The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 07, 2009 #3,720 Publisher-Barry Block, DPM, JD

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UT Podiatrist Provides Advice on Staying Safe in High Heels

A new study confirms what many women may already suspect: high heels not only cause foot pain, they may actually create permanent damage. But there are ways you can stay safe without giving up heels.  "The higher the back of the heel -- 3 inches, 4 inches -- will transfer the load to the ball of the foot," explained podiatrist Dr. Scott Clark. "That pressure can lead to changes, which can actually be a permanent problem." The most common problems: •Nerve and bone deformities on the ball of the foot: •Ankle sprains • Pain in the Achilles tendon •Bunions

Dr. Scott Clark

The recommendation? Wear heels no higher than 1.8 inches. "I tell patients anything below 2 inches is acceptable, or can be acceptable," Clark said. Here are some other "happy mediums": •If you're going to wear heels, make sure they're plenty wide in the toe area •Wear padding on the ball of your foot •Consider going up a half size and inserting heel cups.

Source: Nadine Wimmer, WKLS [12/3/09]

GA Podiatrists Raise Money for ADA

Village Podiatry Centers teamed up again with the American Diabetes Association (ADA) in Atlanta in support of their annual fall fundraising. This year’s partnership netted $5,000 for the ADA from the efforts of physicians and staff. “Our doctors treat a large patient population with diabetes. These patients often have complex foot and ankle healthcare needs that, if left unchecked, can lead to serious infections and even amputation,” said CEO, Dr. David Helfman. “The ADA is doing an outstanding service to our community. We are proud to join them in the fight against this deadly disease.”

Dr. David Helfman

Village Podiatry’s fundraising efforts included a “Wall of Shoes” display in each clinic to solicit funds from patients, family and friends. The physicians and staff also laced up their sneakers and joined the Step Out Walk in Grant Park with a team of walkers and provided an information booth on diabetic foot care.

Alleged Fixation for Surgery (NY)

Facts: On Sept. 23, 2004, plaintiff Maria Grozav, 58, an office cleaning worker, underwent surgery on her right foot--a second hammertoe surgery, a second metatarsal osteotomy and the removal of a neuroma at her second interspace-- performed by Defendant.

Grozav had been treated by and operated on by Defendant several times in the previous years. In June 2004, two years after her most recent visit, she had visited him complaining of severe pain that conservative therapy had not helped to alleviate.

Result: Verdict-Defendant

Plaintiff’s Expert: Ovidio Falcone, DPM, Brooklyn, NY
Defendant’s Experts: Edwin Wolf, DPM, New York, NY; Thomas DeLauro, DPM, New York, NY

Source: VerdictSearch New York Reporter

Editor's Note: This case can be read in its entirety at: http://www.podiatrym.com/letters2.cfm?id=30992&start=1

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Source: Adapted from “Three Tips for More Effective E-Mailing,” James Gaskin, CIO via Communication Briefings
 

Query: Critical Limb Ischemia

When treating critical limb ischemia, do any of you ever place your patients on both Pletal and Trental? I have never seen it done, but I can find no reason not to use the combination.

Wm. Barry Turner, BSN, DPM, Royston, GA
 

Query: Late-Arriving Employees 
 
I have a small office with two employees who are taking advantage of the freedom to come and go without definitive timekeeping. Consequently, they are late almost every morning, and return to the office after lunch with a never ending list of excuses as to why. What suggestions can you give me to pass on to my long-standing employees that may make a difference to them. If a time clock is the answer, then what brand or service is most effective?

Name Withheld

RE: Variations of Practice Patterns in Podiatric Medicine
From: Michael Turlik, DPM

The Obama administration has allocated more than $1 billion to fund comparative clinical trials to determine treatment efficacy. This, in my opinion, is not an academic exercise; the results of the studies, I believe, will be used by panels to develop evidence-based guidelines used in the care of common medical conditions. As a result of the guidelines being adopted, healthcare costs will be driven down. For example, there was recently a published guideline dealing with mammography. This was an evidence-based guideline developed, which recommended that routine mammograms for women between 40 and 50 were no longer indicated.

Predictably, the physician groups adversely affected by this recommendation complained about the validity of the guidelines. If that were the end of it, it is likely that in the future these guidelines would be adopted by payers of healthcare and the result would be a reduction in healthcare costs. Fortunately or unfortunately, the patient population most affected by these guidelines reacted with outrage which forced the administration to back off from an endorsement. Good science but bad politics.

If the same panel reviewed the effectiveness of treatments for verruca, it is likely that they would find very little level I evidence for the vast majority of treatments for pedal verruca. The lack of evidence does not mean lack of effectiveness, just  lack of future reimbursement. Although there will be the typical professional indignation regarding this, I wouldn't count on patient outrage as in the case of mammography guidelines.

Recent graduates should be very interested in foot and ankle research which demonstrates effectiveness because, in my opinion, that's how the profession will be judged in the future. It will be interesting to see how much of the more than $1 billion is allocated to podiatric physicians studying effectiveness of common podiatric conditions.

Michael Turlik, DPM, Cleveland, OH, mturlik@aol.com
 

RE: EBM
From: Bob Kornfeld, DPM

There are a couple of critical issues at work here, and excuse me for putting in two more cents on this subject.
 
Number 1: Has anyone who is looking for EBM criteria taken any time to admit that they are hell bent on proving protocols simply because insurance companies are demanding more EBM? Are you really going to cooperate with them? They are doing this simply so that they can have more control and deny more claims. That is the ONLY reason. It is not at all to improve the delivery of medical care in this country. And you have all fallen right into the trap. Once you establish EBM standards for all podiatric treatments, you will see more failed protocols, lower reimbursements, and more claims rejections. You might as well just tie a noose around your neck and let the insurance companies hold it.

EBM may give the practitioner more reliable statistics, but we all know that statistics are far less meaningful in the clinical trenches. Do you really want to be that robotic? Is your idea of medical practice to perform treatments that are mandated by EBM and not your clinical judgment? Haven't you had enough of insurance company interference with what you deem medically prudent treatment? Keep it up. Soon, they will mandate frontal lobotomies for all physicians who have the gall to think for themselves!!
 
Number 2: Who will volunteer to foster progress? If you are not going to get paid for anything outside of approved EBM procedures, who will be the ones to surrender income in order to pave newer and better roads? Who?
 
My advice...tread carefully with this one. You may be signing your own death sentence.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
 

RE: Seminar on H&Ps (Stephen Kinard, DPM)
From: Pete Harvey, DPM

I am pretty sure the Scholl College still periodically offers H&P courses. Check their website for contact info.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
 

ASSOCIATE POSITION - HUDSON VALLEY, NY

Excellent opportunity for a three-year surgically trained foot and ankle physician. We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM with ability, and a desire to teach and take ER call. If interested, please forward CV to: healthyfeet4ever@yahoo.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 - 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 f-massuda@footexperts.com

ASSOCIATE POSITION - NASHVILLE TN

Excellent practice opportunity-associate leading to partnership for PSR-36 trained physician. Well-established and growing state-of-the-art practice located in Nashville area. Hard-working, personable, highly-motivated individual needed. Bilingual-Spanish/English a huge plus.  Great opportunity with excellent salary and benefits. If interested, forward CV to NashvilleFootDoc@gmail.com

PRACTICE WANTED- NYC/LI AREA

I am an ABPS board certified podiatrist seeking to purchase a well established practice. I am looking for the current practitioner to help with the transition. All offers will be considered. Complete confidentiality will be upheld. Please contact poddr45@yahoo.com for more information. This advertisement is not affiliated with a broker.

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.

ASSOCIATE POSITION- TAMPA BAY AREA, FL 

Excellent opportunity for a hard working, ethical and outgoing podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. A Florida license and a minimum 2-year residency are required. Salary commensurate with training plus benefits. Email CV to podiatryfl@yahoo.com

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

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

PODIATRISTS 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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION – PORTLAND, OR

Busy foot and ankle clinic located in Portland, OR. Multi-offices. Excellent referral base. Good mix of conservative care and surgery. Emphasis on and known for diabetic foot wounds. Brand new office/equipments. Excellent supportive staff. Seeking well-trained foot and ankle surgeon. Prefer at least 2 years of training. Best quality is eagerness and willingness to learn, and the ability to adapt. cyberpod@yahoo.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

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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