11/26/2024    Rod Tomczak, DPM, MD, EdD

My Surgical Experience as a Patient ( Ivar E. Roth, DPM, MPH)

We should all be thankful that Dr. Roth is an
enlightened member of the podiatric community who
is able to share with us what we shouldn't do, I
think. He has not been familiar with insurance
billing for some time, since he has converted to a
direct pay model, Somehow he is still an expert on
how the insurance panel members are unethical.
These providers are, after all, only interested in
making money. Dr. Roth has the ability to see into
a provider’s mind and discern their true
intentions without the use of phrenology, tea
leaves, or Tarot cards.

Unfortunately his psychic gifts do not extend to
today’s JBJS where a multicenter review of
orthopedic rehab modalities. Dextrose prolotherapy
has shown promise as a low-cost, efficacious, and
safe treatment for plantar fasciopathy. Either the
low-cost description was off-putting or the new
diagnosis of fasciopathy was strange and un-
recognizable.

This JBJS article also dedicates a significant
amount of ink to ESWT and its efficacy with the
addition of independent variables and their effect
on fascial thickness. Some physical medicine and
rehabilitation physicians seem to think these
modalities work. Unfortunately, these physicians
have not met our Dr. Roth, hero for the over-
billed but under satisfied patients. After all,
the patient in question made the mistake of seeing
another podiatrist. He is at fault for not
choosing Dr. Roth from the onset of his symptoms.
The common man-patient is so ill-informed.

I am somewhat distressed by the implications of
standard of care and gold standards when it comes
to evaluating a treating physician’s choice of
procedures and sequence of treatments along with
the changes in a plan. Does Dr. Roth hold himself
out as a gold standard expert, or a pay for
service expert? It would take a lot of chutzpa to
declare that any of the choices listed are below
the standard of care. Who is to decide when one
modality is unsuccessful and modify the treatment
plan to begin treatment with another? It seems Dr.
Roth is.

How long should one treatment be continued before
trying another modality which may be associated
with a remission of pain? And, can anyone
infallibly testify there is no lag time associated
with different treatments. Most rehabilitation
modalities do not work in minutes. After all,
hasn’t the literature concluded that plantar
fasciopathy is self-limited?

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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