The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 30, 2008 #3,387 Editor-Barry Block, DPM, JD

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No Best Shoe for Everyone: KS and IN Podiatrists

How can one choose the best shoe to handle and ward off foot problems? First, don't assume the perfect shoe is out there. "There's a lot of hype with shoes," says Dr. Richard Stanley, a podiatrist on the Southside and a central trustee of the Indiana Podiatric Medical Association. "If shoes solved all the world's foot problems, I wouldn't be here." Nor does the fact that one shoe works for one person mean it will work for another. MBT shoes, for instance, may help a person with arthritis but render another person unstable, podiatrists say. Earth shoes may improve your posture but exacerbate tendonitis in another person, many experts agree.

Dr. Jeffrey Agricola

"It's difficult to say that you can find a universal shoe that is going to work for everybody," says Dr. Jeffrey Agricola, a surgeon with Carmel Foot and Ankle.

Dr. David Sullivan

Podiatrists are reluctant to endorse one shoe brand over another. Dr. David Sullivan, a Westfield, IN podiatrist, doesn't tend to advise his patients to purchase any special brand. "The jury is still out on a lot of these shoes," he says. "Their theories make sense on some level, but as far as being healthy for the feet and ankles long-term, it's really hard to say yes or no definitely."

Dr. Barry Wesselowski

One of the few measures of how healthy a particular shoe is comes from the American Podiatric Medical Association. That organization issues seals of acceptance to shoes that meet the standards of a committee of experts. Companies submit products to the committee and then committee members test-drive the shoes for a few weeks. They consider how the shoe wears, whether the heel is stable, and whether the shoe is too tight in the toes, says Dr. Barry Wesselowski, an APMA spokesman. "The seal is just a good place to start," says Wesselowski, a podiatrist in Independence, KS, "but it doesn't mean if it doesn't have the seal, then it's not good."

Source: Shari Rudavsky, Indianapolis Star [10/28/08]

NJ Podiatrist Receives Award for Volunteer of the Year

Dr. Hal Ornstein has been a resident of Howell, NJ for over 13 years and has been providing foot & ankle care for its residents for over 18 years. Dr. Ornstein’s passion beyond foot and ankle care has been his selfless devotion to non-profit work in the community. It is for this reason that Dr. Ornstein was given the “Volunteer of the Year Award” from the Howell Chamber of Commerce on Friday, 10/24 at the Annual Chamber of Commerce Dinner Dance.

Howell Township Mayor Joseph DiBella Presents Dr. Hal Ornstein with Award

With his family, friends and colleagues in attendance, Dr. Ornstein was applauded for his endless contributions to the Howell community and the world around it. “I have never met such a compassionate person…a person who puts others' needs first and will take his shirt off to help others,” said Sara Andreyev, president elect of the Howell Chamber of Commerce.

Artificial Joints: Payments to MDs from Manufacturers Continue

A federal criminal investigation settled last year placed a "temporary halt on the paychecks of several thousand doctors who were moonlighting as consultants" for medical device companies, but the "money is flowing again," the Chicago Tribune reports. Under the settlement, several of the largest U.S. manufacturers of artificial hips and knees agreed to pay $310 million in penalties to resolve allegations that they used unethical and illegal business practices to encourage surgeons to use their products. The companies, which admitted no wrongdoing, also agreed to follow new compliance procedures under federal monitoring for 18 months (American Health Line, 9/28/07).

Despite the settlement, "between buying out old contracts and inking new ones under stricter compliance standards," the amount paid by the companies to surgeons "could be bigger than ever," and critics "see trouble ahead for patients, who they say have no effective way of evaluating how the financial stakes shape their treatment," according to the Tribune. However, "even critics see a big difference between doctors demanding a kickback and those sharing in the profit from developing a new product or procedure," and to date "federal investigators have failed to spell out the extent of criminal activity in the hip and knee industry, leaving open the possibility that payola was the exception, not the rule," the Tribune reports.

Source: Greg Burns, Chicago Tribune, [10/26/08] via American Health Line [10/28/08]

Query: Fixation S/P Fracture in Diabetic

My patient is a type II well-controlled diabetic, active 67 year - old female, 155 lbs who dropped a "few books" on her left foot. She sought treatment after 2 weeks of walking on the injury. There was a minimally displaced transverse fracture of the proximal aspect of the 2nd metatarsal as seen on x-rays, initially.

2nd Met Fracture in diabetic at 6 weeks

The x-ray you are viewing is status/ post 6 weeks injury. She was unable to have surgical intervention at the time of the injury and was amenable to CAM walker/minimal ambulation X 4 weeks ). I see no interval bone healing and have recommended ORIF. What type of fixations, pins/plates/screws would you consider and specifically what type of plates has anyone had experience with given the location of the fracture and patient's active lifestyle?

Dale Berkley, DPM, Trenton, NJ

Query: Neuroma Excision and Nerve Implantation

Can someone tell me what the proper CPT would be when a neuroma excision (CPT 28080) is performed, and the distal end of the common digital nerve is fed through and sewn into the intrinsic muscle at the site? Is the nerve "implantation" considered a second procedure?

Teresa Roll, Office of Chris Byrne, DPM, San Luis Obispo, CA

Response: The code is CPT 64787 - implantation of nerve end into bone or muscle (list separately in addition to neuroma excision).

It is an "add-on" code, and, as noted in CPT, you would code it separately from the neuroma excision code. Add-on codes are "listed procedures commonly carried out in addition to the primary procedure performed...Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. All add-on codes found in the CPT codebook are exempt from the multiple procedure concept."

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found here

RE: 4th Ray Resection or Transmet? (Jeffrey Kass, DPM)
From: Multiple Respondents

In all likelihood, your 4th ray resection would not hold up over time for the reasons you alluded to. Based on the clinical information and radiograph presented, a transmetatarsal amputation would be the prudent choice. You might consider a TAL at the same time to off-load the forefoot.

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

I would perform a transmet amp with a tendoAchilles lengthening, assuming the vascular status is adequate for healing. Be sure to create a nice plantar flap for the closure. Subsequently, provide the patient with a well-made orthotic with filler and extra-depth shoe. I think anything less than a TMA will only set the patient up for further breakdown.

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

I suggest Dr. Kass perform a percutaneous distal 4th metatarsal osteotomy.

Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net

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

At a recent Wright Medical Conference, I posed the question about cracking the lateral cortex during distraction for the 5 and 6 mm. plates. The answer was that the instructors have all cracked the lateral cortex when using a high wedge. The moral of this story is that it is not the end of the world if you crack the lateral hinge, even though you would love to keep it intact. When using it for a high IM angle correction (that I reserve this procedure for), the risk of lateral disruption is high, but the locking plate system and careful placement fixation is strong enough to hold the osteotomy intact. Proper weight-bearing is allowed without a problem (for me it's 4 wks since I'm still not brave enough for immediate WB when the lateral cortex is disrupted).

Arthrex actually discuss the use of a dorsal plate when you crack the lateral cortex, again I have not had to do that and still get appropriate stabilization. With Arthrex plates, I keep them NWB for 8 wks though. This procedure and plating system from Wright is constantly being improved upon. The recent addition of OLIVE wires adapted from the Ilizarov set has been of great help in temporary fixation.

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

RE: Hospital Credentialing (Paul Bishop, DPM)
From: Multiple Respondnets

I am on the credentialing committee of my hospital. The rules are the same for all medical specialties. To come on staff at my hospital you have to be board certified by a medical specialty board recognized by the council on education of the AMA, APMA or the ADA. If you are coming out of a residency, you have three years to become board certified in your specialty or you must resign from the staff.

As for the unboarded big name doc: We recently had a doc from another town, chairman of his department (medicine), in practice for many years, not boarded, apply for privileges. He was told that he did not qualify for our medical staff and that a refusal of privileges is a reportable event to the state board of medical examiners. He withdrew his application.

We also had someone apply for podiatry privileges several years ago with a non-surgical podiatry residency. We told him he could come on staff, but he wouldn't be allowed in the OR.

Myron Bergman, DPM, Somerville, NJ, mbergmandpm@aol.com

Editor’s Note: Additional extended-length letters by Drs. Lazar and Markinson can be read at: http://www.podiatrym.com/letters2.cfm?id=22838&start=1

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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

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 -- 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 Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail Visit our website

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

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

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