The Voice of Podiatrists

November 09, 2006 #2,736 Editor-Barry Block, DPM, JD

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VA Podiatrist is 50,000th Rated Doctor on RateMDs.com

RateMDs.com (http://ratemds.com) announced today it had received its 50,000th user-entered physician rating. Since March 2004, patients across the U.S. and Canada have used the website for praising and panning their medical doctors.

Dr. Annik Adamson

The 50,000th rating was left by a patient of Dr. Annik Adamson of Alexandria, VA, and stated, "Best podiatrist I've ever been to - doesn't restrict treatment by what the insurance will pay. Willing to spend time to discuss options. Will skip lunch to see you (as she did with me when I had a broken toe)."

RateMDs.com allows patients to anonymously rate their physicians in several categories including punctuality, helpfulness and knowledge. The website is free of charge for all users.

NJ Podiatrist Rides In Israel For Children’s Hospital

Mark Berger of East Brunswick, NJ spent five days, Oct. 29 to Nov. 2, riding 268-miles through deserts and over difficult terrain as part of the seventh annual Wheels of Love Alyn International Charity Bike Ride. The tour is a fund-raiser for the Alyn Pediatric Hospital and Rehabilitation Center for Physically Handicapped Children in Jerusalem.

Dr. Mark Berger

Berger is a first-timer who decided to ride because “I wanted to do something to make a difference.” Berger, a podiatrist with offices in East Brunswick and Monroe, said he has cycled for years and participated in triathlons and marathons. “I’m doing it for personal and professional reasons,” he said. “I’m a podiatrist so it ties in with the congenital deformities the hospital treats.”

Source: Debra Rubin, New Jersey Jewish News

AZ Podiatrist Cruises to Easy Victory in Half Marathon

He was hoping his first career road race win would be a little more dramatic, but Brian Hutcheson will proudly take it. "I didn't know if any professional runners would show up and I didn't know how tough the competition would be," said Hutcheson, 39, a Tucson podiatrist, who won Sunday's TMC Everyone Runs Half-Marathon. "I thought guys in their early 30s would be out in front."

Dr. Brian Hutcheson

Hutcheson was all alone by the halfway mark and won in 1 hour, 20 minutes, 48 seconds, five minutes ahead of runner-up Kevin Stone. He was 2.5 minutes behind last year's time when he was fifth.

Hutcheson might be wondering what would happen if he were a little more active on the racing scene, although he sticks faithfully all year to a workout schedule. He only ran two races in 2005-2006 since last year's inaugural Everyone Runs race. "I've just been trying to keep up a decent amount of training," he said. "I'm pointing now to the Rock 'n' Roll Marathon in Phoenix in January. Before last year's half-marathon here I had my best time ever in a marathon, 2:48 in Milwaukee. But I was at my peak then. Now I'm going to try reach a new peak."

Source: Bryan Lee, Tucson Citizen [11/7/06]

Does anyone know if there are any studies for the use of Sculptra to aid in the treatment of atrophy of the panniculosis adiposis? What is the protocol and technique for injections?

Jim Fisher, DPM, Eureka, CA

RE: Surgery For Obese Diabetic (Phil Culliton, DPM)
From: Multiple Respondents

Pragmatism is the best course. Don't overthink it. Forget the screw and the EHL transfer. Do the Keller and tenotomize the EHL. Don't forget the antibiotic prophylaxis. Minimize dissection as much as possible. Try to keep him off the foot for a month following the procedure.

Geoffrey Habershaw, DPM, Boston, MA, Geoffrey.Habershaw@bmc.org

It sounds like trouble brewing. Besides the possibility of the screw breaking I would be very concerned about the likelihood of extension of the osteitis with conversion to a true osteomyelitis after placing a screw down the medullary canal. My first option would therefore be a partial hallux amputation.

Art Hatfield, DPM, Long Beach, CA, afootjob@juno.com

I know many of you have had patients who were totally unprepared - because they didn't listen to your pre-operative discussion - for actually being laid-up. And I am sure you all have seen some of your patients grow depressed. This can and does happen in "normal" patients.

Dr. Culliton, you should not do surgery on this patient if you are the least bit concerned that the patient will not follow 100% of your instructions. Even a patient who does not have your patient's multiple problems would have a problem of a failed fusion if he walked too soon post-op. Me, I would seriously worry that this patient will be, predictably so, non-compliant. That predictability is what could come back to haunt you.

Robert Scott Steinberg, DPM, Hoffman Estates, IL, Doc@FootSportsDoc.com

I don't think you have much of a choice. Given this patient's situation, you would be best to do a Keller and forget about the EHL transfer, just lengthen it if necessary. You'll sleep much better and your patient will have an acceptable outcome.

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

A patient who is a paranoid schizophrenic is not a question of fusion with a screw vs. a tendon transfer or a Keller, it's a question of being a proper candidate for surgery. I personally don't think he is. It’s okay to treat someone conservatively. The fact that he lives alone is problematic as to control of a post operative patient, who has severe mental disease. The huge patient management issues are pain management issues, all pain meds are depressive in nature, confinement of the part which will be an issue for someone with his background, isolation, etc.

How about protective footgear with accommodation for weight re-distribution, debridement to help prevent further breakdown of tissue. Sometimes this is better than jumping into surgery and creating a bigger set of issues. I would suggest that you change your thought process to assisting him with obtaining appropriate psychiatric care, good internal medicine care as to his malignant obesity, and keep him as comfortable as possible.

TH Sokoloff, DPM, MD (WI), Ketchum ID, THsokoloff@aol.com

One thing that is really critical here is the range of motion of the 1st MPJ. It is important to assess both weight-bearing and non-weight-bearing because of the possible presence of a functional hallux limitus. If the patient's FHL has already been cut then the resistance to dorsi-flexion of the MPJ must be from a more proximal structure. There is often hyperextension of the IPJ because there is limitation of motion of the MPJ. Therefore fusion of the IPJ is not going to address the cause of this ulcer (Not to mention the probability of putting fixation into a bone that may be infected).

The Keller is an interesting idea because this should decrease resistance to dorsi-flexion of the MPJ. However, this destroys the windlass mechanism. One function of the windlass mechanism is to help spread force from the metatarsal heads to the toes. Post-Keller you are running the risk of shifting the ulcer to beneath the first met head or the second met head if the first met has significant dorsi-flexion range of motion available. I would try a rigid rocker-bottom shoe prior to surgery. There are not many good choices with this patient.

Eric Fuller, DPM, Berkeley, CA, efuller395@intergate.com

PRACTICE FOR SALE – CENTRAL FLORIDA

Well established surgical podiatry practice and a state of the art Medicare-certified outpatient surgical center. Gross for 2005 - 1.6 million. Modest down payment. percentage ownership possible. Located in Central Florida. Contact Camille Todd/Transworld Business 321 217 3625 cell or office 407 226-7171

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PSR-24 RESIDENCY POSITION SOUTHEASTERN MI

Available for recent graduates or former PPMR/RPR or PSR-12 residents. this is a major teaching affiliate of Michigan State University college of Osteopathic Medicine and serves 17 residency and fellowship programs. Active podiatric clinics in wound care, limb salvage, foot and ankle surgery, medicine and orthopedics. competitive salary and benefit package. meded@pohmedical.org

PRACTICE FOR SALE - BOCA RATON/DELRAY BEACH FLORIDA

Solo practice in large medical building. Near hospital and surgical center. Gross average 520 k for three years. 80% Medicare, no HMOs or nursing homes. Seasonal. Further growth potential. Large patient base. Well equipped for clinical/management needs, over 90 K cost of assets. Owner relocating. Serious inquires only. Contact FeetInFlorida@Yahoo.com

PRACTICE FOR SALE - TEXAS

Podiatry practice for sale in fast growing suburb of Dallas, TX. Part-time practice, can be made Full-time. General podiatry practice, routine care, orthotics, surgery, etc. Hospital privileges available. Excellent opportunity, don't pass it by. Please respond to: CDinbigD@aol.com.

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