The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 15, 2006 #2,766 Editor-Barry Block, DPM, JD

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FL Podiatrist Uses Full-Contact Orthotics

Many people have tried orthotics to correct foot problems. Some have had success; others have not. Now technology has improved the science of orthotics, and these new versions are helping patients with all kinds of ailments. Foot care is essential for diabetics like Mitchell Levitsky.

Podiatrist Dr. Marc Klein suggested Levitsky try a new type of orthotic called Icon full-contact orthotics. "The old type orthotics -- there was a gap built in, which was part of the biomechanical theory," said Klein.

Dr. Marc Klein

Klein said these orthotics work as soon as the foot and the device make contact. The orthotics are created with flexible foam while the patient is seated; standing places the foot in an abnormal position. They are formed to each person's specific curvature of the arch with respect to their weight and foot flexibility. "If you can get the foot into the proper position, the foot and the ankle, it's going to help on up the chain -- the kinetic chain -- up to the lower back, knees, hips and lower back. With this orthotic, it holds my ankle perfectly vertical. That's the main difference between the two orthotics," said Klein.

Source: Amber Statler, Local 10- TV, Fort Lauderdale, FL [12/14/06]

NYCPM’s Logan Appointed to New York State Board for Podiatry

The Board of Regents of the University of the State of New York has approved the appointment of Loretta M. Logan, DPM, Associate Professor of Orthopedics, and Acting Chair of the Department of Orthopedics/Pediatrics at NYCPM, to the New York State Board for Podiatry, for a term extending through October 31, 2011.

Dr. Loretta M. Logan

Dr. Logan earned her DPM degree from the New York College of Podiatric Medicine in 1989 and received an M.P.H. degree from Hunter College School of Health Sciences in 1995.

Pharmaceutical Websites Keep Getting More Visitors: Study

For the third quarter of 2006, some 33 million Internet users visited a prescription-drug site, an increase of 13% from the same quarter in 2005, according to a new study from comScore Pharmaceutical Solutions. The research firm finds that 66% of 411 visitors to prescription-medication sites report conducting research for themselves, with 10% conducting research for a spouse and 6% for a child. "Consumers are increasingly looking to the Internet to become more knowledgeable about medications that have been prescribed by their doctors, or that seem relevant for their symptoms," says Carolina Petrini, vice president of comScore Pharmaceutical Solutions.

The study also finds that 20% of all researchers report that they first became aware of a product via an online search, with individuals aged 35 to 54 accounting for 23% of those visitors. Drug-related information draws the most attention. Sixty-six percent of researchers report looking for information on drug side effects, and 53% look for drug safety information. Condition-focused information was sought by 53% of visitors, while 29% sought patient information and support programs.

Source: Today in E-Business [12/12/06]

Speakers: Barry Block, DPM, JD (Sponsored by Doak Dermatologics); Harry Goldsmith, DPM (Sponsored by Officite); Mark Schilansky, DPM (Sponsored by Organogenesis); and Paul Kesselman, DPM (Sponsored by Wright Medical).

Click on www.codingline.com/events-ny.htm for details and registration information.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Keloids

I have a case coming up soon (routine HAV) on a lady with previous history of keloids. I have discussed it with a local plastic surgeon who says that there is “nothing new” and just to use steroids in the incisions at closing. Does anyone have any treatment pearls.

Tip Sullivan, DPM, Jackson, MS

Query: Growth Hormone

A 25 year old healthy male needs forefoot surgery. He admits to taking growth hormone pills to treat his shoulder after arthroscopic surgery. He did his own research on the Internet and believes this will help heal it quicker. What do I need to be concerned with (if anything) when performing surgery on any patient currently taking growth hormones (e.g., healing, infection, NSAIDS, narcotics etc...)?

Charles Morelli DPM, Mamaroneck, NY

RE: Alleged Misdiagnosis - Cancer Wrongful Death (Elliot Udell, DPM)
From: Multiple respondents

It has always been my opinion that as "experts" in foot care, one always has to have an "index of suspicion" for tumors that do not have the characteristics of benign tumors. In this particular case, the doctor aspirated "green jelly-like fluid", not clear as you would expect from a ganglion. In addition, the tumor was described as "boggy"; is that how podiatrists describe a ganglionic cyst? My point is that if you do a procedure or diagnostic test, the outcome should validate your opinion or else do a biopsy. The risks are minimal, but you might save someone's life. If one takes the position that because cancerous tumors of the feet are rare, you don't have to make the correct diagnosis, then you are doing a disservice to the public.

Jonathan Haber, DPM, Caldwell, NJ, JHaber4932@aol.com

One problem facing every clinician is that there are many benign dermatological lesions which have a "malignant twin." Knowing this, I personally would conclude it is always better to err on the side of caution and take a biopsy. More often than not I think biopsies are relatively safe to perform. It is rare you can be blamed for taking a biopsy, but if you don't and you miss something the consequences can be devastating.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

This topic is highly debatable. I often struggle with this in the office setting when it comes to removing tumors versus observation. We all know that the incident of primary or secondary malignant tumors of the foot and ankle are rare, but they do exist, as demonstrated by this case. I feel that we are surgeons and therefore should approach masses and tumors as such. Would a general surgeon debate on whether or not to remove a mass, even if they know it is a lipoma? No, they schedule the surgery.

I have taken the approach of counseling patients on the incident of malignant tumors of the foot and tell them we won't know for sure what it is unless we take it out and have it examined by pathology. If they choose a non-surgical approach, I note this in the chart as such. That way if something were to develop unexpectedly, I feel I have done my part in educating and recommending the proper treatment protocol from a medical/legal aspect

William T. Vondette, DPM, Treasurer, Michigan Podiatric Medical Association, Freelandfootclinic@sbcglobal.net

I agree with Dr. Udell that the patient's death was tragic. I also agree that sometimes no matter what radiologic test is performed, there are false negatives. However, I would like to say that I think we, as podiatrists, do not order enough diagnostic tests. We are always worried about the scrutiny of ordering too many radiographs or too many MRI's. Our MD counterparts have no trouble sending a patient for a battery of tests for indigestion with worrying what others may say. When a diabetic is admitted to the hospital for an infection, we always cover our behinds by consulting every service available.

Why not follow that thinking in the office and order that extra test. I know if it were my mother or father I would order that extra circulation test or bone scan. I think a lot of this thinking is that we never did it in the past. It's time to evolve and take this profession to the next level. I myself probably order too many tests, but I do have to say, my possible paranoia has picked up pathology more than one time. Ask the 40 year old non-smoker who is now being treated for lung cancer after I ordered a pre-op chest x-ray and picked up a spot. Food for thought.

Eugene A. Batelli, DPM, Naples, FL, ebatelli2001@yahoo.com

Dr. Udell asks about lesions such as plantar fibromatosis amd ganglions and the necessity of biopsy versus observance. There are important evaluation measures in the approach to soft tissue masses. Regardless of the outcome of the Michigan case cited in the verdict reporter two days ago, the fact that malignancies in the foot are rare is a VERY ANEMIC DEFENSE for a misdiagnosis. Here are some guideleines:

If any soft tissue mass you are looking at is 5cm in any dimension, BE VERY SUSPICIOUS. Do everything you can to establish the diagnosis, including referring the patient. Size can be determined best by ultrasound or MRI, or palpation if clearly small or clearly large. Try to determine if it is subcutaneous or intramuscular. This can be done by Ultrasound or MRI. Intramuscular is a worse sign than subcutaneous, and subcutaneous malignancies tend to fare better. This is more applicable to deep thigh and buttock tumors.

Firmness is a bad sign. Sarcomas tend to be firm and painless until large. Determine if it is cystic or solid. Cancers tend to be solid, BUT There are high grade malignancies that can present largely as a cystic mass.

Masses that rapidly increase in size over a few months are more likely to be malignant than lesions that have enlarged slowly over many years. Pitfall: Occasionally, soft tissue sarcomas present with a history of many years duration.

Every soft tissue mass for which there will be intervention requires a plain X-ray. we are evaluating for fat density (lipoma), calcifications (synovial sarcoma, hemangioma), ossification (osteosarcoma, myositis ossificans), skeletal abnormalities (osteomyelitis, primary bone lesion,periosteal reaction from soft tissue tumor). MRI and CT provide additional information on extent, internal tumor characteristics, and whether lesion is primarily bone or soft tissue. MRI should be ordered with contrast.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@msnyuhealth.org

ASSOCIATE POSITION - FINGER LAKES REGION UPSTATE NY

Leading regional group practice seeking ABPS residency-trained associate with partnership in mind. Excellent compensation/benefit package. Associate to see the same patient mix as partners, and will be involved in expanding the practice. State-of-the-art wound care center. Surgical privileges in nearby PA. Great opportunity for a well-trained, ethical podiatrist to work in a beautiful area that is great for family. NewYorkAssociate@comcast.net

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 - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

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

ASSOCIATE POSITION/ MANHATTAN AND LONG ISLAND

Seeking well trained podiatrist to help expand existing surgical practices. Candidate must be able to acquire staff privileges. Package and terms are negotiable, flexible hours. Email PODO2345@AOL.COM OR CALL (516) 476-1815

EQUIPMENT WANTED – USED X-CELL X-RAY UNIT

Used X-cell midbase Podiatry X-ray unit with orthoposer, Expected price. $3000.00 Mark Robson, DPM, Austin TX. 512 585-0242 mrobsondpm@aol.com

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 - 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 - 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.

PRACTICE FOR SALE – NEW YORK

20 Year practice by-the-sea in beautiful Long Beach, NY. Excellent Terms. E-mail seashell554@aol.com or (516) 432-7300.

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