The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 04, 2009 #3,692 Publisher-Barry Block, DPM, JD

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CA Podiatrist Has Misgivings About Barefoot Running

Running without a properly supportive shoe may lead to problems with tendinitis, according to Dr. Bob Baravarian, a podiatrist at the Foot & Ankle Institute of Santa Monica. In addition, landing on rocks, pebbles, or rough material can cause wounds that may be difficult to heal. Not every runner needs supportive shoes, Baravarian adds, but most require some level of support for long runs in order to avoid problems, particularly if they have low arches.

Dr. Bob Baravarian

Baravarian has misgivings about the increasing popular practice of barefoot running. Yes, he says, it's done in some African tribes, but most of these individuals have run barefoot since childhood and their feet have adapted to the running surface.

Source: Janet Cromley, The Los Angeles Times [10/22/09]

PA Podiatrist Runs for Town Board of Supervisors

Democrat Sheldon Weintraub is running for one of two at-large six-year terms on the Whitpain Board of Supervisors. A retired podiatrist who has lived in Whitpain for 12 years, Weintraub is looking to bring some change to the board of supervisors, he said. "I think the community has had the same people on the board for too long," he said. "I think you can get complacent. I think a change is really important. You need to have a maverick, which is what I call myself — someone who will bring up new ideas to the board and follow through on them."

Dr. Sheldon Weintraub (Photo Jessica Kourkounis)

Aside from bringing a fresh perspective, Weintraub said he is well-suited to be a commissioner because of his ideas and dedication to residents. If elected, Weintraub has several goals he would like the board to achieve, he said. "I'd like to see taxes not go any higher; traffic congestion alleviated; open spaces remain, including (creating) a dog park; and to keep the board of supervisors on their toes, knowing there's more than one way of looking at things," Weintraub said.

Source: Thomas Celona, The Reporter [11/1/09]

Mills, Armstrong Bring Toe and Flow to Indian Health Service Symposium

The Southern Arizona Limb Salvage Alliance (SALSA) service of the Department of Surgery at the University of Arizona had their teamwork on full display this weekend in a novel simultaneous lecture at the Native American Cardiology Program/IHS Conference, held in Scottsdale, Arizona.

(L-R) Drs. Joseph Mills and David Armstrong

Professors Armstrong and Mills described the now well-known "Toe and Flow" concept for amputation prevention. Armstrong went on to suggest, "It is a sad fact that amputations are several times higher amongst Native Americans in the USA than for other Americans. That  doesn't make it right or necessary. These problems are preventable. That's why we come together in symposia like this." The program, chaired by noted cardiologist Beth Malasky, included clinicians, scientists and epidemiologists from throughout the nation.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How do you define success?

Dr. John Mattiacci

John Mattiacci: In reference to podiatry, I think that the key to success is strengthening our local and state societies so that we can be representative as possible. Podiatry is such a small profession.

Dr. Richard Polak

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest  is research protocol specialist Dr. Richard Pollak,   You can register for this event  by clicking here

Query: Tightrope Complication 
 
I recently saw a nurse (for a second opinion) who developed a recurrent bunion following a tightrope procedure. The patient had 2 midshaft tightropes placed by the other physician. The immediate post-op x-rays look great with adequate IM reduction and a corrected bunion. However four months after the procedure, when the nurse started to ambulate daily, she noticed that her toe started to drift, and she redeveloped a bunion. On clinical exam, she is hypermobile at 1st ray. The radiographs show increasing IM angle from the immediate post-op x-rays.

Does anyone have experience with this complication? Would the recommendation be to remove the 2 tightropes in order to perform the needed 1st metatarsal cuneiform arthrodesis or can this procedure be performed with the tightropes kept in place? Her initial treating physician advised her that she could have a distal procedure, but my concern is that regardless of her IM at this moment, it will probably continue to increase secondary to her hypermobility, and needs to be addressed. 
 
Adam Cirlncione, DPM, Glen Cove, NY

Query: Paperless Office by CSC
 
I would like input from anyone using Paperless Office by CSC (Computer System Consultants), especially if you are also using ASPC from dbConsultants.

Dina Rappette, Yorkville, IL

RE: Sarapin for Morton's Neuromas? (Michael Turlik, DPM)
From: David Alper, DPM, Ed Cohen, DPM

Even after 30 years, I still find myself feeling like an awestruck student in the presence of Dr. Turlick's words and assignments! To his posting - I am afraid that I made the same request for literature or references on Sarapin when my neurologist friend first suggested it, and got the #2 response - "Well, it has worked for my patients for years - isn't that proof enough?"
 
My own searching was fruitless, which is why I came to PM News. I will continue to search, but do appreciate the comments and experiences from my colleagues!

David Alper, DPM, Belmont, MA, ToesTen@aol.com

I use 1 to 1.5 cc of Sarapin and 1.5 to 2 cc of lidocaine. I ask the patient from 1 to 10 what their pain level is, and if it is above 7 , I will have them come in once a week. As they improve, I will space it out to every two or three weeks. You need to combine this with strappings because biomechanical control is very important. The beauty of Sarapin is that it is very safe and you can inject more frequently than you would with steroids and you avoid the tissue destruction.

Sarapin comes in 50 mg vials and can be purchased from High Chemical for about $30.00. Contraindications are high blood sugars, PAD, swelling, and poor skin integrity. You might want to give some injections dorsally and some plantarly to help minimize skin irritation. I would be interested in your results and I would suggest it is better to give extra injections than not enough injections. If the treatment is not working, the patient will not be shy about telling you.

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

RE: Bunion Surgery (Richard Frost, DPM)
From: Barry Mullen, DPM

The apparent severity of the osteoporosis would seemingly contraindicate the use of implants, hemi, or total. In addition, a total implant should never be used to attempt to reduce a modestly to severely elevated IM angle...a recipe for...

Editor's Note: Dr. Mullen's extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=30161&start=1

RE: Digital Camera (Charles F. Ross, DPM)
From: Jon Purdy, DPM, Sam M. Horowitz, DPM

I just bought three Canon A480 cameras. They cost $120, use AA batteries, and have 10 megapixels. The best part is that they have a macro- and a super-macro setting that allows you to take photos as close as 1.2 inches. Great bang for the buck.

Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

I have three back office assistants who all have a Canon Digital Elf (many models, no need to spend over $200) and we take pictures of everything and put them in our EMR. Take photos in the lowest resolution unless you plan on printing them. It makes no difference in how it appears on the computer screen and takes up less room in the hard drive. No special lenses are needed

You can get up to two inches away and clarity is excellent, down to the skin lines. Don't use the flash.

Sam M. Horowitz, DPM, Miami FL, Samsfuture@aol.com

RE: TOG Gaitscan (Mark K. Johnson, DPM)
From: Jim DiResta, DPM, MPH, Larry Huppin, DPM

I too have been using the TOG scanner. My experience is limited as I have only used it for the past 4 months but thus far I am very pleased. I have only had one fit problem, and the lab resolved that with no hassles and the quality of their orthotic is excellent.You can obtain static scans, walking and running scans, which are awesome. Initially the amount of information, the graphs and table data from the scan, and interpretating it all can be a bit overwhelming. I attended a lecture conference from TOG company, and that helped a lot. The support from the company has been excellent.

Jim DiResta, DPM, MPH, Newburyport, MA, james.j.diresta.DMS04@alum.dartmouth.org

I recently completed an evaluation and review of 9 scanners and digital imagers currently available in the podiatry market for publication in an orthotic trade journal. Eight critical criteria were found that scanners must meet in order to produce a functional foot orthosis that provides for optimum clinical outcomes. Those were noted in a letter to PM News this past April (http://www.podiatrym.com/search3.cfm?id=25631)  Three pressure mat systems were evaluated and none of them fulfilled the criteria. 

Pressure mat systems provide only two-dimensional information. There is no ability to capture the posterior heel, so a balanced orthosis cannot be made from pressure mat images. Further, several studies have demonstrated that footprint pressure measurements are invalid for predicting arch height. McPoil, in 2006, showed that plantar surface contact area can explain only 27% of medial longitudinal arch height and concluded that “the clinician cannot predict the vertical height of the medial longitudinal arch on the basis of the amount of foot plantar surface area in contact with the ground during walking." Other similar studies are available. 

If one accepts that the ability to balance the forefoot to rearfoot in the frontal plane and the ability for an orthosis to closely match the arch shape of the foot are important for optimum function, then one must also accept that pressure mat systems are not able to create an image acceptable for producing a functional foot orthosis.

Disclosure: I work as medical director for an orthotic lab, but I have no financial connection to any company producing scanners.

Larry Huppin, DPM, Seattle, WA, lhuppin@gmail.com

RE: Fee Update/Medicare
From: Lawrence M.  Rubin, DPM, Lloyd S. Smith, DPM, 
 
In addition to Dr. Lloyd Smith’s heads-up about upcoming confusion from Medicare’s elimination of consultation codes (11/2/09 PM News), we could be grappling with another Medicare issue in 2010  -- a 21.2% decrease in the Medicare conversion factor.

CMS says it will accept comments on these provisions in its final rule until Dec. 29, 2009. Unless something changes, such as Congress intervening, these policies will be applied to Medicare services on January 1, 2010.

Lawrence M. Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com
 
In the recent final rule published by CMS, a negative fee update of 21.2% will be imposed on Medicare's physician fee schedule unless Congress acts. Over the past few years, Congress has consistently acted to stop these updates but have not yet created a permanent solution. There is some optimism this year that healthcare reform will include the necessary permanent fix. 
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: DPMs are Allopathic Physicians (Leonard A. Levy, DPM, MPH) 
From: Thomas Graziano, DPM, MD

Dr. Levy is entirely correct in his definition of "Allopathic Physicians." According to the classification used by the Department of Health and Human Services, the two physician types under the heading allopathic physicians are MDs and DPMs. The osteopaths have their own classification, followed by dentists, chiropractors, and so on. The allopathic philosophy of practice is shared by medical doctors and podiatrists.
 
Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: PM News Tops 12,000 Subscribers
From: Kevin A. Kirby, DPM

I think that many of us who are caught up in this world of instant information that we all currently live in, can easily take for granted how valuable a resource like PM News is to the podiatric medical profession. Here we have a resource that is distributed to over 12,000 subscribers on a daily basis that provides us all with the ability to discuss issues that are important to our profession's political and financial future, allows us to learn of more effective treatments for our ailing patients, and that allows us to learn about the amazing variety of personalities and accomplishments of many of our podiatric colleagues, not only in this country, but within the international podiatric community.

For many of us, PM News is the most important venue for daily communication within our relatively small medical professional community. I am deeply grateful to Barry Block, not only for his insight in creating PM News, but also for his continuing labors that allow us all to strive toward the goal of improving the profession of podiatric medicine both for today, and tomorrow.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

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-SOUTHERN CALIFORNIA, INLAND EMPIRE

2-office multi-doctor practice looking for ethical, dependable doctor to work 3-4 days per week. State-of-the-art, long established practice. Needs a team player which may lead to buy-in for the right doctor. Must be ABPS BC/BE. High surgical volume. Send cover letter and CV to bkatzman2@earthlink.net

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 - 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

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 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

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.

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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