The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 13, 2007 #3,091 Editor-Barry Block, DPM, JD

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PA Podiatrist Warns of Obscessional Jogging

Dr. Bruce Zappan, whose podiatry practice in Center City constitutes one of the largest in the city, says the results of "obsessional" jogging are not pretty. Running on city sidewalks without proper footwear can create a host of physical problems, he says. For the urban runner, Dr. Zappan recommends New Balance shoes and a sturdy sock while he warns that inattention to proper footwear, as well as obsessional jogging without occasional breaks, can lead to problems like runner's knee (or the softening of cartilage in the knee cap), Achilles Tendonitis (what happens to joggers who run uphill rather than on flat surfaces), ankle sprains and shin splints.

Dr. Bruce Zappan

Joggers who have a tendency to get hammertoes or bunions had better be extra careful, he said, because jogging tends to aggravate the joints. "Bunions are overextended joints. If you are not wearing proper footwear the area becomes inflamed, painfully red and irritated."

People who overdo jogging pick up a lot of injuries. The most common and painful is chronic back pain. To avoid chronic back pain that may require months of physical therapy, Dr. Zappan recommends stretching before and after each jog. Jogging on soft surfaces, rather than cement sidewalks, is also recommended. According to Dr. Zappan, the best soft surface is a cork track, such as the one found at the University of Pennsylvania. Barring the availability of a cork track, a good running shoe may help to lessen the ill effects of city concrete.

Source: Thom Nickels, The Bulletin, [11/09/07]

PA Podiatrists Lead Thanksgiving Food Drive

Good deeds are happening right here in Ardmore, where podiatrists Eric Ricefield and Mark Yagodich are teaming with the Ardmore Business Association for another Thanksgiving Food Drive.

Dr. Eric Ricefield

Over 100 organizations, civic groups, churches, synagogues and schools have been contacted for names of families in need this holiday season. This year's goal is to provide over 100 families with Thanksgiving gift certificates for holiday meals.

Dr. Mark Yagodich

Source: Susan Greenspon, Main Line Times [11/7/07]

Most Medicaid Programs Adopt Modest 2008 Pay Boosts for Doctors

Thirty-three states plan to increase their Medicaid payment rates for doctors in 2008. Many also are poised to expand eligibility and to use the program to cover more of the uninsured.

Next year will mark the third consecutive year during which at least two dozen states raised Medicaid physician reimbursements, according to an annual 50-state survey of Medicaid directors. It was released in October by the Kaiser Family Foundation and Health Management Associates, a health research and consulting firm.

Enrollment dropped this year for the first time in a decade due to an improved economy and new citizenship rules, state officials say.

Source: Doug Trapp, AMNews [11/12/07]

Query: Post-Alcohol Injection Rash

I have been using 4% alcohol injections for neuromas for the past five years with no problems. Recently, I had two light-complexioned patients in their 60’s who towards the end of the treatment protocol injection 5 and 6 developed a rash on the dorsum of the foot. The area was slightly swollen and warm. I put the patients on antibiotics to be safe, and the problem resolved. I re-injected the same patients after they recovered from injection #5 with a new batch of 4% and used half the injection amount but the same "rash" area occurred. Any thoughts or suggestions?

Ivar E. Roth DPM,MPH, Newport Beach, CA

RE: Botox for Muscle Imbalances (Tip Sullivan, DPM)
From: Allen Mark Jacobs, DPM

Botox works very well for upper motor neuron disorders (e.g.- foot deformity from CVA, cerebral palsy) but the injections must be repeated every 3 months. For non-spastic deformities remember that the decreased muscle tone and power from the injection are temporary. These injections will have to be repeated every 3 months. I have found them not to be helpful in the presence of a long-standing contracture.

They are helpful for temporary weakening of the gastrocnemius while treating forefoot ulceration or Charcot's joint disease. They are also helpful for the temporary treatment of peroneal muscle spam with tarsal coalition.

Proper dosage and injection placement are important, so read a bit before proceeding

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

RE: Epic EMR (Stanton Cohen, DPM)
From: Jeremy Mason, DPM

I used Epic during my first year of residency at the Cleveland Clinic. I found the software to be user-friendly, and it will reduce your time spent charting significantly once mastered. The learning curve may seem steep if you are less computer savvy, but in my opinion you will be pleased.

Jeremy Mason, DPM, Oklahoma City, OK, cowboyfootdoc@yahoo.com

RE: Coming 10% Medicare Cut
From: Multiple Respondents

It seems to me we are being "brainwashed" by the government. For the past several years we have been constantly placed under a guillotine and almost miraculously we get a reprieve and a pathetically small increase in our fee schedule and we are ecstatic! Unfortunately, these increases don't keep up with my increasing costs. Many of us keep making less and less. The government can spent trillions on a needless war "without any impact on our economy" yet a small increase is destructive to the economy. How much extra cost to our car manufacturers does our deficit spending add to the cost of an automobile? We are told increasing medical costs is impacting all our businesses yet it’s miniscule compared to government impact. The government seems happy to remunerate health insurance CEO's and healthcare corporations at the expense of the providers. We are mandated to spend the same healthcare dollars even though there are more of a senior population to access our services. This is inconsistent with any successful business plan.

I agree with Dr. Ribotsky's business plan since. The "in-network" surgical environment is not profitable and riddled with liability. Unless you can go out of network, get a certified office surgical center, or do a lot of surgical volume, surgery is not very profitable and a lot of surgery relates to a lot of liability no matter how good you are.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

Editor’s note: Extended-length notes by Drs. Smith and Kass appear at:
http://www.podiatrym.com/letters2.cfm?id=16544&start=1

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

DPM-PT POSITION AVAILABLE - NEW JERSEY

Podiatrist/Physical Therapist dual-degree (DPM-PT) needed to join expanding 2 DPM practice and develop an internal Physical Therapy department with strong emphasis to all phases of Podiatric PT; including foot/ankle surgery, sports medicine, peripheral neuropathy and advanced wound care. Will hold position for right candidate. CV/Questions: pat_caputo@alumni.rutgers.edu

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

PRACTICE FOR SALE - MISSISSIPPI GULF COAST

Near Casino's and beaches. Busy Practice with no HMO's and good insurance coverage. Hospital and Surgical Center privileges available. Call (228) 762-9531 or email me at jwbenus@yahoo.com

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