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December 23, 2008 #3,432 Editor-Barry Block, DPM, JD

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Proactive Care Prevents Winter Foot Ailments: APMA President

Chilly weather, drying indoor heat, and hectic schedules can be so rough on feet that it may take a little extra pampering to keep them healthy and happy.

Dr. Ross Taubman

"The colder months often leave our bodies susceptible to hosts of health problems, and foot ailments are no exception," said Dr. Ross Taubman, president of the American Podiatric Medical Association (APMA). "However, being proactive about things such as proper footwear and moisturizing are just two of the ways to prevent seasonal foot ailments."

According to the APMA, the No. 1 way American women like to show their feet a little TLC is by applying moisturizer (48 percent), followed by an at-home massage (14 percent) and stretching (11 percent).

Source: Health News Digest [12/15/08]

Podiatrist Brings Taste of Philly to FL

From the beaches to the Everglades, from Palm Beach to Miami, a famous Philadelphia snack is at home in South Florida thanks to a retired podiatrist. Dr. Stephen Kushner, a native of the City of Brotherly Love, traded feet for soft pretzels in 2006 and hasn't looked back. "I have fun with it. I'm able to replicate authentic Philly-style pretzels every day, make people happy and make a business of it," he said as he salted a rack of 10 in his Davie store, Philly Pretzel Heaven.

Dr. Stephen Kushner

Kushner, 48, and his wife, Cindy, a partner in a public accounting firm, made the move from Philly to Florida in 1990. Kushner joined a podiatry practice, but when malpractice insurance became too costly to make good business sense, he walked away. Soon after, in a visit with his parents in Philadelphia, Kushner went out to buy a soft pretzel -- and had an epiphany. "I called my wife and said I wasn't coming home for a few more days," Kushner said. He launched on a mission to discover how to bake pretzels in Florida to the same taste and texture as those sold at home.

For the next three months, Kushner used his Florida home kitchen as a lab and mixed ingredients till reaching the 'ah-ha' moment. The taste is so authentic that customers doubt Kushner when he tells them he bakes the pretzels from scratch using local water. Anyone can watch. Only a counter separates customers from the kitchen's oven, mixer and kettle.

Source: Eileen Soler, The Miami Herald [12/19/08]

Query: Severe Bromhidrosis

50 y/o male with type-2 diabetes mellitus. He has severe bromhidrosis, even when he is sitting at work. No erythema of his feet occurs. He changes his socks and shoes often. He doesn't have the problem as severe when he is wearing tennis shoes. He has tried OTC powders and sprays, Formadon--formaldehyde solution, and scopalamine without success. I also gave him shoes and socks with more breathability without success Any suggestions for further conservative treatments?

Birute Balciunas, DPM, Kenosha, WI

RE: Benfotiamine Shown to be Efficacious in Treating Diabetic Peripheral Neuropathy From: Michael Turlik, DPM

I was unable to read the article, however, I was able to read the abstract online. In the results section, the authors present a per protocol analysis (PP) and an intention to treat analysis (ITT). While the per protocol analysis is statistically significant, p= 0.033, the intention to treat analysis is not statistically significant, p = 0.055. In addition, the total symptom score (TSS), a secondary endpoint, was not statistically significant.

It would be helpful if the authors reported a point estimate with 95% confidence intervals for the primary outcome relative to the minimally important difference they attempted to show in the study. This would be more helpful than simply p values. My interpretation, based on the data presented in the abstract, is that benfotiamine has not been shown to be an effective treatment for diabetic peripheral neuropathy.

Michael Turlik, DPM, Cleveland OH, mmturlik@aol.com

RE: Cuboid/Peroneal Pain (Mark Aldrich, DPM)
From: Keith L. Gurnick, DPM, Dennis Shavelson, DPM

This sure sounds like a peroneus longus tendinitis as it traverses the cuboid groove on its way to the base of the proximal phalanx plantar-laterally. Why not try a custom prescription foot orthotic, as your padding seems to improve the symptoms. Take a neutral foot impression and order a properly-posted foot orthotic (forefoot and rearfoot) and make sure to get the patient into a good shoe that will accept the orthotics.

I cannot suggest specifically how to write the prescription for the orthotic without additional biomechanical information. Even though you stated that valgus felt padding helped, it does not necessarily mean that the orthotic should be ordered with forefoot valgus posting. Accurate biomechanical measurements and impressions are very important when prescribing custom foot orthotics, and may be even more important for lateral column foot symptoms, which at times can be more challenging to treat with orthotics than medial foot symptoms.

Keith L. Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

Editor’s Note: An additional note by Dr. Shavelson appears at: http://www.podiatrym.com/letters2.cfm?id=23715&start=1

RE: Abscess After Wart Treatment (Howard Zlotoff, DPM)
From: Multiple Respondents

I agree w/ Dr. Meisler's opinion. Current CPT guidelines prohibit one from separately billing for a surgical procedure, or office visit, that is related to the original surgical procedure within its global period. As such, Dr. Kass is also incorrect indicating one may bill for the office visit to evaluate the abscess. The -79 and -24 modifiers may be utilized to bill for surgical or E/M services respectively that arise from problems unrelated to the original surgery.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

An abscess formation, or liquefaction of a wart is an expected (or not an unexpected) occurrence after chemodestruction of a wart. I believe that it is appropriate to append a "-58" (staged procedure) modifier onto the I&D code, CPT 10060.

The incision and drainage should be a covered service even though it may occur during the global aftercare period for the wart destruction.

Arden Smith, DPM, Great Neck, NY, digitiquinti@aol.com

Editor’s note: An extended-length note by Keith Gurnick, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=23717&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.

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