The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

November 16, 2011 #4,307 Publisher-Barry Block, DPM, JD

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IL Podiatrist Discusses Running Shoes vs. Cross-Trainers

Should you buy running shoes or cross-trainers? Go with running shoes if you mostly jog or walk, since they’re engineered for heel-to-toe motion. Why not walking shoes?  “Running sneakers cater to a wider range of foot types and are built to last longer,” says Megan Leahy, a doctor of podiatric medicine at the Illinois Bone & Joint Institute in Chicago.

Dr. Megan Leahy

Leahy says go with cross-trainers if your routine includes an activity like aerobics, weight training, or kickboxing (basically any exercise on a hard surface that involves side-to-side movement).

Source: Elinor Smith, Fox News [11/11/11]

Scholl College’s CLEAR and IPMSA Host Fall Prevention Expert

Falls in the elderly population are a rising challenge in the national healthcare system with an estimated cost of more than $20 billion per year in the U.S. alone. A recent study published in the British Medical Journal (BMJ) by Prof. Hylton Menz and his team demonstrated the effectiveness of a multifaceted podiatry intervention for reducing the likelihood of falls in older adults. To promote the awareness of podiatry’s contribution in fall prevention in older adults, Scholl College’s Center for Lower Extremity Ambulatory Research (CLEAR) invited Prof. Menz, Harvard Fulbright Senior Scholar, to give a grand rounds lecture.

Prof. Hylton Menz

His presentation, “Does Podiatry Have a Role to Play in the Prevention of Falls,” was held at Rosalind Franklin University’s Scholl College of Podiatric Medicine on Tuesday, Nov. 8. Currently, Prof. Menz is a National Health and Medical Research Council of Australia Senior Fellow, and Director of the Musculoskeletal Research Centre at La Trobe University. He has published more than 150 papers in podiatry, gerontology, rheumatology, and biomechanics journals, and he is editor-in-chief of the Journal of Foot and Ankle Research. This event was jointly supported by CLEAR and the Illinois Podiatric Medical Student Association (IPMSA).

NY Podiatrist Performs Sinus Tarsi Implant Surgery on Educadorian Teen

Juan C. Goez, DPM a podiatric surgeon from Bellmore, NY, enjoys sharing his knowledge and expertise. Fluent in both English and Spanish, he has been reaching out to surgeons in Spanish-speaking countries. In his latest outreach, Dr. Goez recently traveled to Ecuador where local doctors identified a 16 year old child who had been suffering with severely painful talotarsal dislocation syndrome and requested Dr. Goez perform the HyProCure® surgery. 

Dr. Juan Goez and Educadorian Teen

Dr. Goez recognized the opportunity to not only help more doctors understand this life-changing procedure, but to help a child in need. The patient came from an economically depressed area and underprivileged background. The family would have been unable to pay the medical costs. Confident that this surgery could change the patient’s life, Dr. Goez agreed to perform the surgery at no charge, the hospital agreed to donate the use of their facilities, and GraMedica agreed to donate the HyProCure® stent.

AZ Podiatrist and Saudi Vascular Expert Start Reciprocal Visits

In a potent symbol of the international diabetes epidemic, two diabetes experts from two sides of the world met to share experiences and preview upcoming collaborations. Mohamed Elsharawy, Professor and Chief of Vascular Surgery at the Saudia Arabia's University of Dammam visited Dr. David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona. 

Mohamed Elsharawy and David G. Armstrong during World Diabetes Day

"Most of the adult populations of the Gulf States have diabetes prevalences between 20 and 30 percent. The most common reason these patients end up in hospital--- just like in the USA-- is for a lower extremity complication," said Armstrong who will reciprocally visit the University of Dammam for the Gulf Vascular Society symposium in February, 2012 to share techniques and outcomes between the SALSA unit in the USA and Gulf States.

Supreme Court to Review Healthcare Reform Law

The Supreme Court announced it will review whether Congress has the power to compel nearly all Americans to purchase health insurance or face a tax penalty and whether the federal government's effort to expand state Medicaid programs amounts to illegal coercion.

In a regular Monday morning order posted on its website, the court announced that it would hear oral arguments on a total of four specific questions raised in federal circuit court decisions that split on the legality of the so-called individual mandate to buy insurance in the Patient Protection and Affordable Care Act. Observers have said that decisions for cases argued in the court's spring term would likely be published by June, which could thrust the case into the national run-up to the November 2012 presidential election.

Source: Joe Carlson, Modern Healthcare [11/14/11]

Query: MRIs and Hardware Placement

About six weeks ago, my patient underwent an uneventful bunionectomy. I used two Osteomed screws. He came to me today because he had an MRI for his knee (ordered by his orthopedist). He told me that he felt a burning sensation and a "buzzing" to the foot during the MRI. He now has swelling and calor to the foot. His x-rays today show some proximal migration (pistoning) of the Osteomed 2.4 screws, I would assume there has been some loosening of the hardware due to the magnet.

X-rays Pre and Post MRI

My concern is - what is the general consensus for MRIs and "recent" hardware placement? I have been under the impression that three months is the window for recent fixation and MRIs.

David Weiss, DPM, RIchmond, VA

Query: Medicare Advantage Demand for Repayment

I received a letter yesterday from one of the Medicare Advantages plans claiming repayment of apparent overpaid claims after an audit they performed in my office about two months ago. The amount of money is substantial, and I do not feel is correct. They claim that my notes do not support the use of 11721 and downcoded 100% of them to 11720 and also are disputing 99213 with the 25 modifier. I keep good notes with my EHR (Medinotes) that support the services provided and feel that these claims by the medical plan are incorrect. Advice would be appreciated.

Name Withheld by Editor   

Editor's comment: PM News does not provide legal advice. In the 11/7/11 issue of PM News, a podiatrist asked what to do when an insurance company requested 87 charts. Our recommendation was to contact a healthcare attorney. The following day, two readers assured the podiatrist that there was "absolutely no cause for concern." We respectfully disagree. We urge anyone subjected to a large audit to err on the side of caution.

RE: Chronic Wound in Type 1 Diabetic
From: David J. Kaplan, DPM

I think taking the patient to surgery MIGHT be a good idea depending on may other issues. Vascularity, of course is a big consideration.  Whether there is osteomyelitis or not, the pressure from this site is problematic and should be addressed. Hold antibiotics for 48 hours so you can get an appropriate bone specimen for C&S. I would not close the wound immediately. Keep it open for 48 hours to make sure it's clean and confirm this with a gram stain and C&S before closure. 

If the patient is relatively active, protect the peroneus brevis. When you go back to do your delayed primary closure, you can re-attach the brevis at that time. DVT prophylaxis is important. Use enoxaparin 30mg SQ BID or 45mg SQ q24 hours for 72 hours. Adequate leg compression and early ambulation are also important factors. 

David J. Kaplan, DPM, San Mateo, CA, drdjkdpm@yahoo.com

RE: Diabetic Patient Check-Ups (Daivd J. Kaplan, DPM)
From: Harry Goldsmith, DPM

There are several things that need to be cleared up regarding PQRS. First, PQRS (Physician Quality Reporting System) is a “voluntary” reporting system dealing with preventive care measures. Medicare happens to incentivize doctors (eligible professionals) to report a minimum number of measures during the year (in 2012, it will be 0.5% of total Medicare allowed charges).

There is nothing I am aware of in PQRS that requires annual, semi-annual, quarterly, or more often follow-up exams.

Second, patients are not scheduled to be seen for...

Editor's Note: Dr. Goldsmith's extended-length letter can be read here.

RE: The Passing of Craig Gastwirth, DPM

The world has been touched by the smile, grace, gentleness and friendship which Craig Gastwirth brought to all who had the honor of meeting and knowing him. I extend my deepest sympathies to his family, friends, and our colleagues who so enjoyed his company. We will miss you, Craig!
 
Michael A. Robinson, DPM, MPH, JD, Past President, ABPOPPM

I remember Craig as a classmate. He was one of the smartest students in the class, and he had a great sense of humor. He was always a pleasure to be around. My sincere condolences to Cheryl, daughter Stacy, son Andrew, Glenn, Bart, and the entire family.

Stanley Beekman, DPM, NYCPM, Class of '76

RE: Minimalist Shoes May Have Some Benefits: TN Podiatrist (Robert Steinberg, DPM)
From: Ray McClanahan, DPM, BS Ed

I got a good chuckle reading Dr. Steinberg criticizing Dr. Chatelain for stating an opinion that lacks scientific evidence, and then in the next paragraph stating his own opinion that lacks scientific evidence. “Running shoes have evolved in a manner that has lowered the foot injury rates, allowing so many more people to take up jogging and running, with tremendous health benefits.”

Dr. Steinberg apparently does not read the medical literature regarding running shoes and injury rates, or he would know that his opinion is not supported there. Dr. Steinberg, will you please offer us your scientific evidence for your opinion? And perhaps an apology to Dr. Chatelain?
 
Ray McClanahan, DPM, BS Ed, Portland, OR, footdr@nwfootankle.com

CPME-CERTIFIED WOUND CARE FELLOWSHIP

Open position available Jan.31, 2012. St. John`s Episcopal Hospital, Far Rockaway New York. State-of-the-art wound care center. All aspects of wound care including hyperbaric oxygen & reconstructive surgery. One year, excellent salary & benefits. Must have completed approved residency and passed boards. Contact Mariann (718) 869-7256

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER ( LUMIX2)

Superpulse 45 watt peak power Laser ( lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPM footcare@comcast.net

EQUIPMENT FOR SALE - CLASS FOUR LASER- USED K-LASERS

I have used K-laser for sale. Still in Warranty. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargeable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact  pistone@telus.net or call 250-754-4192.

ASSOCIATE POSITION – NORTHERN CALIFORNIA / BAY AREA
 
We’re looking for someone entrepreneurial who can help grow our practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. Send your CV and cover letter to cvpodiatrist@gmail.com
 

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV) to northtexaspodiatry@yahoo.com along with a letter of intent

ASSOCIATE POSITION - MARYLAND

Multi-office group seeks highly trained surgical associate to join us. Prefer person with frame and trauma experience. Our practice is state-of-the-art and has all modalities: EMR, PadNnet, on-site billing, diagnostic US, PRP, digital x-ray, etc. Excellent salary, bonus structure and benefits with partnership available. Please forward CV and letter of intent to docsbnb@aol.com

ASSOCIATE POSITION - ILLINOIS PERMANENT P/T

Podiatrist needed for Medinah Spine/Rehab/Podiatry. Upper middle class suburb multi-disciplinary established office seeks perm P/T podiatrist to service established podiatry practice. Please call SueL 630-529-0077 or fax resume to: 630-529-0087.

PODIATRY OFFICE TO SHARE - SEATTLE, WASHINGTON

Fully equipped podiatry office in North Gate area of Seattle. Office located in medical professional building near I-5. Office has 3 treatment rooms, 3 physical therapy rooms, direct digital x-ray, PAD- net, NCV testing equipment, physical therapy equipment. Please contact us: website Tel. 425-643-8901isbinc2006@gmail.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

SUB LEASING TIME on MRI (NYC)

Don't refer out $$ when they can go into your pocket. Beautiful state-of-the-art 5th Avenue medical office is offering lease time on a .31 tesla Esaote extremity MRI, complaint with Stark laws. This particular magnet is the only one accepted by insurances and Medicare as of 2012. For more information email dri@myfcny.com

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