The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 01, 2009 #3,715 Publisher-Barry Block, DPM, JD

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TX Podiatrist Discusses Gangrene in Diabetics

One of the more serious side-effects of diabetes is gangrene, the death of tissue in the body. It usually affects diabetics because of neuropathy — nerve damage that greatly diminishes sensation. In the instance of gangrene, surgery is necessary to remove the dead tissue, but in some severe cases, amputation of the limb is necessary.

Dr. Scott Westmoreland

“The signs of gangrene are typically two: one is pain. If an area is not getting blood flow, it usually hurts, which is not always the case with diabetics because they have neuropathy. The other is just slow to no healing,” said Dr. Scott Westmoreland, podiatrist at Shannon Medical Center. Westmoreland recommended wearing cotton socks and properly fitting shoes and to do daily inspections to ensure there is no lesion on the top or bottom of the foot, and in between toes.

Source: Justin Zamudio, San Angelo Standard-Times [11/20/09]
 

Podiatrists Discuss When to Replace Running Shoes

Your kicks will cushion for only about 200 miles, says Lance D. Barry, DPM, a Georgia podiatrist who has completed 21 marathons. "After 200 miles, the midsole has lost enough impact cushioning to make you more prone to heel pain and carpal tunnel-like symptoms."

Dr. Richard Braver

Don't track miles? Pinch the sole with your thumb on the outside and fingers inside, says Richard Braver, DPM, a science advisor to Runner's World. If your fingers can't compress the sole, they've reached their expiration date.

Source: Men's Health [November 2009]

Canadian Podiatrist Plays in Grey Cup Pep Band

Every year -- whether the Saskatchewan Roughriders are in the big game or not -- the pep band is in constant demand during Grey Cup week. "People are treating us great here, with all the waving and honking horns," added Dr. Adam Katz, a snare drum-playing podiatrist who booked time off work from the Regina Qu'Appelle Health Region to come to Calgary. "There must be a lot of Saskatchewanites living in Alberta, that's all I can say."

Saskatchewan Roughriders Pep Band

Katz moved to Regina from Ottawa a year ago, so this is his first Grey Cup as a band member. As of Friday, he had noticed one thing about the festivities. "There's a lot of green," he said. "People are passionate about the Riders. You can't describe it to anyone else. I tried to tell my parents about it, but they just don't understand what it's like."

Source: Ian Hamilton, The Leader-Post [11/28/09]

Alleged Failure to Diagnose Reflex Sympathetic Dystrophy (New York)

Facts: On Dec. 8, 1998, plaintiff Brian Halpin, 34, an airline's baggage handler, presented to defendant podiatrist. Halpin reported that a baggage cart had rolled over his left foot. He also reported that he was experiencing a tingling sensation in the foot. Defendant performed x-rays, and he opined that Halpin was suffering damage of the foot's soft tissue, but no fractures. He prescribed crutches and anti-inflammatory medication. Halpin did not immediately resume work. During the ensuing several weeks...

Result: Defendant’s verdict ($0)

Plaintiff’s Expert: Gary Saphire, DPM, Brooklyn, NY
Defendant’s Expert: Michael Trepal, DPM, New York, NY

Editor's note: The full text of this case appears at: http://www.podiatrym.com/letters2.cfm?id=30843&start=1

Hospital Subsidies Add New Twist to EMR Selection by Doctors 

Availability of government stimulus money, combined with hospitals being allowed to finance portions of physicians' electronic medical record systems, could make EMR adoption a veritable bargain. Or the stimulus money could make hospital systems less eager to help pay for your EMR, figuring that government funds will instead. Either way, the possibility of combining two avenues of EMR funding has added a twist to the economic picture for physicians deciding what, when and whether to buy.

Doctors can get a maximum of $44,000 in funds from the federal economic stimulus package for adopting a certified EMR system that meets the government's "meaningful use" standards. How much physicians get in stimulus funds will be based on the percentage of their practice that is made up of Medicare or Medicaid patients. Hospitals can get their own share of stimulus funds, but the amount depends on how they're connected with physicians.

Source: Pamela Lewis Dolan, AM News [11/30/09]

Query: Unilateral Spasm

The patient is a 14 y/o white female with a chief complaint of spasm in her right foot. She has a history of minor trauma (she fell after tripping over a stone). She presents wearing a CAM walker but is otherwise unassisted. Her spasm apparently initiated after the fall approximately one month ago. There was no spine injury or complaints. There was no laceration. Her medical history is remarkable for hemolytic uremic syndrome as an infant. She also has history of unexplained tremor 2 years ago which resolved spontaneously. 

Unilateral Spasm

Her physical exam is unremarkable with exception of her right foot. The right hallux is rectus and extended but in spasm. The lesser toes are in extension. There is no erythema or edema. There is normal sensation to the toes. Vascular exam is normal. The extensor tendons are palpated and intact. Mild pain with palpation is elicited over the dorsum of the 1st metatarsal proximally. When she is distracted, the lesser toes and hallux can be manipulated into a corrected position. Radiographs and MRI are negative for tendon and/or joint pathology.
 
Initial impression was muscle spasm secondary to neuropraxia. Muscle relaxants were prescribed which were ineffective. Neurological consultation was obtained, results of which were unremarkable and inconclusive. I've entertained the idea of popliteal and common peroneal nerve block to assess whether or not the "spasm" would release. The patient is now two months post "injury" with no change in her foot "position." Her primary physician recalls that she has had some emotional issues in the past. My differential diagnosis includes conversion hysteria, neuropraxia or neurologic manifestation secondary to her history of HUS. I'm interested to know what others who read this post think or might suggest.
 
Thomas Graziano, DPM, MD, Clifton, NJ
 

RE: Osteomyelitis (William Barry Turner, DPM)
From: Elliot Udell, DPM. Dave Samuel, DPM

Dr. Turner is correct. MRI, in ruling in or out osteomyelitis, may not be an absolute diagnosis maker. A number of years ago I had a patient who I was treating with multiple recurring ulcerations. He was under the care of a vascular surgeon as well. After one particular MRI, the diagnosis came back as osteomyelitis of the third toe, and this was not even the area I was concerned about. That area was not symptomatic. When his vascular surgeon read the report, he immediately wanted to amputate the digit. I fought the matter. I did not make a friend out of this vascular surgeon, but it has been years and the patient still has that toe.
 
The bottom line with most diagnostic tests is that they are a piece of the puzzle, and physical findings along with other tests have to taken in account before proceeding with surgical intervention. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Editor’s note: Dr. Samuel’s extended-length letter appears at:  http://www.podiatrym.com/letters2.cfm?id=30839&start=1

RE: Adolescent Verucca Treatment (Bryan Markinson, DPM)
From: Simon Young, DPM

I disagree with Dr. Markinson. Literature has not shown that cimetidine is any better than placebo. Dr. Cohen and I published a paper in JAPMA involving combination therapy: 12% salicylic acid, (off-label use) Carac, and 40% salicylic acid (i.e., Mediplast)- performed twice daily. This treatment usually requires 6-8 weeks to resolve the lesions.

I have modified the treatment further, recently adding topical OTC liquid freezing agents 3 times per week. My cure rate is far higher than any treatments studied in the literature. The treatment is not doctor-related since the patients do all the work. Patient compliance is important and very few terminate treatment or leave the practice.

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

RE: Metanx and Epidermal Nerve Fiber Density Testing (Allen Mark Jacobs, DPM)
From: Michael Turlik, DPM, Bob Kornfeld, DPM

Editor's note: This topic is closed. Letters from Drs. Turlik and Kornfeld can be read at:  http://www.podiatrym.com/letters2.cfm?id=30836&start=1
 

RE: TX Podiatrist Donates $100K to New Medical School (David G Armstrong, DPM)
From: Michael M. Rosenblatt, DPM

Marque Allen, DPM recently made an extraordinary generous donation to the new medical school at Rowan University (an allopathic program). Every person has one's own reasons to select certain charities over others, and it is a "private" choice. However, as a DPM graduate from an institution that accepted Dr. Allen as a prospective student, I'm sure Temple University's College of Podiatric Medicine would find ample and effective use of that funding. Allopathic medical schools have a much higher rate of donation response, governmental assistance, and recognition than (most) colleges of podiatric medicine.

Dr. Stephen (and Sandra) Wittenberg, a fellow alumnus, recently made a very generous donation to OCPM during  40th reunion celebrations.   My own charity choice is an endowment to APMA's Educational Foundation. It was, after all, podiatric medicine and surgery which placed me where I am today. I don't begrudge personal charity choices, but I hope that podiatrists remember where they came from and who helped put them there. 

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

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 - 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

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

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

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

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