The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 16, 2009 #3,702 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Reebok Easytone Sneakers

Dr. Ethan J. Ciment, a surgical podiatrist at The Chelsea Foot & Ankle Center in Manhattan says that the Reebok Easytone sneaker is the latest incarnation of shoe gear to utilize Masai Barefoot Technology.

Dr. Ethan J. Ciment

"These types of shoes have a sensor (or a roll bar) toward the heel of the shoe that makes the shoes somewhat unstable," Ciment said. This rolling action from the heel strike forces the user to activate under-utilized muscles that are not as easy to engage when walking in conventional shoe gear. In this way, it simulates the act of walking barefoot. When wearing shoes with this kind of roll bar, you take smaller strides, step onto a more bent/flexed knee, and push off with a straight leg. All of this activates your hamstrings and glutes."

Will Reebok's Easytone shoes tone your hamstrings and glutes more than your conventional shoes? Ciment thinks so. "I have treated many patients who wear shoes with the rocker-bottom or roll-bar technology who become so adapted to walking in that different way that they find it very painful to walk or stand in conventional shoes and sneakers, let alone barefoot," Ciment said. "Many patients develop painful forefoot issues like neuromas and even stress fractures from the increased load and weight-bearing on the forefoot that these kinds of shoes demand."

Source: Ronnie Koenig, That's Fit [11/13/09]

IPMA Announces Newly Elected 2009-2010 Officers

The Illinois Podiatric Medical Association recently installed its new officers:

(L to R) Drs. David Yeager, Ada Paolucci, Marlene Reid, Francis Rottier, Joseph Borreggine, and Paul Brezinski.

President: Joseph S. Borreggine, DPM
President-Elect: Marlene Reid, DPM
Vice President: Ada V. Paolucci, DPM
Treasurer David A. Yeager, DPM
Secretary: Francis J. Rottier, DPM
Immediate Past President: Paul F. Brezinski, DPM

MI Podiatrist Inducted into MI Jewish Sports Hall of Fame

Former state boxing commissioner, Dr. Stuart Kirschenbaum, was inducted into the Michigan Jewish Sports Hall of Fame on Nov. 2. The ceremony was attended by over 400 guests, including boxing great, Thomas Hearnes.

Dr. Stuart Kirschenbaum with Hall of Fame Plaque

Kirschenbaum, 64, served as commissioner in 1981-92 and was instrumental in helping establish federal regulations for boxing in the state and for improving conditions for fighters. A former New York Golden Gloves heavyweight contender, Kirschenbaum earned a medical degree in 1970 and is a practicing podiatrist in Detroit. He is founder and president of the Michigan Boxing Hall of Fame, among other offices.

It’s Not About You

Add “oomph” to presentations by stating your goal in terms of what you want your audience to do, not what you want to do. That subtle, but vital, shift in your thinking will lead you to speak more persuasively.

Source:  Adapted from “Power Presentations Tip 01: It’s Not About You,” by George Torok via Communication Briefings
 

Queries: Platelet-Rich Plasma

I would like to know about results on PRP injections. Can they be used as a first line treatment? Does it have to be done in the office or in the hospital? How many injections can the patient have? What is the protocol? I understand that the 50ml of the patient’s blood must be taken and spun to get 3ml. 

Jason M. Grossman, DPM, Old Bridge, NJ

RE: The Application of EBM to Orthotic Therapy (Robert Bijak, DPM)
From: Multiple Respondents

Dr. Bijak has made it very clear that he doesn't understand biomechanics or thinks it is beneath him. Biomechanics, routine foot care, etc., differentiates us from other professions. We are one of the few professions with a doctoral degree that can provide instant relief. There is much research in biomechanics by PhD's in orthopedics, biomechanics, and physical therapy who have access to larger universities.  However, there are podiatrists becoming more and more involved in what happens when the foot hits the ground and the kinetic chain is engaged. Dr. Bijak feels there is too much variability in orthotics to make it a valid treatment option. 

Well, unless you are using robotic-assisted surgery, no surgery whether a bunionectomy with metatarsal osteotomy, hammertoe correction, triple arthrodesis or Charcot reconstruction is exactly the same. There are also variables in what procedure to perform, fixation, and post-op care. I do admit that more study needs to be done and is currently being done. But if all you do is go to surgery conferences, then the world is a nail and you have the hammer.  Podiatric medicine encompasses all of the treatments we provide whether nail, skin, bones, or tendons. This also includes physical therapy, shoe recommendations, and orthotics. That is who we are; if that disgusts you, then become a foot and ankle orthopod. I will stick to my profession "as is." Thank you very much!
 
Patrick J. Nunan, DPM, West Chester, OH, pjndpmrun@aol.com

If Dr. Bijak honestly feels, as he said: "Nail cutting and orthotics will be the anchors that keep podiatric medicine as an "allied health field,"  then might I add, it is opinions like his, translated in the office from a belief to the action that all patients are surgical or not otherwise worth his esteemed efforts, that in turn, give us all a poor image as desirous to cut on everything.
 
I do a lot of routine care, biomechanics, orthotics, medicine, and surgery.  The surgeries above my abilities to perform well, I send out to the better trained podiatrists (yes, Dr. Bijak, I said podiatrists not surgeons), but what I won't do is send my complicated cases out to someone who seems to "look down" on me as part of an anchor rather than a colleague. We have all sorts of podiatrists, most good, and few anchors.
 
David E. Gurvis, DPM, Avon IN, deg1@comcast.net
 

It does not appear from the note that Dr. Bijak has attended any recent biomechanical seminars conducted by PFOLA. For if he had, his understanding of evidence-based research and clinical trials hopefully would change his thinking. These meetings and other certain biomechanically-oriented seminars are not a repeat of lectures from podiatry college, but rather presentations of well thought-out research protocols whose results substantiate and validate the differences of various biomechanical approaches to treatment. I would suggest that Dr. Bijak attend one of these meetings as it may enlighten his current thinking. I would hope so!

Richard Stess, DPM, Mill Valley, CA, rstess@stssox.com
 

RE: CME article on The Use of Dietary Supplements in Diabetic Peripheral Neuropathy By Robert G. Smith DPM, MSc, RPh
From: Lawrence Kollenberg, DPM, Pharm-D

Dr. Smith presented a well-written CME article on the use of dietary supplements for diabetic peripheral neuropathy (DPN). In the article, he presents a good overview of the etiology of DPN, and goes on to discuss the use of many different potential supplements for the treatment of this debilitating complication. His suggestions of use of alpha linoleic acid, acetyl L carnitine, capsacin, and many others are great suggestions.

In one area, he mentions that chromium is one of the most studied mineral supplements, but gives no information on the appropriate dosage, use, or indications of this supplement. Chromium picolinate is a herbal supplement that is used as an alternative medicine to lower high cholesterol levels, control blood glucose, and has been reported for use in weight loss. The usual RDA is 0.2mcg per day. Disease-dependant dose ranges from 0.2 - 0.45mcg per day. High doses can cause severe renal and hepatic damage.

Dr. Smith also mentions Mentanx (a dietary food grade supplement) with indications for possible DPN treatment. It is a food supplement that requires an Rx and is almost never paid for by insurance companies. A prescription for 60 pills is about $50-60.

I suggest that the HOPEand HOPE-TOO trials should have been reviewed for this article in that they discusses the HIGH cardiovascular risk associated with Vitamin E doses of 400IU. Dr. Smith quotes other studies with recommendations of 900IU. I suggest reading the NIH website before starting high Vitamin E doses.

Lawrence Kollenberg, DPM, Pharm-D, Jacksonville, FL, lkollenberg@hotmail.com

RE: Backlit Scanner (Robert Kuvent, DPM)
From: Ron Werter, DPM

I had checked into this a while back, not only for patients , but as a way to scan my own x-rays for an EMR system. HP has a machine (G4050) with an 8x10 transparency scan area for about $200, and there used to be an Epson for the same price and size. There are a couple of Epson machines that do backlit scans for $500-600 (V700 photo and V750 pro). The problem, at least with the cheaper machines, is the amount of time for the scan, up to about 4 minutes for their highest resolution of 4800dpi. They all give acceptable resolution for a computer screen.

I suggest you get the machine from someone you could return it to, if necessary, and try it out.
 
Ron Werter, DPM, New York, NY, hawkeyedpm@aol.com

RE: PECOS (Joseph Borreggine, DPM)
From: Michael J King, DPM, Paul Kesselman, DPM

Allow me to briefly respond to Dr Borregine’s posting on the latest CMS directive: PECOS.

Yes, APMA is trying to “come to the rescue” on this issue. This onerous application/reapplication process is being opposed by many medical organizations including the AMA, AOA and others. A coalition has been formed and a letter of complaint has been generated. We are in daily communication in an attempt to clarify exactly what is needed, if it is needed at all, and  to see if we can delay this process which has been thrust upon us by CMS without due notice or preparation.

APMA is in the process of trying to find out more details and arranging a high level meeting at CMS regarding the PECOS issue and its potential effect on both DME and regular Part B claims submissions. The sources of information on this topic have been many, and all with a different message. APMA is trying to deliver the right message. Any and all information we can gather will be shared with APMA members.

Michael J King, DPM, Vice-President, APMA, MJKing@apma.org

The recent fact sheet from APMA was well- researched and was as up-to-date as possible at the time of its release. At the very end of the E-News posting, APMA documented its pursuit of clarification of this issue with CMS. Telephone conferences have taken place between many professionals and representatives of other medical associations (way too numerous to mention here) and many more are planned. A concerted effort is being made NOT to eliminate the requirements for PECOS re-enrollment. This is a necessary evil to eliminate DME and other Medicare fraud. Medicare has long sought to re-enroll physicians every five years (just as suppliers require re-enrollment every three years).

The position of many medical societies and all healthcare professionals should be that this policy implementation should be delayed until...

Editor’s note: Dr. Kesselman’s extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=30443&start=1

RE: Edwin Probber DPM
 
I am speaking about what my dear friend and mentor, Edwin Probber, DPM would say. "Please STOP. If you really loved me, you would quit podiatry, buy some horses, and meet me at the track." Ed once told me that podiatry would only appreciate him after he was dead. Well, I appreciated him while he was alive and would like to thank him again for knowing him. I met Edwin when I was 16 years old. He inspired me to enter the field of podiatry. I will smile every time I think of him. I hope he has better luck with the horses now that he probably knows which one to bet on before the race goes off. 
 
Thanks Edwin for allowing me to be a part of your life.

David Zuckerman, DPM. Woodbury, NJ

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO 
 
PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - CHICAGO AREA
 
Well-established, state-of-the-art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist. The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

SEEKING ASSOCIATE - MIAMI, FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary + benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

ASSOCIATE POSITION - PHOENIX, ARIZONA
Part Time/Full Time well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/General Podiatry. ER/Hospital Call a must. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.com

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

ASSOCIATE POSITION – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

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