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09/30/2021
RESPONSES/COMMENTS (NON-CLINICAL)
From: Estelle Albright, DPM
Still drilling nails with Dremel drills? These are designed for woodworking, not for medical use. There is no need for podiatrists to be drilling toenails, especially with non-medical tools. I have found that sharp, high quality nail cutters or double-action bone cutters work well on dystrophic nails. This is safer, without nail dust aerosolization risks.
Estelle Albright, DPM, Indianapolis, IN
Other messages in this thread:
10/13/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Medicare Shutdown and Cash Flow
Right now, cash practices are in good shape. Medicare is shut down. We know it’s temporary, but it impacts any practice with low cash flow.
Steven Finer, DPM, Philadelphia, PA
10/06/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Decreasing Malpractice Risk Using a Team Approach
Steven Kravitz, DPM
There has been a lot of literature regarding techniques to avoid malpractice suits. One aspect I do not find discussed as much is selection of patients and not being afraid to reter patients elsewhere when staff or the physician is not comfortable selecting the patient as a surgical candidate.
This includes collaborating closely with a good staff who can also identify aspects of a particular patient that the physician may not identify. Staff may have more time to discuss different aspects and pick up nuances with the patient that the doctor may not have seen. In short, reducing risk by selecting patients is a team approach with physician and staff working closely together to best select patients that they believe are good surgical candidates and will decrease risk of a lawsuit.
Different people have different personalities but that does not mean the patient has to be the doctor's best friend, but it does mean that you, as the physician involved, and the patient must feel comfortable working with each other before you take the knife to the patient.
Steven Kravitz, DPM, Winston-Salem N.C. area
09/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Mark Light, DPM
You can check with Frankford Leather Company in Bensalem, PA
Mark Light, DPM, Marietta, GA.
09/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Doug Richie, DPM
I appreciate the comments made by Dr. Kesselman regarding the role of the podiatric physician in preventing falls in elderly patients. However, I am confused by his statement "Prescriptions and orders for AFO and walker will no doubt fail if the primary reason for the patient's fall risks are not properly addressed."
I am not aware of any studies which verify that an AFO or a walker will prevent falls in non-neurologic impaired patients. Furthermore, I am not aware that addressing "the primary reason for the patient's falls risk" is somehow a requirement which could possibly justify reimbursement for AFOs and walkers specific to the medical necessity of falls prevention? Perhaps Dr. Kesselman can explain the advice he provided in his post?
Doug Richie, DPM, Long Beach, CA
09/16/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bob Smith, DPM, MSc, RPh
I would like to thank and applaud Dr. Kesselman for his communication centered on the increased risk of fatal falls. I also encourage all medical professionals to not only explore these recent suggested literature sources. Twenty-five years ago, I started researching and developed a narrative that was published as: Smith RG. Fall-contributing adverse effects of the most frequently prescribed drugs. J Am Podiatr Med Assoc. 2003 Jan-Feb;93(1):42-50. The foremost reason, the purpose of this narrative was to document the possible plausibility and causality of medication inducing adverse effects. Given the advances in technology, leaders in our profession indicate that podiatrists should be the leading professionals to identify and prevent falls among our most vulnerable populations.
In July of 2025, I began a systematic literature review to obtain actual statistics and numbers of medications that induce fall injury. I have obtained a...
Editor's note: Dr. Smith's extended-length letter can be read here.
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Keith L. Gurnick, DPM
Frustrating as it may be, there are still some medical specialists who are so full of themselves that they feel comfortable giving patients mis-information on topics where they have little expertise or experience. In the world of custom prescription foot orthotics, this is also commonplace. Trying to educate these "experts in everything" is a noble effort, but I prefer to pick and choose my battles and fight the battles I know I can win. I would rather spend my time educating my patients than educating the doctor who probably made a quick off-the-cuff remark anyway.
Patient education should have been done in advance, not retroactively when the concern or complaint was presented. Regarding a refund. If a patient wants their money returned, the reason is inconsequential. I would give the money back; it happens so infrequently it does not matter. If the orthotics have already been dispensed, I would first get the orthotics back, and if they have not been made, I would cancel the order. If they have been made but not dispensed, I would pay the lab fee, and I now have a brand new unused set of orthotics to show the next patient what a custom prescription foot orthotics looks like.
Keith L. Gurnick, DPM, Los Angeles, CA
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Increased Risk of Fatal Falls
From: Paul Kesselman, DPM
A recent article in September 7, 2025 NY Times entitled "Why Are More Older People Dying After Falls," is a must read for every physician, no matter their specialty. The NY Times article points out a three-fold increase in fatal falls over the last thirty years. This compared to a decreased or steady number of fatal falls per capita in other countries.
The reason cited by both the NY Times and its source is the increased reliance on Fall Risk Increased Drugs (FRID) in the U.S. JAMA News while a much lengthier read, provides a substantial amount of statistical analysis and is the foundation of the findings cited in the NY Times article..
Having no other motive but to decrease falls in our most fragile patients, it is imperative to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1D
From: Burton J. Katzen, DPM
When I was in practice and was confronted with this problem comparing orthotics/Hyprocure to store bought arch supports, I would try to educate the patient in layman's terms the difference between pronation and simple flattening of the arch, telling the patient that the majority of the problem was not the height of the arch, but the amount of abnormal motion that occurred when the foot beared weight.
I would demonstrate this by forcefully "shoving" my fist into the patient's arch and showing that I could still easily pronate/evert, or in their words, "flatten" the foot from the sub-talar joint, imitating what an arch support did. I would then lock in the heel with just my thumb to show that I could no longer pronate the foot to demonstrate the difference in control.
I also would never knock a store-bought orthotic telling the patient that, "Hey, The reason Dr. Scholl was rich is because store-bought arch supports do work for many people just like store-bought readers do work for some patients, but other patients need professional care." Also, in my experience, most of the patients I came into contact with had already tried the store bought orthotics.
Burton J. Katzen, DPM (Retired), West Pam Beach, FL
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: David S. Wolf, DPM
I can understand your frustration—and fortunately not very common. When I was in practice, I would have taken the high road in these situations and re-focus the conversation on patient education. I explained the purpose of the custom orthotics, the biomechanics involved, and why we recommended them based on their specific foot structure and pathology.
If they’re still not receptive and demanding, I would make a refund. For every one non-compliant patient, there were too many to count compliant patients. Ultimately—is the time, energy, and potential negative review worth the fee? And most importantly, I wouldn't let one orthopedist's opinion shake your confidence in the value of what we do.
Sometimes, it’s just better to give a refund and move on to the next treatment room. Say to yourself before you walk in, "It's showtime"-and make that patient feel like they are the only patient you have. Patients don't care what you know, they just want to know that you care (Bernie Hirsch, of blessed memory).
David S. Wolf, DPM, retired
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Dieter J Fellner, DPM, Ivar E. Roth, DPM, MPH
Custom orthoses cost hundreds more than OTC devices, and current evidence shows they don’t correct bunion deformity and are not superior to pre-fabs for most common foot pain. However, that doesn’t make them “bogus.” Orthoses can reduce pain and plantar loading, and custom devices are appropriate for patients with complex foot structure or failed OTC trials. For early bunions with over-pronation, they won’t reverse the deformity, but they can reduce symptoms and mechanical stress—which is a valid treatment goal. Our job is simply to match the level of support to the patient’s needs, not to oversell either option.
I guess the question, then, is what unique biomechanical findings does the patient have, to warrant the added expenditure?
Dieter J Fellner, DPM, NY, NY
I would call up the orthopedist and make an appointment to go speak to him. Here is a way to turn a lemon into lemonade. In this meeting, explain what you are doing and why it is preferred to an OTC insole. Hopefully, you can get him to send to you all of his foot patients who need orthotics. It is certainly worth the effort in my opinion. Or make a pair for him gratis. I recently made a pair for an orthopedist in town, and now he sends me ALL his orthotics that he was sending to Hanger.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Carl Solomon, DPM, Bret Ribotsky,, DPM
My response has always been that custom orthotics vs. off-the-shelf are akin to prescription eyeglasses vs. "readers' purchased at the drug store. I told patients that it probably wouldn't hurt to try the OTCs and occasionally with a little luck, they may help some. But although there are no guarantees, the custom orthotics (like prescription eyeglasses) are more likely to be effective since they are custom-fabricated to address a specific problem. In actual practice, it hasn't really happened but If a dissatisfied patient elects to change their mind and cancel them before lab fees are incurred, I suppose I'd give them a refund. Otherwise, if based upon someone else's criticism alone, I would not.
Carl Solomon, DPM, Retired, Dallas, TX
This is an incredible opportunity to turn lemons into Limoncello. I dealt with this often when I first started practicing a long, long time ago. What I would always do is call the orthopedics office, set up an appointment to either meet him for breakfast or dinner, and spend the time to show him how custom biomechanical orthotics can reduce the pain in a patient’s knees and prolong his knee replacements and hip replacement by realigning the forces. Every time I did this, I was able to generate an additional 20 to 50 pairs of orthotics a year from each orthopedist.
Bret Ribotsky, DPM, Fort Lauderdale, FL
09/02/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Bagel Theory of Office Visit Pricing
From: Al Musella, DPM
One of my favorite teachers, the late Jules Shangold, back at NYCPM in the early 1980s used to tell us he set his office visit price at 100 times the cost of a bagel. At the time, a bagel was 15 cents so his office visit was $15. Today, I purchased a bagel for $5. So should we be charging $500 per visit?
Al Musella, DPM, Hewlett, NY
08/26/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Podiatric Groundhog Day
From: Rod Tomczak, DPM, MD, EdD
I came across the book The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons, written by historian Kenneth Durr, PhD with Jerome S. Noll, DPM, EdD. It can be downloaded here as a .PDF.
I suggest that everyone concerned about the growth pains podiatry is experiencing read the salient parts of the 180 page book (first 90 pages) to come to the conclusion that as we grow, we keep getting in our own way, stumbling over our own feet, and continue to be jealous of those that have a little bit more. Except for our growth in podiatric knowledge and scientific/procedural advancements, we are right where we were in the 1950s and '60s. They argued about certification,...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/25/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Joel Lang, DPM
Many years ago, when I first came under the tutelage of Dr. Charlie Turchin, one of the first things he taught was to remove all the springs from clippers and nippers. His reasoning was that you get a better precision and feel for the tissue you are cutting through without having to first overcome the resistance of the spring.
I admit that at first it seemed awkward and difficult and required a different grip on the instrument. My 4th finger became the spring. Once mastered, it did give me a better feel for the tissue. I never used a spring on an instrument for the remainder of my 32 years of practice. Try it!
Joel Lang, DPM, Retired, Cheverly, MD
08/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Dominic Bianco
While it may be more reasonable to change the springs in-house, it can be a daunting and dangerous task. Through my 50 years of providing quality service to podiatrists, I have probably changed and installed well over a million nail nippers springs. Things can happen. Screws can break, screwdrivers can cut your hand, especially a screwdriver that is thin enough to properly loosen and tighten the very small screws.
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Screwdriver injury |
Nail cutters are usually sharp; they can also cut you. I’ve been wounded by screwdrivers many times. This one being the worse case. We have thousands of springs and nipper screws in stock and we can also make custom size springs for any instrument, if needed.
Dominic Bianco, CEO Bianco Instruments LLC
08/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Keith Gurnick, DPM
In my office, I keep a small box filled with used, worn out or broken instrument spare parts, and screws from broken tissue nippers and nail trimmers with broken springs. Often, when a spring breaks on a tissue nipper or a toenail clipper, I can easily replace the broken part quickly and simply with a similar part that I saved, and am able to locate in the box. Otherwise, the broken instrument goes into the box, or into the trash, and I will purchase new ones.
However, if you have broken two out of four new nail nippers, either the quality of the nipper is poor (Pakistani stainless steel vs. German stainless steel) or you are using too small of a clipper on too thick a toenail, or you may be heavy-handed or rushing, or you might just need a larger nail clipper, or you may need to "adjust" or "modify" your toenail clipping technique.
Keith Gurnick, DPM, Los Angeles, CA
08/11/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: How About Three Cheers for Podiatry?
From: Lawrence Rubin, DPM
Let's start patting ourselves on the back for choosing the profession of podiatry. What physician other than the podiatric physician has the opportunity virtually every day of clinical practice to use simple fishing line-type calibrated nylon filaments to check for undiagnosed and untreated diabetic peripheral neuropathy -- and by doing so, potentially prevent a limb from being amputated, and by this, increase that patient's life expectancy?
Three cheers for podiatry, please!
Lawrence Rubin, DPM, Las Vegas, NV
08/08/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Beware of Insurance Phishing Scam
From: Howard Dinowitz, DPM
i wanted to alert PM News to an issue I found in my email. I had it verified that it was a phishing scam. The letter statied that they need verification of a check from an insurance company with a stated amount and a bonafide insurance company that I have submitted claims to in the past.
It had the date of service, my TIN number, but it was lacking the patient's name. They wanted me to fill out the questionnaire to get a check sent to me. After searching through my EMR for 3 years of service, I discovered there was no such claim with that insurance company. The thought process was that this very well could have been from the Change healthcare fiasco. Let this serve as a warning to those receiving similar emails. It looked too good and it was.
Howard Dinowitz, DPM, Brooklyn, NY
08/06/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: DPM, Nurse Practitioner
From: Daniel Chaskin, DPM
Instead of getting an off-shore MD degree, why not work out an agreement with nursing schools so that a DPM might have advanced standing to get that NP degree in less time than a normal nursing student. This way, an unlimited license can be obtained with an NP degree without worrying about getting a residency match with a U.S. medical residency program.
With the DPM degree and NP degree, one can then apply for a podiatric residency program and treat all foot and leg problems without worrying about getting an ankle permit. After all, an NP is licensed to treat the entire body. My question is how many podiatrists obtained NP degrees or nursing degrees?
Daniel Chaskin, DPM, Ridgewood, NY
07/31/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
Thank you, Dr. DiResta, for pointing out the fact that APMA discontinued their sponsorship of the Dartmouth MPH program. I was totally unaware of that, but the fact remains that when it was in place, it provided graduates who went onto non-clinical careers or it simply improved those individual's status in whatever clinical programs they were involved with. Now that Becker's has published the story I wrote about where both MD and DO programs are offering dual programs for medicine and MPH or MBA, perhaps it is time that APMA reassess its importance. Perhaps APMA, if it cannot afford to sponsor this program itself, can partner with other private enterprises which have profited from podiatry well over the years to offer such scholarships to individuals interested in one of these programs.
I have been made aware for some time that APMA has serious financial issues. Having been a member of various committees over the years as well as...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: William Wayne Egelston, DPM
I too enjoy the posts in PM News. Whether one agrees with the authors or not, doesn't detract from their insightfulness. I appreciate the dialogue presented by Drs. Kesselman and DiResta and others on this topic. Considering how things are evolving for podiatrists with diminishing numbers of qualified (academically prepared) applicants, likelihood of schools (some or all) closing and increasing number of MD/DO schools on the horizon. It would seem to me a likely scenario might be that future applicants matriculate to MD/DO schools (domestic/foreign), complete orthopedic residencies and foot and ankle fellowships (or others), then train physician extenders (LVN, RN, NP, PA, etc.) in C&C, nail care, and primary podiatry. I see this as a more plausible pathway than watching our decline and obsolescence.
I see this as I, along with other DPMs at Kaiser (California), functioned in...
Editor's note: Dr. Egelston's extended-length letter can be read here.
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Dr. DiResta gets it! It's not because he mentions me or my ideas about the DO path to an unrestricted license but because of his observations concerning the DPM degree NOT being a starting point to move forward. It is a starting point to move laterally. You can have an MHA, MPH, or a PhD in healthcare, but try to aspirate a knee and see how far a master's degree gets you.
Get the DO degree, then enough ACGME-approved residency time to get an unrestricted license, followed by an APMA fellowship in podiatry from Temple, Touro, LECOM, DMU, or UTRGV. Now you can move forward from your starting point.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
07/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: AOFAS and Podiatry
From: Jeffrey Trantalis, DPM
The American Orthopaedic Foot & Ankle Society (AOFAS) was started in Chicago in 1969. The organization officially added “Ankle” to its name in 1983 to reflect a broader clinical and surgical focus. I was practicing in The State of Washington during this time. One of their goals was to put podiatrists out of business. The irony and sad part of all this is that some of the orthopedists were trained by a podiatrist at Harborview Hospital. Now they have their own institution teaching our profession to orthopedists. The bottle has been opened and now we are paying for it.
Jeffrey Trantalis, DPM, (Retired), Delray Beach, FL
07/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: James DiResta, DPM, MPH
I normally enjoy comments from Dr. Kesselman on the blog, but I do believe he has missed the mark on his recent entry regarding the DPM degree. I can also speak to his comment on the fellowship program at Dartmouth which had been a positive initiative for the profession, but it is simply not true that this is just getting started in the world of allopathic medicine. I completed the program at Dartmouth from 2002 thru 2004 in the initial MPH class and was taught by several MD/MPH faculty. I chose Dartmouth because of their initiative to change the business of what we knew as healthcare delivery and, for both good and bad, they were influential in forming the Affordable Care Act (Obamacare) and the development of what we know today as an Accountable Care Organization (ACO). They continue to be a leader in healthcare delivery innovation.
What I don't think Paul realized is that with present financial constraints on APMA, they have chosen to place their priorities elsewhere and discontinued funding for this fellowship program. This program provided the opportunity for fellows like...
Editor's note: Dr. DiResta's extended-length letter can be read here.
07/28/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: DPM is NOT a Dead-End Degree; It Is Just a Starting Point
From: Paul Kesselman, DPM
Over the last few years, there has been an increase in the "bashing" of the DPM degree by many of my colleagues. Fortunately, there have been many of my colleagues who have called for this eternal bashing to stop. The reasons for those who are not happy with their current lot vary as do those who are satisfied with their careers. But I suspect there are many in the MD/DO, JD, accounting, and other fields who are also not happy with their current career path.
I am not an occupational sociologist or psychologist and cannot get into the mindset of those who constantly bash this profession or specialty (that too seems to be debatable). The purpose of this letter is to demonstrate that there are many individuals who have taken their DPM and used it as a springboard to go...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
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