The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 19, 2009 #3,731 Publisher-Barry Block, DPM, JD

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MO Podiatrist Discusses Footcare for Aging Feet

Dr. Anna DeSaix, a podiatrist with Ankle and Foot Surgeons of the Midwest, says, “As we get older, the fat pads in our feet become thinner.” She says, “this can lead to increased trauma and inflamation of the structures that are normally protected by the fat pads, such as the metatarsal heads. Stress fractures can also occur in the bones of the feet, especially in patients with osteoporosis. Fortunately, these problems can usually be avoided by wearing supportive shoes at all times.”

Anna C. DeSaix

As our feet age, the musculoskeletal structures become more fragile, and the feet become more susceptible to these types of problems. “Skin is thinner and more easily compromised; bones are not as strong and break more easily,” DeSaix says. “Therefore, protecting one’s foot with a good walking or athletic shoe is the most important thing a senior can do to decrease the risk of injuries or pain.”

Periodically checking your feet is a good habit for older adults, she adds. “Feeling can decrease in our feet as we get older, so one might not always be able to feel if an injury has occurred. Looking at your feet on a daily basis to make sure no sores or bumps have developed is a good habit to get into. If there are any changes, such as increased pain, swelling or redness, one should seek evaluation and treatment by a podiatrist.”

Source: Ladue News

NY Podiatrist Inducted into Senior Hall of Fame

The 2009 Westchester County Senior Hall of Fame ceremony gave official recognition to seasoned volunteers, particularly those helping fellow senior citizens. They are nominated by members of the community. More than 500 people came to applaud the honorees Friday at the Westchester Marriott Hotel.

Dr. Arthur Wolstein

Dr. Arthur Wolstein waved his cane in the air as he approached the podium when it was announced that he had just turned 95. He quoted John F. Kennedy: "It's not the amount of years we live in our life, but the amount of life we bring to those years."

Dr. Arthur Wolstein (1937 graduation photo)

Wolstein, who lives in New Rochelle, speaks about Medicare regularly at the White Plains Senior Center. He is past chairman of the Visions Summer Camp for the Blind. "I feel like the most blessed person in the universe," he told the audience, describing his wife's "huge heart" and his four children. "I will never walk alone."

Source: Leah Rae, The Journal News [12/10/09]

Canadian Podiatrist Competes in NYC Marathon

It wasn't your typical guided tour of the Big Apple for Randy Moore, but it was an eye-opening experience he won't soon forget. Moore, the owner of a local foot care clinic, laced up his Sauconys for the ING-New York City Marathon in November. Some are granted entry into the 42-kilometre run through a lottery system, but the 54-year-old Scarborough podiatrist qualified the hard way, through a local marathon in the spring.

Dr. Randy Moore

He ran to a respectable sixth-place finish in his age bracket at the Mississauga run, clocking in at three hours, 21 minutes. In New York City, Moore clocked in at three hours and 45 minutes, well behind winner Meb Keflezighi, a former American Olympic medalist, but the pain and the disappointment of falling short of his aim was easily lost in the inspiration the people of New York City left him with.

Donning Canadian flags on his socks, he could at times hear sideliners hollering "Go Canada" as he and some 44,000 others navigated their way through the city's five boroughs. "The most inspirational was in Harlem; they had a gospel choir singing on the front steps of a church," he said. The next event on the tour for Moore is the Boston Marathon on April 19.

Source: Sean Durack, Inside Toronto [12/15/09]

Send Magnetic Calendars

The new year is almost upon us and a great way to market to your referring doctors is to send a magnetic calendar for the New Year as a nice card. We use “Step into 2010 with FAANT” on a nice calendar that fits in a #10 envelope with a personal note that thanks them for their referrals, wishes them a Happy New Year, and says that it looks forward to helping them step into the new year and making 2010 their most successful ever! The referring doctors can hang the calendar on the refrigerator at their home or office.

Marybeth Crane, MS, DPM, Grapevine, TX. For information on the American Academy of Podiatric Practice Management click here.

Query: Congenitally Deformed Fifth Toe

My patient is a 51 y/o female with congenitally deformed fifth toe who is considering surgery. Her toe is abnormally wide and receives painful shoe pressure on the lateral distal aspect. She also has a congenital syndactyly between toes 4 and 5 which is asymptomatic. She has a normal fifth toenail, which is dorsal to the distal medial phalanx in the fifth toe. 

Congenitally Deformed Fifth Toe

Which bones should be removed? I anticipate removing the distal lateral phalanx and realigning the proximal phalanx with the remaining phalanges and using a K-wire x 3 weeks. I will also be removing a wedge of skin from the lateral aspect of the toe. Any suggestions?
 
Paul Kruper DPM, Kingsburg, CA

Query: Handling Office Emergencies

I am interested in what most podiatry offices keep on hand for an office emergency. Do most have AED's and/or the kits with all the cardiac drugs?  
 
Bryan C. Satterwhite DPM, Shallotte, NC

Query: Removal of Foreign Body Denial

The codes I have for a "splinter removal" are:  ICD-9 729.6 (residual foreign body in soft tissue) CPT: 29192. I have just received a rejection from Empire BC/BS. Are these codes incorrect? If so, what would be the correct codes please?

Charles Morelli, DPM, Mamaroneck, NY

Response: What was the actual EOB denial reason? If I'm reading your post correctly, you billed CPT 29192 for the foreign body removal. CPT 29192 - obviously a mistype - this code doesn't exist. The code series you want is either CPT 10120-10121 or CPT 28190-28193.

CPT 28192 is "removal of foreign body, foot; deep." This presumes that the splinter was deeper than subcutaneous (CPT 10120-10121; CPT 28190). Make sure your coding matches your medical record/op report description.

ICD-9 729.6 (residual foreign body in soft tissue) should work, unless the payer has specific requirements for ICD-9 coding.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Osteomyelitis Case? (Wm. Barry Turner, BSN, DPM)
From: Jeffrey Kass, DPM, Simon Young, DPM

Based on the information given, I would not have kept the patient on Cipro for 8 weeks. To my knowledge Cipro has very little to no Gram (+) coverage; it is more a gram (-) drug. Hence, if your culture revealed gram (+) cocci, I think you would have been better off with doxycycline, or even the Flagyl.

The fact that the patient denies trauma could be misleading as you state she presents with neuropathy, hence, she may not realize it. The x-rays to me look like a neurotrophic fracture which are healing via bony callus. If the distal part of the met head was indeed osteo, I would have to think that bone would die and be resorbed faster than I would think it would incorporate via callus with the proximal segment of bone. An Interesting case, indeed.
 
Jeffrey Kass, DPM,  Forest Hills, NY, jeffckass@aol.com

First and Foremost do not treat the pocketbook! I am truly sensitive to this patient's issues but, from a malpractice point of view, whether you treat an indigent patient or a patient with insurance, the outcomes must still be the same and your liability doesn't change.

In my experience, Cipro is not the best gram-positive modality. Based on your prescription after the white blood cell-tagged bone scan, you emphasize more gram-negative coverage than gram-positive coverage. Infectious disease referral should have been sought. Even though the patient is without insurance, the patient could have been referred to her local hospital clinics.

In these kinds of situations, MRI and white blood cell-tagged bone scans increase the probability of making an appropriate diagnosis for osteomyelitis, but can still have difficulty differentiating between Charcot foot and osteomyelitis. They should not be the sole source. Consideration for blood studies, such as white blood cell with differential, and sedentary rate/ CRP, would further confirm the diagnosis of osteomyelitis if it existed. Although the hospital radiologist performed a needle biopsy, pathology should have been performed, and it would've indicated either no osteomyelitis, an acute osteomyelitis process, or a chronic osteomyelitis process.

Reviewing the x-rays and the patient outcome, I am still not certain that this was not due to a stress fractures as a result of Charcot foot changes rather than osteomyelitis.

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

RE: Strengthening the Feet Will Not Correct Biomechanical Problems (Ray McClanahan, DPM)
From: Bruce Williams, DPM

Dr. McClanahan misses the point of my reply. The argument that he and Dr. CE Richards make against running shoes is spurious at best. While it is true that the percentage of running injuries has not gone down over the years despite the constant evolution in running shoe technology, it is also true that the injury rate has not gone up drastically either. If this proves anything at all, it is that running shoes have had no effect on running injury rates and that we should be looking elsewhere for the real reasons that runners get injured. Dr. Pribut pointed this out quite well I think.

The primary problem in retrospective analyses of this type is that...

Editor's note: Dr. Williams' letter appears at: http://www.podiatrym.com/letters2.cfm?id=31314&start=1  

RE: The Prescribing of Uric Acid Lowering Drugs (Elliot Udell, DPM, James Di Resta, DPM, MPH)
From: Richard Gosnay, DPM, Barry Mullen, DPM

Dr. Udell's comment was especially significant for me because it puts the previous discussion about EBM into proper perspective. Yes, it is true that indocin was shown to be an effective treatment for acute gout. If we are only to practice evidenced-based medicine as fundamentalists, we would only use that drug. However, we are educated in biochemistry, pharmacology, and pathology. If we are to practice as physicians and surgeons, and not as physicians assistants, then we have a duty to use EBM in our decision-making and to also base those decisions on what we know is best for our patients.

Our knowledge tells us that there is no reason to...

Editor's Note: Dr. Gosnay's letter (with photos) appears at: http://www.podiatrym.com/letters2.cfm?id=31307&start=1

Dr. DiResta's comments are well received. However, what exactly is he suggesting? That we, as podiatrists, render primary internal medical services that fall outside our legal jurisdiction as defined by our state's podiatric limited licensure? What boundaries to you want our leadership to break, our limited licensure scope? Well, to do that, the entire podiatric internal medicine curriculum and post graduate training would need to be significantly modified such that it received accreditation from the various licensing boards.

FYI- I do practice podiatric medicine to its fullest extent. Nowhere in my post do I...

Editor's note: Dr. Mullen's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=31310&start=1

RE: Aetrex iStep Machine (Michael Tritto, DPM)
From: Josh White, DPM, CPed

The Aetrex i-Step offers podiatrists an effective method for attracting attention to a shoe/insert program, provides effective patient education with customized take-away material, offers a quicker, less expensive way of getting custom inserts, and provides a streamlined approach for shoe sizing and style selection.

While the i-Step accurately measures foot size, optimal success in shoe fitting is...

Editor's Note: Dr. White's letter appears at: http://www.podiatrym.com/letters2.cfm?id=31312&start=1

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

EQUIPMENT FOR SALE - DIAGNOSTIC ULTRASOUND

MINDRAY DP-6600 Diagnostic Ultrasound for sale. 7.5 Mhz linear transducer. Like new condition, less than 2 years old. Comes with mobile stand. Contact robdaughertyddd@yahoo.com or 573-979-1809 for further information.

PRACTICE FOR SALE – NE OHIO

Long established general practice. Grossing $300,000 annually with very little surgery. Modern, well equipped office in desirable location. Large diabetic patient base with DME. Excellent referrals with over 500 new patients per year. Great growth opportunity for surgically trained podiatrist. Owner will stay to introduce. Email: docjoc227@hotmail.com

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

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.

EQUIPMENT FOR SALE

X-Cel MB-700 X-ray unit, All-Pro Processor, and Anodyne unit.
731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.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 - 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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