The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 02, 2007 #3,082 Editor-Barry Block, DPM, JD

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We’ve just posted the November CME titled “"Towards Better Management of Diabetic Foot Complications" By Kenneth Rehm, DPM

Running NYC Marathon No Impediment for TX Podiatrist With Cerebral Palsy

Running 26.2 miles isn't easy for anyone, but Dr. Trisha King takes on that challenge with another hardship. "I don't have much movement in my right hand and my right leg is weaker," said King. She was born with cerebral palsy, a neuromuscular disease with no known cure.

Dr. Trisha King

It takes a little longer for King to tie her shoelace, but chances are she'll still beat you to the finish line. "Because of my right hand they don't think I can do it and can't believe I'm trying to do it. I've proved them wrong so far and plan on proving them wrong throughout my whole life." Against the odds, she ran track and cross country in high school, and finished her first marathon in 2003. This weekend she'll compete in the New York City Marathon, with hopes of qualifying for Boston, the runner's holy grail.

As a mother, and a podiatrist, King hopes her story will inspire others. "A lot of time they're coming in for a problem when they see that I have a problem they like that and they know I can sympathize with them," said King. "You can overcome a lot of things."

See video at http://everythinglubbock.com/media_player.php?media_id=5683

Source: Lauren Murphy KLBK-CBS 13 (TX) [10/30/07]

Feet Need Protection From MRSA Infections: NY Podiatrist

Dr. Andrew Shapiro, a Trustee and chair of the public relations committee for the New York State Podiatric Medical Association, advises that feet should not be overlooked when maintaining personal hygiene to avoid MRSA.

Dr. Andrew Shapiro

MRSA--the acronym stands for Methicillin Resistant Staphylococcus Aureus—is an antibiotic-resistant form of the very common S. aureus bacteria. It is spread by personal contact and can enter the body through open sores or wounds. “It doesn’t make sense to be an alarmist, nor is it wise to overlook basic measures that may provide protection. These measures should include our own two feet,” Dr. Shapiro says.

“If you have a pedicure, make sure the salon is clean and that the water is fresh. Bring your own instruments. If that’s not possible, make sure what is used on your feet is either new or completely sterilized. Do not allow cuticles, calluses or corns to be cut. If you want these treated, see a podiatrist,” says Shapiro.

Lobbyists Seek Quick Action on Payment Rate Fix

Physician groups are pushing members of Congress to work quickly on passing legislation to avert a 10% Medicare physician reimbursement rate cut scheduled to take effect on Jan. 1, 2008, The Hill reports (Young, The Hill, 10/31). The Senate Finance Committee is discussing a Medicare package that could prevent the scheduled payment cut and provide subsidies for rural and low-income seniors.

Lawmakers have assured physician lobbyists that the payment fix bill will not be pushed to 2008, and a Finance Committee spokesperson said that Chair Max Baucus (D-MT) "is diligently working on completing robust Medicare legislation" before the end of 2007. However, one lobbyist said that it is "pretty uncertain at this point" whether the bill will be in place this year. Another lobbyist said, "I expect it's going to be the last vote on the last day" (The Hill, 10/31).

Source: The Hill via American Health Line [10/31/07]

Query: Identification and Identity Theft

We have recently experienced several new patients in our office refusing to provide personal information such as social security numbers or driver's license numbers out of identity theft concerns. I am tempted to instruct my staff to accept these patients on a cash only basis, in so much we would have little recourse in a potential collection action. I am curious as to how others are dealing with this phenomena.

Stefan Feldman, DPM, Westlake Village, CA

Editor’s note: PM News does not supply legal advice. The issue of what ID can be requested is a tricky one because some states prohibit merchants from requesting driver’s licenses or Social Security numbers.

What you can and should request is an insurance card and some sort of photo ID. If patients can’t (or won’t) produce this information, you can certainly accept cash or you can politely let them know that the office policy is designed to protect both you and them from insurance fraud.

RE: Plantar-Flexed Halluces (James Fisher, DPM)
From: Multiple Respondents

It is oftentimes not advisable to place an implant into a joint with deformity secondary to neurologic disease. Subclinical polio with bilateral symmetrical presentation is very unlikely. The EHL is primarily L5 innervated,and a lesion affecting this nerve root is a consideration, although again, bilateral symmetrical presentation unlikely.

Consider anatomic variation (MRI, CT to define the EHL, EHB). If anatomical variance is causative, consider appropriate tendon transfer (eg- EDL to bone or EHL) with appropriate arthroplasty and/or osteotomy, or arthrodesis.

If anatomical variation is not causative, and you have objective reason to suspect a neurologic disorder of lower motor neuron etiology, perform or have performed a neurologic examination prior to implant arthoplasty or indeed any surgical intervention. The nature, extent, and progressive nature of such disorders will determine to a large extent what if any surgical interventions are appropriate.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

I had a similar case that actively plantar-flexed in stance, causing chronic ulcerations. I would send the patientt for a neuro consult, just to protect yourself. Then, if he is a candidate, fuse the hallux in mild dorsi-flexion. A fusion would give a permanent solution.

Tim Kemple, DPM, Derry, NH, tkemple@comcast.net

The surgical goal is to make him walk comfortably. In my experience when dealing with neuromuscular deformities it is best to fuse. A1st MPJ fusion will solve his problem. A total joint implant will fail quickly and you will ultimately need to do a (much more difficult) fusion.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

I would be hesitant to place bilateral implants in a 25 year old male that appears to have a functional hallux limitus. An arthrodesis of the joint would place it in a proper functioning position without the long term concerns of implant failure or continued plantar draw of the phalanx on the metatarsal head.

Robert M. Przynosch, DPM, Asheville, NC, przynosch@bellsouth.net

Editor’s Note: An extended-length letter from Dr. Mullen appears at:
http://www.podiatrym.com/letters2.cfm?id=16388&start=1

RE: Allied Lab/ Dr. Comfort Workshop
From: Marc G. Mittleman, DPM

I attended the Allied Lab/Dr. Comfort free workshop at LAX this past Saturday. It was the type of workshop that should be repeated from time to time. Harry Goldsmith, Doug Richie, and Bret Ribotsky are all very knowledgeable in their areas of expertise.

I always come away with one or two practice pearls from these things and it helps to jumpstart my focus on the things that matter, providing excellent patient care while making a living in these ever more difficult times of falling reimbursements and competition from other forces. Even after 25 years of practice, we can all learn and implement something new.

Thanks for organizing and/or supporting these types of events...I am surprised that more colleagues do not take advantage of these great programs.

Marc G. Mittleman, DPM, Torrance, CA, drmgm@verizon.net

Editor’s note: If you enjoyed this small group workshop in Los Angeles, you're going to love the small group workshop put on by Codingline-PM News-AAPPM immediately following the 2008 APMA Seminar...on The Big Island, Hawaii. See www.podiatrym.com/hawaii for details...both Harry Goldsmith, DPM and Doug Richie, DPM will be there with a host of other speakers and expert panelists.

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PRACTICE FOR SALE -VENTURA, CA

Satellite office in Ventura, CA. Located very close to the hospitals and referral sources. Potential for further future growth. Nice coastal community and nice weather all year around. Inquire at tkhk@sbcglobal.net

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