United States scored 66 on a 100-point scale. The study also breaks down how the nation fares on the following five dimensions on the same 100 scale:

• Quality: 71
• Equity: 71
• Long, healthy and productive lives: 69
• Access: 67
• Efficiency: 51

Source: Kevin B. O'Reilly, AMNews [10/23/30/06]

Query: Lapidus on Down’s Patient

I have a 42 y/o F Downs syndrome patient who is moderately retarded and has a painful bunion. I have succeeded over a several year period in keeping her asymptomatic with shoe style changes, but she can no longer participate easily in ADL or her sheltered workshop due to pain at the bunion. Her intermetatarsal angle is 25 degrees, requiring a Lapidus procedure. I have had her evaluated by physical therapy and she cannot deal with crutches nwb, but is able to do a walker, “mostly” non-weight bearing but still takes occasions steps to maintain her balance.

She will be taken care of at home, post operative by her older mother (70 y/o), and to complicate matters more, her 1st met base on the DP X-ray is narrow enough that I will not be able to place two screws in my standard position (dorsal distal to proximal plantar, and a second 3.5 screw from dorsal proximal to plantar distal). I am considering a dorsal plate with an interfragmentary screw and cast, or possibly both internal fixation and a mini-rail. Has anyone had any experience doing this surgery that typically would require strict non-weight bearing in a patient who probably will not, or cannot maintain her nwb status?

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

Query: On-Line Patient Scheduling Software

We are going to outsource our billing. In doing this, we will lose scheduling ability which comes with our current billing software. There are two of us and we have two offices. I assume we need a web-based program or a local server. I would appreciate any suggestions.

Jack Hamilton. DPM, Augusta, GA

RE: Palmetto Awarded Competitive Bidding
From: Paul Kesselman, DPM

Palmetto GBA has b een awarded the competitive bidding implementation
contract. The competitive bidding DME structure is in its infancy. It will gradually be implemented over the next few years, but must begin by 2007. Palmetto will be entrusted with developing the competitive bidding process. Exactly how this process will be implemented is still uncertain.

It is believed that products covered under the Therapeutic Shoe Bill, surgical dressings, custom ankle foot orthotics and prosthetics will NOT be subjected to the competitive bidding process. Many ready-to-dispense products provided by DPM’s, however, will be covered under competitive bidding. These include: CAM Walkers, crutches, canes and off-the-shelf ankle foot orthotics.

I would continue to urge podiatric practitioners to petition their congressional representatives to exempt podiatrists from the general competitive bidding process. MD and DO physicians are already exempt from the general competitive bidding process. This places the podiatric patient at a most unfavorable disadvantage, particularly when faced with an acute injury.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Scanning X-Rays (Sam Bell, DPM)
From: Mark M. Levine DPM, Richard A. Simmons, DPM

I have been scanning my x-rays quite successfully for close to a year now. I include the scans with my EMR software and the patients seem to be very impressed with the technology as I soom the image in and out in front of them. One can also adjust the brightness level and the contrast on each film.

One needs a scanner with a "transparency adapter." This is a tool used by photographers to scan their negatives and transparencies. The largest one I found was for 8x10 meaning you can't scan 10x12 films, so it will work except for the largest feet.

I was very fortunate and picked up a Microtek ScanMaker 8700 on E Bay slightly used. The scanning process itself takes about 2-3 minutes per film once they're developed and you then link it to each individual patients files on the EMR. I have no regrets and will continue to do this till I upgrade to a full digital system.

Mark M. Levine DPM, Middle Village, NY, MLevine3@optonline.net

About three years ago I purchased a Microtek Scanmaker 5900 for about $100. This allows scanning up to an 8x10 positive or negative. The concept is simple: when scanning a positive (picture) the light is reflected, but when scanning a negative (x-ray) the light shines through it. If you go to a knowledgeable place, such as CompUSA, one of their sales associates should be able to help you.

A 'side benefit' of this equipment is that you can digitize the black-and-white and color negative strips produced when you took pictures with a film camera.

Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com

ASSOCIATE POSITION - NEW ENGLAND

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HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

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