The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 30, 2009 #3,688 Publisher-Barry Block, DPM, JD

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PM News Tops 12,000 Subscribers

PM News has reached another milestone. This week our subscription list passed the 12,000 reader mark. PM News was founded in 1994 and initally reached about 50 Internet pioneers. It has grown exponentially over the years from several hundred to several thousand readers, and has been, since its onset,  the most widely read podiatric newsletter in the world.

PM News would like to thank all of our devoted readers and participants as well as our advertisers for making this publication possible.  

For Safer Winter Sports, Watch Your Feet: APMA President

From the downhill rush of snow skiing to placid casual skating, cold-weather sports provide a fast track for fun and cardiovascular health. But colder temperatures and the exhilarating speeds attained during such sports can also expose your feet and ankles to debilitating injuries.

Dr. Ronald D. Jensen

"Healthy feet and ankles, which act together as accelerators, steering, brakes and shock absorbers in winter sports, are not only crucial to success in competition, but also help keep the body upright and out of the emergency room. Any problems with the foot or ankle could have serious repercussions for winter sports participants," said Dr. Ronald D. Jensen, president of the American Podiatric Medical Association.

Source: NAPSI [10/28/09]
 

CT Podiatrist Charged in Illegal Prescription Scheme

Police working with the state Department of Consumer Protection arrested two doctors Monday on charges of  illegally obtaining prescription painkillers in separate cases both involving the same pharmacy, police said.

Dr. Gary N. Grippo

Dr. Gary Nicholas Grippo, a podiatrist with offices in Guilford, West Haven and Clinton, on several occasions allegedly wrote out prescriptions for Vicodin, another prescription painkiller, to people all with the first name Mary but with different last names, Assistant Chief of Police Thomas Fowler said. All had addresses beginning with No. 6, he said. The same pharmacy manager noticed the pattern and got suspicious. Fowler called the number of prescriptions "more than would appear normal."

Grippo was arrested on charges of obtaining a controlled substance by fraud and deceit and possession of narcotics, according to police records. Grippo allegedly was picking the prescriptions up himself, "saying he was picking them up for a relative," Fowler said.

Source: Pharmacy Choice [10/28/09]

Pelosi Unveils House Healthcare Bill

The House speaker, Nancy Pelosi of California, today unveiled a $894 billion healthcare package that would provide insurance for up to 36 million people by broadly expanding Medicaid, the state-federal insurance program for the poor, and by offering subsidies to moderate-income Americans to buy insurance either from private carriers or a new government-run plan.

According to the Congressional Budget Office, the bill would reduce future federal deficits by about $30 billion over the next 10 years, meeting President Obama’s demand that the health legislation not add “one dime” to the nation’s indebtedness.

The House bill would impose a new income surtax on individuals earning more than $500,000 and couples earning more than $1 million — a so-called millionaire’s tax. While Democrats have insisted that the healthcare legislation is crucially needed, Congressional Republicans warn that it will raise taxes, unwisely cut Medicare services, and increase healthcare costs overall.

Source: David M. Herszenhorn, NY Times [10/29/09]

Query: Sarapin for Morton's Neuromas?

I am curious if anyone out there is familiar with, or is using, injections of Sarapin for Morton's neuromas. A neurologist in my area has been touting this treatment for "instant, long-term" relief. I seem to vaguely remember hearing about Sarapin in school, but have no personal experience administering it.
 
David Alper, DPM, Belmont, MA
 

Query: PECOS System

With Medicare adding another bureaucratic layer to medical care, can I add a statement to the "ABN form" for Medicare recipients regarding the new PECOS requirement that states Medicare will not pay for the particular DME service if "your ordering physician is not enrolled in the PECOS system", to ensure that I don't end up giving out free diabetic therapeutic shoes starting January 1st, 2010?
 
Philip E. Larkins, DPM, Escondido, CA

RE: Transmetatarsal Amputation in a Sensate Patient (Jared Clifford, DPM)
From: Multiple Respondents

I don't think "patient request" is an indication for transmetatarsal amputation.
 
John Chisholm, DPM, Chula Vista, CA, dr_triguy@yahoo.com

Rather than being prompted by the patient to perform her surgery of choice, why not present more reasonable options? It is difficult to judge the patient's condition from only a picture and short description. I am assuming there is no neurologic component such as CRPS.  Why not straighten the toes with possible Weil osteotomies, soft tissue work, and whatever else is needed? Post-operatively place her in an L5000 for buttressing and prevention of re-deformity. With an amputation, she is going to need that filler anyway.  
 
Jon B. Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I can only imagine the long-term frustration regarding your patient's deformity. I had one patient who asked for a TMA following a crush injury which resulted in loss of her 2nd and 4th rays and painful forefoot lesions. She underwent a TMA and had no issues w/amputation/stump neuromas. However, in your patient, I would consider a couple of other surgical options. 

If you haven't already, I would propose to her as an alternative: 1. Callus distraction/lengthening of the 1st metatarsal, and then once out to length, shortening metatarsal osteotomies w/rebalancing at the level of the MTP joints. 2. Another option would be a 1st metatarsal lengthening procedure w/PMR. Both are reliable; the 1st option is both cosmetic and more functional. Neither are quick and as easy as a TMA...and that is what she may want. 
 
S. Jeffrey Siegel, DPM, Philadelphia, PA, heeldoc@verizon.net
 

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

With the tibial sesamoid almost completely lateral to the fibular sesamoid groove, I am dubious about the prospect of getting transverse plane correction with a fibular sesamoid excision. A Lapidus fusion can swing the first metatarsal over while eliminating mobility (which could cause another recurrence).

Radiographs and the lateral tracking on exam indicate that there are joint changes which would not allow the hallux to assume a rectus position once the first metatarsal is straightened. So, a head osteotomy to only correct PASA will likely be needed. When this is required with a Lapidus, I am wary of shortening the first metatarsal further. So, instead of shortening the medial cortex, I lengthen the lateral side with a chip of autologous bone graft. I use a Reverdin-Green type cut with a long plantar arm. That way, the plantar arm heals long before the bone graft incorporates, thus providing stability. Hallux varus can be discouraged by leaving the adductor tendon intact.

Richard Gosnay, DPM,  Danbury, CT glabroushead@gmail.com

I think that a Lapidus is the best solution for this bunion. A bigger issue that this brings up are patients like this who have minimal complaints yet truly need surgical correction.

It is not uncommon to have patients come in with horrendous bunions but only complain of a toenail problem, a corn between the toes, or the bump. Dr. Berman's patient is even exercising 5-6 days a week "without problems." It is difficult (and sometimes impossible) to get patients to comply with surgery that will take them off their feet, off exercise, and probably off work for a while. It is so frustrating that no matter how much we work with them to understand the need for surgery, that they just want the nail, corn, or callus trimmed. What is even more frustrating is when then return years later, stating that they are ready for surgery but their health, circulation, bone density, etc. has changed, and they are no longer good candidates for surgery by that point. I know we can't fix all of them but it would be nice to be able to help more patients like this.

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

The important considerations are correcting the high IM angle, the PASA and DASA. In my earlier days of practice, I probably might choose a base wedge osteotomy, a Reverdin bunionectomy, and an Akin. An Austin could be substituted for the Reverdin. The Reverdin bunionectomy should have a dorsal distal proximal plantar cut with the plantar cut proximal to the sesamoids. I have learned that you can get a great result just by doing a Reverdin Akin bunionectomy, an adductor tenotomy, and lateral first MPJ capsulotomy. If you increase the medial wedge cut in the Reverdin bunionectomy, you get more PASA correction. You also get considerably more IM angle correction by cutting through the lateral cortex of the first metatarsal and shifting the metatarsal head in a lateral direction. These procedures are taught in Europe, Mexico, and South American medical schools as well as in the AAFAS.

Ed Cohen, DPM, Gulfport, MS, ECohen1344@aol.com
 

RE: Effect of Custom and Semi-Custom Orthoses on 2nd Metatarsal Bone Strain (Kevin Kirby, DPM)
From: Steven Gershman, DPM

Every few years, this profession seems to get embroiled in the debate about orthotics. Those of us who work with orthotics a lot know what we see, etc. Those who don’t use them much tend to impugn them, etc.

My only addition is that we, as a profession, should be thankful for people like Kevin Kirby, who has done so much to improve our knowledge base and education about biomechanics and orthotics. Some of the letters recently have been a bit derogatory in their tone toward the work people like Kevin Kirby have done. It bothers me to see this. We are a small profession and we need to pull together and thank the people who put themselves out there to improve our knowledge.  

Steven Gershman, DPM, Auburn, ME, Obsidianom@aol.com
 

RE: Ultrasonography Course (Marc Katz, DPM)
From: Henry Slomowitz, DPM

I recently read a post from a physician who seemed to say that an ultrasound course is not needed, and you can simply learn how to do it from a book. It is statements like that...

Editor's note: Dr. Slomowitz's extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=30033&start=1

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.

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com 

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 - 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

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

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 11,500 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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