The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

October 26, 2010 #3,993 Publisher-Barry Block, DPM, JD

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Corrected Link

The correct link for Dr. Adam Landsman's letter which appeared in yesterday's PM News can be accessed by clicking here.  We apologize for any inconvenience.

IL Podiatrist Discusses Plantar Fasciitis

Plantar fasciitis, a common source of heel pain is the top persistent foot ailment and among the most debilitating, according to the American Podiatric Medical Association. The pain is easy to ignore at first, as it eases after you walk around a bit. But it's unwise to leave it unchecked.

Dr. Marlene Reid

"It is so much harder to get rid of heel pain the longer you let it go," said Marlene Reid, co-owner of Family Podiatry Center in Naperville, IL, and president of the Illinois Podiatric Medical Association. Open-heeled shoes such as flip-flops, slides or sandals are common culprits, as are new shoes your feet aren't accustomed to and old shoes with worn-out heels, Reid said. This is one of the few conditions for which high heels are not the evildoers.

Source: Alexia Elejalde-Ruiz, Chicago Tribune [10/22/10]

TUSPM Professor Discusses Prevention and Treatment of Frostbite

With cold weather on the horizon, podiatrists at Temple University’s School of Podiatric Medicine warn that people of all ages need to take precautions to protect their feet from cold-related injuries like frostbite, ankle sprains and fractures. “Warm towels and water should be used to warm the affected area at the first sign of numbness. The person should then see a doctor, who can determine if there’s any tissue damage,” said James B. McGuire, DPM, assistant professor of podiatric medicine.

Dr. James McGuire

“Dressing properly is the best defense against the problems that severe weather causes,” said McGuire. “But it is important to remember that proper footgear is just as important as a warm coat, hat and gloves.”

CA Can't Stop Podiatric Medicaid Services Without U.S. Approval, Judge Rules

A Sacramento federal judge has ordered the state to keep providing adult dental, podiatric, and chiropractic services to poor people in underserved rural areas until it gets permission from federal heath authorities to discontinue the benefits. U.S. District Judge Frank C. Damrell Jr. ruled Wednesday that, while the services are not mandatory under the federal Medicaid program (Medi-Cal in California), the Legislature's decision to end them last year as a cost-saving measure was unlawful without federal approval.

Damrell issued an injunction barring further implementation of the change in the Medi-Cal plan until the state gets federal approval. Anthony Cava, spokesman for the state Department of Health Care Services, said Thursday the department, which oversees the Medi-Cal program for people below the poverty line, will abide by the judge's order. He said that the department will resume reimbursements to qualified healthcare centers and rural health clinics for the services.

Source: Denny Walsh, The Sacramento Bee [10/22/10]

AZ Podiatrist Inducted as The 2010 Honorary Fellow by ACCWS

The annual meeting of the American College of Certified Wound Specialists (ACCWS) was the venue for the induction of Professor David G. Armstrong as the 2010 Honorary ACCWS Fellow. Armstrong noted, "I look at the previous three fellows-- Will Lee, Neal Sharpe, and Gerit Mulder-- and I think that I'm obviously bringing the class of the College down a bit-- but I'm no less honored by the College's oversight!"

Dr. David Armstrong

Armstrong continued in observing, "The ACCWS was founded to be the voice of wound care. I think it, along with the other terrific organizations working in this area are fostering interprofessional partnerships that start and end with the patient. It's a privilege to participate in making a difference."

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

Bret Ribotsky: What is the value of OPEIU to podiatry?

Dr. Kathleen Stone

Kathleen Stone: I think that the value is the knowledge and the connections of people that they have. I think that is how they protect and work with their membership, and they see our membership and our physicians. They know that their members need the podiatric care because we are the best at what we do. The combination of the two things now, working in collaboration, gives us the solid numbers. In the Senate and Congress our12,000 members is nothing.  Our coalition with OPEIU provides us the clout of millions.

Dr. William Scherer

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature podiatric educator and entrepreneur, Dr. William Scherer. You can register for this event by clicking here

Query: Sign-in Privacy Under HIPAA

My staff brought to my attention that we should be having patients sign in on a removable label  so that their names aren't visible to patients who sign in after them for HIPAA privacy. Is that necessary, or is there a more efficient/cost-effective way to protect privacy?

Stephen Pirotta, DPM, Fayetteville AR

Editor's comment: PM News does not provide legal advice. While removable labels for sign-in are an excellent way to ensure patient privacy, they are not mandated under HIPAA. What's important is that only patients' names be on the sign-in sheet. If you do not include any personal health information (PHI), e.g., diagnosis, procedure or test planned, etc., you have acted "reasonably" to protect patients' PHI.

RE: Bilateral "Burning" Heel Pain (Elliot Udell, DPM)
From: Peter Bregman, DPM, Makabis Yousefpour, DPM

With due respect to Dr. Udell, I would like to clarify. My injection technique to diagnose an isolated nerve entrapment is to use only a very small amount of 1-2cc of Lidocaine and 4mg of Decadron. This is such a small amount that it does not have any significant systemic effects.  However, you need to know the anatomy and have good technique, which you can learn at the AENS courses.

If it is plantar fasciosis, then I recommend using an autologous platelet injection with ultrasound guidance. Make sure you debride the fascia by some sort of blunt technique (rasp or needle), and then inject PRP directly into the swollen and hypoechoic area. You may also want to consider stem cell injection, as well, prior to anything too invasive. This new biologic technology has tremendous healing capability for anything that is in a hypoxic environment with damage.  The mesenchymal pluripotential cells can literally find the damage and repair it, especially when injected near fat, which also has stem cells in it.

Peter Bregman, DPM, President, Association of Extremity Nerve Surgeons, footguru@comcast.net

I had a patient with chronic burning sensation in both of his heels. He is diabetic, but does not demonstrate a classic "de-gloving" pattern of DNP and most of the burning was localized to the heels. MRI revealed Baxter's neuritis with some inflammation of the plantar fascia. I did inject him several times (4) with a mixture of Lido, Dex, and Depomedrol 40. The patient only got minor relief from these injections. Finally, after multiple other treatments, including strapping, orthotics...we discussed surgical options. He was against surgery due to his DM, but agreed to RF ablation.

I used Podiatherm for the procedure and approached the point of maximum tenderness plantarly. After only one treatment, in one of his heels, the pain has decreased to about 20%, and the other heel feels about 50% better. He is happy but does not want the procedure again. The reason is that the procedure cannot be done under complete anesthesia since the patient has to respond to where he feels the pain the most, and that is the area you want to deliver the RF to. Also, you have to be careful of not damaging the motor nerves, which could easily be determined by fasciculation of the foot. You also want to make sure that the patient's neurovascular system is intact. 

Makabis Yousefpour, DPM, Los Angeles, CA, makdpm@yahoo.com    

RE: Title XIX

This is just a reminder to contact your legislators regarding Title XIX inclusion of podiatrists as physicians. I wrote to my congressman and both my senators again today asking for their support for H.R. 1625  and S. 654. Hopefully, everybody will do this. It’s like chicken soup for a cold---it couldn’t hurt!

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

RE: The Handwriting is on the Wall

I have a Medicare patient who fell and sustained an ankle sprain and a rotator cuff tear. I recommended an excellent orthopedic surgeon who is known for his shoulder surgeries. She went to his office with her MRI and had a consultation. When she asked when he could perform the surgery, he told her he has opted out of Medicare and all Medicare patients will have to pay cash for the surgery with no reimbursements from Medicare. So I called a friend of mine who is an orthopedist and he gave me another name. She called this other office and was told he no longer accepts Medicare. My own internist, who participates with no insurance, has now opted out of Medicare as well. I believe this will become the ever-increasing trend as physicians strike back against a system that pays us little and hassles us a lot.

I also just received notice that my personal family insurance plan will be raising my premiums by 60% for a plan with reduced options. 60%!  It is obvious that insurance companies, as well as Medicare, will be putting themselves out of business in the near future unless there are realistic changes to the way things are done. I foresee a major healthcare crisis as doctors opt out of insurance and Medicare control, and as physicians over the age of 50 opt out of medicine altogether.

Bob Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com  

RE: FDA Laser Clearance For Treatment Of Onychomycosis ( H. David Gottlieb, DPM)
From: Narmo L. Ortiz, Jr., DPM, Robert Scott Steinberg, DPM

With all due respect to Dr. Gottlieb who stated, "I believe that the right of a manufacturer to enforce territorial limits for their device is legal", have you ever heard of the terms monopoly, fair trade, and fair competition? Dr. Gottlieb's comment after that statement is an example of why our profession is in its present predicament. We are not dealing with trades in the stock market nor in real estate, where "first come, first served" is king. We are treating human beings who deserve equal access to healthcare by providers (podiatrists) who should have EQUAL access training, scope of practice, and the use of current technology in ALL of the United States.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

It is that exact arrogance, as exhibited by Dr. Gottlieb's post, that has hurt podiatry for years. We are specialists of the foot and ankle, in all its aspects. Individually, we may decide to concentrate on one aspect in our practice, but to chastise those of us who practice podiatry to its fullest, investing our time to educate and give patients choices, is  disingenuous.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@FootSportsDoc.com 

RE: FDA Laser Clearance for Treatment of Onychomycosis (Keith Gurnick, DPM)
From: Robert D. Teitelbaum, DPM

I remember when Lamisil was first introduced in this country after having had a very good run in Europe (with no warnings about liver function issues). I think there was a mycologic cure rate of close to 80% after six months of treatment. This new FDA designation of "improvement" in mycotic nails with the new laser is of no help at all. I get "improvement" in nearly 100% of my patients with what I call aggressive debridement every three months and the patients' daily use of Formula 3.
      
Lamisil has now gone generic. A pharmacist spoke with me and said 28 Lamisil sell for $493 and the generic equivalent is $60 - $1,500 versus $180 for the cost of full treatment by pharmaceutical. Cost was always an issue with Lamisil, and now that is gone. Has that piqued your interest?

I have always felt that the liver problems encountered with the use of Lamisil were linked to the greater number of prescription meds that average Americans are taking, as compared to Europeans. The liver, as the primary organ of biotransformation of pharmaceuticals, it is safe to say, is stressed by all drugs. The major consideration I have when I prescribe Lamisil is the number of other medications the patient is taking. No one wants to hand out the straw that breaks the camel's back. If there are multiple meds, a baseline liver function study is in order if the decision is made by both doctor and patient to try the Rx.
 
Robert D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Ridiculous Shoes - Part 1

Can you hunt with these?

Source: Submitted by Dr. David Secord

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

ASSOCIATE POSITION - NASSAU COUNTY, NY

Experienced board certified podiatrist wanted for busy diversified practice located in Nassau County, New York. Energetic DPM, please send CV to JELLA810@GMAIL.COM

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.com

ASSOCIATE POSITION - CALIFORNIA

Busy, surgically-oriented practice in Bakersfield, CA seeks ABPS qualified/certified surgeon to join our existing two surgeons. Must be hard-working and honest. Strong reconstructive surgical practice with trauma privileges and wound care center/diabetic limb salvage center. Starting in December or January. E-mail CV to aghams2@aol.com

ASSOCIATE POSITION - BROOKLYN, NY

Podiatrist needed Part-time: Established practice in Bay Ridge, Brooklyn. Practice encompasses all aspects of podiatry. Please send resume to: hfasdpm@gmail.com

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

ASSOCIATE POSITION - NORTHERN NEW MEXICO

Associate needed for a dynamic group practice in Northern New Mexico. We are looking for a well-trained 3-year surgical resident to help us build our practice leading to partnership. In New Mexico we have a leg law. Besides a great professional experience, we have the mountains for skiing, fishing, hunting, and horseback riding. Ideal for an experienced podiatrist looking for a location change. Please send a resume to FootandAnkleAssociates@comcast.net

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION – NORTH, CENTRAL & SOUTHERN ILLINOIS
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

EQUIPMENT FOR SALE -  WHIRLPOOL AND WHIRLPOOL CHAIR

Professional, Whitehall brand 15 gallon Podiatry Whirlpool and Whirlpool Chair. In excellent condition. $2000.00. Please contact fergusondpm@aol.com

EQUIPMENT FOR SALE: PADNET SYSTEM BY BIOMEDIX

Less than 1 yr old. Two computer laptops included to allow flexibility of testing in 2 offices. Training by Biomedix included in price. Willing to sell for remainder of balance on lease. Contact by email at hassenfratz@hotmail.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

SPORTS MEDICINE FELLOWSHIP

The Palo Alto Medical Foundation Surgical/Sports Fellowship Aug 1, 2011 thru July 31, 2012. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Responsibilities include assisting in all types of foot and ankle surgery (approximately 500 cases), seeing patients in the sports clinic and completing 2 papers/research projects. Benefits include salary of $56,500/yr, medical, dental, malpractice, and CME allowance. Interviews at the Midwest Podiatry Conference Mar 3-5, 2011 & ACFAS Mar 8-10, 2011, but on-site visit is preferred. Minimum 24-month surgical residency training pre-requisite. Send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM. HeySax@AOL.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER - PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

PM News Classified Ads Reach over 12,500 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 12,500 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.

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