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November 14, 2006 #2,740 Editor-Barry Block, DPM, JD

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7th and 8th Textbooks By Helfand Published

Foot Health Training Guide for Long-Term Care Personnel was published by Health Professions Press of Baltimore on October 13, 2006. This is the 7th textbook edited by podiatric legend Arthur Helfand, D.P.M. of Narberth, PA.

Dr. Arthur Helfand

Dr. Helfand’s eighth edited text, Public Health and Podiatric Medicine - Principles and Practice - Second Edition, was published by the American Public Health Association and released on November 5, 2006 at the Annual Meeting of the APHA.

Helfand is a former president of the APMA and been instrumental in incorporating the fields of geriatrics and public health in podiatric medicine.

Insurers Offer Health Reform Plan

The health insurance industry proposed a $300 billion plan to expand healthcare coverage to all children in the U.S. within three years and 95% of adults within 10 years. The proposal by America’s Health Insurance Plans includes expanding Medicaid eligibility to all uninsured adults with incomes below the federal poverty level; offering a tax credit of up to $500 for low-income families who secure health insurance for their children; and providing $50 billion in federal grants to help states expand coverage.

In addition, all consumers should be able to buy any type of healthcare coverage and pay for qualified medical expenses with pretax dollars through a new universal health account, AHIP said. And the federal government should match working families’ contributions to such health accounts, AHIP said. The group estimated that full implementation of its plan would cost the federal government about $300 billion over 10 years.

Source: Jennifer Lubell, Modern Healthcare [1113/06]

Melanoma: Immune System Might Be Able to Attack Cells

The body's immune system might be able to fight off melanoma if a reliable method can be found to inhibit regulatory cells that normally control the body's disease-fighting cells, thereby allowing the body "to mount a continuous attack on the cancer," according to two new studies released this week at a European cancer meeting in Prague, Czech Republic, the AP/Albany Times Union reports.

In one study, Jason Chesney of the J.G. Brown Cancer Center in Kentucky found that in five of seven participants with advanced melanoma, a drug combination that suppressed T-regulatory cells caused their tumors to shrink or remain stable. In the second study, researchers led by Jeffrey Weber, a professor of medicine at the University of Southern California, blocked a protein on the T-regulatory cells that "inhibited them enough for the immune system to attack cancer cells," the AP/Times Union reports. Of the 25 patients tested, 24 were still alive after 17 months and three were cured of cancer, according to the researchers.

Source: AP/Albany Times Union via American Health Line [11/13/06]

Query: Grafted Jones Fracture

A basketball player with a Jones fracture was referred to me. He had received a cancellous bone graft from the lateral malleolus. When I checked the Fx with x-rays and ultrasound imaging, the Fx line was just about healed, but it wasn't edged by cortical bone. The original treating doctor wants to put the player back on the court in a couple of weeks or so. Does anyone have experience with this approach? What is the healing time before play can be resumed with a grafted Fx like this? Is re-fracture inevitable?

Frank Graham, DPM, New York, NY

RE: V Osteotomies (Arden Smith, DPM)
From: Multiple Respondents

My favorite "V" osteotomy for lesser metatarsals utilizes a v cut as
close to the transverse plane as possible. A K-wire is placed dorsally and centrally just proximal to the cartilage surface at an acute angle approximating the weightbearing surface.The metatarsal is then V cut with a oscillating saw at about 60 degrees foll;owing this apical axis guide. This minimizes perhaps even negates any dorsi-flexion of the metahead, causing floating toes. You can slide the head proximal to shorten and fixating with a threaded k-wire is easily performed. I believe that Wolfe's law applies at the healing site in relieving plantar pressure.

Michael Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com

My opinion of the Weil osteotomy vs. the "V" is that the Weil osteotomy is actually easier to perform, allows for much better decompression of the MTPJ (affording better hammer toe correction), is amenable to cannulated screw fixation, and has much better and more predictable outcome. When performing hallux valgus surgery, I will always evaluate the congenital length of the 2nd metatarsal and determine if a hammer toe or any plantar callus exists. If so, I perform a Weil osteotomy with a hammertoe operation (if a digital deformity exists.) Because all bunion operations shorten the 1st metatarsal to some degree, congenital elongation in itself is enough of an indication to perform a Weil osteotomy of the second metatarsal, even without a clinical 2nd toe deformity or metatarsalgia.

I believe this concomitant procedure will prevent transfer metatarsalagia as an untoward result of bunion surgery. This simple yet powerful lesser metatarsal osteotomy has been instrumental in my surgical practice.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

I have had great success with the v-osteotomy for lesser metatarsal. I am careful to distinguish between a metatarsal that is plantar-flexed and one which is elongated. The true v works well for the plantarflexed and in my hands it is stable enough for one .045 K-wire. I have even floated them if they seem to be solid after compression. They are put in a post op shoe for three to six weeks. I think the problem with the v osteotomy comes when we try to correct an elongated met with a dorsi-flexion procedure. I will use a double v osteotomy for elongated mets and those are always fixated with a wire. Your ultimate decision should be to do the procedure you are most comfortable doing for the right indication.

David Gutierrez, DPM., Bronx, NY, DOCG2100@aol.com

RE: Off-site Access and HIPAA (Pat Caputo, DPM)
From: Robert Nunberg, DPM

I have used gotomypc for at least six years for personal and office use. I have found it to be a useful tool to be able to acquire information when away from the office as well as work remotely from my second office. Its firewall has been secure and safe. It is also relatively cheap to purchase. Verizon of Massachusetts is now offering a package to purchase gotomypc with its phone service, for much less than the traditional method. I am not certain of its HIPAA compliance. I like it and would recommend it at any time as well.

Robert Nunberg, DPM, East Boston , MA, robert.nunberg@verizon.net

RE: HPV and Cervical Cancer (Dale Smith, DPM)
From: Ivar E. Roth DPM, MPH

14 years ago I went with my wife to the gynecologist for a removal of a HPV virus lesion. I looked inside at the lesion before he removed it. The lesion looked like a flat wart that we see on the skin of the feet. I then contacted the university of Irvine Medical School’s dept of dermatology and discussed this finding with the director of the dept. The Dr. also thought there could be a link of foot warts and HPV.

I did biopsies of several patients’ foot lesions and the derm dept typed these against known HPV virus types. The outcome was that there was no correlation, so the study ended.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multilocation practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.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

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