The Voice of Podiatrists

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October 28, 2008 #3,385 Editor-Barry Block, DPM, JD

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NY Podiatrist Discusses Bunions

Bunions, if you have one you know because you have to pass up those fancy shoes that offer no comfort, yet only style. “A bunion is a deformity of the foot where the bones are misaligned so what ends up happening is you have these two bones that should be parallel and one of them starts to shift in and causes the big toe to come inward," said podiatrist Dr. Jennifer Hutton. The force of the bones pulls on muscles and tendons that insert into the big toe and causes it to pull, and a bump forms on the side of the foot. It affects children, women and men.

Dr. Jennifer Hutton

“We do find that of most of the men who come in have larger bunions because men have a lot easier time finding a shoe to fit them in. So usually, when the men get really severe or really bad, they are coming in with a lot of pain. The shoes that women wear are narrow and pointy, so they can have very small bunions and have pain,” Hutton said.

Conservatively, depending on the pain, we use ice and anti-inflammatories. If it is just that the bump is hurting in a certain shoe sometimes we will pad it. Besides that, if it comes in and somebody has terrible pain, we give cortisone injection just to get it to flare down, but it’s no getting rid of it,” said Hutton. In mild cases, the side bump can be surgically removed. Moderate cases involve more surgery of the bone.

Source: Marcie Fraser, TWEAN News Channel of Albany (NY) [10/26/08]

Heartland Podiatry Conference Uses Interactive Video

The Heartland Podiatry Conference is proving to be a leading course in podiatric medicine and surgery. This year’s annual conference was hosted by the Iowa Podiatric Medical Association and included 370 participants from multiple states in the region. The keynote address was given by Warren Joseph, DPM who highlighted current and future therapies for skin and nail infections. Dr. Joseph noted the field may be much different in the near future as research is concentrating on devices for onychomycosis, such as microwave therapy and single dose laser treatments.

Dr. Armstrong presents a case live from the University of Arizona.

The conference also featured David G. Armstrong, DPM, PhD. who lectured from his office at the University of Arizona using Apple’s iChat technology. Dr. Armstrong presented a case live from the University’s hospital which included photos, and a question and answer session.

Pressure of Medical School Has Many Contemplating Suicide

More than 2,200 medical students from seven medical schools participated in a recent study on whether they had suicidal thoughts.

Source: "Burnout and Suicidal Ideation among U.S. Medical Students," abstract, Sept. 2, Annals of Internal Medicine

Gift Etiquette

A professional associate - a patient - a physician you refer to - has given you a gift. Should you open in front of the person who gave it to you?

Business etiquette expert Ann Marie Sabath says that you should not. "Avoid opening the gift unless the person encourages you to do so." In fact, Sabath says, while most Americans are comfortable with opening gifts immediately, doing so is considered rude in many cultures. Reason: If you exchange gifts and your gift is of higher value, the other person could be embarrassed.

Source: Adapted from One Minute Manners: Quick Solutions to the Most Awkward Situations You'll Ever Face at Work by Ann Marie Sabath

Query: Ketamine/Ketoprofen/Gabapentin Topical for Treatment of Neuropathy

A patient presented with a topical gel from a local compounding pharmacy consisting of ketamine 10%/ ketoprofen 10% /gabapentin 6%. I have never written for this compound, but this patient was very pleased with the relief it has given her, stating that her neuropathic pain was much improved within the first 24 hours of use. Has anyone here written for this compound regularly? What has been your experience with it?

Nat Chotechuang, DPM, Bend, OR

Query: Hospital Credentialing

I have been asked by one of my hospitals to gather credentialing information specifically regarding non ABPS boarded applicants. I would like to hear from other DPMs who are familiar with the credentials process who have encountered applicants who are certified by an alternative board to ABPS. What do you do in a circumstance where an applicant is "world renowned" as a foot and ankle surgeon, but not ABPS certified or qualified? Have your hospitals granted practice credentials to non-ABPS or non-APMA recognized board certification / qualification?

Paul Bishop, DPM, Yorkville, IL

RE: Plate System for Osteotomy (Jason Serpe, DPM)
From: Ira Weiner, DPM, Kevin Lam, DPM

I have used the Wright medical BOW plate on several occasions and it has become my plate of choice. There are some caveats with it though. First and foremost, it is not all that easy to make the cut. It has to be done slowly and carefully, so as not to fracture the lateral cortex. Fracturing the cortex can literally become a disaster, but when done correctly, the results are completely reproducible. Second, you should also use some type of bone filler with it to fill the void created by the plate. I have used Wright Medical Allomatrix for this and it works extremely well. Finally, Wright Medical indicates you can have the patient bear partial weight after the procedure. Frankly, I am not that brave, and prefer to cast the patient.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

I have used both the Arthrex and Wright medical plate. I'm more of a fan of the Wright medical plate for one main reason: 1) the screws are locking, thus have better stability, thus earlier WB. I do the like the Arthrex instrumentation, but I have found the screws to be weak, especially the long stabilization screw. It is a wonderful plate, but I am worried about early WB with this plate since it is not locking.

The one problem that Wright Medical is working on currently is to get a better distractor in preparation for the plate. Correction is 2 degrees for every mm. of wedge. I usually pack the space with Allomatrix. It works wonders. The learning curve is in the use of a locking plate itself. But once you've done one, it's a 30 - 45 min procedure, and very powerful.

Common pitfalls and pearls:
1) not locking the "bullets / guide" all the way tight prior to drilling.
2) Use the Olive wires in the Wright set to temp stabilize the plate prior to drilling.
3) Do not over-tighten the locking screws because the plate is titanium, and you can sink the screw and ruin the locking mechanism.
4) I like to stabilize the proximal two screws, since that is most stable. Then carefully fixate distally. Once you drill, you can't take it back at all.

To be fair, Arthrex does have a great product, but I'm just a sucker for the stabilization, low profile that locking plates offer.

Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

RE: Corticosporin Otic Suspension Discontinued (Richard Rettig, DPM)
From: Hal Ornstein, DPM

All the podiatrists in our practice stopped using Corticosporin otic solution when performing a matrixectomy several years ago due to the excellent results we got with use of AmeriGel wound dressing. It is much more convenient for the patient, with no soaking and once-a-day application. Outcomes are significantly improved with less redness, infections, pain and drainage. The Oakin in AmeriGel Wound Dressing provides the antimicrobial properties to fight off and kill the most common infections, and helps to remove debris. Amerx has packaged the AmeriGel nicely in a small box that includes gauze, Band-aids and wound wash. It is nice that we can add to the bottom line since Amerigel is not a prescription product and patients love that they save a trip to the pharmacy.

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

PRACTICE FOR SALE – DALLAS TEXAS

10 year old practice for sale. All phases of podiatry: routine care, diabetic foot care, surgery, etc. Grossing $185,000 on three days per week. Could easily be full-time. Located in busy shopping center. Great Potential. Start making money from day one!! Owner will stay for transition. All serious offers considered. MUST SELL!! please respond to: footdoc8390@yahoo.com

SUBLET SPACE WANTED - NORTHERN NEW JERSEY

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

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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