The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 11, 2010 #4,008 Publisher-Barry Block, DPM, JD

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NY Podiatrist Provides Children's Shoe-Buying Advice

You've got the dress or the suit, but what about the shoes? Heels or not? No high heels for girls younger than 13, advises Dr. Michael Pliskin, chief of podiatry at North Shore University Hospital in Manhasset. Once a girl's foot has finished growing, she can consider heels, but the lower the better. "The lower the heel, the safer it is, the less likely she is to sprain an ankle," Pliskin says.

Dr. Michael Pliskin

Hand-me-downs or new shoes? Constantly wearing shoes that have adjusted to another child's foot can cause irritation and other problems, but borrowing a pair for a fancy party shouldn't be an issue, Pliskin says. He recommends spraying the interior with Lysol and using antifungal powder.

Source: Beth Whitehouse, Newsday [11/9/10}

WesternU Professor Presents Poster at Canadian Wound Care Meeting

A poster titled "The Role of Ready-To-Use, Lightly Absorbent Waterproof Dressings With Non-Adherent Wound Bed Contact Layer" by researcher and WesternU Assistant Professor Patris Toney, DPM, MPH was displayed November 4–7, 2010 in Calgary, Canada.

Dr. Patris Toney

This presentation was at the 16th Annual Canadian Association of Wound Care (CAWC) Professional Wound Care Conference at theTELUS Convention Centre. 

AAPPM Event Raises Over $1,500 for Student Practice Management Initiatives

More than 60 people gathered to partake of the leaf and the grape at the “Wine and Cigars with the Stars” event at the recent American Academy of Podiatric Practice Management (AAPPM) Fall Practice Management Workshop in Fort Lauderdale.

Attendees at AAPPM Wine and Cigars Under The Stars Fundraiser

The event, which raised over $1,500 for AAPPM student practice management initiatives
was sponsored by Bako Pathology Labs.

PA Podiatrist's Devotion to Diabetic Care Stems From Her Own Condition

Dr. Honor Manilla has never met a foot she didn't like. The Worcester podiatrist specializes in diabetes and diabetic foot conditions, and she is also board-certified in wound care and limb salvage, serving on a multidisciplinary team at Mercy Suburban Hospital's Center for Wound Healing and Hyperbaric Medicine in East Norriton.

Dr. Honor Manilla treats diabetic patient

Her devotion to the care and treatment of the diabetic foot and lower leg pain lies in a personal drive to learn about her own condition. "I saw the need to be educated about my own condition," she said. "I am a Type I diabetic and that made me interested in medicine and to help other people with this condition. It's not easy living with diabetes, especially Type I, with insulin shots daily, medications, diet, and exercise."

Source: Tony Di Domizio, The Reporter [11/9/10]

IN Podiatrist is Forensic Crime Fighter

By day, Michael Nirenberg of Crown Point, Indiana helps people treat warts, arthritis, ingrown toe nails, heel pain, and all sorts of other foot problems. In his spare time, he helps the police solve murders.

Dr. Michael Nirenberg

For one case, a double homicide in Idaho, Nirenberg analyzed foot impressions left inside shoes that the suspect wore in jail. They matched those left at the crime scene. “The way you wear one pair of shoes, a lot of times, will carry over to your other shoes,” he told a local TV news reporter.

Source: Virginia Hughes, Plos Blogs [11/9/10]

Query: Positional  Reddish/Purplish Blotches

A 23 y/o female who is severely autistic was brought in by her mother concerned about discoloration in her feet. The mother states the problem has been present for several months but only occurs when the patient is sitting with her feet flat on the ground. It resolves with ambulation. Medical history includes severe anxiety, eczema, autism, Robinow syndrome, and questionable hyperthyroidism. Meds: Zoloft 50 mg. daily and Topamax 30 mg. bid. Physical exam revealed her pedal pulses were weak but intact. The patient was unresponsive to a neurological exam. 

When the patient sat with her feet flat on the ground, reddish/purplish blotches were noted subcutaneously over the dorsal aspect of the midfoot which disappeared when she ambulated. No dermal lesions were noted. There was a cyanotic hue to her feet in dependency as well as mild subungual cyanosis. The mother states the condition is painful. Previous attempts to discontinue the Topamax caused severe hysteria. Any ideas?

Michael J. Ryan, DPM, Charlotte, NC

Query: Monitoring Employee Use of the Internet

I use a small office Internet router/network that I bought at Staples.  I have four computers hooked up to it, and I am comfortable that its built in firewall and security systems protect the information stored in these computers from cyber attacks. E-mailing and use of the Internet is absolutely necessary in today's practice. However, I do not know how I can monitor that office staff is not e-mailing radiographs, blood test results, or protected information. A visit to my local computer superstore was worthless. Any ideas?

Emilio A. Goez, DPM, Freeport, NY

RE: Dermagraft Layers (Bob Kuvent, DPM)
From: Robert G. Frykberg, DPM, MPH, Lee C. Rogers, DPM

We use Dermagraft very frequently in our clinics for very complex wounds. Rather than waste the cells, we often do fold over the excess product into the wound. While there is no in vitro data for or against this procedure, I believe that it increases the dosing of the living neonatal cells, growth factors, etc. An example would be packing the tissue into a deep tunnel with a “roll” of the dermal replacement product. We have found this to be a very successful way to manage such wounds, with no detrimental effects of “doubling up” on the graft. 

Robert G. Frykberg, DPM, MPH, Phoenix, AZ, robert.frykberg@va.gov

Advanced Biohealing has performed a dosing study published by Gentzkow in Diabetes Care (1996) where they evaluated three groups vs. a control for healing by week 12. They looked at a single layer of Dermagraft weekly, a doubled-up piece every two weeks, and a single layer every two weeks. They found that the best healing rate in 100% closure and 50% closure was obtained with a single layer every week. Based on this information, CMS has based their reimbursement on one piece weekly.

Lee C. Rogers, DPM, Los Angeles, CA, lee.c.rogers@gmail.com

RE: Bunion Procedure? (Angelo J. Bigelli, DPM)
From: Pete Harvey, DPM, Jeffrey Kass, DPM

Risk Management Rule Number One: If a patient requests surgery, this not mean that you must perform surgery. If you are not 100% certain of the procedure that her foot requires and if you have not personally performed MANY of these procedures, then the patient should be referred to someone who routinely performs this surgery. I have noticed several times in this forum that doctors seem to be asking other doctors what procedure to perform. If the question is rhetorical, that is one thing. However, if it is literal, then it is indicative that the doctor posing the question has no idea what to do. That is a scary scenario. The patient and the doctor are best served if the patient is referred to the proper person who routinely performs this surgery.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

I don't think enough information was given. Diabetes, in and of itself, is not a contraindication to surgery. The question is - Is the diabetes under control? Is the circulation good? When the question is raised, should a procedure be done - I ask why not? The patient is in pain, and if there is no contraindication, then perform the surgery.

There are a myriad of bunion surgeries, and I am sure responses will include everything from a Lapidus to a first MPJ fusion, to a Keller, to an Austin Keller, to a simple bunionectomy, etc. Obviously, the obesity can play a role in the decision-making. Since the other health issues were not mentioned, I don't see how anyone can really answer the question of whether or not to proceed with the surgery. This is a perfect example of how you can ask for a textbook answer of what procedure should be done based on x-rays and how the surgeon really needs to customize the surgery to the patient and "other issues."  

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Prolotherapy for Achilles Paratendosis (Brent Rubin, DPM)
From: Kent Sweeting, B.Hlth.Sc.(Pod)(Hons)

We recently conducted a randomized control trial investigating the use of prolotherapy for Achilles tendinopathy (published in the British Journal of Sports Medicine, doi: 10.1136/bjsm.2009.057968).  In this study, we used a solution of 20% glucose/0.1% lignocaine/0.1% ropivocaine. Tender points were injected with 0.5ml – 1ml (a maximum of 5 ml in total) weekly until the patient was pain-free.  Short-term results of prolotherapy injections were slightly better than eccentric loading exercises, though results at 12 months were similar. When combining prolotherapy injections and eccentric loading exercises, patients improved more rapidly than either group alone, though results at 12 months were similar. I use a very similar protocol in my practice.

Kent Sweeting, B.Hlth.Sc.(Pod)(Hons), Brisbane, Australia, kent@performancepodiatry.com.au

RE: Three Strikes and You're Out? (Frank Lattarulo, DPM)
From: H. David Gottlieb, DPM

The question of how many steroid injections to give per site or per condition is one I remember being asked about in 1980 while in podiatry school. It's one I keep asking residents now, and the answer is the same. There's NO evidence-based literature to support any number. Dr. Harvey Lamont has been consistent for many years now at recommending one injection only because the condition is really fasciOSIS not fasciITIS [and there is literature now to back that up]. Long-acting steroids hang around [at least some part of them do] for a long time. There is no literature to really use, so I suggest we all do what we are already doing, and that is using our background knowledge of medicine and our patient, our evolving understanding of disease states, and treat our patient the way which works best for us.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

RE: Moving Office and Notifying Carriers (Chuck Ross, DPM)
From: Lisa Schulze, DPM

Our office mailed 1099's with the updated information, and that seemed to suffice for all carriers except Medicare.

Lisa Schulze, DPM, San Antonio, TX, lisa.schulze@yahoo.com

I have moved my office more than anyone should ever really move, and I can tell you there are no real shortcuts to the notification process. Every insurance company has different notification requirements, some by mail, others by fax, and some on line. The one commonality to all is a W-9 with your new address.

The insanely bureaucratic Medicare booklet isn’t as bad as it sounds. There are sections in it for every possible scenario, and a simple change of billing or service address only takes a few minutes to complete. It does take 2 or 3 months for them to process it, and they will hold up your payments until...

Editor's note: Dr. Howard Fox's extended-length letter can be read here.

RE: Medicare Made Funny (David T. Weiss, DPM, Richmond, VA)
From: Multiple Respondents

I got a good chuckle from Dr Weiss' movie because it is exactly how the conversation goes.

Bob Kuvent, DPM

Priceless. Great job. Thank you for three minutes of truly enjoyable watching.

Frank Lattarulo, DPM

LOVED it! Dr. Weiss hit the nail right on the head!!
 
Lynn Homisak, PRT

RE: Start Future Olympians Young?

Years ago, I treated a newborn with club feet with plaster casts. The new mother was shy and naturally upset at the prospect of her little baby in casts and was uncertain as to how to socially handle it - how much to tell other people. I told her that she need only discuss details with grandparents and other close relatives. All others who might express some passing interest were not entitled to any explanation.
 
On her return visit, she related a story of having the child in an infant carrier in the upper shelf of a grocery shopping cart. When another shopper saw the child's feet sticking out in casts, she asked the mother sympathetically "Oh, what happened to the baby?" The mother replied "Skiing accident!"
 
Joel Lang, DPM (retired), Cheverly, MD

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate to start immediately. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

POSITION AVAILABLE -  NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening for the right candidate. Join a well-established podiatric group in Southwest Florida. We are a multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated individual. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Please respond to JLH459@aol.com

ASSOCIATE POSITION - CALIFORNIA

Busy, surgically-oriented practice in Bakersfield, CA seeks ABPS qualified/certified surgeon to join our existing two surgeons. Must be hard-working and honest. Strong reconstructive surgical practice with trauma privileges and wound care center/diabetic limb salvage center. Starting in December or January. E-mail CV to aghams2@aol.com

ASSOCIATE POSITION – NORTH, CENTRAL & SOUTHERN ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

SEEKING EMPLOYMENT OPPORTUNITY - NORTHERN, NJ

Looking to relocate my current position closer to home. I am honest, ethical, punctual and hard-working. PM and S-36 trained with over four years of work experience. Seeking a full-time employment opportunity starting as an associate with the potential for partnership in the future. If interested, please contact  footdoctor36@gmail.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - MARYLAND AND DC

Immediate opportunity to join our group in Maryland and DC. Will consider full or part-time. Our practice is general podiatric care with a heavy slant on sports medicine/orthotics. In-office ASC. Must be PSR 24-36. Send cover letter and CV to hgodpm@verizon.net

EQUIPMENT FOR SALE - WHIRLPOOL AND WHIRLPOOL CHAIR
 
Professional, Whitehall brand 15 gallon Podiatry Whirlpool and Whirlpool Chair. In excellent condition. $2000.00. Please contact fergusondpm@aol.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss.Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

ACTIVE PRACTICE FOR SALE - NYC

Part-time practice, capable of expansion to full-time, desirable Mid-town Manhattan location, fully-equipped, established for over 30 years. Doctor is retiring. (212) 247-5148 Fax (212) 581-0148.

PRACTICE FOR SALE - CONNECTICUT

Outstanding solo practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

PM News Classified Ads Reach over 12,500 DPM's and Students

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