The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 27, 2009 #3,685 Publisher-Barry Block, DPM, JD

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IL Podiatrist Discusses Running in Cold Weather

When the body gets cold, it focuses its blood and energy on keeping the internal organs warm and protected — at the expense of your hands and feet. “The old saying is, ‘If you want to keep your feet warm, wear a hat,’” said Fred Weil, a sports medicine podiatrist from Mundelein. “A hat is very important because you can lose up to 30 or 40 percent of your body heat through your head.”

Dr. Frederick Weil

Weil, 68, has been “running for over 30 years and never used the treadmill,” he said. “Part of the nice experience of exercising is being outdoors.” He has cross-country skied when it was 20 below zero. Bitterly cold temperatures won’t keep him inside, but ice will. “That’s the one time I avoid running outside: if it’s real icy,” he said. “It can be hard to maintain your balance.” If it’s even a little slippery outside, you want to wear shoes with some traction in the sole, like trail shoes, Weil said.

Source: Lori Rackl, Chicago Sun-Times [10/22/09]

NY Podiatrist Presents His Brain Cancer Crusade to Neurosurgeons   

Al Musella, DPM, of Hewlett, NY addressed the combined annual meeting of the Society for Neuro-Oncology and the American Association of Neurosurgeons in New Orleans today. Musella is the president of the Musella Foundation For Brain Tumor Research & Information, Inc, a 501(c)(3) non-profit public charity dedicated to improving the lives of people dealing with brain tumors. His talk was about the Grey Ribbon Crusade, which is his vision for uniting the brain tumor advocate community to work together as an army against the disease. 

Dr. Musella addresses neurosurgeons

The Grey Ribbon Crusade will unite over 100 brain tumor organizations in the USA with group fundraisers and awareness campaigns, group funding of research, as well as a common grant application for all participating members – to make life easier for the researchers! So far, 58 organizations have joined, and have already jointly funded 9 out of the 16 grant requests.

FL Podiatrist Presents at Mexican Dermatology Congress 

Dr. Bret Ribotsky recently presented at the VII Congress of the Mexican Society of Dermatology and Oncology in Puerto Vallarta. 

Dr. Bret Ribotsky in Mexico

Ribotsky covered topics on “How Foot Function Affects Nail Pathology” and “Pedal Soft Tissue Temporary Augmentation,” and received wide acclaim.

Query: Perceived Ingrown Toenail Problem

This is a 43 yo healthy female with unremarkable PMH with pain to both sides of both great toes along the borders. 18 months ago, she had P&A's performed by another DPM to both the lateral and medial border of both great toes. She had exquisite pain after the procedure and was unable to go to work for a week. She took 3 months to fully heal the areas. She states that the toenail surgery did not relieve her symptoms. She is uncomfortable with wider shoes and she is currently wearing 1/2- full size larger shoes. The toes are even tender when barefoot.

18 months Post-op P & A

Clinically, the nails are unremarkable, but she has minimal, if any, swelling to the lateral border along the base of the great toenails. There is no recurrent ingrown nails. The medial and lateral borders of each toe are tender, mainly at the base of the nail matrix, moving proximally toward the IPJ. The P&A long-term results look great to me. I am looking for suggestions as to how to approach this.

Hans Blaakman, DPM, Duncan, SC

RE: Recommendations for Bunionectomy (Alan Berman, DPM)
From: Multiple Respondents

A Lapidus will correct the deformity from where it is originating. Anything less will only buy her time until the next surgery. 

David L. Nielson, DPM, Roanoke, VA,  pampantla@hotmail.com

It looks like the patient would be a candidate for an OBWO. There is plenty of autogenous bone to use as graft. Once you stabilize the the osteotomy, evaluate the cartilage on the head of the first met relative to the base of the proximal phalanx. If it looks good, then take an intra-op x-ray and consider a repeat Akin, either proximal or distal, depending on how the corrected ray now looks.

Frank Lattarulo, DPM, NY, NY, DOCLATT@aol.com

It appears to be an irregular joint, and a substantial IM angle. I think a head osteotomy is destined for failure. Yes, you do have to take into account the symptoms; does it warrant surgery? And you do have to be clear of what the expectations of surgery are. But I think this commands more than a head osteotomy. Traditionally, a base procedure is probably the best option. I would strongly consider instead, a first 1st MTPJ fusion. A head osteotomy with a adductor tendon transfer is probably not wise, given the irregularity of the joint, with results too unpredictable, unreliable, and a potential for a hallus varus. She may be too young and active for the new Tightrope procedures as well. I would probably opt for the 1st MTPJ fusion, provided the patient was receptive to it.

Robert Colligan, DPM, Norfolk, NE, rcolligan@cableone.net

My suggestion is to have a thorough discussion with the patient about revision bunion surgery. The first surgery, whether done open or in MIS fashion might just leave this patient with a very thin joint capsule and you will never know the condition of the cartilage until you view it. Inform the patient that she might be trading off an unsightly non-painful bunion that causes shoe-fitting and choice issues with a better cosmetic foot which might hurt after.

The IM angle looks larger than my criterion for a distal metatarsal osteotomy. If you are doing that type of procedure along with a fibular sesamoidectomy, you should be concerned about a potential hallux varus, if you tighten any remaining medial capsule to help hold the toe straight. Either way, she still may require a tibial border hallux partial matrixectomy for her chief pain complaint. Why not do this more simple procedure first and see how the patient responds? Revision surgeries are almost always more challenging than a pristine deformed foot.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
 

RE: Effect of Custom and Semi-Custom Orthoses on 2nd Metatarsal Bone Strain
From: Kevin A. Kirby, DPM

An interesting research study has just been published which adds to the considerable body of scientific literature which demonstrates that custom foot orthoses are more effective than semi-custom orthoses at treating mechanically-related foot pathologies. The study was conducted by a group of Iowa researchers on eight fresh-frozen cadaver specimens which were tested on the dynamic gait replicator, developed by one of the researchers, Erin Ward, DPM.

The dynamic gait replicator allows a cadaver leg and foot to be literally “walked” overground by attaching the eight major extrinsic muscle tendons of the cadaver foot-leg preparation to load cells and electric actuators that simulate the phasic muscular activity of walking gait. Strain gauges were attached to the second metatarsals of the cadaver feet, and then the feet were walked over three types of insole conditions: a flat insole, a semi-custom orthosis, and a custom orthosis. The research goal was to measure the differences in deformation (i.e., strain) of the second metatarsal during walking over the three insole/orthosis conditions. (Meardon SA, Edwards WB, Ward E, Derrick TR: Effects of custom and semi-custom foot orthotics on second metatarsal bone strain during dynamic gait simulation. Foot Ankle Intl, 30:998-1004, 2009).

The results of the study showed that custom orthoses had significant effects on compression, tension and shear strains, and on compression strain rates and shear strain rates; whereas the semi-custom foot orthoses had significant effects only on tension strain and shear strain rate. The researchers postulated that the better performance of the custom orthoses was likely due to the better congruity of the custom orthoses to the plantar foot than the semi-custom orthoses.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
 

RE: Don’t Overlook the Potential Negative Role of Vitamins and Minerals
From: Paul Kesselman, DPM

A fairly healthy, active 90 year old female recently presented to my office with general complaints of foot and leg fatigue. She also related some recent general lethargy beginning 6- 8 months ago. Her medical history was positive for osteoporosis and early macular degeneration. She admitted to taking Actonel, Caltrate-D bid, and eye vitamins bid. She informed me that... 
 

Editor's Note: Dr. Kesselman's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29937&start=1

RE: Ultrasonography Course  (Ira M. Baum, DPM)
From: Alan Kalker, DPM, Marc Katz, DPM

Esaote has a course at their office in Indianapolis taught by Dr. Nathan Schwartz. It is a one-day course and was excellent. It's well worth the trip. It is free if you buy the ultrasound from them, and they do have an outstanding, easy-to-use unit with very good resolution - the Mylab 5.

A good text is also essential. I have Ultrasound of the Musculoskeletal System by Bianchi and Martinoli. While it covers the whole body, much of the material beyond the foot is very relevant. For those who have not yet purchased an ultrasound, it is one of those things that you cannot imagine practicing without once you have one.

Alan Kalker, DPM, Middleton, WI, ajkalker@wisc.edu

There is minimal benefit to an ultrasound course, but it certainly would cause no harm. Here's the best way to become highly proficient. It takes time and there is a learning curve but you will be thrilled with the outcome. Get a really clear MRI of the foot. Try to label the structures. If you have trouble, sit with one of your radiology friends. If you have the Primal videos, that may help too. If you have any doubt, get an anatomy book. Use your foot and find every structure that you can find. Look at online pictures to see the ultrasound images. Trace all structures. Before you know it, you will have trained yourself far beyond any course. Then, set aside a little extra time with patients and find structures. It’s a learning experience for you, and if you discuss ultrasound images with patients, they are very appreciative.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
 

RE: Sign of the Times
From: Wm. Barry Turner, BSN, DPM

Am I the only one who sees it as peculiar that a drug rep cannot give me tools to check the sensitivity of a diabetic foot, but a lobbyist can wine and dine my "representative" to the federal government? I can understand why drug companies have been sanctioned to stop overloading physicians with what can be considered bribes. What concerns me is that the people who determined this sanction, still take "gifts" from the same companies, but it is not considered "bribes." HUH? 
 
I understand that there was a question of "influence" when a physician was provided with a fishing trip for being helpful to a pharmaceutical company. I am so grateful that this influence does not extend to our federal government - (Heavy sarcasm intended). But what can you expect of "people of power" who have voted themselves to have medical insurance superior to their constituents? They have ceased to be representatives, and are moving closer to the seat of dictatorship.

Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@gmail.com
 

RE: Obama’s Healthcare Plan (Jason Kraus)
From: Keith Gurnick, DPM

Originally, United States businesses began offering to provide health insurance coverage for their employees as a perk, to attract and retain employees without increasing their taxable income. Over time, employees felt ...   

Editor’s Note: Dr. Gurnick’s extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=29929&start=1

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

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

PM News Classified Ads Reach over 11,500 DPM's and Students

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