The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 03, 2008 #3,364 Editor-Barry Block, DPM, JD

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PA Podiatrist Offers Tips on Preventing Athlete’s Foot

"Dark" and "moist" are good words for chocolate cake, but not for your feet. Dr. Ira Meyers, a podiatrist in Huntingdon Valley, PA, warns that runners and other athletes who have an affinity for not-quite-dry shoes are at risk for athlete's foot.

Dr. Ira Meyers

Some tips: When you finish a workout, don't leave your shoes in a dark, damp place. If you need a quick turnaround, stick newspapers or paper towels in them to soak up wetness.

Post-workout, wash and dry your feet thoroughly before putting on a fresh pair of socks, he says. Powders or sprays — before and after runs — also help eliminate the funky stuff. And if you have athlete's foot, don't wait: Get an over-the-counter treatment with a fungicide.

Source: Nick Sortal, South Florida Sun-Sentinel [10/1/08]

60 NYCPM Students Volunteer at ADA Diabetes Expo.

Last Saturday, sixty NYCPM student volunteers from the Classes of 2009, 2010 and 2011 donned their white coats at the American Diabetes Association's Diabetes Expo, held in New York's Javits Center, and performed more than 200 foot screenings for Expo attendees. More than 400 people stopped by the Foot Clinics of New York/NYCPM booth to ask questions and to pick up informational literature.

NYCP Volunteers at ADA Diabetes Expo

Supervising the volunteers were NYCPM faculty members Anthony Iorio, DPM, Associate Professor and Chair, Department of Community Health and Medicine, and Assistant Dean for Continuing Medical Education; Johanna Godoy, DPM, Instructor of Surgical Sciences; and Khurram Khan, DPM, Clinical Assistant Professor of Podiatric Medicine.

Medicare Publishes Billing Edits to Reduce Payment Errors

The Centers for Medicare & Medicaid Services has announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments. CMS established the MUE program to reduce payment errors for Medicare Part B claims. Claims-processing contractors utilize these edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims.

These edits check the number of times a service is reported by a provider or supplier for the same patient on the same date of service. Providers and suppliers report services on claims using HCPCS/CPT codes along with the number of times (i.e., units of service) that the service is provided. Prior studies, including one by the U.S Department of Health and Human Services’ Office of the Inspector General in May 2006, identified significant Medicare overpayments because provider or supplier claims sometimes report services with too many units of service. These errors may be caused by numerous factors, including clerical errors and coding errors.

CMS first implemented the MUE program January 1, 2007, with edits for about 2,600 HCPCS/CPT codes. There have been quarterly updates adding additional codes. The October 1, 2008, version of MUE will contain edits for about 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. CMS has not yet determined if there have been any savings in the MUE program since it was implemented.

Source: CMS

7 Steps to Responding to Criticism- Part 2

Share this process with your staff to increase everyone's ability to absorb and profit from corrective feedback:

• 5 Assess the benefits of sharing your perspective. Don't start an argument or delve too deeply into a trivial issue. Sometimes, the wisest course is to accept criticism in the spirit it was offered. At other times, you may wish to share information that changes the patient's view of the situation. If you do so, offer your viewpoint in a courtesous and helpful fashion, without denying the patient's right to a different viewpoint.
• 6. Apologize if necessary. Remember, An apology is not necessarily an admission of guilt. You can sincerely regret an inconvenience without taking responsibility for causing it. Simply say, I am sorry that happened; that was not my intention."
• 7. Respond. What will you do after having heard the patient's feedback? Explain how you will act differently in the future.

Source: Adapted from TLC at Work: Training, Leading, Coaching All Types for Star Performance by Donna Dunning.

Query: Unusual Case of Cellulitis of the Left Fifth Toe

Last week, a patient presented with a painful, swollen left fifth toe. Her history is that she tried cutting a corn in the bathroom and three hours later the toe swelled up. Examination revealed an edematous, hot, red toe. The cellulitis ascended to the MPJ. There was a feeling of flocculence in the toe. There was no portal of entry anywhere near or on the toe. I palpated fluid in the joint. My differential diagnosis was infection or acute gout. I placed her on two antibiotics and drained the toe. A copious amount of white creamy non-odorous, material came out, which appeared like either tophaceous material or an exudate. I ordered a Gram stain, aerobic and anaerobic cultures, and sent an adequate amount of the material to pathology to examine for abnormal cells and gouty crystals. Today, the toe is almost totally better.

Clinical problem: The Gram stain was negative for any micro-oganisms. Some white cells were present. The blood tests were normal, including the CBC and uric acid. There was no growth in the culture, and today the path report came back - no sign of gouty crystals, uric acid or any abnormal cells - nothing! This did not clinically mimic an inclusion cyst. Any feedback?

Elliot Udell, DPM, Hicksville, NY

Query: Creaking Midmark Chair

I have a Midmark chair that creaks when un-tilting the patient. It does not creak when tilting, although it is not completely smooth. Usually, the heavier the patient, the more it creaks. I've tried WD40, lithium grease, and a light oil without improvement. I called Midmark and had them listen to the sound, but they could not figure it out. I had a medical equipment repairman take a look, and he wasn't sure. He thought it might be the actuator, and said it might break tomorrow or years from now, but to use it until it breaks. The chair is 8 years old. If anyone has encountered this problem, I would appreciate any advice.

Philbert Kuo, DPM, Chesapeake, VA

RE: HAV, Hammertoes, and Met Adductus (Joseph S Borreggine, DPM)
From: Multiple Respondents

This case will not do well with your proposed Austin bunionectomy and arthroplasties. In addition to the first metatarsal, the lesser metatarsals must be aligned with corrective osteotomies. Interphalangeal arthrodesis of the digits would also offer a more stable correction.

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

I would recommend distal osteotomies of the 2nd and 3rd metatarsals with lateral displacement to re-align the joints. You may need to add a 2nd and 3rd MPJ capsulotomy. I would place pins through the toes, across the MPJ’s, and I would fixate the osteotomies. You will then have room to do a distal osteotomy (Austin) with screws and re-align the 1st MPJ.

Howard Stone, DPM, Glenview, IL, drstone@nspodiatry.com

I would absolutely correct the MTA. Then, the bunion would be amendable to a modified McBride/Akin. In addition to the obvious soft-tissue work around the lesser MTP joints, I have have very good success with medial closing wedge phalangeal base osteotomies for digits 2-4. Two small drill holes and 2.0 prolene for fixation is all you need. I have done tendon transfers, head rotation and shortening osteotomies, medial closing met. head osteotomies - none has been as easy, predictable and has passed the test of time as the phalangeal base procedures.

S. Jeffrey Siegel, DPM, Long Beach, CA, heeldoc@verizon.net

RE: Skin Discoloration over Post-op Site (Josef Geldwert, DPM)
From: Simon Young, DPM

Would anyone entertain a skin biopsy to r/o melanoma before considering a screw metal reaction?

Simon Young, DPM, NYC, simonyoung@juno.com

RE: Disabled Patients in the Office
From: Michael M. Rosenblatt, DPM

Many years before I was a podiatrist, a friend of mine brought in his very elderly grandmother who had a badly infected toe to see Matthew Borovoy, DPM in the Detroit area.

The elderly woman spoke only Yiddish and couldn't walk at all. My friend Neil (now a retired language professor) told the staff that his grandmother couldn't get into the office. Dr. Borovoy walked outside and gently lifted the elderly lady into his arms, put her on a treatment chair, and treated her. He offered to help her to get back home if Neil could wait until the lunch hour.

He then gently deposited her back again in Neil's car. When Neil told me about this, later on that day, he was in tears.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

PODIATRISTS NEEDED - CHICAGO -- NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

PRACTICE FOR SALE -CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way with 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. For additional information contact QVAN@aol.com or 305-975-5516.

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

TIMESHARE – MOTIVATED SELLER

Golfer's paradise in Myrtle Beach, S. Carolina! Click here for details! Great for family vacations. Fixed deeded week. Beachfront resort, RCI Exchange, price reduced...DPM special...must sell! $13,500/or bo. Timeshare points also available. Contact footfixr@consolidated.net or 1-800-366-8397

CASE CONSULTING

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 – CONNECTICUT

Full or part-time position available for a podiatrist licensed in CT. This practice encompasses wide variety of patients including Diabetic wound care and general podiatric care. Must be willing to cover all aspects of the practice including nursing homes and house calls. Please e-mail CV to RPMDPM@aol.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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