The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 19, 2011 #4,335 Publisher-Barry Block, DPM, JD

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Health and Nutrition Go Together: FL Podiatrist

Dr. Stephen Leonard says that cold feet can be caused by poor circulation, although there could be other reasons. He emphasized preventive measures including not smoking, having a good diet and taking calcium and vitamin D supplements to enhance foot health.

Dr. Stephen Leonard

"Take vitamin B12 and walk or exercise regularly," he said. "If you walk you get more oxygen in the legs which helps circulation. "The longer you're in medicine, the more you realize that health and nutrition go together," he said. "I take vitamins. Science is proving you need them."

Source: Roxanne Deangelis, Hernando Today [12/15/11]

FL Podiatrist is 4th Barry Graduate to Become FPMA President

Samir Vakil, DPM, FACFAS, a 1991 graduate of the Barry University School of Podiatric Medicine, will be inducted as president of the Florida Podiatric Medical Association (FPMA) during their annual scientific and management meeting in Orlando on Jan. 20, 2012. More than 250 podiatric physicians and their guests are expected to attend the presidential banquet. 

Dr. Samir Vakil

This will be the fourth time a Barry podiatric graduate is elected as president of FPMA. Terence McDonald, DPM ’92 served as president in 2010; Bradley Haves, DPM ’90 served in 2009 and Roger G. Beck, DPM ’90 served in 2006.

MI Podiatrist Lectures to Chinese Orthopedic Residents

The Sixth International Congress of (the) Chinese Orthopaedic Association (COA) took place in Beijing, China, December 1–4, 2011. The largest orthopaedic event in China was host to over 10,000 orthopaedic surgeons. While in attendance at the COA, Jian Zhong Zhang, MD, Director of Foot and Ankle Services, Chief of the Department of Orthopaedics at Beijing Tongren Hospital and Capital Medical University was introduced to the HyProCure® Extra Osseous TaloTarsal Stabilization (EOTTS) device made by GraMedica®.

(L-R) Drs. Michael Graham and Jian Zhong Zhang

Dr. Zhang invited Dr. Michael Graham, founder of GraMedica and the inventor of HyProCure®, to lecture to his residents and fellow surgeons at the Beijing Tongren Hospital.

Senate Dems Mull One-year Extension on Doc Pay

Senate Democrats are considering a one-year extension of current Medicare physician pay rates, according to several congressional sources, or only half as long as the two-year extension passed by the House of Representatives on Tuesday.

The shorter extension in the Senate stems from challenges in finding the spending cuts or tax revenue to pay for the estimated $38.6 billion two-year cost of averting a 27.4% cut in Medicare physician reimbursements scheduled to take effect Jan. 1. Maintaining the current rates for only one year would cost $20.6 billion, according to the Congressional Budget Office.

Source: Rich Daly, Modern Healthcare [12/15/11]

Query: Orthotic Therapy For Hallux Rigidus

I have an active 64 year old male patient who has 3 degrees dorsiflexion at the 1st MP joint with severe pain on palpation at the dorsolateral joint, as well as pain on ambulation. X-rays show a decrease in the 1st MP joint space, with mild spurring at the dorsal joint. 

Hallux Rigidus in 64 Year Old

This patient would like conservative, orthotic management. Any suggestions regarding appropriate orthotic therapy (Morton’s extension, 1st ray cutout, etc.)?
 
John Scholl, DPM, Lady Lake, FL

Query: Advanced Composite Materials in Podiatric Medicine

This year, the U.S. Department of Defense and the Army's Medical Research Command issued the grant topic proposal SBIR A11-109 "Advanced Composite Insoles for the Reduction of Stress Fractures."  I have seen advanced composites such as carbon fiber and Kevlar being used in more medical applications recently. What successes and failures have our practitioners had utilizing this space-age material in their treatment regimens for stress fractures, ulcer care, and in performance orthotics?

Steven King, DPM, Maui, HI

RE: Chronic Diabetic Ulcer (Kel Sherkin, DPM)
From: Multiple Respondents

Assuming that vascular evaluations have been done, that ulcer needs to be biopsied immediately. After, and only after a malignancy has been ruled out, can you employ various other wound healing modalities.

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

Consider a biopsy of the ulceration to rule out malignancy. If that comes back normal, consider hyperbaric O2 treatment, along with weekly debridement as a more aggressive treatment. If her diabetes is not controlled, she will need to have her HgA1c below 7 minimum to encourage healing as well.
 
Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

Looking at the photo, the eschar and punched out appearance, my first suggestion is to get arterial Dopplers and a vascular consult as soon as possible. Get an infectious disease consult promptly as well, an MRI to see the extent of the soft tissue and to see if there are chronic bone changes, which will help but not make your diagnosis. Perform debridement of all necrotic tissue with deep cultures and deep tissue biopsies and send to pathology. Doing this, along with ID consult, can determine parental vs oral antibiotics. Structurally, the location of the wound suggests a hallux limitus. The patient needs a Morton's extension or rocker bottom accommodation to the shoe because the ulcer's appearance suggests that it is weight-bearing. If this fails, a Keller-type arthroplasty might be necessary. If this is not comfortable for the patient's well being, refer him out!

Ross B. Feinman, DPM, Detroit, MI, rbfeinman@aol.com

RE: 8 y/o with Abnormal Gait and Calcaneal Apophysis (Mark Aldrich, DPM)
From: Jane Suval, DPM

I bet Dr. Aldrich is right when he says it is not biomechanical. I would get a full neurological work-up; also the OT should be able to test his sensory development as well as motor skills. It appears there may be more to this than just heel pain.

Jane Suval, DPM, Boynton Beach, FL, ejjet@bellsouth.net

RE: Life-long Maintenance Regimen for Onychomycosis (Michael Turlik, DPM)
From: Bryan C. Markinson, DPM

Dr. Turlik’s contributions in this forum are multiple. He has been steadfast in demanding level-1 evidence and in his support of the practice of evidenced-based medicine (EBM). These are the current buzz words across all of medicine. There is no doubt that we should have the ability to critically review research in all cases. He is extremely far ahead of most of us in this regard. But I personally am a clinician. I fear that put to the evidence test, a lot of what we do would not make the grade. Ultrasound-guided ganglion aspiration, orthotic intervention for almost any condition, backed up by the statement “more research is needed,” etc.

Can it be, in some instances, that EBM may be a ball and shackle and will stifle innovation? Dr. Turlik also strives for complete elimination of bias. Yes, in a perfect world. In truth, elimination of bias is a fantasy. As soon as someone puts an idea on paper, and he or she gets to the next step without discouragement, bias is fixed into the equation. As for money, someone has to get paid to try new things. I have the ability to evaluate someone’s integrity considering multiple factors. That is what disclosure is for, but Dr. Turlik advises even more suspicion when a disclosure is made.

As far as the pulse dosing of terbinafine study, which was beautifully done, Dr. Turlik states that the conclusion stated was not supported by the evidence. To me, that is for research methodologists to argue. I employed the recommendations in the article in my practice. It works as stated. I refuse to believe that it works merely because I want it to, as purists would assert, and that I should not employ the therapy until a “better” study is done. Practical, or heresy?
 
Bryan C. Markinson, DPM, NY, NY,  Bryan.Markinson@mountsinai.org

RE: Concierge Medical Care on Demand (Bret Ribotsky, DPM)
From: Ed Davis, DPM

Dr. Ribotsky has presented a type of concierge care performed a la carte which, I believe, is easier to test-market than making the switch to an all cash practice. The third-party payment system is in a slow meltdown, with physicians bearing the brunt of declining reimbursements.
 
There are several models of all-cash practices including the "micropractice" which is based on low volume and low overhead.  Such models appear to fit primary care best as surgical practice is more challenging to go to cash. The American Association of Physicians and Surgeons, aapsonline.org, is a good resource for non-third party practice. Here is an example of a surgicenter in Oklahoma that uses a cash model: blog.surgerycenterok.com/
 
I am only aware of a couple of all-cash podiatry practices. They seem to be happy with their choice.
 
Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net

RE: Standard of Care - Neuromas (Michael Rosenblatt, DPM)
From: Donald Brann, DPM

Dr. Rosenblatt wrote, “An interesting example is absolute alcohol injection for neuroma. When I was in practice, cortisone injection, padding, and surgery were the standard of care. That has been replaced now with absolute alcohol injection in various dilutions.”
 
What scientific study/peer-reviewed literature documents the certain clinical effectiveness of dilute alcohol injections as compared to other modalities for the treatment of intermetatarsal neuromas? This is no more the standard of care for intermetatarsal neuromas than ultrasound-guided injections are for plantar fasciitis. Where is the science? Where are the clinical trials comparing similar groups of patients with different modalities and measuring outcomes? More than one practitioner utilizing a particular modality with some success hardly qualifies as “Standard of Care.”
 
Donald Brann, DPM, Orland Park, IL, d.brann@comcast.net

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER (LUMIX2)

Superpulse 45 watt peak power Laser (lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPMfootcare@comcast.net

EQUIPMENT FOR SALE - LASERSCOPE LASER SYSTEM

Laserscope Model Lyra i YAG Laser system with 3 handpieces, eyewear sets, calibration unit, complete manual, foot control and video information, for fungus nails, vein therapy and hair removal. The unit has the attached cooling system and all accessories. flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - NEW JERSEY

Associate/Partnership available to energetic doctor(s) or willing to merge into larger group/multi-specialty practice. 25% Medicare, 75% Privates/HMOs, No Medicaid. 8,500 visits per year. Diversified  hospital/office wound care, hospital/ASC surgery, and general podiatry. 27 years of excellent local reputation. 2,700 sq ft office opposite hospital in desirable Monmouth County. capstops@aol.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be a PSR-24 or PM&S-36 trained. 100K start. Must be ethical, self-starter, hard worker ,team player. Willingness to learn / work as part of a team. Great ancillaries & surgery facility. Must be proficient in rearfoot/ankle surgery. Email CV and recent cases to: susmitad86@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV)to northtexaspodiatry@yahoo.com along with a letter of intent.

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA
 
Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com
 

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." toDrgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate practice seeking PSR-24/36 trained associate. Full-time position with  partnership opportunity. Must be ethical,  highly-motivated with strong surgical and medical skills. Please send CV topalpodiatry@att.net

ASSOCIATE POSITION - NEW MEXICO

Exciting opportunity for an associate in sunny Albuquerque, New Mexico. Please visit our website atFamilyFootTeam.com for all the details and how to apply.

ASSOCIATE POSITION - TEXAS

Practice in Houston is looking for PSR 24/36, BE/BC trained doctor. We are situated in an affluent area with a large medical community with EMR, diagnostic ultrasound, digital x-ray, multi use laser and our own surgery center. We seek a highly skilled surgeon, well-trained in trauma, wound care and rear foot reconstructive procedures willing to learn and incorporate into our “system.” Must be outgoing, goal-oriented, motivated and positive. Partnership available after successfully attaining the first year’s goals. Compensation includes excellent salary, health benefits, paid vacation and CMEs. Please send CV, references and letter of interest to faajobs@gmail.com

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contactpistone@telus.net or call 250-754-4192.

PM News Classified Ads Reach over 13,500 DPM's and Students

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