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November 29, 2008 #3,412 Editor-Barry Block, DPM, JD

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Barry’s Evans Appointed to Quinnova Advisory Board

Quinnova Pharmaceuticals, Inc., a specialty pharmaceutical company focused on using innovative and patent-protected topical drug delivery platforms, has announced the appointment of Dr. Chet Evans, currently Vice President for Medical Affairs at Barry University, to its scientific advisory board.

Dr. Chet Evans

Said Quinnova President and CEO Jeffrey S. Day,” Dr. Evans is held in high esteem by the academic medical and podiatric communities. His vision as a pioneer in skin and wound care, and diabetic foot management, facilitated our decision to invite Dr. Evans to be a member of our scientific advisory board. We are pleased he has accepted the appointment.”

Murano Elected Chairman of MA Podiatry Board

Dr. Raymond S. Murano has been elected Chairman of the Board of Registration in Podiatry for the Commonwealth of Massachusetts. The primary function of the Board of Registration is to protect the health, safety, and welfare of the consumers of Massachusetts. The Board also functions to set the scope of practice and set the standards for podiatrists.

Dr. Raymond S. Murano

Dr. Murano has been in practice for 24 years in Medford, Massachusetts. He has been on the Podiatry Board since 1999. For the past 4 years Dr. Murano has served as the Board's Secretary. Dr. Murano is the Chief of Podiatry for Hallmark Healthcare Lawrence Memorial Hospital. Dr. Murano is Board Certified in Podiatric Medicine, Podiatric Surgery and is a Certified Wound Care Specialist. He has a private practice in Medford, MA.

Source: Medford Transcript [11/27/08]

Query: Surgical Management of Hypercoagulable Syndrome

I have a patient who wants to have her painful bunion surgically corrected. She told me she has a condition called "hypercoagulable syndrome" and is currently taking Coumadin. This patient is 45 years old and is otherwise pretty healthy. I already plan to obtain medical clearance from her MD prior to pursuing surgery. The bunionectomy would be a long-arm Austin and I could do it without an ankle tourniquet. I will ask her MD how to proceed with managing her Coumadin peri-operatively. Does anybody else have any experience or advice on how to manage this case?

Dan Methuselah, DPM, Columbia, SC

Query: Inheriting Employees

I just purchased a second practice where there are other doctors who are presently working in the practice as employees. Once I take over, they will remain in the practice and become my employees. I have always worked with other docs in the office, but never with ones who were my employees. Both of these doctors have been out of residency for just a few years and do not have much experience in running a practice.

How far do I go with these doctors in suggesting to them as to what they should be doing? On one hand, I know I can be a teacher and mentor, but on the other hand, I want all the patients to be treated in the way I think they should be treated.

Name Withheld

RE: Prolotherapy (Arthur Gudeon, DPM)
From: Bob Kornfeld, DPM, Martin Harvey BSc (Hons)

I have been doing prolotherapy for over twelve years. My experience with it is that it is an excellent treatment for chronic connective tissue inflammations, it can repair partial tears very well, and in general, fills a void for tendon and ligament pathology. The choice of proliferants is critically important, as is dosage and placement of solution. This is best performed under ultra-sound guidance.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

I have been using either 10 - 20% dextrose with lidocaine or platelet-rich prolotherapy using the cascade autologous platelet system (cascademedical.com) in my UK podiatry practice for around three years. It has proved an interesting and safe alternative to the often ineffective use of steroids in conditions such as plantar fasciopathies and Achilles tendinopathies.I have had encouraging results and now personally use it as a treatment of choice. It is under-used in the UK and most of the published studies originate in the USA such as : Prolotherapy in the Treatment of Foot Problems, Tsatsos and Mandal J Am Podiatr Med Assoc.2002; 92: 366-368.

Martin Harvey BSc (Hons), Tamworth, Staffordshire. UK, podmart@tiscali.co.uk

RE: Orthotics and Bunion Surgery (Dennis Shavelson, DPM)
From: Barry Mullen, DPM, Simon Young DPM

Root biomechanics has long postulated that 1st ray stabilization via orthotic wear can improve functional metatarus primus elevatus and varus, thereby delaying the progression of HAV and HL. This theory is not new and I believe most podiatrists ascribe to it. Is Dr. Shavelson now intimating that "neoteric biomechanics" somehow reduces and/or resolves pre-existing fixed/structural metatarsus primus elevatus and/or varus? I'd need to witness and comprehend its theory before believing it. Is this what you refer to when you say podiatrists practicing Neoteric biomechanics do "this" everyday? If so, then I look forward to its proof.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Functional hallux limitus is a sagittal plane deformity rather than the tri-plane deformity associated with a bunion. If the practitioner addresses functional hallux limitus in its early phases, i.e., Long 1st. metatarsal, hypermobile first ray, assuming there is no other pathologic component, such as RF or FF varus or PTTD, orthotics will possibly help the sagittal plane component- namely elevatus. Hallux limitus/ridgidus foot types show minimal transverse plane deformity. I do not believe the HAA or IM would be affected at all, and there are no studies to cite that they would.

Manual therapy: I assume splinting, spacers, electrical devices, or manipulation will only have a chance of working when the deformity is flexible. Once the muscle imbalance cascade has occurred (medial capsule stretching, lateral capsule tightening, FHL drifting in the lateral of axis of motion, abd. hallucis weakening, add. hallucis tightening, and pulling the proximal phalanx laterally), it causes retrograde medial force on the 1st metatasal. The 1st metatarsal deviates medially off the sesamoids.

Furthermore, the EHL and FHL lateralize from their normal axis of function. FHL becomes a weaker plantar-flexor, but now also causes a varus rotation on the hallux. The EHL gains strength and maintains the hallux laterally. The FHL and Adb. hallucis contribute to the bunion deformity and soft tissue manipulation via manual means. Orthotics will not stop this cascade. You must re-establish orthopedic congruity, muscle balance, and biomechanical integrity for orthotics to exert their benefit. You cannot correct an osseous deformity utilizing only soft tissue means.

Unfortunately, Neoteric biomechanics is being promoted as an alternative to Root biomechanics based only on anecdotal evidence and without its biomechanical theories ever being studied. Until these biomechanical concepts are studied, the profession should be cautious.

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

RE: Fairest Compensation (Name Withheld)
From: Paul Kruper, DPM

I would ask for 40% of what is paid on the services you provide. That forces the employer to deal with the own overhead costs. Even if the overhead is over 60%, that should not come out of your compensation. The employer will only pay you on what they receive, not what is billed. Then the onus is on you to keep track of what is billed and follow up.

Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

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.

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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

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

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

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 – 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

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