The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 22, 2006 #2,772 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We want to take this opportunity to wish the entire podiatric community Happy Holidays!!!

PM News will be published on a limited schedule for the coming week. We want to remind our readers to add bblock@podiatrym.com to your address books. We have received several notes from AOL subscribers who did not receive the issue dated December 19, 2006. All readers can access both the current and previous issues of PM News on our website www.podiatrym.com

PA Podiatrist at Grand Opening of Race Track Casino

People have been coming to the race track Philadelphia Park for more than 50 years and many were in attendance at the grand opening of the new casino Tuesday. Dr. Howard Nelson has been coming here for 40 years, since he was 14. "We’re here all the time," said his wife, Debbie. "He is, anyway." And now that they have slots, "I won’t mind coming with him."

Dr. Howard Nelson

Nelson is a foot doctor, but he grew up in pool rooms and at the racetrack. He loves the action. His only complaint is there is no floor where you can both watch the horses run and play the slots at the same time. "Get all the action in at one time," he said.

Source: Bill Spencer, Delco Times (PA) 12/20/06}

Bush Signs Healthcare Law

President Bush signed into law a tax, trade and healthcare bill that includes provisions to reverse a 5.1% reduction in Medicare physician reimbursements scheduled for 2007 and to allow increased contributions to health savings accounts. The law maintains the current level of Medicare physician reimbursements in 2007 and provides a 1.5% increase in reimbursements to physicians who agree to report data on certain quality-of-care measures.

In addition, the law eliminates a requirement that annual contributions to HSAs not exceed the amount of the annual deductibles for the health plans to which they are linked.

Source: American Health Line [12/21/06]

Only 23.8% of Privacy Complaints Investigated by OCR: Report

Investigators at the HHS Office for Civil Rights (OCR) may find a lump of coal in their stocking after a new survey reports that only 23.8% of the 22,964 medical privacy complaints lodged with OCR between April 2003 (the effective date of HIPAA) and September 2006 were investigated.

Melamedia, LLC's "3rd Annual Review of Medical Privacy and Security Enforcement," finds that of the 5,400 complaints investigated, OCR took informal action in 3,700 cases. Of the remaining 1,700, OCR found that the covered healthcare entities named in the complaint in all cases had not violated the HIPAA privacy rule, according to Melamedia.

"These statistics raise a lot more questions than they answer," observes Dennis Melamed, editor and publisher of the report. "While we shouldn't read too much into these statistics," Melamed says, "they do point out that we still do not have a grasp on how well we protect patient confidentiality. And that, by itself, is important to know as the U.S. pursues a national system of electronic health records and personal health records."

Souce: Today in E-Business Health [12/21/06]

Query: Hyperbaric Medicine Regulations

I'm researching hyperbaric medicine in other states and in hospital settings, certification, etc. to hopefully add this modality to the OH scope of practice for podiatry. I know about Texas and have printed off their statute to review. Are there any other states with applicable laws? Any suggestions of how we could frame this to gain the most benefit (supervision and treatment possibilities) would be appreciated.

Jimelle F. Rumberg, Ph.D., CAE, Executive Director - Ohio Podiatric Medical Association, jrumberg@opma.org

RE: Hallux Limitus (Peter J. Bregman, DPM)
From: Multiple Respondents

My suggestion is to try to manipulate under local anesthesia, use properly made foot orthotic with dancer's pad. More diagnostics may give more insight with MRI, more biomechanical measurements will help determine orthotic specs. If unsuccessful, she may need surgical intervention.

Arnie Ross, DPM, Los Angeles, CA, asross1@juno.com

Before following one surgical "failure" with another, why not just tell her to interdict the hight heels? The cheilectomy may have provided her with the maximal improvement she may obtain through surgical intervention. Obviously, manipulation under anesthesia with injection, joint distraction with an external fixator, and decompression osteotomy are possible options. However, should these efforts fail she may very well be upset with you! After all, surgery for the problem you described is not an imperative.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcgobal.net

I would recommend manipulation first as you suggested but I suspect
this will not mobilize the sesamoid apparatus sufficiently. I would open it up and de-glove the sesamoids and if that is not enough then a
decompression osteotomy would be the next step and could be evaluated at the time of the de-gloving procedure.

Gerald Peterson, DPM, West Linn, OR, Blkjck@ifixft.com

Only 3 degrees of plantar-flexion and a hard end-range-of-motion would make me think of dorsal capsular adhesions which are a common sequela following a cheilectomy if aggressive post-op plantar-flexion and dorsi-flexion work isn't done soon after surgery. The sesamoids no doubt had reduced glide preoperatively which would developed over the course of the limitus' progression. Often the sesamoid/metatarsal articulation becomes degenerative as well.

If the first surgeon did not free them up or if they are degenerated they may continue to be symptomatic. It sounds from your description like they are still bound down. Unfortunately, manipulation under local or even sedation may not help. Try injecting local and a soluble steroid into the medial sesamoid/metatarsal articulation to see if she gets some relief. If this is not effective then you may need to open the area, free up the sesamoids with a metatarsal elevator and also release the dorsal capsule. Place your incision along the medial MTPJ as this will also help with post-op ROM.

Make arrangements before surgery for post op PT to include aggressive sesamoid glide, dorsi-flexion and plantar-flexion work. The therapy should begin within 4 or 5 days of the surgery. A word of additional advice: communicate directly with the P.T. so they know exactly what you expect of them. Too often it seems that the patient gets a gamut of modalities on a variety of other areas (ching-ching) and the therapy that we really want the patient to get is minimized. Tell your patient what the therapist should be focusing on, too.

Howard J. Bonenberger, DPM, Nashua, NH, HOWARDBON@aol.com

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 - 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--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

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.

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.

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 9,000 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 9,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• 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.