The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 18, 2006 #2,767 Editor-Barry Block, DPM, JD

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NY Podiatrist Explains Shoe Style to Foot Damage Ratio

The ratio of shoe style to foot damage goes something like this, explains podiatrist Robin Ross of Shelter Island, N.Y.: The skinnier and taller the high heel, the more potentially ankle-twisting the shoe becomes. And, if a narrowly sharpened toe box squeezes your little piggies day after day, don't be surprised if beneath your pedicure you discover black-and-blue nails.

Dr. Robin Ross

Chic sneaks. Even so, "there's no way you or I or one of my clients is going to wear a pair of clodhoppers with a sexy outfit," Ross admits. So to minimize the damage while maximizing the look, Ross recommends limiting time spent walking or standing in the heels. Wear running shoes to and from the event-and afterward, pamper your feet with a massage or an Epsom salts soak. Better yet, eschew 4-inch stilettos for lower heels or platforms. Look for shoes made of materials that "breathe"-like leather, canvas, or a running shoe's nylon mesh-rather than plastic. "The good news is that the pointy shoe is heading more toward the rounded toe box," Ross notes.

Source: Diane Cole, US News & World Report [12/17/06]

PHR Push: Big Companies Tell Physicians They Better Go Tech

A coalition starting with five big employers believes it can lead physicians to technological waters and make them drink. Wal-Mart Stores, Intel, BP America, Pitney Bowes and Applied Materials are launching an initiative under which they will invest at least $5 million to give electronic portable personal health records (PHR) to employees through a Web-based framework called Dossia. Other employers are being invited to join the coalition, which launches its service in mid-2007.

Unlike a paper-based or electronic medical record that doctors create and store in their offices, a PHR is created, owned and maintained by patients. Several companies offer PHR products to consumers. Some charge a fee while others, including payers and Medem, which is partly-owned by the AMA, give it to consumers for free. Most PHRs, including Dossia, are Internet-based. Doctors don't need an EMR to enter information in a patient's PHR, just a computer, an Internet connection and their patients' permission. Dossia, like other PHRs, does not allow patients to change doctor-entered information.

The American Medical Association and others in organized medicine are generally supportive of EMR and PHR adoption. But they do not support mandates on doctors to do so. The Dossia initiative as of yet contains no mandates for employees to see physicians who will accept and update PHRs.

Source: Tyler Chin, AMNews [12/18/06]

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Query: Difucan Dosing

I am currently treating a middle-aged woman who has had long-term unsuccessful treatment for onychomycosis. Last year her dermatologist biopsied her nail and a yeast was determined to be the cause of her nail problem together with a secondary pseudomonal infection. She is currently using a variety of topical meds without significant benefit.

Since Lamisil is not indicated for a yeast infection the patient had side-effects from Sporanox, I am using topical gentamicin sulfate cream for the small amount of greenish discoloration on her nail plate/nail bed. I am considering Diflucan. What dosing have you used for this treatment and for how long?

Larry Dorman, DPM, Miami, FL

Query: Peroneal Brevis Split

I have a 59 year old female with an MRI-confirmed split of the perneous brevis tendon from the myotendonous junction to just proximal to the insertion at the base of the fifth metatarsal. The patient has no history of trauma or injury and it is a unilateral condition. I would appreciate any insight into the origin and possible treatments, the patient is leaning more toward conservative than radical surgical intervention.

Dale M. Smith, DPM, Chicago, IL

RE: ESWT Studies (Peter Riznyk, DPM)
From: Barrett E. Sachs, DPM

I have had the same problem with the HMO's here in Florida regarding ESWT (high and low intensity) approval. I know the Weils have done studies but until the major insurance companies, e.g., Blue Cross. Aetna, Cigna, et al., start approving the procedures, none of the HMOs will follow suit. I have had heated discussions with the medical directors of the major HMOs in South Florida and it is still considered experimental. I have been told that the HMOs will look for any clause in any contract not to pay for the procedure. I have had ESWTs approved by my podiatry network, only to be canceled by the HMO. I do know that many of the companies providing ESWT instrumentation are doing studies and are fighting the system.

Barrett E. Sachs, DPM, Plantation, FL, Uncletenose@aol.com

RE: Alleged Misdiagnosis - Cancer Wrongful Death
From: David M Krausse, DPM, Bryan C. Markinson, DPM

So, is what Dr. Smith is saying is that had it been an orthopod who made the mistake, it would've been Okay for Dr. Haber to testify? We can't just put on blinders to someone’s mistakes just because they happen to hold the same degree as us. If the doc made a mistake, then he should be held accountable. I don't know all the particulars of the case, but when I suspect a ganglion cyst and I aspirate "green" fluid from it, my next move is to biopsy it, end of story. Perhaps you don't agree, and that is your perogative, but don't bad mouth Dr. Haber for saying what he believes is correct.

David M Krausse, DPM, Hopewell, NJ, footdr68@verizon.net

I am distressed at some comments of Drs. Allen Jacobs and Peter Smith, both professional friends of mine. Dr. Smith intimates that if negligence occurs and the treating physician "feels bad," it diminishes the negligence. He then states that an expert witness for the plaintiff is somehow even more venal if he "flies to Michigan to testify against one of our own." These notions are immature and demonstrates complete lack of knowledge of how the system works. Even though the jury verdict reporter is scanty on details, it still brings out the most visceral responses in the readership of PM news. I have said it once, I'll say it again...if I am the plaintiff, I want the likes of Dr. John Haber reviewing my case. Even with the short vignette presented about the trial in Michigan, I was shocked at the verdict.

Dr. Jacobs, who has deftly demonstrated problems on both sides of the
malpractice litigation bar, goes too far when characterizing Drs. Fenton and Haber as "accusing a colleague of "wrongful death" just to make a few dollars as an "expert witness.." It would be much more appropriate, in my opinion, to lament how "for just a few dollars, a podiatric surgeon who has no business managing a soft tissue mass will do so." It is amazing to me how everyone excepts that a wrong site surgery is malpractice but it can "happen to anybody," but "wrongful death" that results from butchering up a tumor case can be a career ender that should result in sanctions against an expert witness who sets forth the disturbing details. That is simply not fair and kills our credibility.

Ed Note: The full version of this letter appears at: http://www.podiatrym.com/search3.cfm?id=12037

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

Editor's note: This topic is now closed

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

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.

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 – SOUTHERN WISCONSIN

Thriving Southern Wisconsin practice looking for an ethical, hard-working and highly trained podiatrists for an associate position at a well-established practice. Applicants must have completed a 2-year residency and be trained in all aspects of podiatric medicine. Strong potential for future partnership opportunity. Please fax CV and cover letter to (608)829-1319 or e-mail us at footdr@madisonpodiatrists.com.

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

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