The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

November 17, 2012 #4,615 Publisher-Barry Block, DPM, JD

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Minor Foot Problems Can Worsen if Unchecked: MD Podiatrist

Even seemingly minor issues, such as sore feet or bunions, can worsen and ultimately require costly surgery if left unchecked, says Dr. James Christina, of the American Podiatric Medical Association.

Dr. James Christina

Whether you should see a podiatrist or an orthopedist depends on your condition. In general, a podiatrist is the best bet for minor problems and for surgeries to correct chronic issues like hammertoes. Orthopedists are surgical specialists often recommended for breaks and other sudden injuries (they also tend to be more expensive).

Source: Walecia Konrad, Money Magazine [11/16/12]

Identification of Pre-Diabetics Is Key to Prevention- FL Podiatrist

"If we can identify those Floridians that have pre-diabetes, and those that have the risk factors to develop pre-diabetes, we have an opportunity to prevent them from progressing to full-blown Type II diabetes," said Dr. Chet Evans, chair of the Governor's Diabetes Advisory Council, at a press conference on the steps of the Florida Capitol in celebration of World Diabetes Day.

(L-R) Ms. Haley May, Dr. Dennis Cookro, deputy secretary of health, and Dr. Chet Evans.

Joining Dr. Evans was Dr. Dennis Cookro, Deputy Secretary of Health, and Ms. Haley May, a type I juvenile diabetic and an advocate of diabetes awareness and prevention. The historic Florida Capitol Building was lit in blue to commemorate World Diabetes Day.

FL Podiatrist Provides Shoe-Buying Advice

Dr. Tara Fussell, a podiatrist at Orlando Foot and Ankle Clinic says you either pay now or pay a painful price later. “Most women start to complain about hammertoes in their 40's to 50's. They can attribute their foot changes and the deformities in their foot from when they were younger and wearing the tight pumps,” said Fussell. “I tell patients minimize the time you're going to wear them. If you're going to go to the theme park, the mall, or to run errands, maybe it's not the time to wear those high heel tighter shoes,” said Fussell.

Dr. Tara Fussell

She also advises women to do their shoe-shopping toward the end of the day. “Most people's feet swell throughout the day and can go up a half to a full size with that swelling," Fussell said. When all else fails, Fussell says the best way to cushion the soles or prevent blisters is lining your heels with lamb's wool, which you can find at most shoe or craft stores.

Source: Jessica Sanchez, WKMG (CBS) [11/16/12]

SGR Patch Expected in Lame Duck Session

The co-chair of the GOP Doctors' Caucus is “pretty confident” that Congress will approve a one-year freeze in Medicare physician pay rates during the lame duck session of Congress. Rep. Phil Gingrey (R-GA) told reporters Thursday that the caucus has discussed a plan to push during the post-election session of Congress, a one-year freeze in Medicare physician pay rates, which are slated for a 27.5% cut Jan. 1. During the lame duck, there will be a patch,” he said.

Gingrey was confident that Congress would find the $18 billion needed to offset the cost of a one-year payment freeze and suggested using savings from cutting programs included in a recently released annual report by physician Sen. Tom Coburn (R-OK) on wasteful government spending. However, Gingrey rejected the use of savings from the end of the Iraq War—an SGR pay-for long favored by Democrats—as “smoke and mirrors.”

Source: Rich Daly, Modern Healthcare [11/15/12]

Query: DOX vs. Advanced MD
 
We are considering switching after two years from Cerner Powerchart to either Advanced MD or DOX. Has anybody done this? How satisfied are those who use either of these software programs?
 
Gary S Smith, DPM, Bradford, PA

RE: Shoe Recommendation

I have a youthful 52 y/o female patient with narrow size 12 feet. She has been searching for a supportive lace-up shoe that fits an orthosis. But most of the nicer styled supportive women's shoes that do come in narrow widths stop at size 11, or the size 12 version is too wide. She is searching for a shoe that does not have an orthopedic look. Does anyone have any recommendations?

Ayne Furman, DPM Alexandria, VA

RE: Pea-Sized Plantar Fibroma (David Kahan, DPM)
From: Evan F. Meltzer, DPM, Barry Mullen, DPM

I have found that small (<2-3 mm) plantar fibromas often respond to 1 intralesional injection of corticosteroid of your choice. This would seem to be an ideal treatment for your patient.
 
Evan F. Meltzer, DPM, San Antonio, TX, Evan.Meltzer@va.gov

Are you sure about your diagnosis? While a post-traumatic fibroma is conceivable from a foreign body penetration due to the relative lack of adipose tissue along the plantar surface of the foot and the fascia's anatomic proximity to the dermis, the history of this chief complaint is more highly suggestive of either an epidermal inclusion cyst or foreign body granuloma. In either case, Verapamil is unlikely going to influence this mass. Excision is the treatment of choice. Try pressure dispersing the mass during the athlete's season, and if painful enough to hinder athletic performance, excise it during the off-season.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Pea-Sized Plantar Fibroma (David Kahan, DPM)
From: Brad Makimaa, DPM

I clearly would not first assume fibroma. I certainly would not jump to verapamil on a 17 year old. I also would not have a surgical discussion without a proper diagnosis. I would get an MRI. This will give better insight to the diagnosis which can direct the best treatment. I am much more inclined to think more of inclusion cyst or scar tissue as the primary diagnosis. Diagnosis must be established first, i.e. Is this mass attached to the fascia or arising from it? Is there a metal or organic fragment? I assume that an x-ray was done. This vastly changes your surgical planning and discussion with the patient on outcome and post-op scenario.
 
Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net

RE: EMR Employee Screw-Ups Can be Costly
From: Name Withheld

I went through stage 1, achieved a pass mark, and  received my check, only to find that the employee who did my billing was slacking so much (billing once and then not following up with it)  that the insurance company did not pay, or patients did not get bills. I  had thought that lack of normal income coming in was due to this slower pace, but in the end, it was incompetence of the employee. So I now bill off-site. The employee walked. I smiled when the billing company started billing properly. I now have monies paid, but I suffered a loss financially, so I place this warning to other docs starting up with an EMR. Monitor your employees closely.

Name Withheld

RE: HBOT Oversight (Eric Goldenberg, DPM)
From: Elliot Udell, DPM
 
One of the problems with hyperbaric oxygen therapy centers in my geographic area is that many, if not all, of them are affiliated with wound care centers. Both I and many of my colleagues have experienced loss of our patients to these centers when they were sent there solely for hyperbaric oxygen. The straw that broke the camel's back for me with regard to these centers was when a doctor working at one of these wound care centers lulled the patient into coming to him for the rest of his podiatric medical and surgical needs after his wounds were healed. I would love to use hyperbaric oxygen as an additional modality in the care of many of my patients with diabetic wounds and hope that these centers will someday find a way of of not taking over the total wound care of my patients.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: HBOT Oversight (Eric Goldenberg, DPM)
From: Wm. Barry Turner, BSN, DPM

It took me over two years, multiple filings with my local State Board of Podiatry and the Regional Medicare Medical Director before it was agreed that I would be allowed to supervise and be paid for the supervision and technical component of full body hyperbaric oxygen therapy, when treating lower limb pathology. I have supervised and  been paid for providing full body hyperbaric oxygen therapy in the  State of Georgia for almost a decade. I am unaware of any insurance carrier that has denied me payment. I do have a letter from my regional  Medical Director of Medicare (at the time) stating that Medicare does acknowledge that this service is within my scope of practice and as such, is payable by Medicare.
 
Read your state's scope of practice act! The Georgia Practice Act says that I am not allowed to supervise general anesthesia; it does not mention anything regarding HBOT. The decision to allow me to provide HBOT (was made via a phone conference in the Georgia Assistant Attorney General's office, with the Assistant Attorney General and the Medical Medicare Director) may have been influenced by my HBO advance training and being ACLS-certified for over 20 years. As with anything I do in my practice, if I am negligent or perform outside my training and do not perform to the acceptable norms, I and my license are held responsible for my actions. If you do decide to supervise full body HBOT, please be appropriately trained and keep your ACLS training and certification current.
 
Wm. Barry Turner, BSN, DPM, Bogart GA, claret32853@ymail.com

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