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| PM News | |
The Voice of Podiatrists
Serving Over 15,790 Podiatrists Daily
November 04, 2013 #4,906  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
written permission of Barry Block
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| PODIATRISTS IN THE NEWS | |
Bunion Surgery Should be Done Only After Failed Treatments: MI Podiatrist
Dr. Mehmet Oz recently had special guest podiatrist Crystal Holmes, DPM on his show. She told viewers that bunion surgery should not be performed just because someone does not like the physical appearance of the foot due to bunions.
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Dr. Crystal Holmes |
Dr. Holmes said that when bunion surgery is decided upon, it should only be done after conventional bunion treatment methods have been tried to relieve the pain that can come from bunions. “If you can’t take it [the pain] anymore, that’s when surgery should be discussed with your doctor,” says Dr. Holmes.
Source: Tim Boyer, Emax Health [10/31/13]
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| PM NEWS QUICK POLL | |
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Results of Last Week's Poll |
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| AT THE COLLEGES | |
WesternU Faculty and Students Volunteer at Care Harbor
Western University of Health Sciences faculty and students are volunteering at Care Harbor/LA, one of the largest free health clinics in California. “It’s a good opportunity as a student to come and get clinical experience with patients, and at the same time help out in the community,” said third-year College of Podiatric Medicine student Bryan Levay, who volunteered Oct. 31 and planned to return during the weekend. “Care Harbor is receptive to podiatry. We get exposure to people in the community who might not get podiatric care outside of this program.”
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(L-R) Jacob Meisenburg, Shahdad Saeedi, Darrel Richards, Chris Tyree, Dr. Cristina Marchis-Crisan, Bryan Levay, Teague Gearhart, and Nathanael Smith |
Levay joined his classmates and CPM Assistant Professor of Podiatric Medicine Cristina Marchis-Crisan, MD, DPM, at Care Harbor/LA on Thursday. “This is a great opportunity for the students to have hands-on experience because they see a variety of pathology here,” Marchis-Crisan said. “On the other hand, we also give something to the community they otherwise might not have been able to reach because of their location or income. So in this way, those who do not have money can still have access to foot care.”
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| INTERNATIONAL PODIATRISTS AND FOOTWEAR | |
Even Symptomless Diabetics Need Annual Foot Exam: Malta Podiatrist
Podiatrist Christian Ellul has noted an increase in awareness on foot education, particularly among diabetics, but says that it is still scarce among the rest of the Maltese population. “Everyone is aware of the importance of routine dental check-ups, but how many actually undergo foot check-ups?” Ellul asks.
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Christian Ellul |
“Yet complications related to the foot and lower limbs can be severe enough to lead to permanent disability.” Frequency of visits to a podiatrist depends on the condition(s) one is suffering from. However, Ellul recommends that diabetics should at least have an annual review, irrespective of whether they are suffering from foot pain or not.
Source: Stephanie Fsadni, Times of Malta [11/1/13]
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| ON THE INTERNATIONAL LECTURE CIRCIT | |
AZ Podiatrist Speaks at Indian ADA Symposium
The American Diabetes Association hosted its 8th annual "Best of ADA India" series this year in simultaneous symposia throughout the nation of more than one billion. Dr. David G. Armstrong, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA). was one of four featured U.S. speakers in standing-room-only meetings in Bangalore and Mumbai.
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Dr. David Armstrong |
All told, the speakers presented to thousands of clinicians in four days spanning the entire nation. In addition to Armstrong's participation, symposia in Bangalore featured U.S. Professors Peter Reaven, Jane Reusch, and Hermes Florez from the Universities of Arizona, Colorado, and Miami, respectively as well as local leaders in each city.
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| QUERIES (CLINICAL) | |
Query: Achilles Ulcer in PVD/DM Patient
I was consulted to see a 78 year old diabetic male who was s/p a femoral popliteal bypass. Before the bypass, he reported a 2-month history of multiple blisters on the feet, all of which healed except the lone ulcer on his heel. The ulcer was necrotic with eschar and slough. He went to rehab after his bypass, and I treated the wound with Santyl daily for about one month.
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Achilles Ulcer in PVD/DM Patient |
The result now is an exposed Achilles tendon. The ulcer measures approximately 5 x 3.5 cm. It is getting larger. Despite the bypass, his arterial flow is diminished. My plan is to send him to HBO. What would be the best treatment to start granulation over the Achilles? Would GraftJacket be appropriate?
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| QUERIES (NON-CLINICAL) | |
Query: Source for Heel Wedges
I am looking for a source to purchase pre-fab heel wedges to achieve either a varus or valgus rear foot positioning that can be placed in shoes or glued to patients' orthotics or OTC insoles. I would prefer a cork or rubber-cork material, if possible.
Jack Ressler, DPM, Tamarac, FL
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| RESPONSES/COMMENTS (CLINICAL) - PART 1A | |
From: Todd Lamster, DPM
As a last ditch conservative option, you could try an ultrasound bone stimulator. This may make a difference, especially if there is surrounding bone marrow edema in the head of the metatarsal. If this doesn't work, then unfortunately it looks like surgery is warranted, so in my opinion, you have two surgical options. You can perform an arthrotomy on the 3rd MTPJ with subchondral drilling, or you can perform a hemi-cap procedure on the head of the metatarsal. Since you noted vascular issues, arthrodiastasis is contraindicated. If you are going to move forward with surgery, you may want to get a vascular consultation with non-invasive vascular studies including TcPO2 and digital toe pressures.
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| RESPONSES/COMMENTS (CLINICAL) - PART 1B | |
From: Itamar Rosenbaum, CPed
As an AVN has been almost definitely ruled out, the following approach might be very helpful. 1) A CAM walker up to the knee for a period of 6-8 weeks. 2) after that period of time, make an orthotic with a forefoot post to sulcus made of 45 durometer EVA, and a cut-out on the forefoot post sub 3rd met head (make sure the forefoot post is 3/16" thick tapering to 0" distal once it reaches the sulcus area). 3) Do not place a met pad or bar on the orthotic. 4) Add a 1/16" layer of padding, either Poron or PPT on top of the entire length of the orthotic before applying the top cover.
5) For footwear, in the initial 2-3 month stage post CAM walker, use a sneaker as it will be much easier to accommodate the proper orthotic. 6) Accentuate the rocker sole in the sneaker by doing a sandwich rocker sole modification 1/4-3/8 inches thick proximal to the met heads; tapering to 0 distally, while extending all the way back to the heel area of the shoe at original thickness minus an 1/8". 7) Prior to closing the rocker sole modification, cut out the area in the shoe sub 3rd met head, which will essentially create a 0 gravity area completely offloading the metatarsal. 8) Give this patient a calf and hamstring stretching regimen to reduce any equinus influences that are exacerbating this situation. It should work very well and will not look "orthopedic" when the shoe modifications are done professionally.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2 | |
From: Jeffrey Kass,DPM
Equinus is a clinical diagnosis. The leg with respect to the foot is not at 90 degrees. However, the patient is in pain and may not be standing in a normal weight-bearing manner. He may be shifting weight secondary to pain. So, before treating an equinus, make sure the patient has one before you weaken his Achilles' tendon or gastroc. If the device is not completely seated under the talus in the sinus canal, this could potentially be a source of pain.
Make sure the calcaneus can still evert a few degrees. One can see a perfect correction in film, but if you can't evert the heel 3-5 degrees, then you close down the ability of the heel to evert at all. The heel must not be locked down. If this happened, you would need to downsize the device. Don't assume because you put one size in the contra-lateral foot that the other side is a mirror image. The feet are independent of each other with regard to sizing of these implants.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2B | |
From: Jeffrey Root
I believe Dr. Batelli made an important point when he implied that other deformities (i.e., conditions) may be creating an additional pronation moment that is acting at the subtalar joint and therefore on the implant. From the x-rays, it appears that the patient may have a metatarsus primus elevatus and/or a forefoot varus (forefoot supinatus?) position of the forefoot. If the implant successfully limits the range of subtalar joint pronation, then it could create an uncompensated or partially compensated forefoot varus condition.
In other words, the patent may need...
Editor's note: Mr. Root's extended-length letter can be read here.
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| RESPONSES/COMMENTS (CLINICAL) - PART 3 | |
RE: PRP Therapy for Plantar Plate Tears (Charles Morelli, DPM)
From: Barry Mullen, DPM
I respectfully disagree with Dr. Morelli utilizing the following rationale and philosophical approach to foot surgery.
What´s interesting about plantar plate tears is that, for many years as a profession, we didn't appreciate this pathology. Even today, I see many cases misdiagnosed as neuromas because "burning" pain is often ascribed as a pain descriptor and when the tear is eccentrically located, the 2nd toe will drift, often medially, giving a pseudo Sullivan sign associated with space occupying soft tissue masses in the web space. For years, many....
Editor's note: Dr. Mullen's extended-length letter can be read here.
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| RESPONSES/COMMENTS (CLINICAL) - PART 4 | |
From: Joan Schiller, DPM, Gian Steinhauser, DPM
It could be a worm.
It could be shingles. Antiviral drugs, such as acyclovir, may help stop progression of the rash, especially if used early in the course of the blister breakout. Similar drugs, such as Valtrex or Famvir, can also be used. These drugs may also help stave off the painful after-effects of shingles or post-herpetic neuralgia.
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MEETING NOTICES - PART 1
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| RESPONSES/COMMENTS (NON-CLINICAL) | |
From: Mitch Barber, DPM
It is my understanding that high-powered class IV lasers (per state guidelines) require the doctor (e.g. DPM, DO, DC, or MD) to oversee the treatment with a laser. It is reasonable to have a tech or assistant who is certified perform the treatment while the doctor is present in the facility; however, an "unattended" laser system could raise eyebrows concerning risk management and coverage through your malpractice carrier.
When I checked my coverage with my carrier, I was told that I needed to abide by the state guidelines for use of the device as well as who operates the laser. I strongly urge all those using a class IV laser to review their state guidelines and contact their state board before even considering a laser that is not fully operated by the doctor or assistant.
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MEETING NOTICES - PART 2
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Choose any or ALL (50 CME Contact Hours) from the 30+ CME Category-1 articles posted
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| CLASSIFIED ADS |
ASSOCIATE POSITION – DALLAS/FT WORTH, TX
Dynamic, busy practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified podiatrist, PSR-36 preferred. Excellent salary and benefits compensation package, for the right candidate, who is motivated to work hard. Contact/Send resume to: jmh6122@yahoo.com
ASSOCIATE POSITION - CT (GREENWICH, FAIRFIELD AND NORTH HAVEN)
Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to: Dr.Kassaris@yahoo.com
ASSOCIATE POSITION - DAYTON, OHIO
Join an established group practice in Dayton, Ohio excellent reputation, large referral base. Base Salary$120,000, benefits and bonus structure. EMR;diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to: Ohiomedical@aol.com
ASSOCIATE POSITION - PENNSYLVANIA
Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to: 123bunion@gmail.com
ASSOCIATE POSITION – BROOKLYN
Podiatrist needed for busy Brooklyn practice. Must be at least Board Qualified. Surgical background, personable and able to travel to different offices in Brooklyn. Part-time to start, with the potential for full time and partnership. Please email CV to evangbreth@gmail.com or fax to 718-840-0653.
PART-TIME PODIATRIST WANTED - SUFFOLK COUNTY, NY
Approximately 25 hrs/per week Must be reliable and punctual. Must have excellent chair-side manner and be highly skilled in conservative care. Offering $50/per hour. No other benefits. bombbustr7@aol.com
ASSOCIATE POSITION - CENTRAL FLORIDA
Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future. To apply please go to www.yourcareerinpodiatry.com
HOME FOOT CARE, INC. - LOS ANGELES, CALIFORNIA
Looking for reliable, honest, and motivated podiatrists to join our group to assist with house calls to patient’s home residences, and some group facilities. Candidate must be willing to drive throughout the San Fernando Valley and the greater Los Angeles area. Part/Full time, flexible hours, independence, great compensation! If interested, please email resume to: homefootcare@hotmail.com
RECONSTRUCTIVE FELLOWSHIP POSITION – SOUTHWEST, FL
R U a SuperStar? PM&S36 or PSR24. prerequisite. Hardworking w/o Ego. ABPS BC/BQ required RRA. 1 year Fellowship will entail Ring, Rods, complex reconstructive planning/procedures and practice management. Research projects and posters to present at yearly fellowship conference. Send CV, Tell why you are a superstar. mny1029@gmail.com
CENTRAL KENTUCKY - DIABETES MANAGEMENT FELLOWSHIP
Directed by Dr. Jonathan Moore of Cumberland Foot and Ankle Centers of Kentucky, this non-accredited, 1-year fellowship starts in July and offers a wide variety of training opportunities that focus on diabetes, but span a wide variety of pathologies and unique training opportunities. Work hands-on with our office administration team to learn ICD-10. Our on-staff certified orthotist, physical therapist, shoe store staff, MRI director and other team members will make this the most valuable training year of your career. Generous stipend, benefits, and free housing. Learn more at www.myhappyfoot.com (click the Fellowship Tab). Send CVs to jmoore@aappm.org.
PRACTICE FOR SALE - DEBARY, FL (SOUTH OF DAYTONA BEACH AND NORTH OF ORLANDO)
PRACTICE FOR SALE - CONNECTICUT
Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com
PRACTICE FOR SALE - NASSAU COUNTY, NEW YORK
60 year old practice currently operating only 16 hours per week. Plenty of room for growth. Stable lease. Grossing 100k priced for quick sale at 65k. Three complete treatment rooms plus O.R. staff in place. Turn-key operation. Respond to footman007@aol.com
EQUIPMENT FOR SALE - 10 WATT LASER
10 watt laser. Hardly ever used 9K Still under warranty. E mail Dr. Zuckerman at: footcare@comcast.net. for questions and pricing .
PM News Classified Ads Reach over 15,500 DPMs and Students
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management® Magazine and Podiatry Management® Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
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