The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 18, 2007 #3,120 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.

CA Podiatrist Offers Holiday Foot Advice

Podiatrists say hours of partying and pavement pounding equals an annual increase in holiday heel pain, calluses and corns. "You might use Vaseline on the corn or alternately you could even use ChapStick and what that'll do is reduce the frictional forces," said Huntington Hospital podiatrist Dr. Mark Kidon.

For heel pain, Kidon recommends over-the-counter arch supports and heel lifts. If the pain persists, he usually prescribes custom orthotics. "Orthotic therapy for chronic heel pain is very successful," said Dr. Kidon.

At the end of the day, Dr. Kidon recommends a homemade holiday foot soak made of two handfuls of pine needles and three sticks of sugarless spearmint gum. Grind it up, boil it, and drain it. Then pour the mixture in a basin of warm water. The gum's sorbitol and pine needle oil soften and invigorate tired feet. "It'll fill the room with a scent of holiday cheer," said Dr. Kidon. Dr. Kidon says you can get the pine needles from a Christmas tree, wreath, or you can probably find them on the ground. Just make sure the gum contains sorbitol.

Source: Denise Dador, ABC News [12/15/07]

NM Podiatrist Roasted at His Retirement

Dr. Leon Cohen has helped thousands of Carlsbad residents get off on the right foot. And, depending on the location of the specific ailment, 2002's New Mexico Podiatrist of the Year has helped thousands more get off on the left foot, too.

Dr. Leon Cohen

Cohen, a foot doctor in Carlsbad since 1959, went out in style, celebrating his retirement in a roast held Friday night where he traded jokes and barbs with his roasters while seeming to enjoy both the thrill of victory and the agony of de-feet.

Cohen's partner for the past three years, Dr. Lyle Folsom, said Cohen has a superb national reputation as a foot and ankle doctor. But locally, Folsom teased, Cohen is probably best known for telling jokes to his patients. .

Source: Kyle Marksteiner, Carlsbad Current-Argus [12/15/07]

Does it Pay to Switch?

The year-end deadline for physicians to change their participation status is important because it likely will determine how doctors will be able to bill the program and receive payment for all of 2008. If physicians do not inform their Medicare carriers in writing of their intent to change their status before Jan. 1, they will be locked into their current choices for the next 12 months -- possibly under a newly reduced fee schedule.

The highest amount a physician actually can receive for a hypothetical $100 Medicare service varies depending on his or her participation status.This year's decision is more complicated than usual given the pay cut's unprecedented size and lawmakers' delay in addressing it. Physicians who decide not to participate still can see Medicare patients for a reduced fee. They can decide on a per-patient basis to accept this "assignment." Doctors who don't accept assignment get the reduced rate and also can balance-bill patients up to 15% more. As a result, they may receive up to 9.25% more than participating doctors for the same services.

Changing from participating to nonparticipating status has a potential downside. Non-PAR physicians who do not accept assignment do not receive the government's portion of the fee directly from their carriers. Instead, Medicare reimburses the patient directly. The physician thus must invoice the patient for the full amount: the payment, co-payment and balance-billing charge.

Source: David Glendinning, AM News [12/24/07]

Query: Multi-Specialty Groups

I am thinking about joining a multi-specialty group. Have there been any good articles on this subject? What is the best source to research questions to ask?

Jennifer B. Ryder, DPM, Rapid City, SD

Editor’s Note: Podiatry Management published an article titled “The Multi-Discipline Practice” by Deborah Green, JD in January, 1999.

RE: Wide Shoe to Accommodate AFO (Francine G. Schiraldi-Deck,DPM,MS)
From: Paul Kesselman, DPM, Josh White, DPM, CPed

There are a plethora of shoe styles out there that will accommodate this type of AFO. The thickness of the plastic and length, length of the foot plate, patients shoe size and width and the patients foot type (flat, cavus etc.) will dictate which shoe will be most accommodative of the device.

It is also possible the patient will need "odd sized" shoes (the non AFO foot will need smaller shoe).

I would therefore suggest in this scenario, that the patient may be best served being sent to a pedorthic facility unless you have a large inventory of shoes.

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

AFOs requires shoes to be deep, wide across the midsection and firm in the heel counter. In the neoprene style, three good options are the stretchable suede Velcro from OrthoFeet, the T1200 from Aetrex and the Athletic Stretch Walker from Pedors.

All are featured in the new footwear catalog from SafeStep (www.safestep.net) that actually has a section of just stretchable shoes from various manufacturers. Also displayed is the actual extra depth in the various shoe models.

Another possible option to improve shoe fit is to try a prefabricated lace up gauntlet AFO like the Velocity AFO from DJO. There are feet that are so large or misshapen that when using a custom AFO, a custom molded shoe is the only alternative.

Josh White, DPM, CPed, President, SafeStep, joshwhite@safestep.net

RE: Bunionectomy for Patient With Severe Gout (Diane Phalen, DPM)
From: Art Korbel, DPM,MD, Gilbert D. Shapiro, DPM

Once you clean out the tophus material, I have always used a Keller in such patients with great results.

Art Korbel, DPM,MD, Coral Springs, FL, Classicboats4425@aol.com

In my experience with that type of destroyed joint, a double-stem, flexible-hinged silicone implant with grommets (Swanson design) is a simple and highly effective procedure. To try to remodel such a joint by partial arthroplasty, cheilectomy or re-positioning etc. is like trying to re-balance and/or re-align a bald tire. Reality check: the joint is shot! To fuse it will attempt to put two moth-eaten ends of bone together. Finding reasonable bone to fuse will probably result in a shortened hallux. I have never seen a recurrence of gout in an implanted joint--- probably because there is no longer a joint! Why do we so often look for more involved/difficult solutions when simple/effective ones are so readily available?

Gilbert D. Shapiro, DPM, Tucson, AZ, gdshapiro@comcast.net

RE: Patient Who Returns After Being Discharged
From: Howard L. Lazar, DPM, JD

To discharge a patient properly and fairly, inform the patient both verbally (in person) and by written notice delivered by traceable means. The text I have used states that the success of appropriately rendered care depends upon the mutual cooperation of the patient and the physician, that each of us has an obligation to the other in managing the problem under treatment, that we had not achieved the necessary rapport and mutual cooperation required for successful treatment, that he was consequently putting himself at risk, and thereby putting my reputation at risk, and that he should seek the services of another physician with whom he is able to establish an appropriate physician-patient relationship. I also included a description of the conditions present at that time, and progostications of the failure to comply with instructions, and for failure to seek appropriate treatment elsewhere.

Your clinical records must thoroughly document the patient's condition on each of the visits, the nature of the noncompliance, the attempts to explain the compliance required, the continued noncompliance, and the notice of discharge given to the patient.

A patient so discharged was never again allowed back into my practice. I informed the patient that I would never again treat that patient, even for emergencies. The patient would be directed to an emergency room for urgent care. A discharged patient is quite likely to harbor some resentment toward me, and may tend to be dissatisfied with any service I provide.

If, after discharge, the patient's condition has become worse for failure to obtain care elsewhere, accepting the patient back into your practice makes you liable for appropriate treatment of the exacerbation. More aggressive treatment may be required, and the treatment outcome may be less than satisfactory, in the patient's opinion.

You cannot reasonably discharge a patient because you are dissatisfied with your results, or for the patient's failure to pay your fees when there is a threatening condition present.

Howard L. Lazar, DPM, JD Bloomfield Hills, MI, howardlazar@comcast.net

• 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.