The Voice of Podiatrists

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December 09, 2008 #3,420 Editor-Barry Block, DPM, JD

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NY Podiatrist Recommends Moderation With High Heels

Manhattan podiatrist Dr. Suzanne Levine won't leave home without some fancy footwork -- two-and-a-half inches for daytime, four at night. "Put on a fabulous pair of Prada and you feel rich. Even inexpensive shoes provide a boost," says Levine, owner of 300 pairs of shoes. Although teetering about increases the likelihood of sprains, pain and injuries, it's a balancing act: "Chocolate isn't good for you either, but there's such a thing as moderation."

Dr. Suzanne Levine

The New York podiatrist recommends varying heel heights, bringing along a change of shoes, and to exercise and stretch. She recommends Stiletto RX, fillers injected into the balls of the feet, to ease pain from when walking on heels.

Source: Joanne Richard, Chatham Daily News, Ontario, Canada [12/8/08]

OPMA Elects New Officers for 2009

The Ohio Podiatric Medical Association (OPMA) has elected Kevin Sneider, DPM, as president for the Association’s 2009 year. Dr. Sneider is a member of the Northwest Academy of the OPMA, a graduate of OCPM and practices in Port Clinton, OH.

Dr. Kevin Sneider

In addition, the following were elected to the executive committee for 2008:
Dr. Thomas W. Kunkel, 1st Vice President, of Girard
Dr. Alan J. Block, DPM, MS, 2nd Vice President of Columbus
Dr. Angelo Petrolla, Secretary/Treasurer, of Youngstown
Dr. Mark Gould, Immediate Past President of Avon Lake

The following will serve as the 2009 Board of Trustees: Dr. Derrick O. Jackson of Youngstown, Young Physician; Kristen Burton of Lakewood, Student Member - OPMSA; Dr. David J. Hintz, MPH of Elyria; Dr. Karen Kellogg of Fairlawn; Dr. Paul Lieberman of Brooklyn; Dr. Jack Buchan of Columbus; Dr. Kevin Schroeder of Beavercreek; Dr. Bruce Saferin of Toledo; Dr. David Zink of Cincinnati; and Dr. Bruce Blank of Martins Ferry.

Obama Announces Electronic Medical-Records Plan

President-elect Barack Obama outlined a plan to electronically link hospitals, physician offices and the patients who rely on them as part of a multipronged approach to help boost the U.S. economy. Though still measured on details, Obama sketched out a plan in a weekend radio address to “make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year.”

Obama has signaled to lawmakers that he wants a bill ready to sign when he takes office on Jan. 20, 2009. Appearing on the news program “Meet the Press,” Obama on Sunday stressed the importance of acting quickly. “The key for us is making sure that we jump-start that economy in a way that doesn’t just deal with the short-term, doesn’t just create jobs immediately, but also puts us on a glide path for long-term, sustainable economic growth,” he said.

Source: Matthew DoBias, Modern Healthcare [12/8/08]

Query: Painful Heel Fissures

This is a 43 y.o. nurse with painful fissures at the “rim" of the heel bilateral, which has not responded to Superglue, multiple OTC emollients and lubricants, even under occlusion and/or gel sock. She has just finished a 10-day trial of oral Lamisil and recent WNL medical/laboratory evaluation. This became evident about 1 year ago, coinciding with her relocation from Hawaii to our very dry, high desert. In Hawaii, she routinely wore open sandals without difficulty. She has learned to wear closed shoes with socks at all times here. I debrided the painful lesions and have placed her on Amlactin. Any suggestions of additional and/or alternative treatments would be appreciated.

Pat Evoy, DPM, Bend, OR

RE: Persistent Pain and Numbness in Foot (Robert M. Przynosch, DPM)
From: Multiple Respondents

Have you blocked sural nerve proximal to the symptomatic area? Did she at least get temp relief from the local? Look at foot gear, activity, biomechanics. Any relief with immobilization? Are the symptoms consistent w/ RSDS? Has all blood work been done for metabolic neuropathies? Look for other motives--e.g., Workman's Comp., insurance? Have other family members in the room with her (with her consent) and discuss the problem to get a "feel" for any underlying issues.

If local block gave immediate relief and I felt like I had no other option, I would consider simply resecting the sural nerve. Consult a pain management physician first. If immobilization helps, I would look more toward a biomechanical etiology.

Tip Sullivan, Jackson, MS, tsdefeet@msfootcenter.net

This would be an excellent case to treat with cryosurgery. Neuroablation of the sural nerve just proximal to the malleolus would stop the pain. The way to see if this would be appropriate would be to drop less than 1 cc. of Marcaine around the nerve. You could use ultrasound to find the neurovascular bundle and to increase accuracy. This should be numb laterally. If it is, then cryosurgery would work well. I see these problems frequently and they are sent to me from the pain management docs who have tried the same treatments that you tried. These patients do well and have excellent results. These are usually localized to the foot and there are rarely EMG or MRI changes.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor’s note: An extended-length note by Peter J. Bregman, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=23492&start=1

RE: Floroquinones and Tendon Injuries
From: Elliot Udell, DPM

The 12/1/08 issue of the Medical Letter reports that studies have shown that the incidence of injury after taking quinolone antimicrobials is from .14% to .4%. The risk is higher for patients over 60 years of age and those taking corticosteroids. The article went on to cite a case control study in Italy involving 22,194 cases non -traumatic tendonitis and 104,906 controls.

Relevant to podiatric medicine is the part of the study that reports Achilles tendon rupture occurred with fluroquinoline treatment in one of every 5,989 patents in general and one of every 1,638 patients who are over 60 years of age.

Elliot Udell, DPMHicksville, NYElliotu@aol.com

RE: HMOitis and Research (Dennis Shavelson, DPM)
From: Multiple Respondents

There never has been a "pipeline for research" in podiatry. Many years ago, APMA created a research endowment to assist investigators in funding research projects. When I was the APMA President in 2004, I created a committee at APMA to manage this endowment and fund acceptable proposals. The dollars are small compared to other funding sources, but the endowment exists and projects are being funded.

Allopathic medicine has developed its "pipeline" by creating an academic environment at medical schools, health science centers, within the pharma, biotech and device industries. Podiatry would need to do likewise. We are taking some of those steps but they are limited. We need to do more.

Most of us are in private practice without access or the inclination to engage in major research projects. We simply try to provide the best possible foot and ankle care in the world and do that very well.

Lloyd Smith, DPM, Newton, MA, lloydpod@yahoo.com

Dr. Shavelson's words are a profound and urgent call to this profession. The double blind/placebo controlled framework fails miserably to reveal many efficacious and worthwhile therapies. In the integrative medicine approach, we are dealing with "layered protocols" in which a single piece of the protocol would fail a double blind approach because, by itself, it will not net the same result as the entire protocol together. A protocol-based approach to medicine by its very nature is not testable via this format.

In integrative medicine, we may be applying principles in our treatment methods to influence the epigenome by identifying and controlling mechanisms that may misdirect or impair the immune system and once these mechanisms are addressed, we can then use natural, gentle medicines to address the symptoms. Yet, if you take one of the medicines and test it in isolation via the double blind format, it will not appear to be efficacious.

It is time to expand our horizons and see the "bigger picture." Double blind/placebo controlled studies do reveal efficacy in symptom care, but there is absolutely no way to apply these principles to true health care. The time is now to think outside the box. If not, the box just keeps getting smaller and smaller and smaller.

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

Why shouldn't insurance companies play these tactics? Government agencies seem to be on the insurance companies' side. Government agencies and state insurance regulators will only respond if many cases are documented before acting; otherwise everything else is tabled.

If insurance companies can "legally" withhold or deny coverage they are saving millions. After all, it is for-profit insurance companies' goal to pay their stockholders.

Simon Young DPM, NYC, simonyoung@juno.com

New York College of Podiatric Medicine Reunions

The Alumni Association of the New York College of Podiatric Medicine is interested in assisting any classes celebrating significant reunions next year, e.g. the Class of 1984 (25th reunion), the Class of 1989 (20th), the Class of 1994 (15th), and the Class of 1999 (10th). or all classes interested in a reunion, now is the time to act. For example, you may wish to have an event during the upcoming New York Clinical Conference, which is convenient and widely attended. Please contact Howard Rusk, Jr., Director of Alumni Relations, at hrusk@nycpm.edu He will gladly help plan and coordinate all your reunion activities.

ASSOCIATE - METRO NEW YORK--LONG ISLAND & NEW YORK CITY

Excellent Opportunity for immediate partnership with established practice. Excellent Salary arrangement, serious inquiries only. Send CV along with response. E-mail: rrranch7@yahoo.com

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

PRACTICE FOR SALE – CONNECTICUT

Well-established. Grossing 200K; Norwalk/Westport CT. Dr. recently deceased. High Volume Medicare ; NO BROKERS; Please email: berist92@gmail.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Excellent opportunity for PSR 24-36 foot and ankle surgically-trained physician. Looking for hard-working, personable, highly-motivated individuals to join our group and build their own practice. Position leading to partnership. Great opportunity with excellent salary and benefits. Please e-mail CV and references to cavallinig@foothealers.com

ASSOCIATE POSITION- BALTIMORE, MARYLAND

Busy practice in the Pikesville/Owings Mills area located in 1st class medical building seeks motivated individual to work PART-TIME. Must be surgically trained. Must have a great personality and a good sense of humor. State-of-the-art office with hospital-grade ASC. Good mix of general podiatry, sports medicine and surgery. Competitive salary. Benefits for malpractice and health insurance allowances are available and negotiable. Please forward your CV by fax to 410-602-9781 or by email at mwaiken@comcast.net

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 –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

NJ PODIATRY PRACTICE WANTED

Two eager podiatrists are looking to acquire another podiatric practice in New Jersey. Not interested in a partnership, just a complete buy out. The practice must be participating with Aetna. If interested, please call (917) 301-1919 or e-mail at NJFootDoc@hotmail.com

ASSOCIATE MONTANA

Great opportunity for a PSR-24 or 36 residency trained individual to join a dynamic two doctor group with physical therapy. Needs good FF surgical skills, RF a bonus. Beautiful office and great area of the country for outdoor recreation minded individuals. Opportunity for partnership after employment. Reply to: jclough@sofast.net

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