The Voice of Podiatrists

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December 05, 2006 #2,757 Editor-Barry Block, DPM, JD

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William H. Garrett Sr., DPM , 84

Dr. Garrett died on Wednesday, Nov. 29, 2006, at Methodist Hospital, Rochester, MN.

Dr. William H. Garrett

In high school, Dr. William H. Garrett was a gifted athlete. He participated in football, basketball and was the co-captain of his high school track team. Dr. Garrett held the state 100-yard dash record for two years. He served in the U.S. Army in the Engineers Aviation Battalion during World War II. He graduated from Scholl College with a degree in podiatric medicine. He was a well-known podiatrist who retired in 2002, closing his practice of 47 years. He served as president of the Iowa Podiatric Medial Society from 1974 to 1975.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation, 9312 Old Georgetown Rd., Bethesda, MD 20814.

Source: Quad Cities Online, Moline Dispatch (IL) [12/3/06]

Most Common Foot Problems are Diabetes-Related: MD Podiatrist

"The most common foot problems I see are complications due to diabetes," says Dr. John DeLeonibus, a podiatrist with a practice in Annapolis. "Problems due to impaired circulation and loss of feeling in the feet. The most common foot neuropathy is a diabetic neuropathy."

Dr. John DeLeonibus

Dealing with diabetic patients isn't unusual for podiatrists. In fact, Dr. DeLeonibus has noticed an increase in diabetic-related foot problems in recent years. His patients also are getting younger - and heavier. Little surprise, obesity is a major contributor to joint disease and stress on the feet as well as to Type II diabetes.

"They'll come in with whole extremities swollen like a balloon," Dr. DeLeonibus says. "I'll go through their medical history. Are they urinating a lot? Thirsty? And they'll say 'Yes.' I'll ask if they are diabetic and they say 'No!' When I take an X-ray, the bones are falling apart in their feet. They'll have dozens of micro-fractures in their feet that's totally missed in the emergency room and with doctors who don't deal with feet.

Source: Wendi Winters, The Capital [12/3/06]

AZ Podiatrist Supports Musicfest

North Scottsdale service clubs have stepped up to the plate to help the Arizona Musicfest program with financial and other assistance. Musicfest is a youth education program that provides help for students in schools that do not offer full music programs. The program is gaining support from service club members. “This is an absolutely wonderful program,” said North Scottsdale resident Al Schwartz, a member of Scottsdale Airpark Rotary Club. “Music is so much more important than people realize.”

Dr. Al Schwartz

A retired podiatrist, Dr. Schwartz would like to see the program expanded into schools in southern Scottsdale. “Some of the schools in south Scottsdale could really benefit from this program,” Dr. Schwartz said.

Source: Rusty Bradshaw, Independent Newspapers, [11/28/06]

Query: Necrobiosis Lipoidical Diabeticorum

When I express the contents of the bullae from necrobiosis lipoidical diabeticorum, the contents are almost always sterile. My treatment has been to use an Unna boot and Multidex and/or Silvadene. For the most part, this is a successful treatment. Can someone point to literature that addresses the treatment for this condition? Does anyone have any treatment pearls?

Jim Fisher, DPM Eureka, CA, jimf@humboldt1.com

RE: GAO Recommends Lowering Payments to ASCs
From: B. Thomas Kempf, DPM

So the government wants to pay ambulatory surgery centers less than hospitals because the surgery centers are doing similar cases "at a lower cost." That's great. What's next? Let's say I find a way to run my practice more efficiently (for example, I shop around for better prices on supplies, I negotiate a more favorable lease, I motivate my employees to get more work done each hour). Is Medicare going pay me less because I run my office "at a lower cost" than the podiatrist down the block? Why is providing healthcare the only profession that gets penalized for trying reduce overhead and increase profits?

B. Thomas Kempf, DPM, Sayville, NY, drftlong@optonline.net

RE: “Floating” Toe Post-op Osteotomy (F. Don Chantiles, DPM)
From: David Weiss, DPM

I have found this complication when the Met parabola is "shortened too much" or with a Extensor tendon contracture. I usually will do an EDL Z-plasty with pinning. Also, a FDL Transfer with pinning plantarly seems to help with really unstable toes. As we all know, each foot is different, and you just have to have a "feel" for what is happening intra-operatively and manage with splinting postoperatively.

David Weiss, DPM, Richmond, VA, podmed3@msn.com

RE: Tinea Versicolor (Philip Larkins, DPM)
From: Bryan C. Markinson, DPM

Dr. Larkins writes the following in his post explaining why terbinafine is not a good drug for Tinea Versicolor: "This pesky infection tinea versicolor, sometimes called creeping infection or sun spots, and often mistaken for tinea pedis. This fungal infection of the skin is caused by the organism Malassezia furfur. It is estimated to colonize over 90% of the population. This organism only occupies the most superficial or "dead layer" of the skin, the most superficial stratum corneum, not the epidermis, hair or nail structures."

Firstly, I do not recall a post recommending terbinafine for this
infection. Secondly, the notion that this infection is "often mistaken for tinea pedis" must be his personally. Tinea versicolor is VERY RARE on feet, and when present causes a characteristic de-pigmentation of the skin, as it does anywhere it occurs. Clinical diagnosis is best afforded by a Wood's light, with a characteristic yellow and green flouresence to the scales. Lastly, the organism CAN involve the epidermis, specifically the hair shafts, causing a variant of the disease called piedra.

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

RE: Non-Healing Stress Fracture (Jay C. Goldstein, DPM)
From: Marjorie Miller-Khawam, DPM

The patient needs to get completely off her feet! Have the patient avoid weight-bearing for 4-6 weeks, which is the biggest problem with stress fractures.

Marjorie Miller-Khawam, DPM, Long Beach, CA, Footssy@aol.com

RE: A Picture is Worth 1,000 Words (Dennis Shavelson, DPM)
From: Paul Busman, DPM, Barry Mullen, DPM

Years ago a patient came in wearing a pair of shoes like that. As a demonstration, I took weight-bearing x-rays of her in the shoes and out, leaving off her name. I used to lay one film atop the other and could show other patients the affect of wearing these torture devices.

Paul Busman, DPM, Troy, NY, BREWERPAUL@aol.com

No one would argue that shoe width, length, and toe box depth are three major factors that eventually lead to forefoot symptoms with chronic, repetitive stylish shoe wear. Regardless where you learned functional lower extremity bio-mechanics from, the real question is whether you believe Davis' Law of Soft Tissue exists and whether it's influenced by body structure, pedal function and whether, in turn, it influences lower extremity function through compensation. Hopefully, the question's rhetorical! Equally obvious is the bio-mechanics wheel needs no major reinvention with respect to acquired equinus. It's ALL about heel height!

I do consider myself open-minded, but in this case, I'm sorry, I find Dr. Shavelson’s heel height comments completely outrageous and an insult to our profession's true bio-mechanical wizards who preceded you. Our colleagues in the trenches, who must effectively balance a women's zeal for style against realism and its impact on pedal function, should not be influenced by these comments. I, for one, ain't buyin' Dr. Shavelson’s rap, and trust my colleagues won't either.

The classic bio-mechanics textbooks do not require re-invention. Their collective knowledge has helped provide the foundation most of your colleagues require to achieve the success they've enjoyed managing this very destructive force. The reason why women can't walk barefooted, or in flats, plain and simple is absolutely because of the adaptive shortening of the plantar fascia and Achilles tendon created by prolonged excessive heel height wear. That's common knowledge pertinent to Davis' Law of Soft Tissue and basic bio-mechanics, not Dr. Shavelson's delusion!

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0027.

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE POSITION- MEMPHIS, TN

30 year-old, high volume, multi-office practice in Memphis, looking for 24-36 PSR trained individual. Good opportunity for reconstructive surgery and wound care. No nursing homes or weekends. Potential partnership opportunity. Contact Footdok4@gmail.com.

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

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