09/16/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Paul Hilbert, DPM
I encourage readers of PM News to read this article in response to the story about the neurologist featured in The Pod of Inquiry.
Paul Hilbert, DPM, Navarre, FL
03/11/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
RE: CA Podiatrist Reviews Development of Blake Inverted Orthotic (Kevin A. Kirby, DPM)
From: Elliot Udell, DPM
Dr. Kirby is 100% correct in sounding the alarm that residency programs and probably the profession as a whole are not doing enough to train podiatrists in biomechanics and orthoses. There is a light at the end of the tunnel and Dr. Kirby is a shining example. He is sponsored by a lab and writes columns on biomechanics and lectures all over the world. The Root lab is also sponsoring weekly educational write-ups on different aspects of biomechanics. Every podiatry lab should do what it takes to hire the Kevin Kirbys of our profession and promote biomechanics at seminars, conventions, at the schools, and on forums such as PM News online.
The model that needs to be followed is how pharmaceutical companies promote their drugs. They advertise in every medical medium and don't depend upon the medical profession to do their bidding. This is what our podiatry labs need to do or the ultimate future will be that the healthcare profession will no longer consider podiatrists experts in biomechanics and foot orthoses.
Elliot Udell, DPM, Hicksville, NY
03/08/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Kevin A. Kirby, DPM
Dr. Richard Blake was the biomechanics fellow at CCPM when I was a 2nd year student. Many runner-students in our Class of 1983 helped Dr. Blake make his inverted orthosis in the early years of development of this device. Three years later, I became the CCPM biomechanics fellow and used my positive experience with the Blake Inverted Orthosis to invent the medial heel skive technique, which also produces a varus-shaped heel cup in a custom foot orthosis as does the Blake Inverted Orthosis. Either of these orthotic devices can be used effectively to treat patients with pronation-related foot and lower extremity pathologies.
In regards to the relative lack of biomechanics and foot orthosis therapy knowledge in today's younger podiatrists, I have been commenting and trying to raise an alarm to the podiatry profession on this problem for the past two decades. Unfortunately, the problem is only getting worse. Chiropractors, physical therapists, pedorthists,...
Editor's note: Dr. Kirby's extended-length letter can be read here.
03/07/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS) - PART 1B
From: Jeffrey Trantalis, DPM
I would like to add to what John Throckmorton, DPM said about biomechanics. Biomechanics provides a window to the lower extremities and lower back. Conservative care is always a preferred benefit when successful. Sports medicine along with biomechanics allows treatment for the lower extremities' muscles and joints. Overuse injuries are a big part of this.
Our training in biomechanics is unsurpassed by other professions. Orthopedists frown having us around because we can provide non-surgical relief. After all, they are called orthopedic surgeons for a reason. The lack of exposure and access to the lower extremities and lower back is where podiatrists are limited.
The orthopedist would rather get paid for the surgery than not. It comes down to money not what podiatrists can do for their patients. I tried unsuccessfully to expose to other professions what a podiatrist can accomplish at medical schools. As you might have surmised, they were not interested. We have to remember that we have a talent other professions do not present.
Jeffrey Trantalis, DPM, Delray Beach, FL
03/07/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS) - PART 1A
From: Paul Kesselman DPM
I couldn't agree more with Dr. Thorckmorton's comments. In our cherished goals of becoming equal to MD/DO orthopedic surgeons with 3-year mandatory surgical residencies, we have inadvertently given the keys to the store to others. There are many other providers who now wish to fill in the vacuum left by podiatrists abandoning biomechanics for the scalpel. In addition to our MD/DO colleagues, we now have other specialties such as dermatology publishing biomechanical predictors and NPs wishing to fill this gap.
What can set podiatrists apart from others is the application of biomechanical principles which we held so near and dear in the past. My fellow 65+ year old practitioners will easily tell you that if you follow your patients long enough, you will find that the results you achieve on the OR table may not stand up if you don't understand, address, and correct/respond to the biomechanical pathologies of your patients.
Paul Kesselman, DPM, Oceanside, NY
03/06/2024
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: John Throckmorton, DPM
It was great finally seeing acknowledgement and attention given to the Blake inverted orthotic. As a biomechanical podiatrist (old school), I’ve used these orthotics multiple times to avoid surgery and keep my patients walking great. I find it funny that at podiatry meetings, if I mention the Blake inverted orthotic to younger podiatrists (under age 40), they answer, “Huh?”
Three-year residencies are the best in our profession and a one-year fellowship added is great, but learning biomechanics of the lower extremity and foot is what makes our profession better than orthopedics when it comes to keeping humans walking and running.
John Throckmorton, DPM, Moorseville, NC
05/19/2023
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Paul Kesselman, DPM
Dr. Davis brings up some very interesting points, all of which have been discussed ad nauseum for more than a decade. There have been innumerable meetings with every healthcare professional organization involved in providing all orthotic devices affected by this policy. I have attended countless meetings and discussion groups with these organizations and CMS. Long before that, a significant number of examples of how this broken policy is counterintuitive to patient outcomes was presented to the DME MAC and eventually to CMS were discussed.
The problem with the absurd five-year same or similar rule does not square solely with the DME MAC, but with language contained in the Social Security Act and the absolute unwillingness of CMS to change that...
Editor's note: Dr. Kesselman's extended length letter can be read here.
05/18/2023
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Ed Davis, DPM
Many thanks to Dr. Richie and Dr. Kesselman for their efforts to enable podiatrists to prescribe AFOs to Medicare patients. This is a necessary and important service to improve the lives of many patients who have restricted mobility due to malfunction of the foot and ankle. The reimbursement process has been, at times, a tortuous one. The documentation and forms required to demonstrate need for AFOs and document proper device delivery are available on the websites of many podiatric orthotic labs. Difficulties with reimbursement persist despite following the rules for documentation.
Here are some of the challenges:
1. Incorrect interpretation by DMERC Medicare carriers of the...
Editor's note: Dr. Davis' extended-length letter can be read here.
05/17/2023
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Paul Kesselman, DPM
Kudos to Dr. Ritchie on his presentation on how to get insurance to cover AFOs. It was well presented and timely. Many past webinars and articles presented or written by podiatrists, orthotists, pedorthists, and others have discussed this subject. However, there remains resistance to providing AFOs, particularly when the provider identifies a patient has already received another AFO within the past five years (AKA Same or Similar). While I understand the resistance and difficulties and time costs associated with the appeals process, this should be straight-forward and can be streamlined.
It is important to remember that you as the prescriber and supplier, unlike with therapeutic shoes, have 100% complete control over...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
03/03/2023
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Ivar E. Roth DPM, MPH
Dr. Rubin is 100% correct. Many times I have seen a patient who told me that their Dr. told them they have a short leg when really it is a pronation issue. I make them their orthotics and problem solved.
Ivar E. Roth DPM, MPH, Newport Beach, CA
03/02/2023
RESPONSES/COMMENTS (PODIATRIC PODCASTS)
From: Lawrence Rubin, DPM
I found this information about standing pelvic x-rays and limb-length differential very interesting. In the early 1970s, as a clinic faculty member in the Illinois College of Podiatric Medicine in charge of roentgenology, we were collaborating with a group of osteopathic physicians in a study. The study involved taking and analyzing standing pelvic x-rays in patients with asymmetrical hyperpronation.
Although the study was on a small group and was never published, we did find that when one foot was pronated more than the other, this could be comparable to an anatomically shorter limb, and the effect upon pelvic tilt and the spine could be the same. We also speculated that this measurement could be useful in podopediatrics, since it would enable prescribing orthotics when indicated early on in a child's developmental stage.
Lawrence Rubin, DPM, Las Vegas, NV
