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01/28/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: New MD Shoe Company Tells People to "Ditch Your Orthotics"

From: Kevin Kirby, DPM



A new shoe company, OESH, founded and owned by Casey Kerrigan, MD, has some interesting language on their new website where they make the following claims: "Ditch Your Orthotics: Just as traditional shoe design is flawed, so is the concept of immobilizing the foot with an orthotic. Orthotics are not only worthless, but actually harmful. Whether flexible or rigid, made of foam or plastic, an orthotic detrimentally increases joint torques and pressures. Even a minimal, flexible, off-the-shelf orthotic increases knee joint torques and forces that are associated with knee osteoarthritis." (oeshshoes.com/technology/)

 

Of course, Dr. Kerrigan's shoe company isn't shy about making other claims: "OESH is the first and only footwear with a midsole that provides compression and release, when and only when it should."

 

I find it interesting that an academic MD would not only totally ignore all the prospective and retrospective research that shows that foot orthoses are very effective at reducing the pain and disability from many musculoskeletal pathologies, but would then fabricate stories about foot orthoses being "harmful"....just to sell more of his company's shoes.

 

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

Other messages in this thread:

01/06/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Bone Mineral Density Testing (Robert Bijak, DPM)

From: Jon Hultman, DPM



There is a significant “disconnect” that has evolved over the past forty years between scope of licensure and reimbursement. This has occurred because podiatric licensure has not kept pace with podiatric training and education. It was clear forty years ago that a DPM seeing a patient with a systemic disease (such as gout or diabetes) would treat the foot complication and then refer the patient out for the systemic disease. DPMs also encountered patients in whom they suspected gout or diabetes, even making a preliminary diagnosis based on a blood test or joint aspiration, and then referring the patient out for treatment of the systemic disease. In those cases, DPMs were paid for the screening tests and the treatment because they were able to use a foot diagnosis. But what about osteoporosis, diabetes type II, obesity, and a host of other systemic conditions in which the foundation of treatment is walking at least 30 minutes a day? 



This treatment is well within the education and scope of DPMs and significantly augments the medical treatment being provided by other specialists; however, a DPM is not reimbursed for this treatment or for any screening test unless a foot and ankle diagnosis is used. While an insurance company might be technically “correct” in not paying a DPM for a screening test before making a referral to another specialist when there is no foot or ankle diagnosis, or for providing treatment that gets or keeps patients walking to reduce the costly complications of chronic conditions, it doesn’t make it right or even medically sound. Based on the training, education, and performance of today’s DPMs, this no longer makes sense.



Jon A. Hultman, DPM, MBA, Los Angeles, CA, jhultmaned@calpma.org

01/09/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Bone Mineral Density Testing (Sloan Gordon, DPM)

From: Elliot Udell, DPM

 

Dr. Gordon cites the use of a peripheral bone density test, which studies the calcaneous instead of the gold standard which studies the hip and spine to determine if a patient has osteoporosis and may warrant systemic treatment. Devices which use the calcaneus have been around for a while, but should we be sending our patients for this test in lieu of the gold standard? In the paper, he quotes from "Precision and Discriminatory Ability of Calcaneal Bone Assessment Technologies" by Greenspan, et al. They studied a fairly small number of patients and concluded that the calcaneal devices compared well with the hip and spine tests; however, the authors state at the end of the paper the following: "...future studies are needed to determine whether these techniques can be used to monitor disease progression or response to therapeutic intervention."

 

Other papers published reached similar conclusions and also call for more studies to determine if the calcaneal studies are as good a test as the gold standard, hip and spine test. Osteoporosis is a serious disease with systemic clinical ramifications. In our practice, we send patients to radiologists for the gold standard test which studies the hip and spine and, if the results are positive, the patients are referred to appropriate specialists for follow-up.

 

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

01/18/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Wood Laminate Flooring in the Office (Arthur Lukoff, DPM)

From: Brian Kashan, DPM



After reading the posts of the use of wood flooring in treatment rooms, my only comment is that ANY flooring with seams, e.g., tile, laminate, wood, etc. does get bacteria in the seams. These are called fomites, and is not as easily dealt with as prior posts suggest. In treatment rooms, there is always spilling of materials. Fluids will seep within crevices as well as under them. Wiping, sweeping, and the use of disinfectants will not always get to the entire spill, and moisture will eventually cause bacterial growth.

 

Brian Kashan, DPM, Baltimore, MD, drbkas@att.net

01/20/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Our Challenges: Innovate, Grow, or Wither Away? (Howard Dinowitz, DPM)

From: Bryan C. Markinson, DPM



Dr. Dinowitz posts a well-thought-out detailed appraisal of the myriad of encumbrances that exist upon medical practice today. He is also correct in saying that these are not limited to podiatrists. However, one thing that is glaringly missing from most postings of this nature, especially when the comment is made that all of medicine is similarly affected, is simply that any MD, in any state, in any city, on any given day of the week, at his or her will, can get employment for $160,000 dollars a year.



It may not be the best of venues, or the most desirable location, etc., but it is there always and always will be. The shortage of primary care physicians is enormous, guaranteeing these employment opportunities well into the future, in any healthcare system. Podiatric medicine could find ourselves in similarly good stead, if we as a profession decided to produce podiatric medical and diabetic specialists, as triple the amount of diabetics in the next two decades are staring us right in the face. Yet we have chosen to be/emulate foot and ankle orthopedic surgeons.



Dr. Dinowitz challenges us to grow or wither away. We need to first seize upon what podiatric medicine patients will be serving up for us to treat. We will be ready for the osseous ankle, that seemingly holy grail of podiatric surgery, but how much of that will there be to go around?

 

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

01/31/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: New MD Shoe Company Tells People to “Ditch Your Orthotic” (Kevin Kirby, DPM)

From: Mathew M. John, DPM

 

I guess as an orthotic wearer for the past 25 years, my body has been “harmed”, even though I have had relief from chronic tendonitis ever since wearing these “detrimental” devices. But I’m sure Dr. Kerrigan, MD would just have me wear one of her ‘attractive’ $195 shoes, and my life would be complete. Her shoe may be great for some patients but to turn a blind eye to past research on orthotic therapy and attack those who prescribe them stating that we are harming our patients is just plain negligent.

 

Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

02/03/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: New MD Shoe Company Tells People to "Ditch Your Orthotics" (Kevin Kirby, DPM)

From: Steven King, DPM



I would like to thank Dr. Kirby for keeping us up-to-date on the latest in biomechanics and shoes.



Dr. Kerrigan has a very nice website and interesting approach to "gravity mitigation", be it called contact phase impact or midstance weighting. She is working with the newest materials (carbon fiber) in new ways to help her patients.



To quote from the OESH website, "OESH is different. It is the first and only evidenced-based shoe properly designed to reduce stresses on  your joints and all other injury sensitive areas of your body." This sounds a lot like the pitch used for...



Editor's note: Dr. King's extended-length letter can be read here.

02/14/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)

From: Alan Sherman, DPM



I am a podiatrist and am proud to be one. And if it takes 50 more years to improve the reputation of that brand to the point where we are satisfied with our reputation, then let's all continue working on it Monday morning. I was raised to believe that you don't request or demand a reputation - you earn it and are granted it by others. Yes, don't be shy, show them what you do, show them what you got and the results you get...but you don't give yourself creds. You can apply for them, but they are given, not taken.



Leonard Levy has been an inspiration to me since I was a student at CCPM in 1977, and has been among our greatest ambassadors in the world of medicine. He has upped our reputation, not just by what he says, but by what he has done. I agree with him that we are physicians, we are surgeons, just as we are...



Editor's note: Dr. Sherman's extended-length letter can be read here.

02/18/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: New MD Shoe Company Tells People to “Ditch Your Orthotic” (Kevin Kirby, DPM)

From: Juliet Burk, DPM



I read the comments in PM News with interest about OESH Shoes. All the fuss was enough to drive me to the OESH shoe site. I was interested enough by the concept to order a pair, and have been wearing them almost two weeks. I have also been in contact with the folks at OESH via email.



They have recently changed their marketing stance on orthotics as listed on their website. Although they still preface their page with the slogan “Ditch your orthotics,” they no longer attempt to wholeheartedly condemn orthotic therapy. But I wouldn’t care if they didn’t. Here’s why. First, the shoes are great. I have already...



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

02/22/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)

From: Gerald Peterson, DPM



Many years ago, our state association made an effort to STOP using the term podiatrist in our communications. I personally made an effort at a national level to stop using the term podiatrist in favor of the term podiatric physician and pushed others to do so. I feel the other terms "foot and ankle physician" or "surgeons" is just grandiosing ourselves rather than defining ourselves. We are podiatric physicians and surgeons! Podiatrist is just a short version of the same. What we do and how we present ourselves defines us, but we should ALL use the term podiatric physician in communicating to the public and outside agencies.

 

We are podiatric physicians and surgeons just like allopathic physicians are medical physicians and surgeons and osteopaths are osteopathic physicians and surgeons. They all have short terms for who they are too - ENTS, pathologists, orthopedists, dermatologists, etc. Let's not get hung up on beating each other up on terms. Our presentation to the outside world should always be podiatric physicians or, if you prefer, podiatric physicians and surgeons (just a bigger mouthful to get out in conversation).

 

Gerald Peterson, DPM, West Linn, OR, DRP@ifixft.com

02/23/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)

From Fred Huss, DPM



I'm not sure I understand this debate.

I go to the urologist for my prostate exam.

I go to the ophthalmologist for my eye exam.

I go to the optometrist for glasses.

I go to the dentist for my teeth.

I go to the psychiatrist or the psychologist for meds or talk therapy.

I've been to a gastroenterologist for my colonoscopy.



When I was admitted for CABG....



Editor's note: Dr. Huss' extended-length letter can be read here.

02/24/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Overburdened by Paperwork (Joseph Borreggine, DPM)

From: Howard R. Fox, DPM



With all due respect to Dr. Borreggine, if you’re losing patients because of an excessive amount of paperwork for a new visit, you might want to consider what you’re asking them to complete before they get to your office. My patients complete a simple, one-page registration form that captures basic information. The opposite side of this form is a simple privacy policy.

 

We don’t use any forms for medical histories, medications, allergies, etc. Every new patient is brought into the consultation room where I personally take their medical history. It takes less time for me to ask pointed, relevant questions that relate to their issues than it would take for them to tell me about the boil on their buttocks when they were age 16. Taking your own history helps establish the doctor-patient relationship. On average, it takes about 2 minutes for a patient to fill-out the registration form and sign the privacy statement, during which time, we photocopy their insurance card, and less than 5 minutes to sit in a non-medical room and talk about why they need my help.

 

Having the unfortunate experience of being a patient myself in more than my share of doctor’s offices, I can tell you that it’s frustrating for the patient as well as the doctor to feel like you’re buying their house when you come to a new doctor. First impressions last a long, long time.

 

Howard R. Fox, DPM, Staten Island, NY, fox.howard@gmail.com

02/27/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Overburdened by Paperwork (Josephine Borreggine, DPM)

From:  Richard A. Simmons, DPM

 

Dr. Borreggine wrote that a patient cancelled before the first visit because of the burden of paperwork. The tone of the cancellation notice blamed the doctor for the burden. Years ago, I pre-empted this type of response by placing the following heading on my office paperwork, “For the service to be paid for by your insurance (including Medicare Part “B”), the 1995 and 1997 Correct Coding Initiatives (CCI) require completion of all pages of this form.”



When there is a complaint, the potential patient is always told they have the right not to participate in Medicare (or any insurance coverage) and simply be a cash-paying customer. I have found that when people understand that the burden was imposed on me and not imposed by me, they empathize with me about where this nonsense originated.



Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com

03/03/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: The Technological Imperative: A Warning (Allen Jacobs, DPM)

From: Tip Sullivan, DPM



I write this with the greatest respect for one of our most notable podiatric physicians, Dr. Jacobs. His points regarding technology and utilizing off-label applications of surgical devices made me think of other things along the same line. Perhaps a slightly greyer area, standard of care. I have listened to Dr. Jacobs speak, I believe for Metanx, and I can recall actually believing I should start doing skin biopsies on diabetics and sending them for peripheral nerve density studies following his inspiring lecture.



To me, this was as exciting as going to a national meeting and hearing about some new off-label use of an implant. While this made my Metanx rep very happy, it is not what I would call standard of care in my neck of the woods in podiatry or any other medical specialty. I would venture to say that if I had a diabetic patient who developed complications from such a surgical procedure, I would have to call Dr. Jacobs in my defense. I am sure we would win.

 

Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

03/05/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: The Technological Imperative: A Warning (Tip Sullivan, DPM)

From: Allen Jacobs, DPM



Dr. Sullivan recently expressed his concerns regarding epidermal nerve fiber density testing. I would like to allay his concerns. I am in possession of 49 published studies examining epidermal nerve fiber density testing published in peer-reviewed, medical, and scientific journals. 45 have been published prior to 2011.



Epidermal nerve fiber density testing has been well-established for the qualification and quantification of small fiber neuropathy, and as a validated methodology to assess response to therapeutic interventions for the management of peripheral neuropathy. I hardly believe this test is "experimental" or "investigational."



There are, to my knowledge, no published peer-reviewed studies to support the utilization of Pegasus grafting for the resurfacing of the first metatarsal in hallux limits/osteoarthritis. This is not to suggest that such an approach may not prove effective. It is however, "investigational."



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

03/06/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: DR X-Ray Equipment (Neil H Hecht, DPM)

From: Andrew Shapiro, DPM

 

We have been using the A2D2 DR digital x-ray system for 8 months. The quality of images, ease of use, and support (with no extra fees!) have been superior.

 

Andrew Shapiro, DPM, Valley Stream, NY, drshapbark@aol.com

03/10/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: ICD-10 Preparation (Joseph S Borreggine, DPM)

From: Arthur Lukoff, DPM



I hope this gloom and doom is just that. If the health industry has this shoved down their throats, I can see a lot of health professionals retiring, especially those in smaller practices and serving areas away from metropolitan areas. Most smaller providers will not and should not have to carry that kind of financial burden and put up with that type of payment delay. I hope cooler heads prevail. Or it will be adios to personalized medicine.



Arthur Lukoff, DPM, Ellenville, NY, footdoc45@hotmail.com

03/12/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Depreciated Value of Equipment (Name Withheld)

From: Robert Wunderlich, DPM, George Jacobson, DPM



Depending on the age of the equipment, it may already be fully depreciated (from a tax standpoint). I suggest making a list of the equipment and the date(s) of purchase, and discuss this with your accountant to see if there would be any additional depreciation deduction(s) available when you assume ownership of the practice. Most office equipment is considered fully depreciated after 5 or 7 years.  Also, see the IRS free Publication 946, How to Depreciate Property at irs.ustreas.gov/pub/irs-pdf/p946.pdf

 

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com



After I evaluated a practice, I sat down with my CPA and explained why the practice fit my purposes, and he explained any tax benefits or liabilities. I suggest that you do the same.

 

George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

03/13/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Depreciated Value of Equipment (Name Withheld)

From: Steve Goldman, DPM, MBA



Depreciation, or as it's also known, Accelerated Cost Recovery (ACR), is a method of valuing an asset (instrument or equipment for example) that is worth less over the time it has been used, or put into service. There are many methods of calculating depreciation, but the most common accounting method is something called "Straight Line Depreciation."

 

Let's say you purchased a treatment chair for $10,000 today. Let's also say that you anticipate the expected useful life of the chair, for argument's sake, to be 7 years. Let's also assume that the asset (treatment chair) decreases in value 10% each year it is used. So a depreciation schedule for the chair would look like:

 

Time (Year) Depreciation   Accumulated   Depreciation     Net Value

0                  $          -            $                               -          $ 10,000.00

1                  $  1,000.00        $ 1,000.00                            $   9,000.00

2                  $  1,000.00        $  2,000.00                           $   8,000.00

3                  $  1,000.00        $  3,000.00                           $   7,000.00

4                  $  1,000.00        $  4,000.00                           $   6,000.00

5                  $  1,000.00        $  5,000.00                           $   5,000.00

6                  $  1,000.00        $  6,000.00                           $   4,000.00

7                  $  1,000.00        $  7,000.00                           $   3,000.00

 

Time 0 represents the day of purchase. After the 7th year, the net value of the original asset that was once worth $10,000 when it was new, still has some residual value. In this case, $3,000. This amount at the end of the useful life of the asset is called the "scrap value."

 

Steve Goldman, DPM, MBA, NY, NY, stevegoldman@att.net

03/14/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Study Guides for ABPS Re-certification Exam (Ann Miller, RN, MHA)

From: Andrew Shapiro, DPM

 

I'd like to alert PM News readers about a negative experience I had with Podiatryprep.com (Foot & Ankle Research Consortium, Inc.). On the recommendation from a PM News posting, I purchased the ABPS Re-certification version for $350. I selected them because they advertise "interactive examination simulations" and their order form includes "Questions and Answers." The (CD) study material arrived with no such  "Q &As". It was strictly a study guide. Since I had numerous study guides already, I had no use for it. I tried to contact them by phone and e-mail numerous times. Their only response, by e-mail, was an offer for me to purchase an additional "Surgical Q&A CD" for $250!  Buyer beware.

 

Andrew Shapiro, DPM, Valley Stream, NY, drshapbark@aol.com

03/15/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Changing Banks for Medicare Direct Deposit (Joe Borden, DPM)

From: Paul Kesselman, DPM



An EFT application should not require any modification of your Medicare status with your carrier. It should only require a new EFT application. This is a simple form which may also require either a cancelled check or a letter from your bank. For most Medicare carriers, the change should only take about three weeks.



Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

03/21/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: ABPS Name Change (M. W. Aiken, DPM)

From: Bryan C. Markinson, DPM



I have always believed that the ABPS is one of the best-run entities representing DPMs. When I visit a colleague who has the ABPS certificate on the wall, there is no question that it indicates to me a superior level of dedication and skill that resulted in the attaining of that status.



But my adoration ends there. It seems that most DPMs with the ABPS credential, "the credential you can trust," strongly favor the name change designation to American Board of Foot and Ankle Surgery. The most often stated reason is that it most accurately reflects to the public what those DPMs with ABPS certification most often do. Really?



I am also concerned about the renewed attack on...



Editor's note: Dr. Markinson's extended-length letter can be read here.

03/23/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Appoint an Inspectress (Hal Ornstein, DPM)

From: Sam Bell, DPM



Back in the late 1960's, Dr. Leonard Hymes taught a wonderful practice management section at PCPM. One of the things he stressed was to sit in the exam chair and observe the treatment room from the patient's point of view, and then do the same with the rest of the office. 40 plus years later, it is still great advice.



Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

03/24/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)

From: Edmond F. Mertzenich, DPM, MBA



The main question I had about this particular posting was where the figures of around $80,000-$270,000 are coming from. As has been posted, ICD-10 has been around for a while with the codes available for free from CMS. I would like to know how these figures were generated. I have a hard time understanding this because if the codes are free, and they have been already developed, there is no cost for designing them. 



As for computer programming (of which I’m not very knowledgeable) to me it is mostly a matter of just putting the codes into a program, changing a few boxes to enter the codes, and making sure the information is transmitted correctly. CMS has mandated version 5010 usage by June 2012. Version 5010 allows for ICD-10 transmission.  If these costs are true, then what is driving them?



Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com

04/27/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Sterilizing Bits Between Debridements (Alan Meyerberg, DPM)

From: Barry Mullen, DPM



Hysteria is probably overstating the podiatric mindset, but I suggest we all don't underestimate the well-known side-effects of breathing and contact sensitization of nail dust/particulate matter. Various delayed hypersensitivity reactions and pulmonary side-effects from chronic, repeat exposure are very well documented. Listed below is a microcosm of the plethora of articles written on this topic for review.



The first publication I'm aware of that alerted clinicians to these complications is Pugh,J., Skone, JF 1972 "The health of the chiropodist in a developing community service" The Chiropodist 27(2)53-55



Millar demonstrated a 41% asthma increase in podiatrists relative to...



Editor's note: Dr. Mullen's extended-length note can be read here.

05/04/2012    

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2


RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Jeff Root)

From: Robert Bijak, DPM, Kevin A. Kirby, DPM



As the writer of one of the two letters that Mr. Root referenced, I must take issue with his statement, "We must all accept the limitations of the research environment." We must NEVER accept a poorly constructed study, and must discard its conclusions. There are enough myths in podiatric biomechanics and orthotic theory already. Observer bias is one type of study error, and Mr. Root has a well-known bias in the area of shoe inserts. 



Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com



As Jeff Root very clearly stated, the research study on anterior knee pain (i.e. patellofemoral syndrome), which I posted on PM News a few days ago, prospectively investigated the therapeutic effects of foot orthoses versus no treatment over a six week treatment period. The orthoses used were over-the-counter (OTC) orthoses and showed a significant effect in reducing the knee pain with 79% of the subjects who received these OTC orthoses (Mills K, et al., 2011).



Certainly, it seems plausible if OTC orthoses can have this much therapeutic effect for the treatment of patellofemoral syndrome by presumably altering the kinetics and kinematics of the foot and lower extremity, then the judicious use of prescription foot orthoses made with modifications such as inverted balancing position, well-formed medial arch, medial heel skive, and varus forefoot extensions will have an even greater potential to relieve the pain from patellofemoral syndrome by more specifically altering the kinetics and kinematics of the foot and lower extremity in order to address the abnormal biomechanics that result in this condition. 



Unfortunately, at this time, no research studies have compared the therapeutic efficacy of OTC to custom foot orthoses for the treatment of patellofemoral syndrome. However, in my clinical experience and that of many other sports podiatrists who routinely treat cases of patellofemoral syndrome in running and jumping athletes, specially modified prescription foot orthoses are quite effective, along with hip and thigh strengthening exercises, in successfully treating this painful and disabling condition.



Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

Mycoside3