The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 26, 2006 #2,774 Editor-Barry Block, DPM, JD

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Walking in Winter Helps Control Diabetes: NM Podiatrist

Every season brings unique challenges. In summer, walking barefoot on hot pavement is a threat, because a blister can turn into an ulcer that doesn't heal. Diabetics who have lost feeling in their feet might not realize they're wounded. In winter, stress, lack of sleep, overeating, delayed meals and influenza bring more disruptions to the goal of keeping your blood sugar level as close to normal as possible. Then there's the cold to worry about for those who have poor circulation.

Exercise, as approved by your doctor, must not fall by the wayside. "It helps to regulate the blood sugar," adds Dr. Marc Stess, a podiatrist in Santa Fe. "I've had a number of patients that have been able, over time with a fairly serious walking program, to cut down and almost eliminate some of their medication. So exercise is the best -- and walking is really the best exercise for people with diabetes."

Dr. Marc Stess

Stess, of Family Foot Care and St. Vincent's Wound Care Center, also recommends buying thin ski socks, which wick the moisture away from the feet and keep them toasty. Well-insulated winter boots are also a good idea, he said. "In the winter, again, circulation is not good because diabetes affects the very small blood vessels," Stess said. "So (people) are more susceptible to the cold. There's more opportunity to have cold damage and frostbite."

Source: Diana Del Mauro, The Santa Fe New Mexican [12/23/06]

Lepow Publishes Chapter in Helfand Public Health Text

The Chapter entitled “International Podiatric Medicine – A Description of Podiatric Public Health as Viewed Through the Federation Internationale des Podologues (FIP)” by Ronald Lepow, D.P.M., represents the first time that international podiatric medicine and foot health have been discussed in a public health textbook.

Dr. Ronald Lepow

According to Dr. Arthur Helfand, Editor of Public Health and Podiatric Medicine (2nd Ed), "the American Public Health Association (APHA) expressed great delight with this chapter.”

Lepow, former present of both APMA and FIP has been invited to speak on the subject at the World Congress of Podiatry that will be held in Copenhagen Denmark in May of 2007.

Limited Rooms Open For Superbones/SuperSkin, Passports Not Required

Superbones/Superskin has procured a small number of additional rooms at the previously sold out Atlantis Hotel in Nassau, the Bahamas.

Additionally, the State Department has delayed its new requirement of passports for travel to Canada, Mexico, and the Caribbean until January 23, 2007.

Query: Office Assistants Rendering Unsolicited General Medical Advice

What has been the experience of the readership on this subject? I have a medical assistant who fancies herself as a knowledgeable person on the use of holistic treatments for various general medical ailments. She reads a great deal, but has no formal training past high school and is not a licensed professional.

While I have asked her not to give out advice, I overheard her discussing treatment of a patient’s cold with Vitamin C and colloidal silver. I am not an expert on the subject, but if a patient were to have an adverse outcome or complain to a referring physician or the state podiatry board, could I get in trouble?

Bruce Krell, DPM, Chandler, AZ

RE: 1st MPJ Fusion (Donald Carlson, DPM)
From: Lowell Weil, Jr., DPM, MBA, Jerry Cosentino, DPM

We had a similar situation as this several years ago where a woman had failed two osteotomies and two fusion attempts and wanted her toe removed. After recently hearing Sigvard Hansen, MD talk about converting ankle fusions to TAA successfully, we suggested she consider a hinged total silastic total joint replacement with titanium grommets. She accepted this procedure and ultimately did pretty well. Granted, it was not terribly functional, but it alleviated the pain and allowed her to keep her toe for cosmetic reasons. I think offering this alternative is viable as long as the patient understands the situation. I have subsequently converted 6-7 non-unions to implants with moderate success.

Lowell Weil, Jr., DPM, MBA, Des Plaines, IL, WeilJr@aol.com

I have been using a tendon inter-positional arthroplasty for hallux limitus and hallux rigitus deformities for over 16 years, with very good success. On occasion, I have used this technique on failed fusion procedures of the first metatarsophalangeal joint.

The essence of the procedure is to create a spacer between the proximal phalanx and the first metatarsal. This concept is very similar to the Keller procedure, however, I harvest a small section of the extensor hallucis longus (just a small medial piece, in order to avoid damage to the remaining tendon function), or excessive capsular or fascal tissue, or in some cases I harvest a section of the gastocneimus tendon. This is what I insert into the joint space.

The beauty of this procedure is that an inserted implant is not necessary, therefore the limitation of poor bone density is not necessarily a factor.

One point needs to be made in regards to the hypermobility of the first metatarsal. It is my opinion that this hypermobility is one of the primary causes of degenerative changes in the first metatarsal phalangeal joint area. Therefore, a plantar-flexed and/or a decompression osteotomy is necessary to perform in conjunction with the a tendon interpositional arthroplasty, to improve longstanding joint function.

You may refer to my article that was published in The Journal of Foot and Ankle Surgery, September/ October, 1995, Vol 43, Number 5, pg. 501, or feel free to call me at area code 813-251-6636.

Jerry Cosentino, DPM, Tampa, FL, gcosenti@tampabay.rr.com

RE: Peroneal Brevis Split (Dale M. Smith, DPM)
From: Jared Frankel, DPM

Split peroneus brevis tendon can be treated with immobilization but success rate to abate symptoms is not good. The potential for complete rupture of the tendon exists. In my humble opinion she should treated surgically with primary repair of the tendon and excision of necrotic tendon and supplemented with graft jacket to strengthen the repair. Tendon repair augmentation with graft jacket is documented in the literature. Make sure the peroneal retinaculum off the fibula is not torn. This could be the culprit causing the tendon to split and sublux over the fibula. This should be repaired if present.

Jared Frankel, DPM, Elmhurst, IL, drfrankel11@comcast.net

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

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.

POSITION AVAILABLE - NEW YORK AND/OR NEW JERSEY

Part-time and full-time positions available for any or all of the following office, assisted living facilities, hospitals, and house calls. Please Fax CV to (212)473-8563.

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

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

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.

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