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December 22, 2008 #3,431 Editor-Barry Block, DPM, JD

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NY Podiatrist Discusses Foot Chi Reflexology Mat

Dr. Howard Dinowitz, a Brooklyn podiatrist and spokesperson for New York State Podiatric Medical Association, says most of the evidence regarding the various benefits of reflexology is anecdotal rather than scientific. “Reflexology has been around for centuries and some people swear by it and some people swear at it,” he says. “Some say it’s cured their insomnia and their sciatica and that they breathe better and have wonderful erections because of it.” A study conducted at the Oregon Research Institute does seem to offer more empirical proof, however. Researchers had 108 adults, age 60 to 92, use a cobblestone mat for 16 consecutive weeks and found that it “improved physical function and reduced blood pressure to a greater extent than conventional walking in older adults.”

Dr. Howard Dinowitz

Dinowitz says he never “debates success,” but does advise moderation when using the Foot Chi, especially for people with diabetes who may suffer from neuropathy (i.e., the lack of peripheral sensation or feeling in the feet). “You might not feel if you’re bruising yourself or exacerbating an ulcer,” he says. “Otherwise, the only other people I would caution about using this product would be anybody with sensory nerve deprivation, anybody who has hypersensitive skin. And anybody who’s very ticklish.”

Source: Diane Mapes, MSNBC [12/17/08]

2 NYCPM Student Groups Donate Socks, Shoes

Two groups of NYCPM students demonstrated their holiday spirit toward the end of the year by collecting and donating socks and shoes for the needy. The Class of 2010 held a Sock Drive, collecting 96 pairs of socks, which were then donated to New York City’s Bowery Mission Homeless Shelter.

Brittany Korn (NYCPM Class of 2010) and a representative from the Bowery Mission Homeless Shelter show off three of the many pairs of donated socks.

The student-run International Podiatry Club at NYCPM conducted a shoe drive to donate new and used shoes to needy people around the world through the organization Soles4Souls. More than 270 pairs of footwear were donated, coming from students, NYCPM and Foot Clinics of New York faculty, as well as administration and staff.

Benfotiamine Shown to be Efficacious in Treating Diabetic Peripheral Neuropathy

A double-blind, placebo-controlled study that examined a relatively large cohort of 133 patients suffering from diabetic peripheral neuropathy was published in Experimental and Clinical Endocrinology & Diabetes (official journal, German Society of Endocrinology [and] German Diabetes Association). The study demonstrated, to a high degree of statistical confidence (p=0.033), the efficacy and safety of benfotiamine in the treatment of diabetic polyneuropathy.

The improvement was most pronounced at dosages of 600 mg. per day, although patients benefited from 300 mg. per day, as well. It was found that improvement increased with treatment duration. The best results were obtained for the symptom "pain", with improvement also noted in patients experiencing numbness and tingling. Treatment was well-tolerated in all groups. Adverse effects were comparable in the treated and placebo groups.

Source: Stracke H, et al. Benfotiamine in Diabetic Polyneuropathy (BENDIP) Exp Clin Endocrinol Diabetes 2008; 116: 600 – 605.

Query: Cuboid/Peroneal Pain

My patient is a 57 y/o teacher on pravastatin for cholesterol, otherwise healthy. I treated her for recalcitrant right plantar fasciitis in winter/spring of ’08. It returned in June and responded to injection. In October, she experienced pain in the “arch”, which in fact was at the cuboid on the right foot. She feels the “pain moved.” She has a tiny plantar fibroma that is asymptomatic. Resisted peroneal longus stress causes pain under the lateral-plantar cuboid.

I’ve used cuboid pads, valgus-posted felt, icing; all with very little response. The valgus-posted felt helps the most, but activity still exacerbates the pain. Radiographs are negative. The problem seems to be more at the peroneal groove on the cuboid, but she has no distal peroneal tendon pain. Flatter shoes feel better than heels. Any input would be appreciated.

Mark Aldrich, DPM, Antigo, WI

RE: Heloma Neurofibrosum (Gary A. Lieber, DPM)
From: Dennis Shavelson, DPM

Dr. Lieber’s patient’s foot type is a classical rigid forefoot type in functional foot typing. Using the clinical info supplied, she probably has a rigid rearfoot type as well. If she has normal circulation, I would biopsy both lesions and R/O the need for excision. Then, I would cast negatives in standard Root position (plaster or foam) and order a 2/3/4 bar post of approximately 3-5 mm. along with aggressive first and fifth ray cutouts to the affected foot (other foot currently unknown).

I would make the device of a forgiving plastic, so as to provide shock absorption, and use a plantar shell fill of low density crepe. I would also consider adding a 2 mm. heel lift B/L to accommodate concomitant functional equinus (or ask the patient to wear shoes with higher heels).

Dennis Shavelson, DPM, The Foothelpers Lab, drsha@foothelpers.com

RE: Abscess After Wart Treatment (Howard Zlotoff, DPM)
From: Jeffrecy Kass, DPM, Kenneth Meisler, DPM

I respectfully disagree with the Codingline response given by Dr. Zlotoff regarding billing for an I & D of abcess following destruction of wart procedure. We all know that the possibility of an ulcer forming s/p, inducing a chemical burn or freezing skin is a possibility. If it occurs, as the doctor pointed out, we know it was a direct result of the treatment instituted. To then turn around and bill for that, is not the right thing to do.

There is a 10-day global period for CPT code 17100. Technically speaking, by the letter of the law, any treatment related to that same problem would be inclusive. I would not have a problem with billing out for an office visit for the evaluation because you are taking time to see the patient and dealing with a problem, even though it is within the global period. But billing for a procedure when you induced the problem is just wrong.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

Editor's Note: an extended-length note by Dr. Meisler appears at: http://www.podiatrym.com/letters2.cfm?id=23699&start=1

RE: Insurance Contracts (Paul Bishop, DPM)
From: Neal Frankel, DPM, Bryan C. Markinson, DPM

Insurance companies do look at statistics when re-negotiating contracts but you have to be in a position to be able to give them those statistics and "prove your worth", so to speak. Our group has consistently received increases in our contracts every year because:

1. All of us use the same tax ID#, thus we have a claim history for the whole group. We have demonstrated savings to both the employer and insurance company over what they have paid out for foot care among doctors not in our group.

2. We credential ourselves using an NCQA-approved company that allows the insurance company to save credentialing costs by delegating the credentialing to us, and therefore pass some of the savings to us in the form of an increase in fees.

3. We total 75 podiatrists. We do see a larger number of patients, and therefore an insurer would rather give us a 10% increase over paying out-of-network costs. Now you have to be ready to "walk" if the insurer will not negotiate with you and stick to it.. So, to say we should be paid more because we "are the specialists" is correct, but remember an insurance company is a business to make a profit. So, if you want to get paid more, than you need to be ready to prove it.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com

Editor's note: An extended-length note by Dr. Markinson appears at: http://www.podiatrym.com/letters2.cfm?id=23701&start=1

ASSOCIATE POSITION - CHICAGO AREA

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. The payscale is based on straight Commission. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

PODIATRISTS NEEDED 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 Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION - MANHATTAN

Park Avenue boutique practice seeks part-time associate. Experience and integrity necessary. Please fax resume and salary requirements to (212) 889-6150.

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

FLEXIBLE, Part-Time opportunity with growing podiatric medical group. MUST have CURRENT DME supplier and Medicare provider numbers. Earn over $1,000 per day, with no nursing homes. Fill in any openings you currently have in your schedule. Flexible hours available for your available time blocks. If interested, e-mail scpodgroup@yahoo.com

PRACTICE FOR SALE – CONNECTICUT

Well-established. Grossing 200K; Norwalk/Westport CT. Dr. recently deceased. High Volume Medicare ; NO BROKERS; Please email: berist92@gmail.com

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