The Voice of Podiatrists

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December 08, 2006 #2,760 Editor-Barry Block, DPM, JD

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NY Podiatrist’s Mission “Dampen Statistics One Patient at a Time”

When the Westside Podiatry Center in Skaneateles, NY welcomed Daniel Ferreras, D.P.M., to its staff one month ago, they welcomed an invaluable source of information on a massive medical plight. Ferreras completed his fellowship at St. Vincent's Catholic Medical Centers in diabetic wound care, an area of podiatry vital to a population with a rising rate of developing diabetes. More than 20.8 million Americans are diabetic, with 54 million additional Americans falling into a pre-diabetic category marked by high blood sugar.

Dr. Daniel Ferreras

“It's just staggering,” Ferreras said of the statistics. The rate of diabetes balloons within the 65-and-older demographic that also comprises the bulk of Ferreras' patients He estimates up to 65 percent are either diabetic or susceptible to the disease, which bears dire ramifications with respect to podiatry.

Approximately 30 percent of diabetic adults suffer from impaired sensation in the feet due to nerve damage. That complication is responsible for patients who present Ferreras with large ulcers on their feet without having noticed them prior to their visit. He also attributes this common scene at his office to a philosophy of living with foot pain that pervades older generations. “They don't go to the doctor until it's too late,” Ferreras said. Such delays in seeking care often lead to amputation of the foot or lower leg. Roughly 60 percent of all non-traumatic lower limb loss is precipitated by diabetes. Ferreras has made it his mission to dampen that statistic one patient at a time.

Source: David Wilcox, The Citizen [12/5/06} Photo Credit, Jason Rearick

NJ Podiatrist Creates Children’s Cancer Fund in Son’s Name

Noah Price died last year at age 3. But amid the pain, the love goes on. It shines through the work of his mother, Lisa Price, who started the Noah's Gifts Foundation to help families with children battling cancer and other chronic illnesses. And the love is plainly visible among the volunteers who cook meals, provide emotional support, do errands and contribute funds to help the families.

Noah Price

The foundation's latke sale, Latkes For Love, raises funds to help offset medical and daily living expenses for families of sick children. Orders can be placed on the group's Website at www.noahsgifts.org until Thursday .

Noah's Gifts helps families across the country regardless of religious or ethnic background. On an average, the group helps four families a month with everything from emotional support to daily living and medical expenses, she said. But Price dreams of making Noah's Gifts a household name. "I can't turn my back on these people," said Price, a podiatrist who left the workforce when her son was diagnosed. "I wouldn't be able to sleep if I didn't do this."

Source: Deena Yellin, North Jersey Media Group, [12/5/06]

Senators Urge Screening Of Medicare Beneficiaries

Nineteen senators in a letter sent on Monday to HHS Secretary Mike Leavitt requested that he "make diabetes screening and prevention for Medicare beneficiaries a top priority," CQ HealthBeat reports. According to the letter, findings from a recent study in the journal Diabetes Care show that 61% of Medicare beneficiaries -- 21 million of an estimated

32 million seniors -- have either diabetes or prediabetes. Of those, 14 million beneficiaries are believed to have undiagnosed prediabetes. "Please include in your FY 2008 budget proposal an aggressive collaborative effort between the CDC, [CMS], and other key agencies to find and screen" those beneficiaries who have not yet been diagnosed, the letter states. The senators, including John Cornyn (R-Texas) and Charles Schumer (D-N.Y.), noted that a clinical trial conducted by NIH found that "modest" changes to diet and exercise prevented diabetes in 58% of participants considered to be at high risk of contracting diabetes. The trial also found that such changes prevented the onset of diabetes in participants over age 60 by 71%. The trial "shows that such an initiative will save lives and money" the letter states (CQ HealthBeat, 12/4).

Source: American Health Line [12/6/06}

Query: Neuroma Release Vs. Excision

I have my doubts about trying neuroma releases vs. excision in patients who ski & rock climb extensively because of the extremely tight footwear they wear. I would like to hear any feedback from anyone that has tried these procedures for this athletic population. Sclerosing was aborted at 4 injections in my patient and I plan on excising the neuroma.

Ben Pearl, DPM, Arlington, VA

RE: Silicon Injections (Jim Fisher, DPM)
From: Sol W. Balkin, DPM, well Scott Weil, Sr., DPM

I'm not sure where Dr. Fisher received the "news" however, I continue to practice 2 half days a week. It is true that I have considered retiring in some 4-8 months, but have set no date. All I do is inject silicone for patients in need of fat pad replacement. Most people treated with silicone have improved or the pain is gone completely, as Dr. Fisher noted with patients he referred.

It is near criminal that this material has not as yet been approved for general use. If there is anyone to blame it is our legal system and trial lawyers who put the Dow Corning Corporation out of the medical silicone device industry due to the silicone breast implant fiasco.

I continually seek a new sponsor willing to pursue this 41-year project. Any suggestions are appreciated.

Sol W. Balkin, DPM, Glendale, CA, swbalkin@sbcglobal.net

I have a patient from the Rocky Mountain area who underwent silicone injections for chronic metatarsalgia. Apparently 2-3 cc. were injected for $4,000 and it appeared as though she had a balloon in her plantar, forefoot. It has now been almost one year and a recent note from the patient this week was that she had a recommendation for a forefoot amputation because of chronic pain in the area.

I doubt that the FDA will release this product without some good clinical trials in the foot.

Lowell Scott Weil, Sr., DPM, Weil Foot & Ankle Institute, WEIL4FEET@aol.com

RE: Cutaneous Fibromatosis Considerations (Tip Sullivan, DPM)
From: Jeffrey Kass, DPM

In geriatric patients who have a painful hammertoe with concurrent HAV - if the HAV/bunion is not painful, I personally feel an isolated hammertoe repair is perfectly acceptable.

I would agree the hammertoe most often is caused by the HAV, and I warn the patient it is possible there could be a reoccurrence of the deformity because I am not addressing the bunion. In these cases, I almost always arthrodese the joint to stabilize the second toe and make it tougher for the hallux to "push it aside."

Dr. Sullivan’s posting most certainly did state an arthroplasty, however, my feeling from the "tone" of the message was that for Dr. Sullivan, an isolated second digit arthrodesis with concurrent HAV would also be rare.

Jeffrey Kass, DPM, Forest Hills, NY

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

Anytime a metatarsal osteotomy is performed where the metatarsal is shortened or elevated, there will be a mechanical effect on the digit to decrease the digital purchase force of the digit. This digital purchase force is the direct result of the downward pushing force of the digit on the ground, which is caused by a downward rotational force (i.e. moment) at the metatarsophalangeal joint (MPJ), better known as an MPJ plantar-flexion moment.

MPJ plantar-flexion moment is caused, when the foot is plantigrade, by a combination of passive tensile forces of the ligaments and/or the active tensile forces of the muscles/tendon units that insert plantarly on the digit. For example, one of the strongest passive plantar tensile forces acting to cause a MPJ plantarflexion moment during relaxed bipedal standing is caused by the central component of the plantar aponeurosis (i.e., plantar fascia), that sends slips to the bases of the proximal phalanges of all of the lesser digits, via the plantar plate.

When the metatarsal is shortened or elevated by surgery or trauma, the resultant decrease in passively generated tensile force within the slip of the plantar aponeurosis that inserts onto the corresponding digit will cause a decrease in MPJ plantar-flexion moment and also a decrease in digital purchase force. If the decrease in MPJ plantar-flexion moment is sufficient, then no digital purchase force will occur, and a floating toe will result. Therefore, the biomechanical lesson for surgeons that want to minimize the risk of a floating toe post-surgically in their patients?....don’t do any lesser metatarsal osteotomy that excessively shortens the metatarsal or elevates the metatarsal head.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

Editor's Note: This topic is now closed

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

As a result of Dr. Mullens comments, I re-read my original posting and wish to make this amendment which I hope will ease the impression that it left for Dr. Mullens and I am sure others that I was recommending high-heeled shoes to all of our female patients (which I am not).

I would like to change the sentence. "In fact, the functional equinus that accompanies the rigid rearfoot functional foot types (TM) has a longer stride and healthier mechanics after a TAL or when in a 1.5"+ heel.", to:

There are actually many feet and postures that perform better in a heeled shoe than a flat one. In fact, the functional equinus that accompanies the rigid rearfoot functional foot types (TM), the most common of the four rearfoot types, has a longer stride and healthier mechanics after a TAL or when in a 1.5"+ heel

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab, drsha@footworldusa.com

ASSOCIATE POSITION – NEW YORK CITY

Looking for an enthusiastic well-trained foot and ankle surgeon to join busy Manhattan/Brooklyn practice leading to partnership. Candidate must have completed a minimum two-year surgical residency program, demonstrate qualities of self-motivation and have impeccable skills in forefoot and rearfoot surgery. Package includes malpractice ins. health ins. plus salary. Terms negotiable. Email Manfootcare@aol.com or call 917-756-3686

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

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) 838-0227.

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.

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