The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 17, 2007 #3,118 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

IN Podiatrist Offers Outpatient Sinus Tarsi Implant

Dr. Larry Best is now offering a potentially life-changing implant procedure to patients suffering from hyperpronation and related disorders. In November, Best completed an intense training program in the use of the HyProCure sinus tarsi implant and is the first doctor in Elkhart to receive a Master Surgeon certification in this procedure.

Dr. Larry Best

The Subtalar Arthroeresis procedure is used in the treatment of hyperpronation, a painful and potentially debilitating disorder. In addition, the sinus tarsi implant is also used in the treatment of many other foot and ankle disorders including flatfoot, bunions and fallen arches. The procedure takes about 10 minutes, is done on an outpatient basis and requires very little recovery time.

Dr. Best graduated from Dr. William M. Scholl College of Podiatric Medicine in 1985 and has been in private practice for over 20 years.

Source: The Truth [12/12/07]

NY Podiatrist Plans for 4th Medical Mission to Nicaragua

Podiatrist Dr. Charles Morelli, president of the Tappan Zee Division of the New York Podiatric Medical Association, will take part in a humanitarian aid mission to Nicaragua during Presidents’ Week this coming February. It is the fourth time he has donated his time and considerable expertise to a journey sponsored by the Mamaroneck United Methodist Church that will provide desperately needed medical treatment and assistance to hundreds of impoverished Nicaraguan residents.

Dr. Charles Morelli

Dr. Morelli practices in Mamaroneck at Sound Shore Podiatry and is on staff at Sound Shore Medical Center in New Rochelle. During his Nicaraguan stay, he will diagnose and treat a wide range of foot problems including painful bunion deformities, complications due to diabetes and childhood gait abnormalities. “It is a week of grueling physical work and incomparable emotional returns,” he says.

Dr. Morelli is hoping to raise over $5,000.Donations will help cover the costs of treatment and supplies for Nicaragua organizations listed www.nicamissions.com. Highlights of previous outreaches can be viewed at www.nicamissions.com/Highlights/Mamaroneck%20UM%20Church.pdf

Senate Likely To Create Bare-Bones Package

House Speaker Nancy Pelosi (D-CA) on Thursday said that the chamber would wait for the Senate to craft Medicare legislation rather than write its own bill because of continued disagreement among lawmakers on what to include, CongressDaily reports (Johnson, CongressDaily, 12/13). The bill is being written to stop a scheduled 10% reduction in Medicare physician fees scheduled to take effect Jan. 1, 2008. Pelosi's announcement "represents a concession for Democrats" because it "means the House has essentially given up on a raft of changes to Medicare that had been a priority" for them, according to CQ Today.

In addition to stopping the Medicare physician fee cut, the Senate bill could include a small increase to physician payments or none at all, according to CQ Today.

Source: CongressDaily and CQ Today via American Health Line [12/13/07].

Query: Wide Shoe to Accommodate AFO

I have a patient who needs shoes like the neoprene of Dr. Comfort style, but wide enough to accommodate a non-flexible AFO [double-leg fracture]. Please advise.

Francine G. Schiraldi-Deck,DPM,MS, Williamsport, PA

RE: Bunionectomy for Patient With Severe Gout (Diane Phalen, DPM)
From: Multiple Respondents

I generally find that an aggressive cheilectomy with arthoplasty of the joint, synovectomy and copious (pulsed lavage) irrigation of the area works. In addition, don't forget to give 1mg IV colchicine pre and post op and some uricosuric (allopurinol, probenecid, indomethacin or other potent NSAID) for 7 days post op to avoid an acute attack. I have had good experience closing the deep layer with PDS and the skin with staples which appear to reduce reactivity.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

I don't see how Dr. Phalen can classify this as Grade 1 Hallux Limitus based on the radiographic and clinical presentation. It sounds like grade 3 to me. I would make sure his uric acid levels are WNL for a while. I think 1st MPJ fusion would be best for him. My main concern is his soft tissues. Frequently, uric acic crystals (chalky material) are within the soft tissues and healing often times is a big problem.

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

Based on the information presented, I recommend a aynovectomy with arthrodesis. Keep the patient well-hydrated in the perioperative period, and consider prophylactic colchicine .6 mg BID. Be prepared for acute flare of the disease, and if it occurs consider IV colchcine 2 mg. to quickly abort the attack. Include a perioperative anti-inflammatory as part of the analgesic regimen.

On a personal note, I like doing such cases with a small external fixation device for fusion. It allows me an "easy out" if things get rough post op. In addition, I feel more comfortable without internal fixation in a gouty joint, although there is nothing wrong is using such devices.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

RE: Patient Who Returns After Being Discharged
From: Carl Ganio, DPM, Simon Young, DPM

Certainly you are within your rights to discharge a patient for non-compliance. It would seem that you proceeded correctly with a certified letter, and an appropriate time interval for emergencies. Having said that, it is my opinion that the patient deserves a reason, and you are completely wrong. It would seem, that your lack of desire to provide a reason implies that your reason is inadequate... again you are mistaken. I support you in your decision and your reasoning. Be strong, and just indicate in the letter that you feel the patient is a danger to herself. Her lack of compliance places HER at risk. This is not about YOU. Place a copy of the letter in the front of her chart, or some message in the computer scheduling or billing program that says "do not reappoint." I hate it when the patient makes it past the front desk, and is sitting in my treatment chair once again.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

I can empathize with Dr. Secord but disagree with "I was actually more than happy to explain his complication, his malignant non-compliance, and his discharge and handed him a copy of his charting, pointing out the careful documentation and pictures of the course of his surgery, stupidity and complication and showed him the door." This patient could go to a governmental agency and make a complaint and you risk an investigation. I think your best course was to provide him a copy of his chart and walk away.

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

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

ASSOCIATE PART-TIME POSITION MARYLAND

Part-time, Leading to a full time position. A well-established, successful podiatry group in Washington Suburban area of Maryland , Ownership opportunity. Surgery Center on-site. Great office staff. Flexible schedule. Great opportunity. Biomechanics and or Surgical residency experience preferred. Fax Curriculum to 240 465 0332. Email pmrypmry@yahoo.com. Call 240 604 4564.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 10,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.