The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 03, 2007 #3,083 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We’ve just posted the November CME titled "The Use of Epidermal/Dermal Replacement Therapies and Combined Replacement Matrices " By Linnie Rabjohn, DPM

You can Earn 30 CPME-Approved CME Contact Hours Online

Singapore Podiatrist Offers Advice to High Heel Wearers

A common problem faced by those who wear high heels a lot is accommodative shortening of the calves, which shrink in length and can result in chronic Achilles tendon and calf pain. This is why some women who have worn high heels for a long time cannot wear flats - their calves will not stretch that far.

Dr. Tye Lee Tze

Podiatrist Tye Lee Tze, who runs The Podiatry Centre at Tanglin Place, has a suggestion: Wear your heels from the house to the car, but take them off in the car. Or, if you're sitting at a table, slip out of your shoes discreetly. Or you could opt for sensible and comfortable shoes that have lower, broader heels and a wider toe box.

You can also do some exercises to help your feet deal with these fashionable heels. Tye recommends stretching the calf muscle and the Achilles tendon to counter the pain. If the pain is located in the heel or the arch of the foot, try rolling a golf ball under the arch with reasonable pressure for approximately five minutes with each foot. You can also place a towel on the ground and scrunch it up with your toes. Once you get accustomed to this, try scrunching up the towel with a small book placed on it to act as a weight. Then progressively move to a bigger book. You can also pick up objects with toes.

Source: Asian One [10/30/07]

Mandracchia Elected IA President

Vincent Mandracchia, a doctor of podiatric medicine and chief medical officer of Broadlawns Medical Center, has been elected president of the Iowa Podiatric Medical Society.

Dr. Vincent Mandracchia

Mandracchia was elected to a two-year term by the members of the state society at the 2007 Heartland Podiatry Conference in Des Moines.

Source: Des Moines Register [10/31/07]

Exercise Prevents Diabetes: Report

Exercise is even more important than weight loss for prevention or control of diabetes, according to a report from the Australian National University in Canberra (Medicine and Science in Sports and Exercise, September 2007). Dr. Richard Telford concludes that obesity is associated with, but does not cause, diabetes, heart disease and premature death. The health benefits of exercise include increasing cells' ability to respond to insulin, lowering blood sugar levels, and preventing all the side effects of diabetes. Weight loss is not necessary for a person to gain these benefits from an exercise program.

Most cases of Type II diabetes are caused by inability to respond to insulin. Strengthening muscles makes cells more responsive to insulin (Diabetes Care, September 2007). Your ability to respond to insulin depends on the ability of muscles to burn oxygen without producing excessive free radicals (called oxidative capacity). When you convert food to energy, you produces free radicals that can damage the DNA in your cells to shorten life. Exercise causes cells to burn food for energy more efficiently, without producing large amounts of free radicals.

Source: Dr. Gabe Mirkin's Fitness and Health e-Zine [11/4/07]

Query: Assessing Risk of DVT/PE

After 25 years in practice, I experienced my first case of a fatal pulmonary embolus in a 43 year old healthy active non-obese female with no previous surgeries of any kind and no varicose veins. She only took Synthroid and birth control pills. She died 17 days after bilateral cheilectomy of the 1st MPJ. She had no symptoms of DVT other than mild pain in the left calf on post-op day 10 that she attributed to wearing the surgical shoes which were lower heeled than most of her shoes.

How do you assess risk for DVT/PE in your patients? What preventive measures do you take (e.g., Lovenox injections, sequential compression devices)? I have gained a new appreciation of the risks of elective surgery.

Jane E. Graebner, DPM, Delaware, OH

Query: Fee Allowances for Diabetic Shoes

I am getting ready to bill A5500 (off-the-shelf diabetic shoe) and A5512 (multi-density insert molded to foot with heat) codes, but cannot find the allowances for these codes under the Medicare fee schedule.

I would appreciate someone letting me know where to look or let me know the allowed price in Texas.

Renee Martinez, Office of Charleen Handzel, DPM ,Southlake, TX

Response: The A5500 code allowance is nationally set, and does not vary by state. Presently, A5500 is set at $61.91 per shoe. A5512 is also nationally set at $25.26 per insert.

You may find the other HCPCS codes and fees associated with therapeutic shoes for diabetics on your DMERC's website, or at http://www.cms.hhs.gov/DMEPOSFeeSched/01_overview.asp

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

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

In this particular case without working extensors, anything but a fusion of the MTPJ will result in continued plantar-flexion of the hallux against the metatarsal, due to the flexor tendons having absolutely no antagonists. An implant would fail miserably. Any phalangeal or metatarsal osteotomy would fail as well because you cannot compensate for the loss of intrinsic extensors with osteotomies. Fusion of the MTPJ would excellent provide structural correction and stability. You may even have to perform a hallux IPJ fusion at the same time to prevent a post-surgical hallux malleus deformity.

Randall Brower, DPM, Roswell, NM, randoman33@yahoo.com

Based on the history presented alone: Conservative care: AFO, Surgical option: 1st MPJ arthrodesis. I don't see what benefit you would get from an implant.

Marc S. Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com

I think the surgical procedure of choice would be a 1st MTPJ fusion. Implants may fail because of the tendon contracture and the patient’s young age. Please consider a neurology consult to properly diagnose or confirm his “sub-clinical case of polio.” Are there other areas of the body that are weak, contracted or are affecting his gait? What is the patient’s long-term outlook with his condition? The neurologist will appreciate the business and may send some patients your way. The patient will appreciate your attention to detail and recommend his friends.

Michael B. DeBrule, DPM, Marshall , MN, drdebrule@starpoint.net

Without knowing the patient activity level, personal goals, etc.. Whenever one has a case with muscle imbalance, first, try to figure out the etiology. Neurology consult!

Then, given this is a patient that needs surgery, the options are real simple. In the face of mm imbalance the safest long-term procedure is arthrodesis. If it is a case that could avail itself to a mm balancing procedure one needs to be very certain of the transfers (e.g., strength, stability, requirements (ie: patient goals). This is a very tricky approach and unless you have a lot of experience I would send it to someone that has. Of course, if you send it out ask if you can scrub the case—you can talk and read all day long about tendon transfers in the foot but in my experience there is no substitute for hands-on.

Tip Sullivan, Jackson MS, tsdefeet@msfootcenter.net

RE: DPM, MD or DPM, DO Degree
From: Leonard A. Levy, DPM, MPH,

I believe that the resistance to the concept of DPMs acquiring the MD (or DO) is symptomatic of insecurity. With the advances that podiatric medicine has made in recent decades, even though our profession is still evolving those in it no longer need to feel any insecurity. An interesting anecdote regarding dentistry and its schools is found by looking at the current dean of Harvard School of Dental Medicine.

R. Bruce Danoff, DMD , MD , an oral and maxillofacial surgeon, is the dean of one of the most prestigious dental schools in the nation. Dr. Danoff has both a dental and medical degree. Members of our profession do not have to give up their DPM degree. After many decades of experience, acquiring the MD degree after the dental degree did not pose a threat to the dental profession or to its dental schools.

Nova Southeastern University College of Osteopathic Medicine is about to graduate its first DPM from an accelerated DO Program for DPMs six months from now, the only nationally-approved program for DPMs in the U.S. I believe that while it may take a little time, ultimately we will find the experience of dentistry relevant to podiatric medicine.

Leonard A. Levy, DPM, MPH, Associate Dean for Education, Planning and Research
Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL,
levyleon@nova.edu

Editor’s Note: DR. Levy has written an article titled “The Contentious Debate About the MD or DO Degree for DPMs” which will appear as the cover story for the January 2008 issue of PM.

We also invite all SAM participants to attend the Great DPM/MD Debate between Barry Block, DPM, JD, Editor of Podiatry Management and columnist John McCord, DPM of Podiatry Today.

RE: Identification and Identity Theft (Stefan Feldman, DPM)
From: Joseph Campbell, DPM

I have had too much experience with this as the Coroner of Bucks County PA. This past summer we had a decedent with six different ID's in his possession, valid license in wallet from CA and car tagged valid in GA, along with two Insurance cards. Only after speaking to his payroll officer in GA and running his finger prints did we actually find out his real name. He was not the first and won’t be the last. We then shipped him back to his country of origin....... It’s more common than you think.

Joseph Campbell, DPM, Quakertown, PA, jcqtn@nni.com

ASSOCIATE POSITION – CENTRAL FLORIDA, ORLANDO AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well established multi-office practice. Applicant must be bilingual in English and Spanish, well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.com

M.R.I FACILITY FOR RENT - NYC and LI

Extremity machine, reads are performed by board certified radiologist, global billing performed by D.P.M location; 121 East 60th street, NYC (Manhattan) 459 South Oyster Bay Road Plainview NY. Call for information and questions. 516 476-1815

PRACTICE FOR SALE – MISSISSIPPI

South Mississippi - Hospital and Outpatient Surgical Center privileges available. Opportunity for Young aggressive podiatrist. Call (228) 762-9531.

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

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,000 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 10,000 DPM's. Write 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 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.