The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 20, 2011 #4,336 Publisher-Barry Block, DPM, JD

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CA Podiatrist Hasn't Seen Injuries Related to Barefoot or Minimalist Shoes

Despite the worries of many doctors, the rise of the minimal shoe hasn't seemed to increase the number of running-related injuries. In fact, Dr. Mark Brenis, a Santa Cruz podiatrist, hasn't seen any injuries related to running barefoot or in minimal shoes. Though he doesn't think shoes are needed to "correct" the motion of the foot, he does think they're good for protection. 

Dr. Mark Brenis

"Personally, my feeling is to go towards wearing shoes," he said. But if runners want to forgo even the most minimal of shoes and bare their soles to the road, he's not that worried. "Have you ever seen the bottom of a barefoot runner's foot?" Brenis asked. "Their skin is like leather."

Source: Meghan Rosen, Santa Cruz Sentinel [12/17/11]

ME Podiatrist Returns to Help Honduran Patients

Over the past several years, podiatrist Dr. Michael Saraydarian and other surgeons from Central Maine Orthopaedics have made annual sojourns to the Ruth Paz Clinic in San Pedro Sula, helping hundreds of patients with surgeries to mend broken legs, amputate badly damaged limbs and fix clubbed feet. But sometimes it's the patients they can't help who stick in their memories. 

Dr. Michael Saraydarian in Honduras

In November, Saraydarian and fellow orthopaedic surgeon Paul Cain traveled to the clinic. Saraydarian has gone every year — sometimes twice a year — since 2005. Saraydarian spent the week repairing broken bones, fixing deformities and amputating limbs when nothing else could be done. He also saw three former patients — one who'd had surgery on a clubbed foot and now needed an operation on the other foot, one who had a problem with a screw that had been put in, and one who arrived at the clinic to just say thank you.

Source: Lindsay Tice, Sun Journal [12/18/11]

Senate OKs Two-Month Freeze on Doc Pay

Wrapping up legislative business before the Christmas recess, the Senate on Saturday approved legislation that freezes Medicare payments to physicians until Feb. 29.

In a vote of 89-10, the Senate passed an amended version of the House payroll tax bill that the lower chamber approved earlier this week. The legislation from Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KS) - which extends a payroll tax holiday for two months - provides no payment update in Medicare reimbursement levels for the nation's doctors in January and February 2012, which prevents a 27.4% cut that was scheduled to take effect on Jan. 1.

Source:  Jessica Zigmond, Modern Healthcare [12/17/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters

Bret Ribotsky: Why did you incorporate aesthetic podiatry into your practice?

Dr. Robert Chelin

Robert Chelin: My main goal is and always will be to eliminate foot pain in our patients. We’re also here to improve foot function, and I think that it’s important that we provide a good aesthetic result. I started doing off-label injections of Restylane and Sculptra to provide “cushions or pillows” for the feet. These products are much better than what was offered in the 1980s.  

(L-R) Drs. Lowell Weil, Sr., Michael King, and David Armstrong

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guests are Drs. Lowell Weil, Sr, Michael King, and David Armstrong . You can register for future events by clicking here

Query: Study Guides for ABPS Recertification Exam

I am looking for suggestions for a study guide or websites to help prepare for the ABPS recertification exam.
 
Bob Kuvent, DPM, Chandler, AZ

RE: Orthotic Therapy For Hallux Rigidus (John Scholl, DPM)
From: Neil B. Levin, DPM

It is a shame, because this appears to be an excellent case (radiographically) for a cheilectomy/decompression 1st metatarsal osteotomy, given the long first metatarsal. If surgery is not an option, however, try putting him in a simple turf toe plate (FOOT MGMT, INC.). It's inexpensive and effective.

Disclosure: I have no financial interest in this company.
 
Neil B. Levin, DPM, Sycamore, IL, DRFEET1@aol.com

You may want to try a Langer Flexible Allsport (Toprelle) with a Morton's extension made from the shell. It has worked well for some patients in my practice.

Michael J. Schneider, DPM, Denver, CO, podiatristoncall@gmail.com

RE: Chronic Diabetic Ulcer (Kel Sherkin, DPM)
From: Elliot Udell, DPM, Jeffrey Kass, DPM

There are some questions concerning the history of this patient. Were vascular studies done to rule out PVD? Was an MRI with contrast done to rule out osteomyelitis? There was a paper published many years ago in JAMA saying that if an ulceration has been present for a long time, one should assume the presence of a bone infection, even if plain films are negative.
 
Assuming that PVD and osteomyelitis are not the culprits, consider using some of the products that contain growth factors. In our practice, we generally start with Regranex. There are many other products on the market that contain growth factors (such as Dermagraft and Apligraft), however based on the photo submitted, extensive debridement of the necrotic tissue will have to be done prior to applying the graft.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Make sure blood sugar levels are being optimized; if no wound C&S was performed, then take one. Just because the patient received 2 rounds of antibiotics doesn't mean you had the right coverage. What if the there was MRSA? Don't assume because you give crutches, the patient complies.

There is likely a biomechanical issue that is not being addressed. Have you checked for an equinus? is there a hallux limitis (maybe functional) that needs addressing? Is there something wrong with the shoes the patient is wearing? Often times, this is the location where the toe box forefoot portion of the shoe "breaks" during propulsion, and sometimes the material gets pressed inward to that part of the foot.

How is the circulation? Are there toe brachial indices that were performed along with PVRs? Consider hyperbaric oxygen, possibly Regranex. You might want to consider ACELL.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Advanced Composite Materials in Podiatric Medicine
From: Keith Gurnick, DPM

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

Donald Brann, DPM asked about scientific evidence, studies, etc. on the effectiveness of absolute alcohol injections for neuroma, and related this to standard of care. In response, I refer him to studies and professional articles by Gary (Dock) Dockery, DPM who is an expert on this therapy. My understanding is that Dr. Dockery has also peformed studies on this.
 
Dr. Dockey has reviewed this academically, and has quoted a number of professional articles on this very subject, quoting data that go back as far as 1973. I refer Dr. Brann to one particular article in Podiatry Today (podiatrytoday.com/article/87), written by Dr. Dockery. I also respectfully suggest that Dr. Brann contact Dr. Dockery directly if he wishes to obtain more academic and studies data on this subject. My understanding is that there is a "wealth" of data on this that should answer his questions.
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Diabetic Shoe Frequency (Paul Kinberg, DPM)
From: Ilona Barlam, DPM

Unfortunately, in my experience, billing A5500 and A5512 even a day before 365 days--was denied by Medicare. So, if a patient were billed A5500 and A5512 on October 1st of 2010, the next pair of diabetic shoes that the same patient can be billed for is October 2nd of 2011.

Ilona Barlam, DPM Seattle, WA, isbinc2006@gmail.com

RE: Why This Country is Going Broke (Robert Bijak, DPM)
From: Brian W. Fullem, DPM

In regard to Dr Bijak's comments about unions, I speak from experience that he is way off base with the salary figures he quotes about UPS drivers. My Dad worked for 40 years as a delivery driver in Utica, NY. He is my hero even though he is "minimally skilled," so I am a little biased, but Dr. Bijak should know better about how hard they work, especially coming from the harsh winters of NYS. My Dad never made close to $100,000. In fact, in his best years, he made half of that at most, but he did work every day regardless of the cold, snow, or freezing roads. In the six weeks before Christmas, he would often leave the house at 7 a.m. and return at 10 p.m. This country would fall apart without all the hard workers that Dr. Bijak belittles with his comments.

How much work does the CEO for Blue Cross Blue Shield do to earn his millions compared to the blue collar workers? How about the Wall Street CEOs that the rest of the country are in an uproar over? Without unions, the workers in this country would have continued to be taken advantage of by the CEOs. My Dad had one accident in 40 years of driving for UPS. It occurred in his second year, and he was fired that day, even though the accident was not deemed his fault.  Guess how he got his job back? You are correct if you answered the union.

Brian W. Fullem, DPM, New Haven, CT, bfullem1@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.

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 - 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

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

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

PM News Classified Ads Reach over 13,500 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 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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