The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 10, 2009 #3,723 Publisher-Barry Block, DPM, JD

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ESWT is Both Non-Invasive and Effective: NY Podiatrist  

"Heel and arch pain are among the most common complaints I see," states Gary Evans, DPM. While conservative care such as proper stretching and custom orthotics are very effective for treatment, there is a new treatment which is non-invasive and has shown excellent success.

Dr. Gary Evans

As Dr. Evans explains, "The most common cause of heel and arch pain is plantar fasciits. Which is pain coming from the fascia, or structure, that basically holds up your arch. In actuality, when the pain is chronic, it is not a true inflammation of the involved fascia but a degeneration of the fascia. ESWT, or extra corporeal high frequency shockwave treatment is a non-invasive, very effective treatment. In simple terms, the application of the shockwaves, through the skin, stimulates the tissue to actually heal with new collagen production." This procedure means little to no down time from work.

OPMA Elects New Officers for 2010

In action taken during the 94th Annual Ohio Podiatric Medical Association’s House of Delegates held in Dublin, OPMA elected new officers to lead the state organization of Ohio’s foot and ankle physicians in 2010.

Dr. Thomas W. Kunkel

President - Dr. Thomas W. Kunkel of Girard, OH
First Vice President - Dr. Alan J. Block of Columbus, OH
Second Vice President - Dr. David Hintz of Elyria, OH
Secretary-Treasurer - Dr. Angelo Petrolla of Youngstown, OH
Immediate Past President -  Dr. Kevin L. Sneider of Port Clinton, OH

Board of Trustees are: Jack Buchan, DPM, Bruce Blank, DPM, Karen Kellogg, DPM, Kevin Schroeder, DPM, Peter Wiggin, DPM, Bruce Saferin, DPM, Paul Lieberman, DPM, Bryan Caldwell, DPM, Brian Ash, DPM: Young Member - Derrick Jackson, DPM and Student Member Amanda Quisno

Delegates and alternates for the APMA HOD 2010 were: Drs. Lieberman and Petrolla. Alternate Delegates are Drs. Thomas Kunkel and Howard Waxman. Drs. Bruce Saferin, Mark Gould, Kevin Schroeder and Bruce G. Blank complete the OH Delegation for 2010.
 

Query: Indomethicin for Acute Gout?
 
In the November 30th, 2009 issue of "The Medical Letter" there is a review paper on the various treatments for acute and chronic gout. One item that caught my attention is that, "There is no convincing evidence that indomethicin, a traditional choice, is more effective than ibuprofen, naproxen or celecoxib." This should finally put to bed the notion that indocin is the only drug of choice even though far safer non-steroidals are available. 
 
The article went on to speak about other protocols such as intra-articular injections of corticosteroids. In my practice, I have found that peri-articular injections work just as well, and there is minimal risk of causing an intra-articular infection. Another protocol they gave in the treatment of an acute flare-up is to give a patient, 1.2 mg of colchicine orally, followed by a second dose of .6 mgs one hour later. The feeling of the authors is that this would not cause GI problems. Has anyone had success with this particular protocol? 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Query: Demand Matching

My hospital is developing demand matching for implant use in the operating room. Does anyone have any guidelines for using porous vs. non-porous coated 1st MPJ hemi-implants at their institution?
 
Shawn Reiser, DPM, Flint, MI

RE: Bone Scan (Charles Morelli, DPM)
From: Simon Young, DPM

I never got an accurate answer from any radiologist other than "several weeks after union has occurred." You must be aware that bone remodeling can take up to several months.

In my experience, the bone scan will stay "hot" for a prolonged period of time after successful union, in the presence of a non-union or delayed union. If it stays persistently "hot" >12 weeks after union, even though radiographically it appears fused and there is no discomfort, most likely you have a non-union. I usually see this scenario with neuropathic feet.

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

RE: Heel Pain in Marathoner (Scott Whitman, DPM)
From: Multiple Respondents

I would take an MRI or bone scan to rule out a stress fracture. You would not want to inject a fracture. 

Gary Gordon, DPM, Philadelphia, PA, drggordon@comcast.net

I had a similar case with an ultra-marathoner in his late 40's. The extreme athletic types will run with pain if they are physically able to do so. Before you inject anything, make sure you get an advanced modality to rule out a stress fracture. Although the history and physical exam points to fasciitis, speak with him about the risks of running long distance on an injured foot. The last thing you need is this guy returning with a frank calcaneal fracture after he attempts the race.
 
David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

Treating athletes, and particularly runners, can be very challenging. Your patient will most certainly run the marathon this weekend, regardless of the potential injuries he may sustain. He is at risk to severely aggravate the condition, tear the plantar fascia ligament, and possibly induce an injury to the calcaneus. I would strongly discourage injecting him several days before the race, because if such injury occurs, you may be challenged later regarding the treatment plan. If he competes in this race as I suspect, and is fortunate enough not to cause serious damage, I would then consider options such as ESWT, custom orthosis, daytime splinting if his occupation is indoors, and if he is amenable....shutting down the running for several months. Convert him to biking, swimming, and weight-training (a non-weight-bearing exercise program). 
 
Steven Gersh, DPM, Pasadena, MD, dslsg@verizon.net

RE: Late-Arriving Employees (Name Withheld)
From: David L. Nielson, DPM, Tom Silver, DPM

People are driven by what is in their best interest. Put a time clock in your office and they will be incentivized by getting paid. You can also have a check list of responsibilities which you can gauge when it comes time to give raises or bonuses. Being on time and punctual is certainly one of them.

David L. Nielson, DPM, pampantla@hotmail.com

I agree with Lynn Homisak that those consistently late employees should be fired BUT only after you make yourself clear on your expectations and they don't follow these. 

1) Sit down with them individually and discuss the problem. Clearly delineate what your expectations are. You should have an "office policy manual" delineating this policy. Let them know the consequences of violating the office policy.

2) Reinforce these expectations, i.e., praise them when they are on on-time and give them warnings when they are not.

3) Fire them only after they have been given two warnings, 1st oral then 2nd written-as deliniated in your "office policy manual". 

I had a lot of these problems when I started in practice and over time learned how to be "the boss"...fair but firm and by the office policy. My employees have been with me 16, 15, 7 & 2 yrs with another retired after 15 yrs. We're a family, working towards a common practice goal.

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

RE: NJPMS Sues Insurer Over Changes in Coverage
From: Michael Nirenberg, DPM

Legal action is not always the best way to solve problems, but nonetheless, I applaud the NJPMS for fighting for their podiatrists.
 
A similar problem has occurred against podiatrists in Illinois. On September 1st, Blue Cross/Blue Shield of Illinois announced it would no longer pay for most diagnostic ultrasounds for muscle-skeletal disorders (including plantar fasciitis). I am very interested to see what action (if any) we will see from the Illinois Podiatric Medical Association.

Michael Nirenberg, DPM, Crown Point, IN, michael.nirenberg@sbcglobal.net

RE: Healthcare Reform (Joseph Borreggine, DPM, William Reider, DPM)
From: Bob Kornfeld, DPM

Drs. Borreggine and Reider reference the statistic that "America's healthcare industry's costs represent 17% of this country's gross domestic product (GDP). This is much too high and is unsustainable. In other developed countries their GDP runs about 8%."

Much has been said about the "high cost" of healthcare in this country but no one seems to...

Editor's note: Dr. Kornfeld's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=31066&start=1

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 - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. Fax cover letter & CV to (843) 208-3348 or E-mail to melissafoot@pol.net
 

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 - 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

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

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