The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 16, 2010 #3,805 Publisher-Barry Block, DPM, JD

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Foot Health a Low Priority for Patients: MA Podiatrist

Podiatrists say the feet are not only low in their placement on the body, they are also way down on people's list of healthcare priorities. "People tend to avoid problems with their feet far too long," said Dr. Walter Wolf, a podiatrist and foot surgeon at Holyoke Medical Center.

Dr. Walter Wolf

"If people have a problem with their head or something on their face, they tend to address it right away, maybe because it's right in front of them in the mirror. With feet, people tend to self-diagnose, or worse, just ignore the problem and hope it goes away."

Wolf was at a loss to explain why feet are treated so cavalierly when it comes to health issues, except for one reason he has heard repeatedly from patients. "People think their feet are supposed to hurt for some reason," he said. "They think it's natural to have foot problems."

Source: The Republican [3/10/10]

Maryland Podiatrist Opens New Shoe Store

Are you wearing the right shoes? Do they always feel comfortable? A new store in Frederick can help you find the right shoe for walking, work, leisure, any occasion, and make sure it fits right.  The store, owned by Dr. David Levine, offers an extensive line of shoes for men and women. It features an iStep machine that uses more than 5,000 sensors to find customer shoe needs. The iStep shows where pressure is put on the foot, as well as any needed orthotics (put inside the shoe) and the true size of the shoe.

Dr. David J Levine

Levine, who has been in practice for 21 years as a podiatrist, is also a certified pedorthist.

Source: Ed Waters, Jr., Frederick News-Post [3/13/10]

MI Podiatrist Faces Additional Felony Charge in Crash  

The Westland podiatrist charged with seriously injuring a Canton Township woman while driving drunk in Plymouth Township waived his preliminary examination Friday morning in 35th District Court. Meanwhile, the prosecution charged Jason N. Choos with an additional felony, related to injuries to the young son of Dawn Hengesbaugh, 40, who remains hospitalized in a coma. Choos, who also lives in Canton, now faces two counts of causing a serious injury while driving drunk, one count of marijuana possession and one count of illegally possessing a pistol.

Source: Matt Jachman, Hometown Life.com [3/14/10}

Medicare Pay Patches Persist as Medicine Demands Long-term Fix

Even before President Obama signed an extension bill that reverses until April 1 an unprecedented 21% Medicare physician pay cut, the Senate had begun work on the next short-term patch -- this one to delay the rate reduction until Oct. 1.

The Tax Extenders Act, which essentially is a longer-term version of the Temporary Extension Act from March 2, was approved by the Senate on March 10 with a vote of 62-36, sending the measure to the House. The roughly $148 billion bill also would extend a number of other unemployment and healthcare assistance programs through the end of the year.

The pursuit of yet another short-term reprieve, again for less than a year, runs counter to the American Medical Association's call for a permanent repeal of the sustainable growth rate formula that helps determine Medicare physician pay rates.

Source: Chris Silva, AMNews [3/15/10]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky:  What is the difference between a homeopathic injection and a steroid injection?

Dr. Robert Kornfeld

Robert Kornfeld: Everything that we do in integrative medicine is designed to change the inflammatory pathway from chronic to primary, so homeopathic medicine is natural diluted medicines that we inject. In this case, the insertion point is the plantar fascia or the body of the fascia, whatever happens to be inflamed. Now we have got molecules sitting inside of it that do not belong there. The body will now come along to detoxify these molecules. That is phase one of primary inflammation which is always followed by a pathway of cellular repair. So, if we inject the molecules of homeopathic medicine in a targeted fashion right into the locus of inflammation, we now get an immune system response that will help to transfer the pathway back to a primary pathway. It is like changing the cell signaling basically, and we can now begin to stimulate healing type of inflammation. I will support this with other modalities, such as nutritional medicines and fatty acids. 

Dr. Michael Trepal

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features  Dr. Michael Trepal, Vice President for Academic Affairs and Dean of the New York College of Podiatric Medicine. You can register for this event by clicking here

Reduce Resistance to Feedback

Do your employees tend to resist hearing your feedback? Improve your communication style with this simple change: Turn “should have” into “could have.”

Example: Instead of saying, “You should have done that a different way,” say, “You could have done that a different way.”

What is the difference? The words “should have” generate guilt for something that has already happened and that cannot be changed. The phrase “could have,” on the other hand, lets listeners know that they had a choice and that they can make a different—and better—choice next time.

Source: Adapted from “Trick or Treat,” Harriet Meyerson, The Confidence Center via Communication Briefings

Query: Moldable AFO for Dropfoot

I recently treated an Iraqi war veteran who sustained a gun shoot wound to his sciatic nerve. As a result, he has a drop foot affecting his left foot. He is otherwise healthy and would like to start running. He has tried extensive PT and electric stimulation. He uses a heavy moldable AFO. Any ideas on a moldable AFO that may allow him to run would be appreciated.

Ira Meyers, DPM, Huntingdon Valley, PA

Query: ADA Comprehensive Diabetic Foot Exam Format

A recent ADA committee suggested a format for comprehensive diabetic foot exams; it suggested that the use of a proprietary force-imprint mat and patient-take-home temperature sensor mat be part of that exam. Are other practitioners using these force mats/temperature mats as part of these exams? What has your experience been?

Mark K. Johnson DPM, West Plains, MO

RE: Recurrent Inferior Calcaneal Ulceration (Tony Quinton, DPM)
From: Doug Richie, DPM

Most, if not all, of the excellent suggestions for treatment of this patient will fail if the underlying shear loads are not addressed. Simple padding or soft tissue supplements do not mitigate the shear stress at the skin interface which is significantly amplified in the neuropathic foot. I have had tremendous success using a simple patch. Known as Richie Ulcer Guard with Shear Ban(R), it is  applied to the top cover of the in-shoe orthosis to supplement all of the other off-loading strategies we use to prevent re-ulceration. 
 
Disclaimer: I am the owner of Richie Ulcer Guard.
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: Accuracy of the Aetrex I-Step (Sam Rosen, DPM)
From: Cam White, CPed

We have been using the Aetrex iStep machine for 5 years, and we are very pleased with its accuracy. We measure people's feet using a Brannock device, and then have them step on the iStep machine. The iStep machine confirms the physical measurement we take, but it also provides valuable information about arch length, arch height, center of gravity, and plantar pressure distribution on each foot. It will also recommend the type of orthotic support needed based upon the foot scan (medial heel posting, metatarsal support, etc.) It's like having a Harris Mat and a Brannock device bundled into an easy-to-use system. It will measure foot length and width and make specific recommendations for the proper shoe to wear. Aetrex technical reps will periodically check your machine to make sure it is properly calibrated.                   
     
The iStep machine acts as a neutral, objective witness when you assess your patients' feet. For example, if you do a pedorthic assessment of a patient's wide, low-arched, pronated foot, the iStep machine will validate your recommendation for the proper support and the need for a wide, straight-lasted, motion control shoe.
 
Cam White, CPed, Austin, TX, camwhite.shoes@gmail.com

RE: Unscrupulous Billing of Routine Care (Dan Klein, DPM)
From: Douglas Dickson, DPM,

In my experience, around 40% of my patients are definitely covered for routine foot care, about 40% are definitely not covered, and the rest seem to fall into a gray area: 
- the patient with non-palpable pulses due to edema, which becomes non-covered when the edema decreases due to medication, support hose, elevation, time of day.
- the patient with diabetes and loss of sensation is covered. How is loss of sensation quantified by Medicare? I cannot find any exact wording in the Medicare literature. The 5.07 monofilament test is subjective as is the tuning fork. How do we know patients are being truthful in their response? 
- the patient who says his toenails are painful. This is also subjective and open to interpretation. 
 
We should be careful implicating a fellow practitioner due to the subjective and inexact nature of the routine foot care rules. Over time, your patient could be covered AND non-covered,  and then covered again due to changes in physical exam findings. I would propose diabetics get 5 covered routine foot care visits a year with no coverage for non-diabetics.  
 
Douglas Dickson, DPM, North Syracuse, NY, podocny@hotmail.com

RE: Laser Holds Hope for Treating Onychomycosis: (Andrew Shapiro, DPM, Stanton Southward, DPM)
From: Allen Mark Jacobs, DPM, Marc Katz, DPM

Although various techniques and modalities may be available to disinfect shoes, socks, or showers, the issue which remains unproven is whether such techniques reduce the incidence of recurrent infection.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

I agree that there should be informed consent, and the patient must know that this treatment is off-label. I would imagine that most Drs. are already doing consent. As far as only relying on older treatments, I totally disagree. They can be...

Editor's Note: Dr. Marc Katz's extended-length letter can be read here.

PRACTICE FOR SALE - FLORIDA CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com

ASSOCIATE POSITION - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. Kindly forward C.V. to e-mail drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit  our website to apply.

HOME FOOT CARE PHYSICIAN NEEDED - LOS ANGELES, CALIFORNIA

Honest, caring, hard-working podiatrist needed to make visits to homebound patients, facilities, etc. for Home Foot Care, Inc. Part time position, flexible hours, independence and excellent compensation. If interested email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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