The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 11, 2009 #3,724 Publisher-Barry Block, DPM, JD

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IA Podiatrist Uses Subtalar Implants to Treat Flat Foot

Flat feet can be diagnosed with a clinical gait analysis to determine how the foot functions, and treatment options, Dr. Phillip Morreale said. X-rays reveal bone structure. Implants more permanently correct severe cases of flat feet. Conservative measures like physical therapy, over-the-counter shoe inserts or custom orthotics provide temporary relief, or delay progression.

Dr. Phillip Morreale and Cheyenne Donaldson (photo Rick Chase)

Cheyenne Donaldson, 7, who had flat feet, had subtalar MBA implant surgery on one foot in July, and on the other in November. This minimally invasive treatment involves a small titanium device inserted into a natural space between the ankle and heel bones, which restores arch formation and influences foot development. "You can see it locks the foot in neutral," said Cheyenne's podiatrist, Dr.  Morreale. "Before you could really torque the foot way out."

Source: Tina Hinz, Courier-Post [12/9/09]

Blank Honored with OPMA Champion of Podiatry Award

Bruce G. Blank, DPM was honored by the Ohio Podiatric Medical Association with the OPMA Champion of Podiatry Award during the 2009 OPMA House of Delegates on Saturday, December 5. Blank, who is a past president of OPMA and his local academy, also serves as a Delegate to the APMA HOD, OPMA Trustee, and APMA’s Health System Committee. He is the current PIAC representative for APMA for OH. 

Bruce G. Blank, DPM

Blank was recognized for professionally assisting OPMA in meeting with the Governor’s staff regarding fee discrimination and being the plaintiff in the litigation against the Ohio Department of Insurance which was filed on July 23, 2009 in Franklin County Common Pleas Court by OPMA. Dr. Blank is in private practice as a solo practitioner in eastern OH.

Query: Bunion Pain In Patient with Multiple Joint Pain

I have a 43 yo, WDWN Caucasian female, who presented with a chief complaint of painful bunions with increasing discomfort over the past few years. She has no previous tx, PMH, Family HX, non-contributory, no meds. ROS non-contributory. There is a moderate HAV and a mild tailor's bunion as well, with NO pain through ROM, but pain on palpation at the medial aspect of the 1st MPJ. 

Accommodative padding and orthoses have been ineffective. She has related additional joint discomfort such as in her thumb, back and hip.  An arthritis profile was negative. Radiographs do not reveal anything other than the usual deviation at the 1st & 5th MPJ's with arthritic changes. Any thoughts would be greatly appreciated.

Chuck Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com

RE: Bone Scan (Charles Morelli, DPM)
From: Lowell Scott Weil, Sr., DPM, Barry Mullen, DPM

Tc 99 bone imaging will remain active and "hot" as long as one year following a stress fracture of the tibia. Given those findings, which is in a relatively stable and uneventful fracture, I would imagine that an arthrodesis with an allograft could remain "hot" for up to 18 months or more. As the allograft is replaced by host bone, osteoblastic activity continues, thereby keeping the scan darker in that region as compared to regions where no trauma or surgery was performed.  
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, WEIL4FEET@aol.com

Presumably, Dr. Morelli poses his "hot" bone scan question to determine when it is clinically appropriate to return his patient to activity following surgery. Because so many variable factors exist that affect technetium uptake amidst an arthrodesis' healing process, especially with allograft utilization, it becomes impossible to quantify a time line when uptake should no longer be visualized following a successful union. As such and because of poor specificity, Tc scanning is a poor imaging choice to quantify this. 

I am curious to learn what clinical factors currently exist that provide Dr. Morelli the confidence to exclaim that his arthrodesis was "successful." Is your patient pain free? Does any motion exist at the arthrodesis site? If it does, does it cause symptoms? Do plain films suggest complete union and graft uptake? If all of these clinical criteria are met, then why the need for a Tc scan? I'd simply go with my clinical judgment at that point and return the patient to graduated activity to tolerance, even amidst the setting of a persistent "hot" Tc scan. If significant doubt remains regarding one's patient's healing status, in the presence of persistent symptoms, then a CT scan is the most specific and reliable diagnostic imaging corroborator to assess athrodesis union and graft uptake.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Indomethicin for Acute Gout? (Elliot Udell, DPM)
From: Michael Forman, DPM, Paul Busman DPM, RN
 
I agree with Dr. Udell that any of the NSAID's can be effective in the treatment of gout. One of my associates used to use Clinoril with success. I have also had success with aspirin. Nonetheless, its hard to break old habits and because of the 95% success of indomethacin - that remains my drug of choice. If after five to seven days, there still is pain, I introduce colchicine .6 mg tid. Rarely, is there a failure with that regimen, however, if at the third visit, the patient is still having problems, a peri-articular or intra-articular injection can be given.
 
Obviously a good diagnosis is mandatory. I usually run a 24 hour urine along with uric acid, sed rate and CBC. I usually refer these patients to their internist for ongoing treatment.
 
Michael Forman, DPM, Cleveland, OH, im4man@aol.com

I don't know about your Colchicine protocol, but I used to have excellent results using Clinoril (sulindac) 200 mg PO,BID. It was almost universally well-tolerated and very effective.

Paul Busman DPM, RN, Clifton Park, NY, brewerpaul@aol.com

RE: National Pathology Services (Steven Block, DPM)
From: Ronald Martin, DPM

I'm sorry to hear about Dr. Block's situation. I have been using Bako Pathology Services for over a year now and have been happy with their services. They have a wide array of test options. I have spoken with the pathologists on occasion about certain specimens, and they seem to be very knowledgeable and friendly. I frequently send them a clinical picture with the specimen, and they incorporate it in the report along with the photomicrograph. From the start, they have been dedicated to the podiatric profession both academically and financially.

Ronald Martin, DPM, Shelby Twp, MI, martinr9@hotmail.com

RE: Late-Arriving Employees (Name Withheld)
From: Joel Lang, DPM

Name Withheld did not clearly state his problem. I know the employees arrive late, but is the issue disruption of the patient flow or is the issue employee pay?
 
1) If the problem is patient flow, this is more serious and needs definitive redress. I would fully document and warn employees of potential job loss.
 
2) If the problem is salary, then first institute an honor system and have them clock in and out on paper and adjust pay accordingly. If this system is abused, then refer to 'solution 1'. The purchase of a time clock can unnecessarily alienate otherwise good employees.
 
As a footnote, I had an employee who was chronically late by 10-15 minutes. It did not significantly affect patient flow and she was a terrific employee while she was there. She stayed for 10 years. I tried everything to solve the insolvable problem. I finally decided that her exceptional job performance outweighed the nuisance value of her lateness. I accepted what I could not change. 
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: CMS To Conduct Fifth Annual Medicare Contractor Provider Satisfaction Survey
From: Paul Kesselman, DPM

The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor that processes and pays your Medicare claims. CMS is preparing to conduct the fifth annual Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey offers Medicare FFS providers and suppliers an opportunity to give CMS feedback on their interactions with Medicare FFS contractors related to seven key business functions: Provider Inquiries, Provider Outreach & Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Provider Audit & Reimbursement.

The survey will be sent to a random sample of approximately 30,000 Medicare FFS providers and suppliers. Those who are selected to participate in the 2010 MCPSS will be notified starting in January. If you are selected to participate, please take a few minutes to complete this important survey. Providers and suppliers can complete the survey on the Internet via a secure website or by mail, fax, or telephone. To learn more about the MCPSS, please visit cms.hhs.gov/MCPSS on the CMS website.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: 2012 IRS Rule Will Withhold Some Medicare Pay
From: Joel Lang, DPM

If this ever comes to pass, which is still questionable, practitioners need only reduce their quarterly federal estimated tax by the amount withheld by Medicare. This will fully offset the reduction in payment, maintain cash flows as before, and will make no impact on your tax status at the end of the year. Just a thought.

Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: NJPMS Sues Insurer Over Changes in Coverage
From: Ronald Werter, DPM, Robert Bijak, DPM

I recently became participating with Cigna. Their radiology is paid and credentialed through a company called AIM. I was rejected for payment for a sonogram. I was told when I inquired about this: "podiatrists are not credentialed to do diagnostic musculoskeletal ultrasound." Yet, when I was out-of-network with Cigna, I was paid for sonograms.

Ronald Werter, DPM, NY, NY, hawkeyedpm@aol.com

After 30 years of practice, I'm still reading about podiatrists fighting for their basic survival. I'm sick of it. My solution is this. Take just one podiatry school and make it an MD or DO school. (The mechanics are not as hard as our trying to get accepted as we are.)  Accept ANY and only graduate podiatrists that wish to enter.  No MCATS, transcripts, etc. A DPM is sufficient for admission. If students flunk out, they flunk out, but they at least have a chance. 

At present, getting accepted as a podiatrist in an American medical school is difficult at best, and transfer credit nearly unheard of. If the DPM passes, they take Part I of the Boards. If they pass, they move on. Those podiatrisst who oppose this concept need not apply, and just continue as a DPM. The DPM's with a joint degree will be free of podiatric problems. They will be MD's or DO's. This obviates hospital and insurance discrimination. Lawyers won't say to you in a lawsuit, you're not a medical doctor, are you?

Many, many podiatrists are smart enough, but are inhibited in their professional growth by the lack of podiatric residency training and wildly different scopes of practice. One area does ankle and legs, others are afraid to prescribe allopurinol because it's systemic! Enough of this. We can't wait for them to take us in. We need to make our own pathway. I would like this to be the framework to obtain ideas, opinions and action. Again, if you are happy as a DPM, carry on. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Healthcare Reform (Bob Kornfeld, DPM)
From: Bob Bijak, DPM, Jon, Purdy, DPM

"Swim with the tide not against it." There's a time when a man has to take a stand, not just do what is comfortable and convenient. 17% of GDP is not unsustainable. We have plenty of money; it's just being diverted by crooked politicians. If there is anything we spend money on, it should be healthcare, and that's without relinquishing our independence to the government because we feel insecure to take a stand on what we know is right.

Bob Bijak, DPM, Clarence Center, NY,  rbijak@aol.com

Although I disagree with the notion that we are more “pathologic,” I don’t disagree that proponents of universal healthcare are using absurd cause and effect analysis to try to make their point. What is unarguable is the fact that we have...  

Editor's note: Dr. Purdy's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=31106&start=1

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.

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

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