The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 26, 2007 #3,126 Editor-Barry Block, DPM, JD

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CA Podiatrist Sits on Board Of Barefoot Kids Foundation

Carlsbad residents Loretta and Dan Ross have started their own non-profit organization, the Barefoot Kids Foundation. Dr. Kenneth Rehm, a San Marcos podiatrist, sits on the foundation board. He said that the importance of good, new footwear for children has been overlooked. "There is almost free health care in this country, but there is no free shoe care. People forget about their feet until there is something wrong and they can't walk," he said, stressing the fact that quality shoes for children are important.

Dr. Kenneth Rehm

Rehm said he was amazed to hear that many children in our relatively affluent communities go without new shoes and was happy to lend his support. "They (the Rosses) don't have to do this at all," he said. "They are doing it out of the kindness of their heart. It is such a worthy cause. I am so passionate about the work Danny and Loretta do."

Source: Ruth Marvin Webster, North County Times [12/22/07]

Three Elected to OCPM Alumni Association Board

The Ohio College of Podiatric Medicine's Alumni Association has voted Drs. Michael Canales and Sam Feinberg as Board Members. Dr. Bruce Saferin was voted in as a board member at large.

Dr. Michael Canales is a 2004 graduate of OCPM and recently was hired as a faculty member at the college. Dr. Canales serves as a staff podiatrist at the Spine and Orthopedic Institutue at St. Vincent Charity Hospital, as well as the The Collis Group in Cleveland, Ohio. In addition, Dr. Canales is a member of the teaching staff for Podiatric Surgical Residency at St. Vincent Charity Hospital.

Dr. Sam Feinberg is a 2007 graduate of OCPM. Dr. Feinberg earned his Bachelor of Science degree at the University of Kansas. Currently, Dr. Feinberg is a first year resident at UHHS/Richmond Heights Hospital.

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Query: Biopro Memory Staple

I am interested in hearing from surgeons who have utilized the Biopro Memory Staple. I am thinking of using this to fixate a distal Akin procedure. Any comments/suggestions are appreciated.

Wayne C. Gould, DPM, Dover, NH

Query: ISO CME Credits

I just realized that my license renewal is due by the end of the month and I’m about 10 credits short. I’m looking for a live seminar to attend, but I can’t seem to find one. Can I send in the renewal form saying that I completed the required hours and then make them up in 2008?

Name Withheld by Editor.

Editor’s comment: PM News does not provide legal advice. Providing false information on a license renewal form is a sanctionable from of professional misconduct, which is likely to carry a more severe sanction that simply admitting that you failed to complete the required hours.

Better still, we suggest you consider completing a CPME-approved CME course on-line, such as the one available through Podiatry Management (www.podiatrym.com/cme) and other vendors. Be sure to check with your state as to how many hours of instructional media your particular state allows.

Query: Billing When You Accidentally Cut the Patient

If a patient's movement during a routine foot care treatment resulted in a laceration - with the patient acknowledging that it was their movement that caused the injury - is it appropriate to bill their plan for any treatment of the laceration?

Same question, but this time, the laceration occurred unexpectedly with the performance of routine foot care - no negligence or carelessness on the part of the doctor. Would it be appropriate to bill their plan for any treatment of the laceration?
Arden Smith, DPM, Great Neck, NY

Response: Unless the cut was so signficiant or complex to repair, I would not separately bill for it. Instead I would be assume it to be included in the whatever procedure or service was performing at the time. I, however, the repair was significant (e.g., at the patient to the operating room or blocking the toe to suture the laceration), I would argue for billing the repair.

Tony Poggio, DPM, Alameda, CA

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RE: Shoes for Metatarsus Adductus (J. Michael Bluhm, DPM)
From: Robert S. Schwartz, C. Ped, Itamar Rosenbaum, C.Ped

There are brands of readymade over-the-counter footwear for women that accommodate a metatarsus adductus. Look for footwear that has a straight inner border toe design on the medial side. Most shoe’s toe design (character) are slightly abducted. Among the ones we carry for women at Eneslow are PW Minor “Miss Contour last”; we stock the Dutchess. Drew P48 last; we carry the “Fitter.” Finn Comfort makes sandals and closed shoes. So do Kumfs, Birkenstock and Crocs.

Readymade over-the-counter shoes can be redesigned to create more room for metatarsus adductus. First we take measurements and an outline of the patient’s foot while standing. Then we make a last to accommodate the patient’s foot. We open and sometimes remove the outsole of the shoe. Then we re-last the upper of the shoe over the last that matches the shape of the foot, and repair or replace the outsole.

Custom-made sandals usually provide the best aesthetic and functional result, since the shoe and foot are in harmony and the foot has some freedom.

Robert S. Schwartz, C. Ped., New York, N. Y., rss@eneslow.com

There are several ways to tackle this issue. Due to her age, I don’t think that reversing her shoes is going to be an option in solving her issue, since the foot would usually be fixed in the position they are currently in. What she could do, is either have her shoes modified to accommodate that hallux, or look for shoes that have an adducted forefoot to their shape. Another option is for her to purchase shoes with a stretchable material in the forefoot area. P.W. Minor is one brand to look at as are several others like Xsensible and Aetrex.

Itamar Rosenbaum, C.Ped., NY, NY, nycped@verizon.net

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

The recent action by the ACFAS board to no longer require APMA membership, a violation of the APMA Bylaws, will undermine so much of what has been accomplished because of our organizational unity. I am aghast at this unilateral action by the ACFAS Board. I applaud the APMA Board's efforts to re-mediate the problem. I implore all joint APMA/ACFAS members to urge the ACFAS to reconsider its actions. Having watched the issue for the past 10 years, I am convinced this action will hurt both organizations.

I recently wrote a column in PM (www.podiatrym.com/pmarticle.cfm?id=112) that alluded to a previous effort by ACFAS to follow this path. A survey of its membership at that time indicated the majority would drop ACFAS membership if the decision had been made at that time. I still suspect that the majority of ACFAS members would oppose this action. In a representative democracy, a small group of leaders should not undertake actions of this sort unless the overwhelming majority of its membership support the action. In most organizations, a change of this sort requires a 2/3 vote to change a bylaw. It does at APMA. I do not believe the ACFAS membership actually voted. In fact, a small group of ACFAS Directors made this decision (not unanimously).

If ACFAS does not reverse its position or if a suitable compromise is not worked out, the APMA is required to impanel a Board of Inquiry to investigate options that will include revoking the ACFAS as an Affiliate and creating a new surgical affiliate.

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

As a past president of both the ABPS and the ACFAS as well as a former delegate from Illinois to the APMA, I applaud the decision of the Board of Directors of ACFAS to remove "membership in APMA" as a requirement for continued membership in ACFAS. This was not an easy decision nor was this a decision that has come alive recently. For the past 15 years, ACFAS has wrestled with the issue of either offending APMA or being inclusive of Board Certified Podiatric Surgeons who would like to be members of ACFAS but who refuse to join their state society and in turn the APMA.

I will continue my APMA membership as I have for the past 42 years, but I do believe in choice and I also believe that ACFAS and APMA should have different agendas and responsibilities to their membership. Both societies will continue to flourish but APMA must represent podiatric generalists as well as surgeons and ACFAS has the obligation to expend all efforts and deal with the issues of its' membership of Board Qualified and Board Certified Podiatric Surgeons.

For those who are threatening to quit ACFAS, I still believe in choice and wish them well. When the rhetoric tones down and the societies work separately but with a mutual respect, it will almost be business as usual.

Lowell Scott Weil, Sr, DPM, Des Plaines, IL, weil4feet@aol.com

While this move has been, at best, divisive, I am more interested in our own perceptions of these organizations. I have noted that some have called the ACFAS the "academic" wing of our profession. How is that exactly? While I hear high-minded proclamations using the words "research" and "academics" emanating from newsletters and podia, I am not sure that I see any overwhelming "evidence" (short of often outstanding hands-on workshops) of this wing working alone to push the envelope of work in this area-- certainly nothing that formally challenges or analyzes. Perhaps a better description based on these (very important) services might be the "technical" wing of our profession.

I am a proud rank and file member of both ACFAS and APMA. However, I cannot for the life of me see how (what amounts to) schism benefits either organization. This current podiatry situation seems to me very much like where our country was in the antebellum 1850s. We are seemingly a house divided-- one part slave to the perception that somehow their scalpel, pin driver and odd Rancho cube separates them from their onychomycotic, hyperkeratotic counterparts-- the other sensitive to the fact that just because they bust a nail and trim a corn from day to day doesn't mean they can't saddle up to the head of the OR table.

I don't know where all this leads, but I hope it finally exposes-- and purges-- the deep-seated inbreeding-induced inferiority complex that the most extreme of both sides of this impending conflict have. Using the AMA and the ACS as an example (as some have) is not apt. Podiatry is ONE specialty-- and we are perceived as such by everyone but (it seems) ourselves. If we go down the road of division (and Fort Sumter), we'll ultimately have to meet at Appomattox. Friends, can't we head this one off at the pass?

David G. Armstrong, DPM, PhD, N. Chicago, IL, armstrong@usa.net

I find it quite interesting at the "visceral" response such a move by ACFAS has provoked. I would think that one would want to be part of an organization because of what benefits it can provide its members. Why would one have to belong to one organization to belong to another? It seems purely financially driven to require membership in APMA in order to join ACFAS. Does any other organizations do this? I don't believe MD's need to belong to the AMA in order to have membership in any other organizations?

The dues for APMA are respectable, but when it is also mandatory to join the state association as well which may cost more to join than at the national level, that's problematic. I have/will continue to belong to both organizations, but it seems fair and reasonable to not be "required" to belong to both.

Nicholas Brown, DPM, Wooster, OH, nb78910@yahoo.com

I read with interest the multiple responses to this issue. I personally think that most colleagues have it wrong. Even though each professional organization is supposed to exist for the advancement and improvement of the profession, they all have their own agendas and budgets to meet and do not have to be co-dependent on each other for their own survival.

Yes, they can work together, even have meetings and conferences together, but they should not impose membership demands of having to belong to one or the other as a requirement for membership. That is what the board examinations and degree requirements are for. After that, it should be the doctor’s choice to whom or what he/she wants to join. Case in point, look at the two largest wound care organizations: WHS and AAWC, both are independent of each other but work for a common goal and hold joint conferences yearly.

It is unfortunate that the great State of Michigan has so many complaints and cannot resolve their own issues. It makes me wonder, do those physicians that get involved and cannot fix their issues treat their patients the same way, by just giving up? There is always a solution to any problem, just work harder to find how.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

I have read with interest the last few posts on ACFAS' decision to no longer mandate APMA membership. To the people complaining about it, I ask why should one membership be linked to another? If APMA, ACFAS or any other organization is worth the cost then people will join. This being said I am a member in both and will continue to be. In addition, I think APMA should remove the requirement to be a member of a state society and let the individual decide on what they want to belong to.

Mike Piccarelli, DPM, Staten Island, NY, mcpdpm@verizon.net

Editor's Note:This topic will be closing in the next issue.

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