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12/13/2021
QUERIES
Query: Medicare Part “D” Approved Antifungal Creams
I am curious what others are prescribing as topical antifungal creams that are covered by Medicare Part “D” or supplemental plans. Personally, I got so tired of filling out medical necessity forms that were ultimately denied anyway that I am currently prescribing ketoconazole, ciclopirox, olamine, or nystatin.
The challenge that I have is these are rarely listed as medications of choice by the clinical laboratories, yet those are either OTC (e.g., terbinafine, tolnaftate, etc.) or routinely denied when prescribed.
Richard A. Simmons, DPM, Rockledge, FL
Other messages in this thread:
09/13/2025
QUERIES (NON-CLINICAL)
Query: Sources for Spenco Products
Does anyone have any sources for Spenco products?
A James Fisher, DPM, Eureka, CA
09/11/2025
QUERIES (NON-CLINICAL)
Query: When an Orthopedist Tells Your Patient That Orthotics Are Bogus
I thought I had seen everything until today. A patient presented with plantar fasciitis, early bunions, and abnormal foot pronation. I cast him for custom orthotics. Today, he presented to the office all upset. He had gone to a local orthopedist for something else and ran past his foot history. The orthopedist told him that custom orthotics are bogus and he should get a refund from me and then go and buy Dr. Scholl’s at a kiosk at CVS.
I explained the differences between a Dr. Scholl’s OTC orthotic and what we made for him. How have others dealt with this problem? Would you give the patient a refund based on an orthopedist’s opinion on orthotics?
Elliot Udell, DPM, Hicksville, NY
08/29/2025
QUERIES (MEDICAL MALPRACTICE INSURANCE)
Query: Per Occurrence Malpractice Insurance in California
Just a quick note to all podiatrists regarding insurance coverage at California owned SNFs--PICA doesn't write "per occurrence" policies in California. I am losing an account/contract I've had for 7 years because of this issue. The State of California requires per occurrence coverage. I am going down the list of Med Mal insurers online and am receiving this negative response from them all. Has anyone else had to navigate this issue in California?
John F Swaim, DPM, Red Bluff, CA
08/26/2025
QUERIES (CLINICAL)
Query: Recommended Time Period Between Neuroma Injections
What is the recommended time period between multiple (3) injections for treating neuromas? Each injection is 3cc containing equal parts of: 1% Xylocaine, Kenalog, and Vitamin B12. Orthotics, with the appropriate placed neuroma pads, are also dispensed.
Kel Sherkin, DPM, Toronto, Canada
08/26/2025
QUERIES (NON-CLINICAL)
Query: Jasper Colin Research
I received a solicitation from Jasper Colin Research regarding paid survey participation. I am looking for good and/or bad experiences from others who have worked with them. This would be helpful not only to me but for anyone else here who is approached by them.
H. David Gottlieb, DPM, Baltimore, MD
08/21/2025
QUERIES (NON-CLINICAL)
Query: Source for Broken Springs on Nail Nippers
On four new nail nippers, the spring broke on two of them. When I called the podiatric equipment distributor, I was told that this is normal wear and tear and that they could send it to be fixed which would take 8-10 weeks.
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Broken Springs on Nail Nippers |
From what I can tell, I just need the spring and a screwdriver. Does anyone know where the springs can be purchased?
Richard A. Simmons, DPM Rockledge, FL
08/16/2025
QUERIES (CLINICAL)
Query: Infection Post-Repair of Ruptured Achilles Tendon
A 69 year old female with a PMH of RA ruptured her tibialis anterior tendon at the insertion. She takes methotrexate, plaquenil, and sulfasalazine, along with monthly Orencia infusions, but has held off on the infusions since her surgery 4 months ago. Repair was performed with Arthrex suture tape, anchoring it with a bioabsorbable Swivelock anchor. This was reinforced with a Wright GraftJacket wrap since the tendon was quite damaged. Unfortunately, she has developed a draining 2mm sinus tract at the incision and presumably has infection within either the graft, the suture, or both.
X-rays do not show any concern for bone erosion. Cultures have grown staph hominis and she has been on appropriate IV antibiotics directed by ID for 6 weeks with no resolution. I was contemplating doing a limited debridement of the sinus tract and an adjacent graft or visible suture fibers, possibly dropping some Vanco powder there in an attempt to eradicate this infection. I know there is no way to remove the entire graft and suture without compromising the tendon and giving her drop foot. I did a long Krackow suture to secure it, which is deeply buried within the tendon and bone anchor. She has minimal pain, is active, and is walking about 7 miles/day for exercise. I am just trying to do anything to avoid sacrificing the tendon and would appreciate any advice.
08/16/2025
QUERIES (NON-CLINICAL)
Query: Butterfly vs. Clarius Portable Ultrasound Machines
I am deciding between the Butterfly and Clarius portable ultrasound machines. I would appreciate feedback from any users of these particular brands. I have researched the pros, cons, and pricing of both and they are similar. I am now relying on actual user experience.
Anas Khoury, DPM, Passaic NJ
08/06/2025
QUERIES (BOARD CERTIFICATION)
Query: Board Re-Certification
I have been board certified in podiatry and podiatric surgery for 15 years with the American Board of Lower Extremity Surgery (ABLES). At the time of certification, they accepted my written board examination passing status through the American College of Foot and Ankle Surgery (ACFAS). I had to undergo re-certification every 5 years through case submission, discussion, and review. ABLES was acquired by another certifying board, who has provided verification of certification status for the past 2 years. With my certification expiring soon, this board has told me that I will have to sit for the board exam and submit 50 surgical cases.
I have been in private practice for 20 years and I never imagined I would be sitting for a board exam at this point in my career. As though running a busy solo practice and fighting with insurance companies was not enough already, this adds a bit of stress (not to mention the expense of the application and testing). Is there any advice from others? I have already spoken on the phone with the president of the new certifying board and have gotten nowhere. Another certifying board that I contacted also requires the same process.
Richard D Wolff, DPM, Oregon, OH
08/05/2025
QUERIES (CLINICAL)
Query: The Use of Injectable Hyluronidase Gel for Arthritis of the Feet
For decades, orthopedists and other medical specialists have been injecting hyluronidase gel into knees. There have been a few papers published suggesting that this can be helpful with arthritis of the foot and ankle. Question: How many of you have used this for foot and ankle arthritic conditions and does insurance cover it for foot and ankle osteoarthritic conditions?
Elliot Udell, DPM, Hicksville, NY
07/18/2025
QUERIES (FOOTWEAR)
Query: STAND+ Shoes
Being podiatrists, we are always looking for good shoe options to suggest to our patients, friends, and family. Recently, I came across a shoe called STAND+. Two models of most interest are the Antigrav1 and Antigrav2. Their website states their line of shoes have the American Podiatric Medical Association Seal of Approval. Has anyone tried on these shoes or know about this brand? Any input would be greatly appreciated.
Jack Ressler, DPM, Boca Raton, FL
07/16/2025
QUERIES (CLASS ACTION LAWSUITS)
Query: BC/BS Class Action Settlement (Howard Dinowitz, DPM)
My office manager is concerned BCBS will drop us if we sign up with the Class Action Settlement. BCBS is our best-paying insurance company and we do not want to be dropped from this insurance plan.
Florida Podiatrist
Editor’s comment: PM News does not provide legal advice. In a class action settlement, the defendant generally admits no guilt but agrees to pay a stipulated amount to eligible plaintiffs who file a claim and have not opted out of the settlement. In this case, if it could be proven that BC/BS dropped a provider strictly because the provider filed a valid claim, most courts would consider this “retaliatory” and would subject BC/BS further litigation. Since thousands of claims have already been filed, it’s hard to imagine BC/BS taking this action. Finally, the settlement money from any valid claimant who fails to file merely gets distributed to those who filed valid claims.
07/15/2025
QUERIES (MEDICAL-LEGAL)
Query: Consent for Taking Cultures?
My patient just called me about a bill she got from a lab for toenail testing. She said she had no knowledge that she was tested and she is refusing to pay the lab bill. From now on, I am having people sign a form acknowledging testing (toenail or wound culture), just like I do when prescribing orthotics, CAM walkers, etc. Is there a protocol for having a patient sign a consent form when you take either a wound or toenail culture? Any thoughts?
Name Withheld
07/14/2025
QUERIES (MEDICAL-LEGAL)
Query: Is This a Stark Law Violation?
My office has been approached by EBM Medical to offer compound prescriptions that are not covered by Medicare. Physicians are paid “directly by patients”.
Considering the recent article on the Stark Law, is EBM Medical’s business model to reimburse physicians for compounds ordered directly to patients legal?
Scott T Grodman, DPM, Taylor, MI
07/10/2025
QUERIES (CME PROGRAMS)
Query: New CPME CME Rule
I am a podiatrist in Ohio. It is my understanding the State Medical Board now has a new rule where only the amount spent on a CME is the credit given. For instance, if a physician watches a video for CME, but the video is only 57 minutes long and not one hour, a full credit will not be awarded and only a credit equaling the 57 minutes is given. How will this affect the Podiatry Management CME credits?
Rosella Gabriele, DPM, Cleveland, OH
Editor’s Response: This new CPME rule, which took effect on July 1, 2025 does not affect Podiatry Management’s instructional media CPME-Approved CME program. It only affects programs that use a lecturer, either live or online. PM’s CMEs are each 1.5 credit hours as certified by a psychometrician.
06/25/2025
QUERIES (DEA)
Query: Mate Training
My DEA license renews July 31. I need to complete the 8 hours of opioid education requirement.
I have contacted our state board (KY) who didn't have any information. I sent an email to the DEA asking for guidance without response. Is there a specific MATE training for podiatry? Does any online MATE training suffice?
Steven Block, DPM, Owensboro, KY
06/20/2025
QUERIES (CLINICAL)
Query: Management of Fryberg’s Infraction
My patient is a 13-year-old diabetic female who is a very active soccer player. She recently went through a nutritional issue as she was bulimic for about six months. This has been managed and she’s doing well. She showed up to my office with pain into the third and fourth metatarsal heads and we have an MRI that’s consistent with acute Fryberg’s infraction. I would be very interested to hear how people have managed this.
06/12/2025
QUERIES (CLINICAL)
Query: Hyluronidase for Scar Tissue
I have a patient who is suffering from chronic pain from what I think is scar tissue at the first branch of the lateral plantar nerve. It is affecting the quality of their life. They had surgery for removal of an accessory soleus that was causing pain but it left them with scar tissue causing nerve entanglement. This has been confirmed by post-operative MRI. Local blocks, multiple shots of cortisone, desiccated alcohol, and most recently D5W perineurial injections have all failed in fact some have exacerbated the problem.
She came to see me to discuss hyluronidase injections into the scar tissue to see if that would help. She is vehemently opposed to any other surgery which I don’t blame her. She is a good patient and has reasonable expectations. Does anyone have experience with the use of hyluronidase to reduce scar tissue and what protocols and dosages are being administered?
06/10/2025
QUERIES (EMR)
Query: Recommendations of Podiatry-Specific EMR
I am looking for a podiatry-specific EMR. Any recommendations?
Daniel Kormylo, DPM, Rocky Point, NY
06/09/2025
QUERIES (NON-CLINICAL)
Query: Medicare Verification Websites
Any recommendations for a Medicare verification website? Which are the least expensive ones?
Stan Luksenburg, DPM, Cleveland, OH
06/06/2025
QUERIES (CLINICAL)
Query: Taking Blood Pressure Prior to Minor Procedures
I’d like to ask a question about an incident that occurred the other day. I was excising a painful hyperkeratotic lesion from the 5th toe lateral proximal nail fold with lidocaine plain. During the excision of this 3 mm lesion, bleeding did not stop for more than 30 minutes. I decided to take her blood pressure which was 206/104. I assumed her BP was causing this bleeding issue since she was not on any anticoagulants, no hematologic pathologies as per her PCP.
I’d like to ask if we should take BPs on patients we are doing any procedure on as minor as this is. P.S. the bleeding finally stopped, but I did send her to the ED which confirmed hypertension as well. The lesion was sent for pathology.
Name Withheld
06/05/2025
QUERIES (LICENSING ISSUES)
Query: Preparation Materials for PM Lexus Exam
I'm a retired podiatrist wanting to re-establish my license in CA, so I need to take the PM Lexus Exam. The problem is I can't find any specific preparation materials for that test. Do you know of any such preparation materials? Are there any other study materials in particular that can prepare you for that test?
Name Withheld
06/05/2025
QUERIES (DEALING WITH PATIENTS)
Query: Patients Who Want to be Seen Immediately
We are noticing a trend in our community, and I'd like to know how others are addressing this issue. The problem is that we are getting calls from more and more patients who want to be seen "today", and if we are booked or closed for that day, they go elsewhere. These are not patients with true emergencies who absolutely must be seen immediately. It could be a patient with a mycotic nail or some other foot condition that has persisted for a while and they decided that they finally want to see a podiatrist and don't want to wait for an appointment.
If this is indeed a trend, how are others addressing this situation without having to keep your offices open 24/7.
Elliot Udell, DPM, Hicksville, NY
06/03/2025
QUERIES (CLINICAL)
Query: Short Proximal Phalanx
Over the 36 years of surgery, I have done many osteoclasis procedures on metatarsals—but never on a proximal phalanx alone. A gradual lengthening is preferred over a single stage lengthening due to vascular concerns.
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Short Proximal Phalanx |
I am planning to place the proximal pins in the metatarsal and the distal pins in the distal aspect of the proximal phalanx. I am open to comments and suggestions.
05/16/2025
QUERIES (CLINICAL)
RE: Unusual Surgical Suture
Gary Smith, DPM
I saw a patient this week who showed me their hernia repair incision 3 weeks post-op. The incision had been closed with 10 external horizontal mattress sutures with what appears to be 2-0 Vicryl. The incision seems fine but the patient is still having inflammation and drainage around the sutures in the knot areas above the incision. The patient has been getting it wet in the shower since Day 2 as allowed by their surgeon. I have never heard of absorbable sutures being used like this. It seems to me they are providing a portal for moisture and bacteria to enter the skin. The knots are yellow and look like bacteria farms. Is this something new? Has anybody ever heard of this?
Gary Smith, DPM, Bradford, PA
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