The Voice of Podiatrists

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October 27, 2008 #3,384 Editor-Barry Block, DPM, JD

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TX Podiatrist Discusses “Turf Toe”

The San Diego Chargers star running back, LaDainian Tomlinson, has been hampered all season by an early turf toe injury. This injury can be devastating and has ended many NFL careers. What is turf toe really? According to Texas podiatrist Marybeth Crane “Turf toe is a condition of pain in the base of the big toe. This is usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible.”

Dr. Marybeth Crane

“When a player sustains this kind of toe injury, they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely,” says Crane.

Treatment of toe injuries usually consists of trying to control the inflammation of the joint capsule. Treatment protocol can include: 1. Rest, 2. Ice, 3. Elevation, 4. Taping or padding to off-weight the toe joint, 5. Anti-inflammatories, 6. And in chronic cases, steroid injections to the joint may be helpful 7. Long-term use of a functional foot orthotics to balance the forefoot in the cleats is quite helpful.

Source: Article Alley [10/24/08]

Cozzarelli, Among 7, Named as Top NJ Doctors

John Cozzarelli, DPM of Belleville, NJ has been named one of 7 podiatrists in our annual survey of the state's best physicians as chosen by their peers. For this year’s list of Top Doctors, New Jersey Monthly commissioned an independent survey of the state’s physicians by the Polling Institute at Monmouth University in West Long Branch.

Dr. John Cozzarelli

Cozarelli is certified in podiatric surgery and acupuncture. He is part of the four-person New Jersey Peripheral Nerve Surgery Restoration Team, the only one of its kind in the tri-state area.

Also named were: Patricia Berran, DPM, West Orange, Wayne Caputo, DPM, Belleville, Jeffrey Cohen, DPM, Englewood, Lawrence A. Levine, DPM, Cherry Hill, Ritchard Rosen, DPM, Englewood, and Neal S. Yudkoff, DPM, Montclair.

Source: New Jersey Monthly

Placebos Prescribed by About Half of Physicians, Survey Finds

Between 46% and 58% of U.S. physicians regularly prescribe placebos to their patients, but only 5% of those physicians inform patients about the placebos, according to a survey published on Friday in BMJ, the Chicago Tribune reports. For the survey, researchers at NIH distributed questionnaires to 1,200 internists and rheumatologists nationwide (Graham, Chicago Tribune). The Department of Bioethics and the National Center for Complementary and Alternative Medicine at NIH funded the study (Cheng, AP/Los Angeles Times).

Among the 679 physicians who responded to the survey, about half said that they prescribed placebos to patients two to three times monthly, and more than 60% said that they consider the practice ethical (Reuters/Boston Globe). Almost 70% of respondents said they described placebos to patients as "a potentially beneficial medicine not typically used for your condition," the survey found. Forty-one percent of respondents said that they used pain medications as placebos, 38% said that they used vitamins, 13% said that they used antibiotics, 13% said that they used sedatives, 3% said that they used saline injections and 2% said that they used sugar pills, according to the survey (AP/Los Angeles Times).

Source: Quoted sources via American Health Line [10/24/08]

Survive in a Multi-Tasking World - Part 3

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:

• Stay connected. Stress can overwhelm you if you are not careful. The best strategy is to build a strong network of peers and others who can help you stay grounded. No matter how overwhelming your priorities seem, do not isolate yourself. Take breaks. Strike up conversations. Meet new people to keep life interesting so you can return refreshed to face those multiple tasks.

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

RE: Plate System for Osteotomy

I am considering an opening base wedge osteotomy on an 18 year old female with an intermetatarsal angle of about 17 degrees. I am considering using the plate system from either Wright Medical or Arthrex. Can anyone give their experience with either of these systems and how well they worked?

Jason Serpe, DPM, Bourbonnais, IL

RE: Cracking Sound of 1st MPJ (Edward Orman, DPM)
From: Mike Boxer, DPM

The cracking sound created when a joint moves is due to the breaking of surface tension as the two smooth cartilaginous articulating surfaces move apart or separate during joint motion. A popping or cracking sound will only be heard when the cartilage surfaces are smooth and free of any defects. Unfortunately, it is a normal effect due to a unique positioning of the cartilage surfaces and I do not know of any non-surgical solution to the problem.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

RE: Corticosporin Otic Suspension Discontinued (Richard Rettig, DPM)
From: Neil A Burrell, DPM, Joan Williams, DPM

My recommendation is to use Amerigel post-op. We are very pleased with the results, patients find it easy to use and it will add a little extra income at the end of the day. The manufacturer of Amerigel is also a big supporter of our profession.

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

The brand I use is made by Bausch & Lomb, in Tampa, Florida. Neomycin and Polymyxin B Sulfates and Hydrocortisone Otic Solution. Each ml. contains: Neomycin sulfate equivalent to 3.5 mg Neomycin base, Polymyxin B sulfate equal to 10,000 Polymyxin B units, Hydrocortisone 10 mg. 1%

Joan Williams, DPM, Seattle VAMC, Joan.Williams@va.gov

RE: Former CMS Head Comments on Medicare
From: Robert P. Thiele, DPM

I think we should be very careful about these “report cards” and talk of paying physicians for "good results." Medicine is an art, not an exact science. As we all know, not all patients heal the same way or in the same time frame. Also, not all patients are compliant. Any patient can have a complication despite the absolute best care. Some of us provide care in areas where patients are generally sicker, for lack of a better word, than in other economical or cultural diverse regions of the country. Also, doctors who are leading their particular discipline of medicine (i.e., a world-class cardiothoracic surgeon) are generally going to get the more complex cases with outcomes that may not be as appealing on paper.

If they start basing reimbursements based on results, then doctors will start to cherry pick patients to treat to keep their statistics favorable. Patients will have a very tough time finding a physician who will accept a very complex case. This is not good healthcare. Don’t think that it won’t happen; hospitals are getting report cards at present time based on DVT prophylaxis and pre-op antibiotic use. In the near future, they will be graded on more hospital parameters. These "grades" will be reported to the public. Eventually, reimbursements will be based on them. Doctors are next on the list.

Robert P. Thiele, DPM, Piscataway, NJ, drthiele@comcast.net

PRACTICE FOR SALE or SHARED SPACE FOR RENT - CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way: heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. Contact QVAN@aol.com or 305-975-5516.

EQUIPMENT FOR SALE – NEW ERGO HANDPIECES

New Storz-Ergo Sagittal Saw and Reciprocating Saw. 25% of price donated to Musella Brain Tumor Foundation. Bid on E-Bay by clicking on links above.

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

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

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

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

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