The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

November 12, 2006 #2,738 Editor-Barry Block, DPM, JD

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NY Podiatrist Dislikes DTC TV Ads But Likes Patient Samples

Dr. David Chazan, a podiatrist, doesn't necessarily like those flashy television drug ads. "They give the patient a pre-conceived idea that this is what the patient needs without the proper examination, medical history, current medications taken."

But Chazan doesn't shut his door on drug company reps either. "I can use these samples to dispense to my patients prior to them getting prescriptions to see if the drug is right for them," says Chazan. "If I give them a trial sample of something and see if it works before they go out and spend their dollars, then I'm providing a service."

Source: Elizabeth Harness, WROC Rochester [11/9/06]

Seamless Sock Also Kills Bacteria and Fungi

Imagine a sock that makes your feet not only look nicer but smell better. Teaneck-based Aetrex Worldwide Inc. has. The 60-year-old foot-care products company said Thursday that within the next month, it will introduce its Copper Sole Sock designed to fight bacteria that causes fungus and odor. In addition, the socks are essentially seamless, meaning there is no raised seam that can cause an irritation that could be potentially dangerous to diabetics.

Dr. John M. Galant, a podiatrist in Tenafly, NJ said he couldn't vouch for copper's therapeutic values because he was unaware of them. But a seamless sock would be beneficial to a diabetic, he said.

Aetrex said its claims are backed up by medical evidence. In a 2004-05 study, according to a statement released by the company, a doctor tracked the foot health of 51 patients, including 21 with diabetes.

Source: Dunstan Prial, Bergen County Record [11/10/06]

AAPPM Fall Workshop a Smashing Sellout Success

Beautiful weather, a luxury resort, and some of the best practice management lecturers in the country – it’s no surprise that over 175 attendees packed the Lago Mar Resort in Ft. Lauderdale this weekend for the American Academy of Podiatric Practice Management’s Fall Practice Management Workshop.

Attendees at one of many AAPPM Roundtables

In addition to the well-attended lectures, podiatrists their staffs interacted with each other and practice management experts in small groups and roundtables. Here practitioners shared their successful techniques. One of the most exciting lectures called “pearl jam” consisted of a succession of one-minute pearls on a wide variety of practice management topics.

For information on AAPPM events see www.aappm.org

Query: HPV and Cervical Cancer

I was taught that the cause of plantar warts was human papilloma virus (HPV). Today's news warns of HPV being linked to cervical cancer. Should we be warning our female patients diagnosed with warts to be more vigilant?

Dale Smith, DPM, Chicago, IL

Query: V Osteotomies

Are any of my esteemed colleagues out there still doing "V" osteotomies [w/ K-wire fixation] on central lesser metatarsals? Would you share your experience and compare/contrast advantages/disadvantages with Weil v. "V" v. resectional arthroplasty condylectomies?

Arden Smith, DPM, Maspeth, NY

Query: Richie Brace and PTT

What diagnosis would I use for dispensing a Richie Brace for a Medicare recipient that has posterior tibial tendon dysfunction?

David Sands, DPM, Elmhurst, NY

Response: There is no single code to describe this pathology. It is assumed that the patient has a suspected rupture of the posterior tibial tendon which has led to a progressive flatfoot deformity. Therefore, two codes would be appropriate for this condition:

ICD-9 727.68 - rupture of tendon, nontraumatic; other tendons, of foot and ankle

ICD-9 734 - pes planus (acquired).

It is recommended that two diagnosis codes be used when dispensing ankle foot orthoses (AFOs) when describing the pathology (i.e., tendon rupture) and the deformity (i.e., flatfoot).

Doug Richie DPM, Seal Beach, CA

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

RE: Chronic Tibial Sesamoiditis and HAV (Alan Mauser, DPM)
From: Multiple Respondents

I'd personally use just one incision and instead of using a linear incision, you can shape it into a modified lazy S distally to reach down plantar medially. Of course one needs to watch out for the dorsomedial cutaneous nerve here but it probably beats having to make 2 separate incisions. Be sure not to be too aggressive with the Austin (assuming that's what you're doing) or overdo the medial capsuloraphy as you can throw it into a hallux varus, especially since you're removing the tibial sesamoid.

Rahul Patel, DPM, Flushing, NY, docrahulpatel@gmail.com

Have you ordered a Tc99 bone scan? This would be helpful to locate a symptomatic Bi-partite etc. or DJD of the 1st MTPJ. What is the HA angle and TSP? What is the effective IM? (MA+IM)-15=? Is the joint track-bound and/or limited in DE/PF?

If I was absolutely sure the tibial sesamoid was the cause, I would remove it. You may develop a worsening HV or iatrogenic HV as a sequela of removal. You should inform your patient. The angles should help you decide on the appropriate osteotomies.

Michael R. Cosenza, DPM, Ukiah, CA, michaelcosenza@yahoo.com

I have a middle-aged woman with the exact same symptoms and conservative care for tibial sesamoiditis. When she failed to respond, I ordered a MRI , which revealed osteochondritis dissecans of the first metatarsal head involving the crista and the medial trochlear surface. The sesamoid signal was completely normal. I am interested in recommendations for surgical options. Specifically, could surgical grafting be done in an area with such high loading and irregular contour?

Rick W. Warpula, DPM, Austin, TX drwarpula@austinfamilyfootcare.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

PSR-36 trained associate - partners for multi-location practice with surgery center. Personable/motivated. Position open 6/07 or before. cbyrne@charter.net

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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