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From: Dennis Shavelson, DPM


There is a new fall prevention system on the marketplace that has many benefits over the standard heavy and cumbersome AFOs that fit inside the shoe with a foot plate, and needs to be accommodated with oversized shoes. The system combines the use of an external ankle foot orthotic (E-AFO) that exists outside instead of inside the shoe coupled with a restorative custom foot orthotic (RCFO) cast in optimal functional position.


The lightweight E-AFOs and RCFOs offer increased forefoot, midfoot, rearfoot, and ankle stability, symmetry, support, and balance, while reducing sway and perturbation in stance and when moving about. In addition, the ankle position can be free to move or bolted tight in any position on the sagittal plane, as needed. Two obvious drawbacks are that RCFOs are not covered by Medicare and E-AFO are not covered for three-five years if an AFO has already been dispensed under Medicare.                                                                                                                    

Disclosure: I am a consultant for and national distributor of an E-AFO manufacturer.


Dennis Shavelson, DPM, NY, NY 

Other messages in this thread:



RE: Safety Net for Podiatrists in Crisis

From: Mark E Weaver, DPM


I feel PM News is the most important podiatry blog. There is, however, a vacuum in the area of podiatry camaraderie. There are personal, natural, and man-made disasters in the country every month. California fires, Puerto Rican earthquakes, Floridian hurricanes, Mid-western floods, and major boating and auto accidents. I know that I had local podiatrists who would come to my aid in a personal crisis, But, in a local or statewide crisis as noted above, there is strain on all the local professionals in their own practices. Do we have, or do we need a system to provide assistance for our colleagues that have had unfortunate circumstances?


I have recently retired, but I feel I still have reasonable skills and time that is not unlimited but more available for several years to come to help in cases of emergency. And, for example,...


Editor's note: Dr. Weaver's extended-length letter can be read here.



RE: Zimmer enPuls Shockwave (Supna Reilly, DPM)

From: David Zuckerman, DPM


I wrote an article on this technology. The Zimmer EnPuls isn't FDA-approved. It has no approval for shockwave indications. I am not aware of any results reported except for doctors’ observations. The Zimmer enPuls is a class 1 device, not a class 3 device. FDA-approved ESWT devices have undergone evidence-based studies that are double-blind, randomized, placebo-controlled studies with multicenter evaluations. While the Zimmer enPul may work, it isn't a shockwave device per FDA Class 1 classification.


I am not saying it can't help your patients. It may be right for your practice, but you should understand and know whether a device is FDA-approved or FDA-cleared and for what indications.  


David Zuckerman, DPM, Cherry Hill, NJ



From: William E. Chagares, DPM


The eligibility criteria for access to board certification are set by CPME. This includes the length of post-graduate training required. The APMA HOD, CPME, and recognized specialty boards worked together to create more uniform residency programs of greater complexity and length. This is reflective of the training and education required to accommodate the public need for podiatric practitioners.


There has consistently been adequate, publicly-advertised time for access to certification by graduates of the archival program types of shorter length. Furthermore, GME funding of training programs is linked to the fewest number of training years eligible to access the certification process. This is critical in keeping podiatric residencies fully funded by GME, and thus maintaining viability for the future of our profession. The profession and key stakeholders who are responsible for maintaining a standard of training commensurate with current practice, have consistently endeavored to move forward while allowing adequate opportunity for those from older training models to access the certification process.


The ABPM encourages everyone to reply to CPME's call for public comment during revisions to Document 320 (Residency Training Standards). There was a public comment period for revisions to Document 220 (governance of specialty boards - JCRSB) which was adopted in October 2019. This would have been an appropriate time and place for comments regarding access to board certification.


William E. Chagares, DPM, President, American Board of Podiatric Medicine



From: Jeffrey Kass, DPM,


I agree with the absurdity referenced in the post by Dr. Gertsik. This is a prime example of the divisiveness within our profession. My solution for Dr. Gertsik is to get boarded by the American Board of Medical Specialties in Podiatry. 


Two years of residency would allow you to sit for their board, and 20 years of clinical practice would equate to two years of residency. From your post, it sounds like you would qualify based on your training or years in practice. 


Jeffrey Kass, DPM, Forest Hills, NY



RE: ABPM Non-Recognition of Residencies

From: Vladimir Gertsik, DPM


Since primary podiatric medicine, podiatric orthopedics, and other names are gone (with their respective residencies), it is time to acknowledge that most non-surgical podiatrists are pretty much the same. Some see more kids than others, some do more orthotics than others, but we are still mostly podiatrists. I appreciate the name change. But what I do not appreciate is the stubborn refusal of the Board to recognize their own residency types (now obsolete but nevertheless CPME-approved at their time). 


All podiatrists who have in good faith completed a residency program should have a pathway to board qualification. ABPM does not recognize its own residencies! Why should these pathways ever be closed? This is absurd. If a 2-year residency was acceptable 20 years ago, why is it no longer acceptable? Do 20 years of practice count for anything? Apparently not. What are these boards trying to prove, and to whom? Since there is no logic in all this, I feel that this board is not legitimate.  


Vladimir Gertsik, DPM, NY, NY



From: Joe Boylan, DPM


I never was an advocate of the “Pose Method” regarding the foot strike; forefoot to forefoot. It does help with upper body posture. In my view, a forefoot to forefoot gait for most runners would predispose one to a host of overuse injuries.


An exaggerated heel-toe gait (as we do when walking) is also not recommended. The ideal foot strike is on the plantar heel/mid-foot (almost like a shuffle). 


Joe Boylan, DPM, Ridgefield, NJ



RE: Investing in the Future of Podiatry

From: Allen Jacobs, DPM


Over the last several years, I have observed the commendable efforts of the New York State Podiatric Medical Association in promoting our profession and encouraging recruitment of students to enter the field of podiatry. Each year, the NYSPMA offers a one-day program for college career counselors and premedical advisors introducing them to podiatry. A hotel room, meals, and an excellent program are provided. This includes a tour of the exhibit hall and attendance at a lecture. Students, residents, young and older practitioners, as well as local thought leaders provide a brief synopsis of their experiences and perspective. Additionally, college students are given conference and exhibit hall tours and discussions regarding podiatry as a potential choice for patient care.


Might I suggest that each state society and regional conference take responsibility for doing the same. Yes, some effort and money is required. However, from my observation, it would appear that participation of each state society, possibly with the assistance of a college of podiatric medicine, could potentially serve as an excellent means of student recruitment. Organizations holding scientific conferences, for example ACPM, ACFAS, DermFoot, PRESENT, and many others, should consider the same. There is no crime investing in the future of podiatry. 


Allen Jacobs, DPM, St. Louis, MO



From: David Krausse, DPM


I hope that the new TLC show is helpful in spreading the good work of podiatry around and I hope that the 2 podiatrists featured make good decisions and help their patients. That being said, does it not bother anyone that neither of these doctors are board certified in surgery? 


David Krausse, DPM, Flemington, NJ



From: David S. Wolf, DPM


Kudos to both podiatrists in this reality TV series, who exemplify the finest in our profession. They will educate the public of the scope of our practice and will augment what the APMA has attempted to accomplish. We have all seen the pathology of these TV patients but at least now, it will be seen by millions of viewers. What a positive PR coup for our profession. Wish I would have thought of it.


David S. Wolf, DPM, (Retired) Houston, TX 



From: Jonathan Michael, DPM


With all my respect to the Drs. on the show, I was not impressed at all by the performance that highlights our profession. In one instance, the doctor says I have never seen anything like that and I really do not know how I am going to treat you. Then he made the patient custom sandals when I was expecting some sort of surgical intervention. In the other instance, the Dr. removed a fungus nail that was done distally and crumbled; in my opinion, it should have removed proximal first to avoid the struggle to remove it in pieces. I think that did more harm than good to our profession. 


Jonathan Michael, DPM, Bayonne, NJ



RE: Source for Radiesse 

From: Allen Jacobs, DPM


Saying that “I’ve used this technique or product a bizillion times without any problems” may not be a positive defense for unindicated use. It is analogous to drunk driving, or never stopping at a red light. Most intoxicated people, or those who ignore traffic signals, are not in auto vehicle accidents while driving drunk or ignoring a red traffic signal. However, driving while drunk or ignoring a red light raises the statistical RISK of an accident. Should such an accident occur, you will likely be held accountable. Safe means safe for studies and indicated utilization.


Stating that you “took a course” at some seminar is like implicating the bartender for your intoxicated driving. Taking a “course” at some podiatry seminar does not provide you with a special exemption for the provision of ethical, standard of care treatment to your patients. 


I suggest that at a minimum, patients be informed that the use of the medication or technique has not been studied nor is FDA-approved, and that appropriate verifiable consent be obtained.
Allen Jacobs, DPM, St. Louis, MO



RE: Source for Radiesse 

From: Valerie Marmolejo, DPM


The intended use indications for Radiesse are: “RADIESSE is indicated for subdermal implantation for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds and it is also intended for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.”


While physicians can use Radiesse off-label as they please, the company CANNOT promote, aka sell or market, off-label product use. As podiatrists do not treat the face, there is no reason for the company to reach out to us. 


Valerie Marmolejo, DPM, Seattle, WA



From: Allen Jacobs, DPM


My understanding of Radiesse is that it is not approved for, nor are there FDA studies for, the use of this calcium hydroxylapetite product for the foot and ankle. Experience in facial and hand soft tissue augmentation has demonstrated that Radiesse may be associated with vascular occlusion, downstream embolization, and tissue infarction, among other complications. The manufacturers recommend that Radiesse be utilized for indicated pathology in studied areas (face and hands), and by those TRAINED and EXPERIENCED in its use. Perhaps the reluctance to provide this product is not "anti- podiatry", but rather the responsibility of the manufacturer to not distribute the product for indications not FDA-approved. 


Furthermore, by undertaking Radiesse injection for foot and ankle augmentation, the podiatrist assumes a substantial potential medical-legal liability should a significant adverse sequela occur. Hiding behind a dermatologist to provide Radiesse could further legally implicate the distributing dermatologist in a ruse to provide a podiatrist with a medication for unindicated purpose. Having another podiatrist testify that in their opinion Radiesse may be used sans FDA studies and approval, and having the manufacturer testify that the dermal filler was not made for nor indicated for the purpose used, and that they (the manufacturer) would not knowingly provide ANY healthcare provider with Radiesse for non-indicated use, may be problematic. Caveat emptor!


Allen Jacobs, DPM, St. Louis, MO



From:  Bret Ribotsky, DPM


In response to Dr. Fellner, years ago, when I was involved with DermFoot and running workshops, I had many detailed discussions with a few different CEOs of Merz over the years. The issue is that there is NO FDA-approved use for Radiesse that is within the scope of practice of a DPM. Thus, the attorneys for the company advised not to sell to DPMs directly.  


Workarounds were in place for those who received training that I provided throughout the country (a short term fix). I was involved in a few research papers that were the start of a possible attempt to get an FDA indication for the feet (like the hands). Then I got injured in May 2015, so I do not know what has happened since then. 


Bret Ribotsky, DPM, Boca Raon, FL



From: Joel Morse, DPM


Go North! Go to and you can order a number of dermal fillers including Radiesse for roughly $188 for the 0.8 cc syringe. You must supply them with your medical license and they will get back to you in a few days. I have bought from them, and many podiatrists have received their Merz fillers!


Joel Morse, DPM, Washington, DC



From:  Jack Ressler, DPM


Before I sold my main practice, I researched practice brokers and interviewed a few. The bottom line is that you pay them several thousand dollars to give your practice a "valuation" and even more money when/if they sell your practice. Don't think for a minute that they come out to see your practice first. They will, but you pay extra for that service. I cannot speak for all practice brokers but the ones I spoke with have you sign an agreement that gives them exclusivity of selling your practice. This means they are in the driver’s seat as to how much and what type of advertising they want to do to promote your practice. They do not have to do too much work. The work they do, you pay for. 


Yes, you can still get a buyer on your own, but when under contract with the broker, you still pay their commission. Nobody knows your practice or can sell it better than you! Take some time and look into advertising your own practice. If a sale is pending, then contact a lawyer for further guidance. I sold my own practice and the only advertising I did was on PM News


Jack Ressler, DPM, Delray Beach, FL



From: Cosimo Ricciardi, DPM, Denis LeBlang, DPM


Ditto that on Mr. Crosby. He's a hard worker and good communicator. He will be a great asset in your search.


Cosimo Ricciardi, DPM, FT Walton Beach, FL


I used Mike Crosby to negotiate the sale of my practice last year. He is professional, compassionate, and a wonderful human being. He was there to speak with me and literally held my hand and controlled my mindset throughout the process. It took a while for the situation to come to an end, but Mike was the voice of reason and controlled my stress and anxiety levels and calmly assured me that it would all work out. 


I  recommend him as the guru of podiatric practice sales. 


Denis LeBlang, DPM, Westchester County, NY



RE: Banner Year for Our Sock Tree

From: Andrew Levy, DPM


It was a banner year for socks donations for two homeless shelters and an after school program for underserved children. Our staff estimates that we will collect 1,000 pairs this year! 


Dr. Andrew Levy and Sock Tree


This idea emanated from PM News years ago. Thanks to PM News and our patients.


Andrew Levy, DPM, Jupiter, FL



From: David Gurvis, DPM


I knew what Truvada was.  A habit I picked up years ago is when I don’t know a medication a patient is on, I ask them. Later, or in the room, I look it up. I keep the epocrates app and another drug look-ups in my cell phone and rely on them extensively. We all should.


David Gurvis, DPM, Avon, IN



RE: Majority of U.S Medical Students are Women

From: Leonard A. Levy, DPM, MPH


2019 was the first year that the majority of U.S. enrolled medical students were women according to data released on December 10 by the Association of American Medical Colleges. In 2017, women comprised the majority of first-year medical students. Applicants to U.S. medical schools have increased for women while those for men declined. (Stuart Heiser, Senior Media Relations Specialist, AAMC: Dec. 10, 2019).


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL



From: T. Nat Chotechuang, DPM


Our intake form simply asks, "Gender: ________" and the patient fills in the blank however they wish.


T. Nat Chotechuang, DPM, Bend, OR 



From: Kevin C. McDonald, DPM


I do ANS and sudomotor testing in my office on occasion, as it is available on my ABI vascular testing device. The test involves heating up the soles of the feet and measuring a) the dilation of the small blood vessels beneath the skin and b) the sweat response (as a measure of the function of the sudomotor nerves controlling the sweat glands). A decreased response indicates damage to the autonomic nerves on the soles of the feet while the absence of a response indicates a complete loss of autonomic nerve function. 


Sudomotor testing is considered "investigational" and thus non-covered by the vast majority of insurance companies. I hope that this changes because ANS/sudomotor testing has advantages over epidermal nerve biopsies including a) no injections, b) no wounds, c) immediate, quantified results, d) measuring the nerves of the feet rather than the nerves of the lower legs, and e) a much lower cost. In summary, it's a good test but it's typically not covered by insurance.


Kevin C. McDonald, DPM, Concord, NC



From: Elliot Udell, DPM


Dr. Moore is being very astute in asking whether a new modality is covered by insurance companies. Every year, like clockwork, there is some new diagnostic or therapeutic modality being promoted at our conventions. Very often the sales reps will swear that the new device is covered by insurance and gullible practitioners find out, too late, that the codes given by the salesperson is really specific for a different modality, and under an audit the practitioner will have to pay back all that he or she received. 


In most cases when this happens, the doctor will have little recourse because the manufacturer is long out of business. The bottom line is this: Yes there are new and exciting modalities being developed that can help our patients. As Dr. Moore has done, before becoming a buyer, we need to give a "shout out" and find out whether the device is therapeutically beneficial and whether it will be legitimately covered by insurance companies. 


Elliot Udell, DPM, Hicksville, NY



RE: The Rebalancing of Podiatric Medical and Surgical Residency Education

From: Alan Sherman, DPM


Chuck Ross started an interesting discussion triggered by his attending the always excellent Richard O. Schuster Memorial Seminar in biomechanics last week. He makes the statement that the concern regarding the lack of emphasis on biomechanics should be focused on the 3 years of residency education, where he notes that there is a “dramatic lack of a continuum once students graduate and enter residency programs, with few exceptions as the emphasis is solely upon surgery.”


Allen Jacobs shares his experiences with speaking to residents, “that it is distinctly uncommon to see gait analysis performed on most patients, including those being evaluated for...


Editor's note: Dr. Sherman's extended-length letter can be read here.



From: Bob Hatcher, DPM


This website for Charlotte's Web has a variety of CBD products plus information on production and cost.


Bob Hatcher, DPM, Raleigh, NC

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