The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 26, 2009 #3,684 Publisher-Barry Block, DPM, JD

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TUSPM Helps Soldiers Put Their Best Foot Forward

"Healthy feet are extremely important for a soldier. It's their main mode of transportation over there, and helps get them in the battle and out of trouble quickly," said Kathya Zinszer, chair of podiatric medicine and orthopedics at the School of Podiatric Medicine." Unfortunately, they're not getting the supplies they need." Zinszer learned of the need for foot care supplies while chatting on line with her sister Donna, a Kiowa helicopter pilot and National Guard captain, currently stationed in Iraq.

Kathya Zinszer (left) and students assemble care packages for soldiers stationed in Iraq.(Photo: Jeanne Lockner)

So, Zinszer and a group of students reached out to several vendors for donations of foot care products, from blister packs to orthotics to powders, and recently put together the first batch of several care packages to send off to her sister’s National Guard company. Zinszer credits Kendrick Whitney, associate professor of podiatric medicine and orthopedics and director of the school’s Pedorthics Laboratory, as being an instrumental part in contacting vendors and compiling donations.

AZ Podiatrist Presents at ARIBI

David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) joined six other renowned researchers to present at this year's Advanced Research Institute for Biomedical Imaging (ARIBI) workshop. "We have learned long ago that no clinician is an island when caring for a disease", noted Armstrong, "The same can be said for scientists. When people doing cutting edge optics and signal processing combine with clinicians asking basic questions, the result can be transformative."

Dr. David Armstrong

Armstrong presented a wide range of imaging technologies being developed and tested by SALSA, including 3-D imaging tools to, as Armstrong put it, "Tivo, or time-shift the physical exam" for later playback and analysis, to new methods of measuring skin temperature by patients at home that have been shown to reduce risk for limb-threatening diabetic foot ulcers. The program, coordinated by ARIBI's Director, Professor Ron Lynch, included topics ranging from cutting edge imaging of the nervous system to novel methods to monitor cardiac and oncologic therapies.

Head of FIP Hosted at Special Olympics Headquarters

Dr. Robert Chelin, President of the Federation Internationale Des Podologues, an association for podiatrists with a presence in more than two dozen countries worldwide, recently met with representatives from Special Olympics Healthy Athletes.

(L-R) Drs. Robert Chelin and Stephen Corbin, Senior Vice-President, Special Olympics

A number of potential collaborative projects were discussed, including a Fit Feet demonstration screening at the association’s global conference next year in Amsterdam.

Source: Healthy Athletes Newsletter [October 2009]

Query: Recommendations for Bunionectomy

A 57 Y.O. female in excellent health had a Silver-Akin minimal incision bunionectomy performed in 1987. She has no pain and participates in aerobics and other gym activities 5-6 days a week without problems. She has good ROM and is pain-free with lateral tracking. Her complaint is the continued "curving" of her hallux. The nail is hitting her work shoes, causing discomfort along the medial border. She doesn't like the way her foot looks in sandals and she would like the bump gone so she can wear narrower shoes. 

Hallux Valgus Post-op Silver-Akin

I am considering doing a Reverdin-Laird with a fibular sesamoidectomy, which would allow the cartilage that is functioning to continue as is, and straighten her toe somewhat. Suggestions would be appreciated.

Alan Berman, DPM, Carmel, NY
 

Query: Ultrasonography Course

Does anyone offer a course on ultrasonography of the foot and ankle? For those of you who have an ultrasound unit, has it been of clinical benefit for you and your patients?
 
Ira M. Baum, DPM, Miami, FL

RE: Failed TMA Flap (Tip Sullivan, DPM)
From: Multiple Respondents

I think you might have to first assess this patient's ambulatory requirements. Dr. Sullivan stated that the patient has an AKA on the contralateral limb. Does he wear a prosthetic on that side or is he in a wheelchair? Since vascularization of the limb in question has been performed and I assume further attempts would be fruitless, your options are narrowed. I would remove all devitalized tissue as far proximally as necessary on the foot. You can use a VAC to encourage healing if you like. I've had good success with a split-thickness skin graft after an open amputation in this type of setting, particularly if the patient has limited ambulatory function. I do not believe a GraftJacket or allograft can stand up as well as an STSG in the face of limited arterial inflow.

Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

I have seen a lot of flap failures. I recommend using a KCI wound VAC. The main importance is the application method of placing the wound VAC on the flap. Before I apply the wound VAC, I cleanse the wound edges with isopropyl alcohol, and then apply Mastisol liquid adhesive. This is needed for adherence of the VAC drape and to prevent maceration, which can lead to further breakdown. Then, I apply Mepitel (Molnlycke) over the incision line. This is vital before I place the sponge (if this is not done correctly, the sponge will cause a wound). Note: the sponge can never touch open skin. The Mepitel must be underneath anywhere the sponge comes in contact with the incision surface. If it is not placed correctly, the flap will fail. I like pressure of 175mm hg continuous, and I personally change the Wound VAC every 48 to 72  hours because if it is done wrong, it results in failure. It works well with HBO.

Furthermore, I also protect the heel because many patients will develop ulcerations to the heel because they are trying to keep pressure off the surgical site. I have seen this all too often. You work on one wound and patients develop another.

Finally, I stress no smoking, no caffeine, and infection control. These have to be addressed, along with any protein and diet deficiencies that may be present. I have found the wound VAC to be a very good tool in preventing flap failures.

Susan M Yeager, DPM, Jackson, MS, Susan.Yeager2@va.gov

Editor's Note: Dr. Wunderlich's extended-length notr appears at: http://www.podiatrym.com/letters2.cfm?id=29903&start=1

RE: Custom Orthotics and Podiatry
From: Dennis Shavelson, DPM

Recently, a 32 year old female runner with rheumatoid arthritis was referred to me in tears after orthopedic consultations of stress fracture tibia and compartment syndrome were made without scans or pressure measurements. She was told to stop running. I elicited acute pain in the origins of the tendons of the tibia consistent with acute “shin splints.” Her functional foot type was rigid rearfoot/flexible forefoot and she tested positive for a short right limb. In stance, she exhibited major foot vault collapse with a rectus tendoAchilles.

I applied Unna boots and placed foot centering pads to her shoes. There was 30% improvement after one week and at that time, the patient was cast for custom foot orthotics utilizing foot typing cast corrective techniques producing a pair of podiatric orthotics narrower, shorter, higher arched, and more leveraged than those generated by neutral casting or scans. She is running three times a week again (five weeks later) and has referred me patients.

To those who wish to destroy an area where podiatry leads the pack of medical and pseudomedical rivals, I surmise that you do not trust your orthotic diagnostic, casting, and prescribing skills. Just because you have left the podiatric orthotic train, why would you propose that it crashes? Trained in modern biomechanics, we can still do what others cannot!

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
 

RE: Motherboard for Midmark Podiatry Chair 414 (Randy Beckman, DPM)
From: Gregory T. Amarantos, DPM

Call Universal Footcare. They can have it delivered to your office and it should take about 10 minutes to replace. You can do it yourself with a Phillips screwdriver.

Gregory T. Amarantos, DPM, Chicago, IL, amogreg@aol.com

RE: NYCPM Professor Elected a Fellow of the New York Academy of Medicine

Congratulations to Mark Kosinski on attaining this honor. I’ve known Mark for 23 years, and can say, without hesitation, he is one of the brightest podiatrists I know. He is an asset to NYCPM, and to the students fortunate enough to learn from the very best. Kudos, Mark!

Howard R. Fox, DPM, Staten Island, NY, foxhr@yahoo.com

RE: A Sign of the Times
From: Narmo L. Ortiz, Jr., DPM

I wonder if the Health Care Practitioners of  Minnesota, Vermont, and Massachusetts have complained to their State representatives in Congress. I am sure those representatives may not answer their calls since they will be too busy enjoying the dinner parties offered by the lobbyists from the pharmaceutical companies.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL

RE: Obama’s Healthcare Plan
From: Jason Kraus

The one thing that everyone seems to agree on is that there is great disagreement about the healthcare system in our country. It is interesting to note that most of those who took exception to my comments felt...

Editor's note: Jason Kraus' extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=29890&start=1

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist.  The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)  

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community  www.siouxlandchamber.com. Fax  CV, resume, three references to 712-258-9977.

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

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.

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

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 – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@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.

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com  www.homephysicians.com

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 - 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

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