The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 27, 2009 #3,712 Publisher-Barry Block, DPM, JD

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Holidays Mean Extra Stress for Feet: APMA President 

The average person walks between 8,000-10,000 steps a day—but that number dramatically increases during the holiday season. From inappropriate footwear choices to inadequate foot and leg circulation from prolonged sitting, the journey from point A to point B can often leave travelers with sore soles. However, The American Podiatric Medical Association (APMA) reminds travelers that there are steps that can easily be taken to soothe tired foot muscles and joints.

Dr. Ronald D. Jensen

“Visiting with family and friends during the busy holiday season should not involve having to struggle with foot pain,” said Ronald D. Jensen, DPM, president of the APMA. “Being mindful of basic foot care, even when on the road, can go a long way toward maintaining high spirits and staying healthy during the holidays.”
 

BUSPM Earns Continued Accreditation Through 2016

Barry University’s School of Podiatric Medicine recently received their continued accreditation through 2016 by the Council on Podiatric Medicine Education (CPME) – the maximum allowed under the guidelines.

Barry University School of Podiatric Medicine

The findings were released in November concluding the CPME accreditation process, which included an on-campus site team review in February 2009. While on campus, CPME representatives met with faculty, students, field educators and curriculum committees, as well as university administrators. When releasing their findings, they were particularly impressed with the university’s ability to make significant contributions to the development of the School of Podiatric Medicine.

These findings were made evident by the new building housing the school, the Center for Community Health and Minority Medicine, and the remodeled anatomy laboratory and lecture halls on the main campus in Wiegand Hall. The lab is now called the Bako Pathology Services Anatomy Lab in honor of Dr. Bradley Bakotic, D.P.M., D.O., a Barry alumnus, class of 1992, who provided a grant for the renovation.

NY Podiatrist Holds Holiday Shoe Drive for the Homeless

Dr. Bruce Pinker, a podiatrist, is holding a holiday shoe drive to benefit Helping Hands, which aids Rockland's homeless population. His office, Progressive Foot Care, will accept donations until Dec. 10.

Dr. Bruce Pinker with shoes collected for the homeless.

Pinker said he was holding the drive because many homeless people cannot afford to buy shoes, resulting in foot injuries, severe infections and diseases, such as frostbite and gangrene.
 
Source: The Journal News [11/25/09]

Build a Solid Recognition Program

Recognition is the foundation of employee morale. Construct a successful program using these building blocks:

• Day-to-day efforts. Regularly praise employees and express your gratitude for their efforts. Often, the day-to-day recognition will be low or no-cost. Offer pats on the back, handwritten notes, employee lunches, on-the-spot award certificates, and sincere verbal appreciation.

• Above-and-beyond achievement. When employees deliver extraordinary effort, they deserve recognition from the organization. Respond to significant achievements that support your practice’s core values or business goals—implementing an innovative idea or providing exceptional service, for example—with a tangible award of some value or simply with a formal expression of thanks.

• Career milestones. In many practices, anniversary dates go unnoticed. Yet, marking the date that a person joined your office offers a prime opportunity to highlight each person’s contributions. Make employees feel special at least once each year.

Source: Adapted from The Carrot Principle, Adrian Gostick and Chester Elton, Free Press via Communication Briefings

Query: Congenital Hypertrophy of Intrinsic Muscles

I have a 15 y/o female with congental hypertrophy of both her FDB and ADM muscles...left foot only. Clinically, there is fullness but no pain in the arch and a very enlarged lateral mid and forefoot, especially with weight-bearing. There is discomfort primarily with shoes. 
 

Congenital Hypertrophy of Intrinsic Muscles

I am planning on debulking the ADM muscle only. Any ideas/suggestions?

S. Jeffrey Siegel, DPM, Philadelphia, PA
 

RE: Osteomyelitis (Richard Frost, DPM)
From: Multiple Respondents

Before moving the patient to the OR, first obtain wound cultures and bone cultures (Jam-Shedi may be your best approach). Get your local infectious disease (ID) specialist on board, and present your culture results to him/her. Perhaps, antibiotic therapy may be an option for your patient, as per ID.
 
Bruce Pinker, DPM, White Plains, NY, Pomona, NY, docpinker@yahoo.com

The most definitive procedure for this patient is a TMA -- and depending on how clean it looks or how hard the bone is, as proximal a TMA as you can get. As long as it looks clean after you've resected, I would close it. Continuing six weeks IV antibiotics is probably only necessary if you're not sure what you've left behind is clean, or you send bone from what you've left behind and it still grows (likely staph). 

Also, MRI is not definitive for OM -- you can have traumatic injury causing bone marrow edema, I would get an ESR and CRP as well. The traumatized bone, anyway, may serve as a medium if there is still a healing open wound... how long ago and was there a chronic wound?

Roody Samimi, DPM Sacramento, CA, roody.samimi@gmail.com

Dr. Frost  should explain to the patient that he is not interested in doing serial surgery  either. He should immediately place the patient on crutches. What kind of work does the patient do? How compliant or reliable is he? Is he extremely obese? Can he perform self-care? It’s a socioeconomic situation. Dr. Frost should immediately be in contact with his primary care physician to understand his medical condition and his glycemic control.
 
Prior to considering any surgical intervention, treat the osteomyelitis. Consult with an infectious disease specialist. Consider a bone biopsy to culture the definitive pathogen or pathogens and tailor the antibiotic regimen to eradicate the problem. Once the osteomyelitis is resolved, then I would initially consider some kind of footgear modifications. If medical treatment does not eradicate the osteomyelitis, then you should consider local excision of the involved bone, and treat the osteomyelitis. MRI can’t differentiate between osteomyelitis and Charcot foot, so I would consider an indium scan.

If his footgear modifications do not work, surgical intervention might involve a Hoffmann-Clayton procedure, local resections of the involved metatarsals (high risk of needing further surgery), or TMA.

Simon Young, DPM, NYC, NY, simonyoung@juno.com
 

RE: Adolescent Verucca Treatment (Chris Seuferling, DPM)
From: Multiple Respondents
 
This is the perfect case for oral cimetidine. Take the patient's body weight in pounds and divide by 2.2. That equals the weight in kilograms. Multiply the weight in kilograms by 30. That is the daily dosage in milligrams. Some people use a range of 20-40 mgs/kg daily, but I have consistently used 30.

I max patients out at 1800 mgs daily. There have been no side-effects in approximately 50 cases. The resolution rate ranges from 50 to 80 percent. It should be planned that the medication be taken for three months. In the majority of cases of resolution, it occurs in the fifth to seventh week.

This is off-label use of cimetidine.

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

The pulse-dye laser is the best treatment for this type of diffuse viral infection. You can use local, local with IV Sed, (no epi and infiltrate around the wart; not under) or general anesthesia (which is the best and use local after to decrease P/O pain). You want the blood to be in the wart tissue because if the skin is tense and white from local anesthesia, making the wart bulge, the laser light just reflects off the skin and is not absorbed. Circle the warts with a black magic marker so that you can easily see them through the goggles. The setting we use is about 8.5 joules.

Debride the warts to remove as much surface debris as possible. Blast the warts (10 to 30 pulses each) until they blister up, and puncture the blister with a needle so they ooze. This way the patient will have less pain after the procedure. Sometimes, the treatment has to be repeated.  I would see the patient 3 weeks later, deroof the blisters and lase the base of the deroofed blisters and then apply bi-chloro-acetic acid.  Follow the patient for several months to determine if any small warts appear.  

Jeff Conforti, DPM, Clifton, NJ, jconfortiusa@yahoo.com

Seeing how diffuse it is, I would use liquid nitrogen. It may require several visits. Canthrone acid is a more aggressive option, with the blistering, but may be more effective. And don't forget the duct tape on top!

Roody Samimi, DPM Sacramento, CA, roody.samimi@gmail.com

RE: Metanx and Epidermal Nerve Fiber Density Testing (Allen Jacobs, DPM)
From: Bradley W. Bakotic, DPM, DO

I have been swamped with calls relating to the recent series of comments regarding L-methyl folate (MetanX). There seems to be some level of hysteria regarding the topic of L-methyl folate consumption and a lack of understanding regarding the use of epidermal nerve fiber density testing. Allen Jacobs, DPM could not have been more precise with his comments on the differences between L-methyl folate and folic acid, and the fact that the literature has not shown any degree of consistency regarding the risk (if any) produced by the consumption of folic acid or its derivatives to the development of malignant neoplasia.

Regarding epidermal nerve fiber density, clinicians who prefer to circumvent an evidence-based manner of medical practice can certainly begin treating an unproven and undocumented condition, without a baseline by which to measure improvement, for an indefinite amount of time, but why would they? Most of us can remember a day when neurologists would readily order or perform sural nerve biopsies, which are much more expensive and invasive tests, which carry the potential for a mountain of complications, yet exhibit only a fraction of the sensitivity when establishing the diagnosis of small fiber neuropathy. This test uses a simple punch of skin, yet allows us to define the condition as small fiber neuropathy, establishes a baseline for the disease process so to make objectively monitoring the condition possible, and allows us to identify persons at risk of developing small fiber neuropathy in the future. For some patients, this test makes perfect sense.            

Bradley W. Bakotic, DPM, DO, Alpharetta, GA, brad@bakopathology.com

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 - PHOENIX, ARIZONA

Part Time/Full Time, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/Trauma. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, ABI 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

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 - 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

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

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.

PRACTICE FOR SALE - CENTRAL SOUTH CAROLINA

Practice grossing $400,000 annually based on one full-time doctor with two offices. Surgery is currently about 10-15% but can easily be increased. Medicare makes up 52% of revenues. May be able to take over practice with no money down. Interested parties email to footdocsc@gmail.com

PM News Classified Ads Reach over 12,000 DPM's and Students

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