The Voice of Podiatrists

October 31, 2006 #2,728 Editor-Barry Block, DPM, JD

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Diehard High Heel Wearers Can Develop Shortened Achilles: WI Podiatrist

This season's towering heels can bring with them a host of foot problems if you aren't careful, area foot specialists warn. "As soon as you take a heel, make it narrow and add over two inches, it increases the pressure to the ball of a foot, which changes the way a woman walks and increases the likelihood of that person developing foot problems," says Dr. Theresa Schinke, a podiatrist with Northeast Wisconsin Foot and Ankle Associates in Appleton.

Dr. Theresa Schinke

High heels, when worn regularly, can cause back problems, joint injuries, calluses and pinched nerves, to name a few, Schinke said. There's also the "pump bump," a bony deformity that can develop on the back of the heel over time due to chronic pressure and irritation. And the real high-heel diehards also are at risk of developing a shortened Achilles tendon, making it difficult for them to wear flat shoes.

Source: Wendy Harris, Appelton Post-Crescent, [10/28/06]

SD Podiatrist Conducts Successful Shoe Drive

The Yankton Middle School lunchroom was filled with people for the distribution of free shoes and coats. Saturday's event distributed 315 pairs of shoes. Yankton podiatrist Scott Shindler, who initiated the shoe project about 15 years ago, spent Saturday properly fitting people for shoes.

Dr. Scott Shindler

In the course of his practice, Shindler said he saw the need for donated shoes for both warmth and hygiene. "There are a lot of people who walk around in the cold weather without proper shoes, or they have holes in their shoes," he said.

The shoe project was combined with coat collections at Webster School, which in turn has been adopted by the entire Yankton School District, Shindler said. Homerooms in the high school and middle school receive points for each coat and pair of shoes, with the winning homeroom receiving a pizza party. The students' effort has brought a dramatic rise in the number of children's shoes, Shindler said. "When we got the schools involved, it was great. Now, we have two or three tables of small shoes."

Source: Randy Dockendorf, Yankton Press and Dakotan [10/30/06]

Phyiscians Warned About Investing in Medical Devices

The HHS Office of Inspector General (OIG) says in guidance released Oct. 18 that physician investments in medical device manufacturers and distributors should be "closely scrutinized" under fraud-and-abuse laws. Rapid growth in the number of physician investments in medical device and distribution entities, such as group purchasing organizations, has caught the eye of OIG, which notes the big risk of "improper inducements between and among the physician investors, the entities, device vendors, and device purchasers."

The small-entity investments safe harbor has a condition that "limits safe harbor protection to entities that derive no more than 40% of their gross revenues from investors, such as physicians," notes OIG. "While safe harbor protection requires strict compliance with all safe harbor conditions, the conditions listed in the safe harbors are relevant to the analysis of physician and other joint ventures under the fraud and abuse laws. As noted in the discussion of joint ventures in our Supplemental Compliance Guidance for Hospitals (equally relevant to medical device manufacturers, distributors, and others), the fact that a substantial portion of a venture's gross revenues is derived from participant-driven referrals is a potential indicator of a problematic joint venture."

Source: Report on Medicare Compliance [10/23/06]

Query: Name For Lesion?

What do you call the keratotic tissue that forms along the plantar lateral surface of the hallux and the plantar medial surface of the fifth toe when there is a valgus(hallux) or varus (fifth toe) deformity of these digits that causes a sharp angle between the plantar skin and medial skin (fifth toe) or lateral skin (hallux)? The keratosis forms right at the apex of the angle. It can also happen to the middle three digits if there are similar deformities causing the sharp angulation on weight-bearing and in narrow-front shoes.

Bryan C. Markinson, DPM, New York, NY

Query: Wisdom Problem

I use Wisdom podiatry software and Cerner as my vendor. I am having problems obtaining reports after transmitting my claims to a clearing house – McKesson. Is anyone else out there having a problem and if they did and have corrected it - how so?

Tom Cerillo, DPM, Bronxville, NY

RE: Screening For Hypertension
From: Eric J. Lullove, DPM, Elliot Udell, DPM

The "practice" of medicine, regardless of it being podiatric, general, surgical or even pediatric, warrants the taking of vital signs at each patient encounter. Whether or not it "bullet points" the E/M is irrelevant. We as physicians should be routinely taking BPs, Pulses, height, weight, etc. regularly as part of our in-office management of each patient.

Not only is it good medicine, but it is the right thing to do! You can even take it a step further and glucose meter every diabetic in your practice when they come in.....you would be surprised to find how many of your "wound" patients do not heal because their glucose was over 200 mg/dl on a finger stick screen!

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

I see both sides of this controversy. On one hand I agree with Dr. Levy that podiatrists can be of great public service by picking up cases of hypertension and referring the patients to the appropriate healthcare professional. There are even sophisticated yet inexpensive devices on the market which give a fairly accurate screening of a persons blood pressure without having to use a stethoscope.I thinking about buying this device and doing routine screenings in the office. Kudos to Drs. Ribotsky, Cozena and others for performing this good service . I also understand the viewpoint of others who feel that it not necessary for a patient visiting a podiatrists to have his or her blood pressure take at that time and place. My ophthalmologist, allergist, dermatologist and ENT specialist do not take my blood pressure when I come in for an evaluation or treatment.

There is another part to this controversy. The management of hypertension is not a cut and dry matter. There are many causes of high blood pressure and sometimes anxiety, even the anxiety associated with visiting a doctor for the first time, can make a persons pressure rise. Telling that person that they have hypertension could increase their level of anxiety. There are also differences in opinion among medical professionals as to what constitutes treatable hypertension and to what degree the pressure in a given patient should be controlled and to what extent. To tell a patient they have high blood pressure when the internist has him at optimal control is opening up a can of worms. Treating hypertension is as much of an art and science as controlling pathomechanics in a patient’s foot.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Ed Note: This topic is now closed.

RE: Bariatric Surgery Referral
From: Gary S. Smith, DPM

I practice in a town where the the local hospital has been doing bariatric surgery for five years. I have treated many post bariatric patients. Many of them sit in my office sobbing as they tell of their personal experience and the overwhelming majority say they would not do it again. People that are over weight have an addiction to food just as an alcoholic does alcohol or a sex-aholic does sex. If surgically removing most of the stomach and some of the small intestine (via by-pass) is a medically sound principle in food addicts, then surgeons should be able to cut things out on alcohol or sex addicts as well. This is obviously poor medicine. Since food addiction is not adequately addressed following these procedures, many patients become prescription pain pill addicts. Many patients have gone on to have a myriad of odd physical symptoms after the surgery that may be the result of mal-absorption of minerals or vitamins. Nobody has been able to pin it down. There are plenty of unknowns and concerns with this procedure that suggest more research needs to be done and it is something that should definitely not be recommended by us.

Gary S. Smith, DPM, Kane, PA, penndoc@verizon.net

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