The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

November 18, 2008 #3,403 Editor-Barry Block, DPM, JD

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CA Podiatrist Discusses Treatment for Turf Toe

Turf toe is a relatively common sports injury, and it sounds minor. However, the only ones who think so are those who haven't experienced such an injury. Dr. Timothy Shea, the chief of podiatric surgery at the John Muir Concord Campus, described a classic predicament that confronts athletes. That is, how do you balance the desire to play, at any cost, versus doing what is necessary to heal properly?

Dr. Timothy Shea

Shea, who said he has treated turf-toe injuries for 35 years or so, recommends patients stay off the affected toe for up to six weeks, depending upon the severity of the injury. At that point, athletes should get outfitted with shoes that provide the necessary stability, and then begin a rehabilitation program that ensures full strength in the toe, foot and ankle.

Returning too soon exacerbates the problem, he said. Too often, athletes tend to take the necessary precautions during the week and play on the weekend. "All you do is aggravate the injury again, and you're taking all of the benefit of the week and throwing it out the window," Shea said. "The body takes a certain amount of time to heal. You have to let it take that time."

Source: Steve Corkran, Oakland Tribune [11/15/08]

APMWA Announces 23nd Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 23rd Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics,or any topic that would be suitable for a lay publication.
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
• First prize will be one thousand dollars ($1,000.00) and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
• This competition is open to ANY enrolled podiatric student.
• Entries must be received by 4/1/09 via e-mail at bblock@podiatrym.com
• Entries become the property of APMWA, which may arrange publication of the entry.

Drugmakers Vow to Disclose Their Payments to Physicians

Three of the country's top-10-selling drugmakers have pledged to publicly disclose their financial relationships with physicians. The move comes ahead of bipartisan congressional legislation, the Physician Payments Sunshine Act that would mandate such reporting. The bill is widely expected to pass in some form next year.

Eli Lilly and Co. in September said by the second half of 2009 it would report payments to its physician speakers and advisers. By 2011, the Indianapolis-based drugmaker would publicly report all physician compensation that exceeds $500 a year, including food, entertainment, gifts, travel and continuing medical education, as specified in the Sunshine Act.

Merck & Co., a day after the Lilly announcement, said beginning next year, it too would report payments made to doctors serving the Whitehouse Station, N.J.-based company as promotional speakers. In October, GlaxoSmithKline announced its intent to publicly disclose payments to U.S. doctors while capping annual compensation at $150,000.

Source: Kevin B. O'Reilly, AMNews [11/17/08]

Query: Dyshidrotic Eczema and Keflex

I’ve had two patients now with a rash that looks like dyshidrotic eczema—pruitic, vesicular lesions on the plantar aspect of the foot. Cultures were negative for both patients, yet both have complete resolution of the rash as long as they are on Keflex. The first was a middle-aged man whose rash appeared after walking through flooded gutters in the city while working. His shoes became completely soaked. My treatments have included topical and oral antifungals, topical corticosteroids, and Keflex. The only treatment that alleviated the rash was the Keflex. As soon as the Keflex was discontinued, the rash recurred.

The second patient reported a history of a deep gash along the posterior heel several years ago. This was self-treated and apparently took months to heal. Since then, she’s gotten a dry, pruitic, vesicular rash on that foot, only along the medial aspect, from the heel to the hallux. Again, the only treatment that has worked has been courses of oral Keflex. The rash completely resolves while she’s on Keflex, but recurs as soon as it is discontinued. Neither patient has any significant PMH, has NKDA, neither are on medication, and neither has a history of food allergies. Has anyone else seen this? Any ideas on long-term management?

Carla Porter, DPM, Poughkeepsie, NY

Query: How Long to Hold Chart for Minor?

Does anyone have any information on the length of time we must hold onto pediatric/minor charts? How long past their 18th birthday? I am located in Illinois and would appreciate any information.

Misty McNeill, DPM, Elmhurst, IL

Editor’s response: PM News does not provide legal advice. Generally, you should retain the chart until the patient is age 18 plus the prescribed statute of limitations for malpractice in your state. Since state laws vary, it is prudent to check with a healthcare attorney in your state. In any case, most practice management experts recommend that all charts be held for a minimum of seven (7) years.

In Illinois, Medical malpractice actions must be commenced within two years of the date of the act giving rise to the injury. If the injury cannot reasonably be discovered during that two-year period, the lawsuit must be filed within four years of the date of the act giving rise to the injury. If plaintiff is under 18, action must be brought within 8 years after date or omission causing injury and never after 22nd birthday.

Source: Parker Waichman Alonso LLP

RE: Varus 5th Hammertoe in a 12 Year Old (Richard Frost, DPM)
From: Multiple Respondents

I have had great success with a transverse tenotomy and capsulotomy at the DIPJ. This simple procedure can be performed with a #64 blade from a tiny plantar incision in the office. The single suture can be removed in 7 days. I have performed this in patients from 18 months old to 94 years old with excellent results. Release of the distal flexor, leaving the more proximal structures in place, reduces or eliminates the deformity without elevation at the MPJ. Contraindications include non-reducible deformity, fused DIPJ, or vascular compromise. It's great for reducible mallet toes 2, 3. and adductovarus 4,5.

Mark Robson, DPM, Austin, TX, mrobsondpm@aol.com

Remove the intermediate phalynx, if symptomatic. With the 5th toe, no pinning is necessary and there is very little chance of complication soft tissue healing usually associated with less pain and disability. I had this problem when running track in H.S. and College. I had to use foam sleeves called roll-o-foam to accommodate and/or skin lubrication. All symptoms went away when I wore larger footgear, which took some time to get used to. Now, I am unable to wear the smaller-sized shoes, but I never stopped playing competitive sports

Jan David Tepper, DPM, Upland, CA, jdtdpm@aol.com

If surgery cannot be delayed, then I suggest a double-elliptical oblique skin incision, to remove a wedge of skin. The incision should be directly dorsal medial to plantar lateral and centered over the intermediate phalanx. I suggest a fusion of the PIPJ by removing the cartilage off the head of the proximal phalanx and the base of the intermediate phalanx. When you remove the cartilage off the head of the proximal phalanx, you may need to remove some additional bone laterally to straighten the toe. I would K-wire all the way back through the 5th MPJ (I use 0.45 in a 5th toe.) and keep the K-wire in, preferably 6 weeks.

Place the patient in a CAM walker boot brace until you remove the K-wire. After removal of the K-wire, have the patient tape the toe for an additional 2 months to keep the toe straight. I wouldn't worry too much about the proximal growth plate of the proximal phalanx being opened on the 5th toe at this age. The toe will be relatively shortened anyway.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: ASPS, APMA’s New Surgical Affiliate
From: Multiple Respondents

I’ve always been one to see the benefits of competition in a free market. ACFAS chose to do what they did for whatever reasons they did it. They now have to live with the ramifications of that decision. ASPS may be one of the best things to happen to podiatry; we will soon find out. To say that there are too many organizations is just silly. Who cares how many organizations there are? Is the inference that this should somehow be regulated?

The beauty of freedom is that entities regulate themselves. Organizations are no different than any other entity within a free market. If people find value in 100 of them, and the organizations can financially sustain themselves, then we all have more choice. If, for example, the market dictates viability of only two, then that is all that will exist.

I don’t understand the rationale behind the discussions of how many organizations there should be and how those organizations should function. They will live and die by their own sword.

Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

I do agree with Dr. Thiele. Podiatry is already divided. Why more? The other professions will think we are not organized and this may hurt the podiatry profession. Let's see what happens.

Michael Tran, DPM, Manhattan, KS, mtrandpm@cox.net

I am extremely proud to be a member of the APMA and applaud this decision. I had been a member of the American College of Foot and Ankle Surgeons for 28 years and followed with great interest the unfolding of what I believed to be an unnecessary and potentially dangerous rift in our profession at a time when we need the parity that our APMA leaders are calling for and working to achieve. This stubbornness on the part of the ACFAS was enhanced, in my opinion, by a perceived but unfounded superiority and contrived plan for exclusionary status within ACFAS. Because of the ACFAS's unwillingness to recognize the fragmentation of our profession that was occurring....

Editor's note: Dr. Mandraccia's extended-length note can be found at: http://www.podiatrym.com/letters2.cfm?id=23155&start=1

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we’re in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.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 full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Excellent opportunity for PSR 24-36 foot and ankle surgically-trained physician. Looking for hard-working, personable, highly-motivated individuals to join our group and build their own practice. Position leading to partnership. Great opportunity with excellent salary and benefits. Please e-mail CV and references to cavallinig@foothealers.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 part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PODIATRISTS NEEDED - 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 Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PODIATRIST NEEDED—SEATTLE, WA

Established podiatric practice in Seattle, WA is looking for licensed podiatrist for part-time leading to full-time position. Need help with Adult Family Homes and Nursing Homes as well as in the office. Flexible schedule and attractive compensation. For all details please call 206-661-9644.

PODIATRIST - JAMES H. QUILLEN COLLEGE OF MEDICINE

East Tennessee State University, James H. Quillen College of Medicine is seeking a board eligible/board certified at time of hire podiatrist. The position is clinical and the candidate should be interested in a broad range of podiatry medicine. The position is a non-tenure track position at the Assistant/Associate Professor and contingent upon outside funding. Interested applicants should submit a curriculum vitae to: William Browder, M.D., Professor and Chair, Department of Surgery, East Tennessee State University, Box 70575, Johnson City, TN 37614, e-mail – browder@etsu.edu. ETSU is an equal employment opportunity employer.

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

POSITION - NORTHERN VIRGINIA/DC SUBURB

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