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From: Todd Rotwein, DPM, Lawrence Rubin, DPM


I would ask my esteemed colleagues, where exactly would you draw a line? Would you teach non-podiatrists how to cast for orthotics?


Todd Rotwein, DPM, Hempstead, NY


I agree with Dr. Markinson that podiatrists should not withhold information about podiatric approaches to patient care from other health professionals. Similarly, I find it very disturbing that some podiatrists openly tell me they will not provide preventive diabetic annual comprehensive foot exams, because wound care is their practice's "bread and butter." I realize that this opens up a whole can of worms regarding what is and what is not ethical professional conduct, but ignoring these realities helps no one.


Lawrence Rubin, DPM, Las Vegas, NV

Other messages in this thread:



From: Jay Kerner, DPM


Suggesting an anti-inflammatory diet to patients with gout, inflammatory arthritis, diabetes, etc. is good medicine. Suggesting cherry juice, turmeric, bananas, watercress, and low fat milk products as gout preventatives is, however, in the realm of alternative medicine. Though there have been individual studies suggesting the effectiveness of cherry juice as a gout preventive, there are recent studies that show it has no effect. There are papers now questioning the role of purines in initiating gouty attacks.


There are no studies for these foods for any pathology with the strength of the vitamin D3 or anti-inflammatory diet studies. Advising patients to take them based on ‘recent studies’ is more a belief or exaggeration than evidence-based medicine...regardless of ‘epigenetic factors’. 


Jay Kerner, DPM, Rockville Centre, NY



From: Herbert Abbott, DPM


Dr. Gurnick, having performed tens of thousands of these procedures over the span of a 30 plus years career, and having performed them on both of my own two great digits as well, I must say that Dr. Greenberg is SPOT ON! I am quite sure that he does a thorough informed consent as well, and the patient is aware of all risks, benefits, and alternatives. His wording is “usually,” and he is absolutely correct - any of my colleagues would agree. As for your results, I cannot comment other than maybe you are not doing the procedures correctly?


Herbert F. Abbott, DPM, New York, NY



From: Robert Scott Steinberg, DPM, Bryan C. Markinson, DPM


I think some of my colleagues are being quite naïve, or their egos have gotten the better of them! There was a time when DPMs owned orthotics. 


If you don't respect our specialty, find another profession.


Robert Scott Steinberg, DPM, Schaumburg, IL 


I need to point out some wrong conclusions by Dr. Ribotsky. Firstly, prior to coming to Mount Sinai, I ran a private solo community practice for 16 years, and taught anyone and everyone who asked anything they wanted to learn, believing in that ethic long before I came to Mount Sinai. It brought me more patients, never less. I do agree that academic center practice is different from community practice. Still, I cannot imagine ever that teaching a nurse practitioner or a PA coming back to hurt me by losing patient volume...and in his last statement, about nurse practitioners replacing us.


I know Bret for many years, and when he was actively practicing podiatry, I know for a fact that he never worried about that, as I do not. As the nurse practitioner or similar professionals get more and more into podiatric care, it has nothing to do whatsoever with what podiatrists are teaching them, but rather what practice enhancing opportunities exist that podiatrists continue to trivialize or downright ignore.


Bryan C. Markinson, DPM, NY, NY



From: Ben Pearl, DPM, Stephen Peslar, BSc, DCh


The medical world is a big interconnected ocean; even more so in the age of the Internet. My experiences have led me to the conclusion that teaching is noble, but it is best to know your environment. Know whether you are swimming with the dolphins or the sharks.


Ben Pearl, DPM, Arlington, TX


I worked in a publicly funded foot clinic with 2 other podiatrists. We provided hands-on training to nurses. It seemed to go well. When 2 podiatrists retired, applications for funding 2 positions were filed with management, while the podiatrist and 3 foot care nurses were still at the foot clinic. Then a budget cut occurred and the podiatrist was downsized. Now there are 3 foot care nurses at the foot clinic. They refer patients to their PCPs when a foot problem or lesion requires advanced treatment or examination or radiographs. In retrospect, perhaps if the podiatrists did not train the nurses, then 3 podiatrists would still be working at the foot clinic. 


Stephen Peslar, BSc, DCh, Toronto, Ontario, Canada



From: Kathleen Satterfield, DPM


I was surprised to hear my friend Bret Ribotsky’s take on educating other healthcare providers as to the ways of podiatric care. My experience has been the opposite. In the early 2000s, I wrote a BHPR grant that called for cross-training between family practice physicians and podiatric residents at UT Health Science Center in San Antonio and it was generously funded. Our residents learned how to recognize common health problems they could treat as did FP residents learn how to take care of basic foot problems and more importantly when to refer to us for more complicated care.


It had exactly the opposite effect than what Dr. Ribotsky said. The Podiatric Service got more referrals as did the FP department but both were more accurate and useful. Unfortunately I left UTHSCSA before I had an opportunity to write up the study results but anecdotally they were positive. An internist may know how to perform an ingrown nail avulsion but that does not necessarily mean they are prepared to do it, comfortable to do it, or even want to do it.


I respect my colleague Dr. Ribotsky very much but my experience does not mirror his. In my experience, if interprofessional education teaches my colleagues to do what I do, it may instead make them respect my skills and say “You are the expert here. Please go ahead and do what you do best.”


Kathleen Satterfield, DPM, Pomona, CA



RE: WA Podiatrist Trains Nurses in Medical Grade Footcare (Bryan Markinson, DPM)

From: Bret Ribotsky, DPM, Sheldon Nadal, DPM


Editor's note: Dr. Ribotsky's video response can be viewed by clicking here


I agree with Dr. Markinson’s point of view. I think that by sharing your knowledge with other medical professionals, you are more likely to gain a fan and more referrals than lose referrals.


Sheldon Nadal, DPM, Toronto, Canada



From: Randall Brower, DPM


This article about flip-flops does a huge disservice to our profession. There is absolutely no "good" flip-flop on planet earth! Flip-flops require the foot to over-flex the toes, engage the Achilles too early during gait, and lead to neuromas, hammertoes, foot cramping, and Achilles tendinitis along with PT tendinitis among other over-use syndromes. Marketing gimmicks like "fit-flops" or arch-support flip-flops are terrible for our feet. 


I thought I would be preaching to the choir, but I guess not in this case. It's frustrating that podiatrists have been suckered in to marketing gurus who couldn't care less about feet. There are no biomechanical reasons we should be advocating for flip-flop usage. We, as foot health specialists, should only advocate footgear that is healthy for our feet.  


Randall Brower, DPM, Avondale, AZ



RE: TN Podiatrist Discusses Challenges of Being a Woman in a Man's World (Michael Schneider, DPM)

From: Jenneffer Pulapaka, DPM


A recent question was broached, “Should we reply back to his response?” My answer was swift. Yes, let me make this truly clear -- this is what epistemic entitlement looks like. Did Gina Mendoza ask you to validate her ordeals in residency? No. Do you have more relevant experience as a female resident? No. Are you inserting your disapproving opinion whereby downgrading her expertise as a female in her residency? Yes. You can now stop.


Gina Mendoza is a woman who need not defend her personal experience she thought to be challenging as a female. The fact this conversation continues demonstrates how mansplaining is institutional sexism that highlights an inequitable and imbalance of power in our society between men and women.


Jenneffer Pulapaka, DPM, Deland, FL


Editor’s note: This topic is now temporarily closed.



From: Connie Lee Bills, DPM


Thank you Dr. Pulapaka! I hear you! We are all fed up. Don’t forget to include financial discrimination!


Connie Lee Bills, DPM, Mt. Pleasant, MI



From: Michael Schneider, DPM


I simply asked that Dr. Mendoza’s claim be substantiated. Dr. Kiel said that “Dr. Mendoza, as a woman, is much more able to validly claim discrimination without written substantiation (which of course does not exist).” That opens a door that we actually do not want to go through. All claims of any type of discrimination should be verified lest we become a different type of society.


Michael Schneider, DPM, Denver, CO



From: Kenneth T. Goldstein, DPM


Congratulations to Dr. John Venson! He has given so much to the profession and will continue to do so for the school board. I am proud to be his classmate.


Kenneth T. Goldstein, DPM, Williamsville, NY



From: Brian Kiel, DPM


There may be a "climate" of gender equality but that does not mean there is equality. There is a "climate" of racial equality but climate does not mean equal treatment. Dr. Mendoza, as a woman, is much more able to validly claim discrimination without written substantiation (which of course does not exist). There is unequal treatment of people due to gender, race, or religion. To deny that this occurs is a result of the "privilege" of being a member of a class that does not have to be concerned about discrimination. 


Brian Kiel, DPM, Memphis, TN



From: Ben Pearl, DPM


Regarding my recent Interview with Golden Harper, there was a question by Dr. Steinberg  as  to his degree so I feel obliged to respond. Sometimes people get caught up in life and adventure and do not update various profiles publicly available such as Linkedin. It is best to check more than one source as vigorous journalistic and scientific principles demand. In a 2015 article, Y Magazine, off the Brigham Young website, Golden Harper is listed as a BS (2009) in exercise physiology. 


I was particularly impressed with Golden’s search for knowledge irrespective of what a study might say about the benefits of a particular concept related to his commercial interest of selling a running shoe. 


The study of biomechanics continues to be at times an elusive and controversial area due to the inherent problems of isolating a particular variable, capturing longitudinal data, and repeating trials. One of the things I learned at NIH and from my father, who was a grant administrator there, was to line up your ducks before you cleared your potential grant applicant lest you both end up with egg on your hands.


Ben Pearl, DPM, Arlington, VA



From: Eddie Davis, DPM


The running shoe industry has been able to save money on shoe manufacturing by moving away from structured shoes to shoes with soft single material midsoles. The industry goes through great lengths to justify why they have done so, basically telling us that what we know about biomechanics does not matter. Golden Harper, the creator of Altra shoes was interviewed by Ben Pearl, DPM. Harper stated, "Pronation, supination, and stability categories were not relevant in determining the proper running shoe." Harper described his shoes as being designed more for the natural way that we run.


What is the "natural way that we run?" Does placing a pillow under our feet not change the way we run? Are we to assume that the way each person runs is biomechanically efficient and does not lead to pain nor pathology? I think we know the answers to those questions. Hype from the companies selling overly soft, unsupportive, and unprotective shoes is not something we need accept.


Eddie Davis, DPM, San Antonio, TX



From: James R. Hanna, DPM


Dr. Morelli expressed displeasure about the way our profession was portrayed in a recent article from MSN Money Talks News. I will not comment on the content of that article; however, I take strong issue with his characterization of how local and national leadership represents the profession. Before becoming president of the New York State Podiatric Medical Association, I served on the Board of Trustees for many years. During that time, one of the committees that I co-chaired was the Public & Population Health Task force. This task force has been working hard for several years gathering data on how podiatry plays a significant role in major public health areas such as diabetes mellitus, obesity, the opioid crisis, and falls prevention. We are currently conducting a pilot program in falls prevention at Lenox Hill Hospital. This is an initiative in which the CMS has expressed great interest. This hard data will be used to demonstrate to anyone interested the absolutely vital role that podiatry plays in these areas.


Charles, I can state that throughout all my years in promoting and discussing the role of podiatry with high-level stakeholders at the local, state, and national level, I have not, nor have any of my colleagues,  brought up the topic of “flip-flops are bad for your feet”. Charles, I have known you for many years. If you truly do not know what NYSPMA and APMA do for you and our profession, please reach out to me. I assure you that I can talk your ear off on these matters as I have made them a cornerstone of my time in office.


James R. Hanna, DPM, President-New York State Podiatric Medical Association



From: Mark K Johnson, DPM


I could not agree more with Dr. Morelli‘s comments and assessment of the (my words) dumbing down and reality show subjects that are held up as examples of the expertise of our profession. The APMA and its components should focus on the elucidation to the public of our training, scope, and value of the medical, orthopedic, and surgical services that podiatric specialists offer in the 21st century.


Mark K Johnson, DPM, Bakersfield, CA



From: Robert S. Schwartz, CPed


As a fitter of footwear for over fifty years, here’s what I’ve learned. Generalizations don’t solve a specific persons footwear needs. Knowing the person’s biomechanics, lifestyle and activities, and psychosocial needs are of equal value in deciding what footwear is best for them. New Yorkers who walk for life chose “Five Finger’s” maximum stability footwear vs. twistable styles (when they were popular). Having to go up and down flights of stairs each day and walking on flat, concrete platforms also play a role in “best footwear guidance”. 


Do a forensic on the wear patterns of your patient’s footwear and correlate this with your clinical judgment to achieve best outcomes. Flexible, twistable, stable, “zero-drop”, rocker, toe-spring, medial and lateral reinforcements, stabilizers, counters, are all relevant, only different for each person. Generalizations like stereotyping are often referred to today as being “tone deaf.”


Robert S. Schwartz, CPed, NY, NY



From: David E. Samuel, DPM


Way to go Dr. Kirby. A solid knowledgeable opinion on a very high-end performance shoe. We all need to be very cognizant about how we recommend or opine on products out there without having all the facts/and or actually treating those high-end athletes on a very regular basis and not just seeing a runner or basketball player now and again. This is especially true when these statements are put out in a public forum or widely published article. I bet Nike would not be too pleased either. These athletes are VERY different and this is why these new designs are being engineered from running shoes to hockey skates.


David E. Samuel, DPM, Springfield, PA



From: Kevin A. Kirby, DPM


The big story about the Nike Vaporfly 4% running shoes are not its upper material. Rather, it is the revolutionary combination of a compliant, resilient, and lightweight midsole foam along with a carbon-fiber plate embedded within that midsole foam that makes the Nike Vaporfly shoe so special.


The name “Vaporfly 4%” came about since Nike’s own research by Hoogkamer, et al., published in 2018, showed their shoe reduced the energetic cost of running in all 18 subjects tested, with the Vaporfly 4% shoe being about 4% more energy efficient compared to two other popular marathon racing shoes, the....


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



From: Keith L. Gurnick, DPM


Before I enter a treatment room and greet and meet a new patient on the initial visit, I am already somewhat aware of their chief complaint or main concern(s). On some patients, the concerns are diagnosed quickly and the remedies can be simple, yet they are entitled to and get a proper and thorough examination. Often, however, the patient concerns are more complex, or involve multiple issues, and thus require not only more time, examination, and testing, but also a high level of expertise and experience to diagnose accurately, and develop treatment plans that will yield good outcomes. Experienced and well-trained podiatrists should have this high level of expertise that other healthcare providers just do not have. Replacing doctors with nurses is done for one purpose only, to reduce expenses and make more profits.


Substituting nurses for doctors is another example of The Peter Principle. I would not want to relegate the quality of care that I provide to the entirety of my patient population to any nurse. The Peter Principle is an observation that the tendency in most organizational hierarchies is for employees to rise in the hierarchy through promotion until they reach a level of respective incompetence.  


Keith L. Gurnick, DPM, Los Angeles, CA



From: Joshua Kaye, DPM


During a recent hiking trip in Patagonia, Chile, we were in a bus full of hikers. There were several large signs written in both English and Spanish requesting that the hikers do not remove their shoes due to the foot odor. Our seasoned guide told us that most people don’t understand the importance of choosing the best sock fibers for outdoor activities. Cotton is clearly the worst as it retains perspiration, creating a damp uncomfortable foot. Almost as bad as cotton are the plastic fiber socks containing blends of polyester, nylon, or similar synthetic fibers that supposedly “wick”. Such socks are sold under trade names such as Coolmax or Drymax. Those plastic fibers generate foul foot odor after a short period of use.  


Without doubt, as my professional hiking guide said, the best socks contain a high percentage of merino wool. Not only are they the most comfortable, made of a natural fiber, provide true wicking, but can be worn for several days without laundering without producing any odor. I was very surprised at his knowledge about sock fibers. He suggested that when I return to America, I should do a comparison study for myself. Skeptically, I did his experiment. He was 100% correct. Since then, I tell my patients that once you go to a high percentage wool blend sock, you will never go back to smelly plastic socks. Similar thin dress socks are also available for more formal use when you can “air out” your feet without embarrassment.


Joshua Kaye, DPM, Los Angeles, CA



From:  Robert Kornfeld, DPM


I’m sorry and disappointed to see this kind of biased reporting on this site. CBD has been legalized in all 50 states for use in adult humans and pets (not children other than for seizures). There is far from a paucity of literature about its safety and efficacy. It has been well studied for years and there are still ongoing studies. Yes, there are unscrupulous companies out there. Selling to pregnant women is unethical since there are no teratogenicity studies. Putting it in food is a direct violation of FDA guidelines. It doesn’t belong in food no more than ibuprofen belongs in food.


Claims for its effects in advertising and on labels will always be an issue with the FDA since they don’t allow claims to be made for any natural substance. Putting in chemical additives is another issue. I’m all for removing companies like this from the market. However, this FDA release smacks of BIG PHARMA. There are NO studies to show it can do harm when...


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



From: Tip Sullivan, DPM


I just don't get it? This type of promotion by companies is done in almost every business. I don't see anything morally or ethically wrong with it! I think companies should pay doctors like they do professional athletes to promote them to other doctors and the public. Give me a bunch of money and I’ll wear a scrub hat with your name on it or a set of O.R. scrubs with your company's name plastered all over it. 


Tip Sullivan, DPM, Jackson, MS



From: Dan Chaskin, DPM


Thank you PM News, for bringing Richard Willner's accomplishments to our attention. Even more importantly, thanks for mentioning there is someone available to defend podiatrists and physicians against a sham peer review.


Dan Chaskin, DPM, Ridgewood, NY



From: Elliot Udell, DPM


The American Society of Podiatric Medicine congratulates our executive board member, Dr. Arthur Helfand, on having a chapter published in a text on gerontology. Because of Dr. Helfand's teachings, The American Society of Podiatric Medicine has now dedicated itself to advancing the cause of geriatrics within our profession. To this end, all future lectures and conferences sponsored or co-sponsored by the ASPM will contain lectures on podo-geriatrics. 


Elliot Udell, DPM, Hicksville, NY

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