The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

December 25, 2008 #3,434 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Character Shoes Best for Dancers: NY Podiatrist

While dancers love how heels look and have learned to accommodate to their demands, Dr. Lori Weisenfeld, a New York-based sports podiatrist, sees the effects on her patients. “Heels do elongate the leg and make the calves contract. But there’s nothing less sexy than women having difficulty walking in them.”

Dr. Lori Weisenfeld

“High heels do not allow us to walk in a regular heel-to-toe fashion,” she says. “Also some high, narrow heels are unstable and leave the wearer vulnerable to twisting the ankles, tightening the calves, and shortening the Achilles tendons.”

Weisenfeld says that character shoes are the best choice for dancers due to their wide heel, deep and wide toebox, and common T- or ankle-strap that adds support and stability. In some styles, low platforms in the front of the shoe offset some of the heel height. Wider heels that are placed more firmly below the ankle also help.

Source: Lauren Kay, Dance Magazine [January 2009]

BCBS Partners with Zagat to Expand Physician Ratings

Physicians, brace yourselves: Zagat, which publishes dining guides, is partnering with more BCBS to rank doctors. And if this move to treat doctors' offices like restaurants is not enough, the ratings will not even be based on medical factors. Rather, they will be based on survey results of four factors: availability, office environment, communication, and trust.

This is not the first time Zagat has rated doctors; in the fall of last year, WellPoint (which also runs Blue Cross plans in 14 states) hired Zagat to do the same thing. So, this is just an expansion of the same program. Still, it might have been nice to find out how doctors fared under WellPoint's initiative before BCBS plans went at it again.

Source: Anne Zieger, Fierce Healthcare [12/23/08]

Query: Patient Recall System

I'm looking for a good recall system, either one that uses an Internet database [we get every patient's email address] or snail mail. I'm using an automated telephone reminder system, but it does not really get the patient's attention.

Sloan Gordon, DPM, Houston, TX

RE: Severe Bromhidrosis (Birute Balciunas, DPM)
From: William Nielson, DPM, Bob Kornfeld, DPM

There is a product called Lavilin Foot Deodorant from Israel that works great for this. I always search on the internet for the best price. I have no financial interest in the company.

William Nielson, DPM, Florence, KY, bcnielson@hotmail.com

There is an adrenal component to this condition which, when addressed, can foster improvement and facilitate management. It would be prudent to look at adrenal hormones and neurotransmitters to discover mechanisms that, once identified, can lead to more effective symptom control.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: Cuboid/Peroneal Pain (Mark Aldrich, DPM)
From: Howard Dananberg, DPM, Lloyd S. Smith, DPM

I see this type of problem quite often. The most common complaint involves pain in and around the cuboid, but can also present as vague dorso-lateral foot pain. The best approach is manipulation of the cuboid. Click here for a downloadable article (with photographs) on this topic. Orthotic management is fine once the cuboid has been mobilized. Like all of our podiatric skills, manipulation takes time to master...but once this is learned, positive outcomes become very common place.

Howard Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

Many of these cases are longitudinal splits in the peroneal (longus and/or brevis) tendons starting at the malleolus and sometimes extending to the base of the 5th. If conservative treatment fails ( I use the full gamut of options in most cases including 4 to 6 weeks in a CAM-walker if surgery is rejected), an MRI should be obtained. Although MRIs often fail to show these splits, discussion with the radiologist can be helpful. Certainly, if any indication of tendonopathy exists, a longitudinal tear is likely. Repairs are simple and involve retubularizing the involved tendon - both the longus and brevis need to be examined from the ankle to the base of the 5th metatarsal.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

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

I have been using Neuremedy (benfotiamine) for the past 2 years with 30-40% success rate in the treatment of peripheral neuropathy. I have seen no side-effects with this product, which is well-tolerated.

Paul A. Sommer, DPM, Valpariso, IN, pmdocski@aol.com

In the study, Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a Randomised, Double Blind, Placebo-controlled Clinical Study, the primary endpoint was defined as an improvement in subjective symptomatology, i.e., did patients with neuropathy feel better after receiving benfotiamine? The study showed to a statistically significant level of confidence, p=0.033, that these patients had improvement in their symptoms after a six-week course of benfotiamine.

Of great interest is another study, Benfotiamine in the Treatment of Diabetic Polyneuropathy- a Three Week Randomized, Controlled Pilot Study (BEDIP Study). In this study, a statistically significant ( p=0.0287) improvement in the neuropathy score was observed in a group of diabetic patients with peripheral neuropathy after being given benfotiamine when compared to placebo-treated controls.

In the landmark study, high prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease, it was shown to a high level of statistical confidence, p<0.001, that diabetics have 75% less circulating plasma thiamine when compared to non-diabetics. Thiamine deficiency is a well-known cause of peripheral neuropathy. It should, therefore, not be surprising that benfotiamine, a lipid-soluble derivative of thiamine with high bioavailability, has been shown to reduce the symptoms of diabetic peripheral neuropathy.

In light of these findings, practitioners may want to measure plasma thiamine levels, when possible, prior to initiating benfotiamine supplementation. Readers are welcome to review these and other abstracts at http://podiatrym.com/go.cfm?n=196

Richard Mann, DPM, President, Realm Labs, rhm123@gmail.com

It's great to see that PM News has incited so much debate and controversy regarding performing double-blind randomized studies to show the efficacy of medications or treatments we perform daily in our offices.

In the past, I've referred many patients complaining of pain in their feet or legs to neurologists with the recommendation to evaluate the patient for Neurontin, Cymbalta or Lyrica. Several weeks later, the patient returns stating that the discomfort has subsided or hasn't changed, but they hate the feeling of being sleepy or drugged from the medication.

I've been using benfotiamine in my office for the last 2-3 years. The patients either love it or at worst see very minimal changes, but, no untoward side-effects. So, in the past, I've been a hero to many patients because I've given them relief.

Many of the earlier treatments in podiatry were based on anecdotal information. So, continue with the double-blind randomized studies, but, please don't forget the suffering patients.

Edward Fryman, DPM, Seaford, NY, EFrymanDPM@gmail.com

ASSOCIATE POSITION WANTED – MA, CENTRAL FL, or SEATTLE, WA

Graduating resident in June 2009 with superior people skill & work ethic and diverse PM&S-36 surgical training. Seeking for an employment as an associate. Preference to Massachusetts state, central Florida or Seattle. Khanhmei Wong, DPM. 617-640-1107 or pager 774-299-1943.

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once-in-a-lifetime opportunity to join one of the most successful practices in the United States. No seniority system. If you are motivated and have completed a PSR24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Fax resume, including photo, to: 513-577-7261 or E-mail resume to Kroesch4poh@aol.com

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

PM Classified Ads Reach over 11,500 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 11,500 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

• 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.