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05/14/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Janet McCormick


 


Though I am not a podiatrist, I fully agree with Dr. Lauren Perico's description of necessary foot care and that it is important to prevent foot problems from getting serious. However, many persons cannot perform some of these self-care tasks for various reasons, such as poor eyesight, arthritis, and other deficiencies, even cognitive ones. These persons have two options: having a caregiver perform the care or going to their podiatrist for monthly care.


 


Two problems are obvious with these options. First, podiatrists would be (and many are already) totally overwhelmed with RFC in their practices; and second, these visits would be self-pay/not be covered by Medicare or insurance. An additional problem would be that the podiatrist could not take more treatment-oriented care.


 


A resolution of these problems was found many years ago by physicians through the hiring of licensed extended care professionals. For example, many derms and plastics hire estheticians to perform the routine care that is important for their patients and to perform non-medical care. These services are also not covered by Medicare or insurance. 


 


Many podiatrists are reducing their overload of RFC by hiring trained nail techs to perform this care. These technicians are state licensed in performing the skills within RFC and have completed a medical nail tech program of 20 modules online, followed by an internship to prepare them to work appropriately in a podiatry office. 


 


Janet McCormick, Frostproof, FL

Other messages in this thread:


01/17/2019    

RESPONSES/COMMENTS (NEWS STORIES)



From: Eli Fialkoff, DPM


 


After reading what Dr. Dunleavy had to say about exercise footwear and how it is a common cause of heel pain, my first thought was that this is completely wrong and pointless. In fact, it may even be harmful to put out such baseless information. Having completed several half marathons, including a trail run as well as having extensive training in an orthopedic sports medicine practice, I can say that I have seen multiple patients have reduced symptoms with the proper exercise footwear (counter stability, reinforced uppers, and a well-cushioned sole).


 


I decided to reach out to Dr. Dunleavy, having known him to be an excellent doctor, and he confirmed that his words were misconstrued and rather what he said was that people can have injuries with exercise footwear that is not appropriate for them. This is a cautionary tale of not taking everything the media has to say and whom they quote at face value. 


 


Eli Fialkoff, DPM, Fort Lauderdale, FL 

01/16/2019    

RESPONSES/COMMENTS (NEWS STORIES)



From: Tom Silver, DPM


 


When I was a student, I visited a podiatrist's office. As he was trimming the nails on a patient, there was a loud boom. The whole office shook and things came flying off the walls and counters. It turns out that a woman was driving down the street and claimed she wanted to avoid another car. So she drove over the curb, sidewalk, and lawn, and took out the front of the building (that was set back about 40 feet from the street)!  


 


She was driving away when she got stuck in some mud. When we went outside, the woman was standing outside her car and concerned with only one thing.  When she opened the door of her car to see why she was stuck, her little dog ran away!   


 


Tom Silver, DPM, Golden Valley, MN

01/14/2019    

RESPONSES/COMMENTS (NEWS STORIES)



From: Sam Bell, DPM, Brandon Macy, DPM


 


You can add two more podiatry office car crashes for my office in the past 15 years.


 


Sam Bell, DPM, Schenectady, NY


 


Well, Dr. Taubman, I have a couple of more car crashes for your list. Approximately 12 years ago, a car hopped the parking lot curb in front of my office and smashed into our outer vestibule. More recently, on November 28, 2018, another car ran up onto the lawn of a house adjacent to my office and smashed into the back of my office, putting a hole in the wall of a treatment room. Fortunately, nobody was injured in either incident. Sadly, I received no free publicity from a news report for either incident. There have also been two near-misses (actually near-hits) in the past several years. I fear my office might have a virtual bull’s-eye on it. 


 


Brandon Macy, DPM, Clark, NJ

01/08/2019    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


The concept that standing, walking, and living life barefooted without the covering, protection, and orthopedic benefits of shoes is for me, fake news. Removing shoes when navigating and performing on hard, unyielding surfaces is rarely beneficial. Third world countries do not become civilized until the majority of its people are shod.


 


Shoes stimulate our brains to adapt to civilized life by serving as props that stabilize, support, and buffer us against the ground, obstacles and germs. This is especially important since inherited underpinning degenerative and deforming biomechanical pathology exists for 90+% of us. I can restore, balance, stabilize, support, and strengthen feet better in shoes than barefooted.


 


Our brain maps have the hand and the foot getting the same amount of area. But our brains have not adapted to stand and move us effectively and efficiently in shoes, leaving much pedal brain space unused. The Point Is: our feet have and continue to adapt to shoes in civilized society. It's our brains that need to catch up, not our feet.


 


Dennis Shavelson, DPM, NY, NY

12/24/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From Ron Werter DPM.


 


Dr. Cunha disparages western boots as causing pressure on the toes. As someone who has worn western boots for many years,  I can attest that a well made and well fitted western boot does not encroach on the toes. Good boots also come in widths and are actually quite supportive due to the formation of the insole and shank. A well fitted boot should fit like a well made shoe. The "point" or taper is made as an addition at the front of the boot. I think Dr. Cunha is confusing a western boot with a women's pointed high heel shoe which does taper way too early and crushes the toes.


 


Here are instructions on fitting of western boots from two different boot makers and sellers.


 


Sheplers store of Fort Worth, Texas says, "The ball of your foot should sit at the widest part of the sole of the boot. Unlike feeling for the fit in your toes (as you would in trying on a shoe), the proper location of the ball of your foot in the boot will ensure a good fit throughout. Consequently, if the ball of your foot sits too far forward in the boot, your toes will uncomfortably crowd in the toe box of the boot."


           :


Lucchese boot makers say, "The toe box on a boot surrounds the toes and the front part of the foot. Pressing this area to see where the toes end may work for athletic shoes — but not for boots. This type of pressure could cause permanent damage. To test the toe box area for fit, wiggle your toes — they should be able to move easily inside the boot." 


 


Ron Werter,  DPM, NY, NY

12/24/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Don Steinfeld, DPM


 


Thank you to doctors Bass and Udell. All of us see patients on a daily basis who are enamored with treatments or products that we may have little or no confidence in. It is important not to dispel their faith in what may result in a beneficial placebo effect. That is why when patients show me their magnetic insoles, I tell them that those insoles may make them more attractive. Everyone is happy.


 


Don Steinfeld, DPM, Farmingdale, NJ

12/21/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Elliot Udell, DPM


 


Thank you, Dr. Bass, for calling our intention to the latest scam out there. I am certain that patients will be asking us about its validity. Unfortunately, this is the not the only scam inducing people into spending their hard earned money on phony healthcare treatments that at best have a placebo effect. There is a website called "quackwatch.com." It is an ongoing website that gives the latest scams in all facets of healthcare. It behooves all of us to visit this website not just to keep our patients informed, but to protect all of us and our families from being taken by some of these con artists who seem to be able to practice their schemes without any government intervention. 


 


Elliot Udell, DPM, Hicksville, NY

12/14/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: John Chisholm, DPM


 


In his well worded and thought out reply to the question of diagnosis and treatment of DVT by podiatric physicians, Dr. Levy references the ongoing discussion regarding a non-restricted license, more specifically, an MD or DO. I wanted to take this opportunity to remind my colleagues that there is another, more obtainable option than changing our degree - to change state law to make our current DPM degree a plenary (non-restricted) license. The current education and training of podiatric physicians makes us, after 3 years of residency training, virtually indistinguishable from our MD and DO specialist colleagues.


 


Here in California, we have been working with our state medical and orthopedic associations to change our current restricted DPM license to a plenary license, and we now have agreed on all of the points to a pathway to lead to this change. Our next step is to work to allow DPMs to sit for the USMLE, and we have broad support from all the stakeholders here in California. I urge the profession to support the California initiative and make DPM=MD=DO a reality in each individual state. 


 


John Chisholm, DPM, Chula Vista, CA, President, California Podiatric Medical Association

12/14/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Elliot Udell, DPM


 


Dr. Markinson is asking a question that is absolutely critical to whether we should continue supporting giving MD or DO degrees to students pursuing careers in podiatry. Are these students with duel degrees staying in a career where they are addressing foot problems, or are they veering off into other medical specialties potentially leaving a void in the area of foot care? If Dr. Levy or anyone else has such statistics, now is the time to come forth with this data. 


 


Elliot Udell, DPM, Hicksville, NY

12/14/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1C



From: Leonard A. Levy, DPM, MPH


 


I initiated the DO Program for DPMs in 2005 at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine. It was my intent to enroll applicants who had just completed their podiatric medical degree but I received considerable negative pressure from the podiatric medical educational establishment. As a result, the program offered required that candidates would be DPMs who were about to complete 3 years of residency training. Approval of this program came from the Commission on Osteopathic College Accreditation (COCA) which limited the number of students who entered to no more than two per year. Those accepted would complete the last three years of osteopathic medical school, given credit for the first year. No MCAT was required since podiatric medical students had taken that examination when applying to podiatric medical school. 


 


Few applicants applied to the program which was not surprising since most matriculants had accumulated large debts during attendance at podiatric medical school and then looked forward to three additional years of osteopathic medical school with an annual tuition of $52,990 for Florida residents and $59,385 for out-of-state students. Traditional osteopathic medical students have average loan debt of about $250,000. The viability of the program could not compete with this huge financial responsibility. Also, to my knowledge, few if any of the DPMs graduating from the program continued with their podiatric medical career, instead entering unrelated specialties (e.g. internal medicine). As a result, the program has essentially fizzled out.


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

12/13/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Bryan C. Markinson, DPM


 


Dr. Levy's history in our profession speaks for itself. He has been a staunch advocate for an unrestricted DPM license for many years. However, in this forum several times I have asked what has become of graduates from his DPM/DO program in Florida that was supposed to "solve" this problem. There has never been a response either from Dr. Levy or any of the graduates that I can recall.  


 


I had opined at the time it was started that it would be unlikely for any graduate of that program, with full access to any medical or surgical (MD/DO) residency they could get into, to choose podiatry as their specialty, directly opposite of his intention to enhance the podiatrist. So I ask again, what has become of those graduates? Do they practice as podiatrists?  Does the program still exist?


 


Bryan C. Markinson, DPM, NY, NY

12/12/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Janet McCormick, MS


 


Dr. Anderone's statement, "when cosmetologists aren't following regulations, they could be putting your body at risk" is certainly true. Many short cut salons don't perform proper infection control practices and do put their clientele at risk. However, it is not true that all nail technicians are to be painted with the same broad brush - which many of you do. Many technicians are taking advanced courses to expand their awareness on safety practices and then only perform safe practices. 


 


Rather than warning patients "do not go to nail salons," it is more positive and productive to...


 


Editor's note: Ms. McCormick's extended-length letter can be read here

12/12/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Leonard A. Levy, DPM, MPH


 


Elliott Udell, DPM, asks if we are out of scope if we diagnose and treat DVT. This seemingly simple question is a good segue into the ongoing discussion regarding whether DPMs should have a non-restricted license more specifically, an MD or DO. A DVT certainly can be diagnosed by practitioners from many specialties of medicine such as but not limited to orthopedic surgeons, general surgeons, primary care physicians, and, yes, podiatric physicians. But most often a general internist, family physician, cardiologist, or hematologist manages patients with DVT. 


 


However, even if once and for all we finally had an unrestricted license, unless podiatric physicians had considerable experience managing DVTs, it would not be good practice for the DPM to treat such disorders. On the other hand, if they did have such experience, why not? Having an unrestricted license would remove any legal concerns from such a decision.


 


Leonard A. Levy, DPM, MPH, Fort Lauderdale, FL

12/11/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Richard J. Manolian, DPM


 


In my practice, I tell patients (non-DM, non-PVD) to bring their own equipment and polish to salons to avoid infection risk. 


 


Richard J. Manolian, DPM, Cambridge, MA

12/10/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Elliot Udell DPM


 


Dr. Kass posts an interesting question. Are we practicing out of scope by diagnosing DVT since in most cases the problem is deep to the calf? Are we as podiatrists not legally bound to evaluate and diagnose peripheral vascular disease which could impact a patient foot even though we are testing above the ankle? Many of us have vascular testing equipment in our offices.


 


In our practice, if we suspect DVT, we send the patient to a vascular lab for a Doppler study and if the results indicate a thrombosis, we refer the patient to his or her internist or cardiologist for further treatment, which could range from Coumadin to some of the other oral blood thinners that are sadly advertised on television every night. The diagnosis of DVT is definitely in our ball park, but the treatment could be out of scope, irrespective of the location of the actual lesion. I would love to hear from practitioners in states where the scope of podiatry extends to the knee, if they are routinely prescribing blood thinners for DVT in veins deep to the calf. 


 


Elliot Udell, DPM, Hicksville, NY

12/07/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Jeffrey Kass, DPM


 


I congratulate future podiatrists Lauren Murphy and Brian Wolff on their astute pick up of pulmonary embolisms and DVT on their clinical patient. The faculty of NYCPM should also be congratulated as they must be doing a great job of educating their students.


 


The untold part of this story is that not all podiatrists in New York can treat people above the ankle. This case is a prime example of the absurdness of this law. Where is a pulmonary embolism? Is it in the foot? Is it below the ankle? Where is a DVT? Is it in the foot? Is it below the ankle? Does one need to be Board Certified by ABFAS to make this diagnosis? I think not! The fact that every licensed podiatrist in the State of New York does not have the same scope of practice is a sham. 


 


Jeffrey Kass, DPM, Forest Hills, NY

12/05/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


Dr. DeCaro and I realize the value of using a foot typing method to generate patient cohorts that share good and bad characteristics. Both of us have U.S. patents for a foot typing method that are upgrades of previous foot typing methods and orthotic outcomes. 


Dennis Shavelson, DPM, NY, NY


11/30/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Robert D. Phillips, DPM


 


I read the response letter from Dr. Young. It is unfortunate that he did not take advantage of listening to Dr. Dananberg speak at the recent Richard O. Schuster Memorial Conference. I believe that it is very important that we not criticize other professions in their capability to treat or not treat things that are in their scope of practice. 


 


I have had many fine chiropractors over the years who know what they can and cannot do and are careful in their work-up of patients to make sure that things that they cannot treat are recognized and properly referred. Chiropractors do have radiologic capabilities and are held to the same standards and recognizing abnormal bone density patterns that any other clinician would be held to. 


 


I have listened to Dr. Dananberg lecture many times over the past 30 years, and I don’t believe that I have ever heard him say that...


 


Editor's note: Dr. Phillips' extended-length note appears here.

11/22/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


Dr. Gurnick’s suggestions are spot on. Biomechanics is an intra-tester and not an inter-tester science. The lack of high level applicable evidence proves that. Limb length correction of balance and asymmetry at the level of the foot in closed chain is a vital service podiatry takes the lead on. In suggesting that our colleagues should “be checking for LLD” as an approach that is “quite understandable to our patients”, my comment is that there is currently no consensus for doing that.


 


Over the years. I have developed a protocol for doing just what Dr. Gurnick has ordered. I call LLD “The Inclined Posture or TIP”. Patients understand this terminology and it is kinder to be called tipped than lopsided. I published on this subject in 2016. The important caveat is that about 10% of the time, TIP testing is reversed due to a primary problem in the spine such as scoliosis. In these cases, the bigger bunion and larger foot is often on the short side. Once mastered intra-tester, this program works better than any other in existence.


 


Dennis Shavelson, DPM, NY, NY

11/21/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Robert Scott Steinberg, DPM


 


Dr. Simon seems to suggest that I don't do a thorough work-up. He is also of the opinion all chiropractors don't know what they are doing. On both counts, how unprofessional. Do all DPMs immediately refer out their patients with heel and back pain. I highly doubt it, unless maybe if they are employed by hospitals. Are there chiropractors I do not trust, sure, but the ones I know, do not exceed their training, do not do orthotics, and don't sell products except for the occasional back brace and Biofreeze. Chiropractors have been a steady referral source. Here's what I believe: If you want respect, give respect.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

11/21/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2A



From: Keith Gurnick, DPM


 


Mechanically-induced back pain can be reduced/improved or alleviated with better postural mechanics and improved lower extremity function in standing activities and during gait with the help of custom prescription foot orthotics. This usually requires a combination of treatment modalities including stretching, core muscle strengthening, activity modification, and foot orthotics.


 


An excellent test to see if custom orthotics might be successful is to first try a properly applied low-Dye tape strapping(s) and when indicated also concurrently the use of a unilateral measured heel lift inside the shoe for limb-length discrepancy. Podiatrists who dispense orthotics should be checking for LLD on exams. If the temporary taping and a heel lift helps, I have found that this is a good predictor that custom prescription orthotics will help as well. This two-step approach is quite understandable to our patients who are looking for relief of their back pain. These patients will often try anything but unfortunately they become disappointed when poor outcomes and results don't meet the hype and their expectations.


 


Keith Gurnick, DPM, Los Angeles, CA

11/20/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Simon Young, DPM


 


Treating back pain with orthotics and biomechanical principles without first consulting a neurologist or orthopedist is foolhardy and dangerous. Isn’t it interesting that Dr. Steinberg mentioned chiropractors doing a weight-bearing exam as part of their patient evaluation. How many DPMs do the same exam as part of their patient evaluation, even before prescribing orthotics for back pains. Since we are on the front line, based on this exam, we can refer to an appropriate specialist and provide the patient a beneficial service. 


 


I do recommend orthotics as an adjuvant treatment for lower back pain only after a gait evaluation and consultation by an appropriate specialist. Part of the work-up certainly involves radiographs, possible MRI and EMG/NCV studies, in addition to blood studies. I hope we don’t miss a tumor, rheumatological  disorder, and 1,000 other possible maladies or deformities. 


 


We are not qualified to treat back pain, nor are chiropractors, and we need to be honest to the patient and be part of a team. Only after an appropriate work-up and failed conservative treatment, or in conjunction with standard therapies, do I feel orthotics can be a benefit. 


 


Simon Young, DPM, NY, NY

11/19/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Robert Scott Steinberg, DPM


 


While I offer no scientific proof, I can give you what I have observed for most of my practice. I have shared offices with chiropractors for most of my career. They were all hands-on DCs who stretch and adjust the spine. As part of their exam, they look at the patient standing barefoot. We all understand, or at least we should, the additional stresses that hyperpronation places on feet, ankles, shins, knees, hips, and low back. Far more often than not, appropriate orthotic treatment lessens or eliminates much low back pain. 


 


Robert Scott Steinberg, DPM, Schaumburg, IL

11/19/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Joshua Kaye, DPM, Howard Dananberg, DPM


 


Howard, prior to about a week ago, I had never heard of you. I sincerely apologize to you for not adequately researching your work and accomplishments during your career. It was only after reading your CV online and seeing the extent of your publications, did I understand the extent of your contributions to biomechanics and podiatry over many years. What I did initially find were links on Google that showed the sale of your orthotic products on Amazon, and your involvement in Vasyli. 


 


I was looking to find a direct, reproducible, scientifically-based connection between the use of orthotic devices and the treatment of back pain. In my almost four decades of practice, I have  seen a frightening number of patients who had claimed that their orthotics had been helpful for the treatment of everything from HIV to ingrown toenails. Although I may not necessarily agree with some of your publications and conclusions, you are nonetheless a true scientist and worthy of great praise.


 


Joshua Kaye, DPM, Los Angeles, CA


 



Joshua, Thank you for your gracious reply. As far as I am concerned, our "discussion" is now finished. If you ever want more information as to what you disagreed with what I have written, please feel free to contact me directly. I am always open to a professional discussion on issues.   


 


Howard Dananberg, DPM (retired) 


11/17/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Ira Baum, DPM


 


Thank you to Rock Positano, DPM for your most important action on the inappropriate CMS proposal. Directly presenting the value of podiatric services to a bureaucracy via its decision makers hopefully will add to the mass communication provided by the APMA and its membership. This allows me segue into the value membership in the APMA is to all podiatrists. Financial considerations almost always come into play when considering joining the APMA, but if the proposal to segregate us and reduce fees to our profession ever passes, over the long-term, the cost of membership will be “a spit in the bucket” 


 


In the past, I have been critical of the APMA on other issues, but Dr. Positano and the APMA’s efforts in response to this attack were commendable. Sitting on the sidelines and benefiting from your colleagues who are members of the APMA, is unethical and immoral, particularly when non-members profit equally. Reconsider your decision and join the APMA.


 


Ira Baum, DPM, Naples, FL
Biofreeze