The Voice of Podiatrists

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December 24, 2007 #3,125 Editor-Barry Block, DPM, JD

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MN Podiatrist Uses Nerve Decompression to Save Woman’s Leg

A local woman is especially thankful this holiday that she will not have to have her leg amputated. She has a condition called Neuropathy. About 20 million Americans have the disease which causes the nerves in the legs and feet to swell and eventually die -- making it hard to move. "When she came to me, her leg was purple, cold and extremely tender to touch," said Dr. Kenneth Ammons, a podiatric surgeon at Woodwinds Hospital, in Woodbury, MN.

Dr. Kenneth Ammons

Dr. Ammons said diabetics usually get the disease, but in this case -- her nerves were damaged from a bad fall. The young mother of two tried different medicines, but they didn't work. She was then faced with the possibility of losing her right leg. "I wasn't going to allow the amputation," said Ammons.

He used a new technique that decompresses the nerves. Dr. Ammons is only one of a few surgeons who perform this type of procedure in Minnesota. "I make a small incisions and release the ligament, or the tunnel ... to allow the circulation to now flow back through the nerve again and now the nerve can repair itself," said Ammons. The procedure is done on an outpatient basis and takes only a couple of hours.

Source: Frank Vascellaro WCCO (CBS) [12/21/07]

IA Podiatrist Testifies Pin Placement in Tibia Within Scope of Practice

Asked what he considered "ridiculous questions" about the definition of an ankle, Dr. Vincent Mandracchia pointed to the tibia bone on a model skeleton and offered his assessment:"That is the ankle," he told plaintiff’s attorney Daniel M. Key before the defense rested its case in a trial pitting the patient against The Finley Hospital.

Dr. Vincent Mandracchia

Key's cross-examining Mandracchia revolved on a definition from the Iowa Administrative Code that says, "as used in this chapter, 'human foot' means the ankle and soft tissue which insert into the foot as well as the foot." Finley's attorney Mark Zaiger asked Mandracchia, president of the Iowa Podiatric Medical Society, to put his testimony in context. The doctor explained that for the purposes of working on the ankle, a pin could be placed in the tibia bone by a podiatrist to secure a circular frame if needed. Mandracchia said meeting minutes from the Iowa Board of Podiatry Examiners in 2007 state, "if pins were being used to stabilize a procedure on the foot with pins on the tibia [that is] well within the scope of a podiatrist."

The final emotional exchange between Mandracchia and Key capped Finley's case after calling witnesses for just two of the trial's 13 days. The credentialing process of the hospital also was at the heart of Wednesday's testimony. Mandracchia, who also is the chief medical officer of Broadlawns Medical Center in Des Moines, testified to Arnz's experience, saying there was "absolutely" no reason why the hospital should not have granted privileges to him.

Source: Matthew Ryno, Dubuque Telegraph Herald, [12/20/07]

Editor’s note: The jury deliberated and rendered a defense verdict in favor of Finley Hospital.

Query: Shoes for Metatarsus Adductus

I have a 54 y/o female patient with severe metatarsus adductus. She states that sandals do not place as much pressure on the heels and forefoot as closed-toed shoes, but she would like to find other shoes that do not cause pain in her feet. Outside of custom-made shoes and wearing the left on the right, is there any recommended brand I may suggest to her?

J. Michael Bluhm, DPM, San Antonio, TX

RE: Liquid Nitrogen for Warts (John Moglia, DPM)
From: Pete Harvey, DPM, John P. Miller, DPM

Dermatologists have used liquid NO2 for decades. However, they use it for far more than warts, including actinic keratoses, etc. It is very cost-effective for them. You can purchase a Dewer container for about $400.00. Any local oxygen supplier should be able to come to the office and refill the Dewer from their truck. Each refill can run $10-$30.00 depending on delivery charges, etc. Check with different suppliers because the cost can vary widely.

If you have low usage, the NO2 will evaporate in about three weeks and will need to be refilled. It is applied with a 6” cotton tipped applicator touching gently until the skin blanches. It can be more painful afterward than acid applications.

Another alternative is Verruca-Freeze available at any podiatry supplier. Cryoprobe is another alternative but has higher up-front costs to the doctor. On the other hand, that system may be less expensive in the long run. I also have patients take Vitamin A, use a spray-on antiperspirant on the entire plantar of the foot, and, in some cases recommend over-the-counter Tagamet (an off-label use). Google it for warts. If I use cryotherapy, I rarely anesthetize, but this may be necessary with some patients.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

I use liquid nitrogen in my office. I wrap cotton ball of varying size around an applicator stick and use freeze-thaw-freeze method. I purchased a 22 liter Dewar (insulated storage flask), used, for fifty dollars. New is a bit more, but you can by through chemical supply company or through welding supply. Cole-Palmer is one such chemical supply company.

I purchase liquid nitrogen from welding supply company. They deliver to my office and charge about $75.00 to refill. I can go about four months between refills. This is not my primay method of wart treatment, as it can be quite painful for a few days.......I will often prescribe lortab for analgesia. It is clean and fast. Sometimes retreatment is required. You will refine your technique with experience. It is far more cost effective than histofreeze and clinically more effective, in my experience.

John P. Miller, DPM, Olean, NY, CMille123@aol.com

RE: ACFAS Drops APMA Membership As Renewal Requirement
From: Multiple Respondents

Dr. Ambroziak wrote about problems with the Michigan Podiatric Medical Association and APMA membership. It is a fact that in order to be in APMA, one also has to be a member of their respective state association. This has caused some problems. Occasionally, some local actions by state associations have caused anger and resentment. This causes the individual member to want to drop out of APMA.

Podiatrists need to separate their anger with their local people from APMA. Your state officers, being mostly volunteers, may have their "defects." But they will eventually leave their positions. Instead of being angry with your local podiatry Association for wrongs committed against you or the profession, VOLUNTEER yourself. Get active in your state association and MAKE the changes you want.

But please stay in APMA. Believe me, they have your best interests at heart, and accomplish things that are impossible for individual doctors to do for themselves.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

Kudos to the ACFAS for finally removing the requirement of APMA membership. We are now in parity with allopathic medicine in this regard. The ACFAS is truly the academic arm of our profession and it’s about time its link to the political arm (APMA) has been severed with regard to this membership requirement. The powers that be in ACFAS have listened and acted responsibly on behalf of their membership.

Thomas Graziano, DPM, Clifton, NJ, TGrazi6236@aol.com

As a former board member of ACFAS, APMA House of Delegates member, and past president of ABPOPPM, I have been involved with organizational issues /disagreements with all of the parties -BUT - we always were able to work things out for the good of ALL DPM's.

I remember several years ago where ACFAS asked its membership a similar question that now has resulted in a policy change. My simple question to ACFAS Board of Directors is - Did you poll the membership on this policy change? A bylaws change requires a membership vote? An old saying- "be careful what you wish for, you may not get what you want ".. is appropriate in this issue. No matter what transpires, I plan to keep both memberships and hope that this ACFAS policy change will not last. I, along with others, would be glad to help work through this matter that will result in all of us benefiting.

Joe Agostinelli, DPM, Niceville, FL, jmpa21@cox.net

I have to disagree with Dr. DeVito's assessment of the IPMA. It is not "union-focused", nor is it politically one-sided. I think he has the IPMA mixed up with the APMA, CPME, and ACFAS. They are the poster children for politics, not that that is all bad, but in the instance of ACFAS no longer requiring APMA membership, that is a political bombshell. Now the leadership of the ACFAS not only thinks they are better than the rest of the non-member profession, they believe they are better than the APMA. Are they really? Even after all these years, it still about killing the competition.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

It's all about priorities. I believe that most podiatrists can afford state and national dues. I happen to like my association. However, even if I didn't, we are still talking about supporting the profession and not thinking just about ourselves.So in order to have our profession remain a cohesive group, take some action. We can only help ourselves!

Call ACFAS and say CANCEL. I will. So what, you won't be part of the prestigious organization that is an exclusive club! Action is what it’s all about.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

It is with some concern but overall I rejoice in the recognition that the ACFAS has stepped forward to acknowledge that times and situations have changed. While I fully agree it is important to support our professional organizations I also recognize that in the current era it may be construed not only as collusion in requiring dual (or more) membership in societies to maintain a single chosen membership but also as politically incorrect to force membership in indirectly related factions.

As a rather apolitical individual who has positioned himself predominantly in the glow of academics I am thankful for those who have chosen the ways of “democracy” in pursuit of growth for our profession. I have found it interesting that select individuals who have chosen the non-ACFAS track have not been required to become members of ACFAS to maintain membership in the APMA, and for that matter, the appropriate State affiliate. I applaud ACFAS in the stance taken!

Jim Bender, DPM, Grand Rapids, MI, jim@grand-meridian.com

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

ASSOCIATE POSITION/ BUY-IN -COASTAL SE NC

Excellent opportunity for well trained, articulate, hardworking individual competent in all phases of practice. Long term position available with buy-in also an option. Strong salary and benefits. Gorgeous coastal area. Don't miss this one! Contact kinggy@atmc.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

PRACTICE FOR SALE - MINNESOTA

Minnesota practice for sale in upscale suburban location with turnkey absentee-ownership opportunity. This owner let's this practice run on auto-pilot while collecting $700's and associates treat all patients. This is a very well established practice and staff is willing to stay. Financing is available OAC. Contact American Doctor Sales 614-918-3000 or email us at sell_my_practice@yahoo.com

EQUIPMENT WANTED – USED PORTABLE ORTHOPOSER

I will arrange for delivery or pickup upon purchase confirmation. Please call or email with asking price. 718-896-3080 / afootdoc@ix.netcom.com

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

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