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09/11/2014
RESPONSES/COMMENTS (NEWS STORIES )
From: Brian Kiel, DPM
We must stop telling the public that shoes cause hallux valgus. In a recent post, a prominent podiatrist publicly stated that shoes can cause hallux valgus and can prevent the deformity from getting worse. I am not trying to insult anyone, but this is nonsense. If this were true, why would there be so many unilateral hallux valgus deformities? The patient wore the same shoes on both feet. If this were true, which shoes caused the deformity as I am sure the individual wore many styles and types of shoes over a lifetime. If this were true, then taping the deformity in the opposite direction would reduce it, and we all know that cannot happen.
Hallux valgus is an inherited biomechanical condition. External environment has no effect on the development of the condition, but I do agree that it can exacerbate the symptoms. I do agree with the statement that the only way to "cure" the condition is surgery. Shoes and orthotics can reduce symptoms but not change the structure of the foot.
Other messages in this thread:
05/12/2015
RESPONSES/COMMENTS (NEWS STORIES ) - PART 2
From: Daniel Chaskin, DPM
The prosecutors in this case incorrectly argued that the material gain needed in the element of fraud was the economic difference between an office visit and a nursing home visit. Since this was performed in a room in the nursing home, Place of Service 99 would have been a proper place of service with no economic difference between the allowance for an office visit vs a place of Service code 99.
Daniel Chaskin, DPM, Ridgewood, NY
02/12/2015
RESPONSES/COMMENTS (NEWS STORIES )- PART 1A
From: Barbara Hirsch, DPM
From just reading the PM News article, I thought Dr. Innocenzi treated patients in a nursing home, but billed as if he saw them in his own office, a separate location, which allowed him to bill at a higher rate, and collect way more money, to cover his "rent, utilities, and insurance premiums" (Does Medicare reimbursement really cover those things?). In the original quoted article, it states "According to the bill of information, the Grand Junction nursing home where Innocenzi claimed to have an office was really only a storage room/beauty salon where he was allowed to perform podiatry services rent free for three months. Under the original bill of information, Innocenzi could face ten years in prison, a $250,000 fine, or both"
I don't really think his intent was true fraud. I feel sorry for him. How many other podiatrists have done this also? What codes should he have billed with? What was the place of service he should have used? The nursing home probably gave him a location, a spot to see patients that could be seen in that setting. It is sure easier than treating patients in their beds. Does anyone else think this is a little overboard to be considered fraud? He did this for three months and can face ten years in prison? A $250,000 fine? Or both?
Barbara Hirsch, Rockville, MD
10/15/2014
RESPONSES/COMMENTS (NEWS STORIES )
RE: NY Podiatrist Reveals Inside Story on DiMaggio's Stolen Rings
From: Hartley Miltchin, DPM
These are a pair of Joe DiMggio's game worn, autographed cleats. DiMaggio was one of the best baseball players to grace the diamond.
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Joe DiMaggio's game worn, autographed cleats |
These are from my collection of celebrity footwear, the world's largest.
04/24/2014
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1B
From: Robert Scott Steinberg, DPM
For those high performance road shoes, with little extra space, I designed a special cycling orthotic, with the help of the owner of JSB Orthotics Lab. I figured that since there is no heel strike, there is no need for the plastic shell under the heel. The rear portion is cut off, leaving a convex shape to fit just proximal to the calcaneus. As I said previously, most often I add a metatarsal pad. I also order external forefoot posts, whenever forefoot posting is necessary. I do use a full length, thin top cover. The shell and topcover take up no more space than the shoe's sockliner that covers screws for the cleat. Without the shell under the heel, the calcaneus stays snug in the heel counter.
Disclosure: Other than being a customer, I have no financial relation with JSB Orthotics Lab
01/12/2012
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1
From: J. Marshall Devall, DPM
Regarding the quote from Dr. Otiko about the 3% tetracycline topical called Diabecline, please correct me if I am wrong, but topical antibiotics don't heal diabetic ulcers. MRSA is sensitive to tetracycline, but there are 3 others with better coverage.
J. Marshall Devall, DPM, Temple, TX, JDEVALL@swmail.sw.org
01/12/2012
RESPONSES/COMMENTS (NEWS STORIES ) - PART 2
From: Leonard Kuzmicki, DPM
Couldn't it be presumed that if a patient decides to write online about an experience at a physician's office, they are effectively foregoing their right to privacy? As long as the patient feels free enough to disclose that they received care from a particular provider, why could it not be discussed as long as the reason for their visit isn't disclosed? It seems that this would be similar to a patient having another family member or friend present during a visit - we presume that we may fully discuss the patient's case with this third person present.
Leonard Kuzmicki, DPM, Spring Valley, IL, leslen@yahoo.com
11/05/2011
RESPONSES/COMMENTS (NEWS STORIES )
RE: ACFAOM Presents PM Editor With Lifetime Achievement Award and Honorary Membership
From: Kevin A. Kirby, DPM
I was in the audience for the roast of Dr. Barry Block with Dr. Bret Ribotsky being emcee at last week's ACFAOM conference. I don't remember ever laughing so much or so hard at a podiatry meeting as I did at this event. If the video is half as good as the show was in person, then it is one that I recommend that you all watch. Special thanks to Barry, Bret, and the others who contributed their comments both live and on video to make this a very memorable and enjoyable event. It was a great evening and a great seminar.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
11/01/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1
RE: Early Diagnosis of Bunions Can Prevent Surgery: CA Podiatrist
From: Brian Kiel, DPM
I must respond to the article by the podiatrist stating that since women have most of the bunions, their footwear must cause them, and the use of orthotics can prevent them. This is nonsense. First of all, how many times do we see unilateral bunions? To the best of my knowledge and experience, people wear the same shoe on both feet; therefore, there should be no unilateral bunions.
Hallux valgus deformity is the result of mechanics and function determined at the moment of conception. To think that a shoe worn for a few hours each day could cause this deformity is absurd and doesn't take into account bunions seen in men and juveniles. Orthotics are important, but only to affect the mechanics, which may alleviate some or all of the pain, but in no way can they prevent the progression of hallux valgus. I think it is time we quit propagating this misinformation to the public.
09/20/2011
RESPONSES/COMMENTS (NEWS STORIES )
RE: APMA Nixes MD/DO Referendum
From: Ivar Roth, DPM, MPH
Until recently, I thought having an MD degree behind our names was a good move for the profession. Since my original knee-jerk reaction, I have changed my mind. Here is why. We have a great profession which we should be proud of. We are a distinct specialty area that is unique, much like the dentists have their area of specialization. With our recent educational and residency upgrades, we have finally arrived and the answer is not to group us in with an MD degree where we could lose our uniqueness. Podiatry should do what the state of California is doing.
California is instituting, in the near future, a physicians and surgeons status for us which will give us an unlimited degree to do whatever we have been training for and does away with all the credentialing issues and turf battles. This strategic change allows us to keep our degree but now practice to whatever level we are competent at. The process will require changes in the curriculum at our podiatry schools so new graduates will be P&S certified and equivalent to their MD counterparts. A pathway for those already in practice to upgrade themselves to P&S status will be made available, thus solving those issues. This solves everyone’s problems and is a way to truly get parity but keep our uniqueness intact. America and the world needs DPMs. We have the potential to have unlimited growth in the short and long-term as our services are needed and growing every day with the aging population.
Editor's comment: The analogy of podiatry to dentistry would only hold true is the medical specialities of dermatalogy and orthopedic surgery did not exist. The world needs podiatrists and podiatrists need equal payment and treatment.
09/12/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1
RE: PM News Now Reaches Over 13,000 Podiatrists
From: Bob Levoy
Congratulations to Dr. Block on having the subscriber list of PM News top 13,000 -- and for his ability to provide such timely and useful information to the profession.
Bob Levoy, Manhasset, NY, blevoy@verizon.net
09/12/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 2b
RE: APMA Nixes MD/DO Referendum
From: Michael Tritto, DPM
Many years ago, DOs changed over to MDs in California. (proposition 22, 1962-- which was later overturned in 1974). They had the opportunity to change everywhere but instead chose to change back to the DO degree. Why? Because over time, they had achieved parity in the educational and testing process, and keeping their degree helped them keep their core as to what distinguished them from their MD counterparts and their philosophy of medicine.
I, for one, am all for parity, but I do not want to lose the DPM degree that makes me unique to any allopathic or osteopathic counterpart treating foot and ankle disorders. We chose podiatry. Now there are some that are unhappy with the DPM degree and want to change it. It seems like those that want the change want to do so with no mention of requiring additional education? Are we all to be "grandfathered in"? I don't think that would...
Editor's Note: Dr. Tritto's Extended-length letter can be read here.
Editor's comment: We know of no one who has ever suggested grandfathering an MD or DO degree for podiatrists. Existing podiatrists would need to complete courses such Ob/Gyn and psychiatry, as well completing clinical rotations and passing the same USMLE tests as other allopathic physicians. Podiatry is a specialty, not a general medical umbrella such as osteopathy. We can be compared more to dermatologists than osteopaths. By analogy, should dermatologists have their own degree to maintain their unique identity?
09/12/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 3
RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Allen Jacobs, DPM)
From: Dennis Shavelson, DPM
I cannot agree more with Dr. Jacobs in his overall assessment of podiatry and what needs to be done to professionalize ourselves. We have both watched our profession grow as advocates, educators, and practitioners. But I must interject an opposing view when it comes to his call to stop advertising unproven and self-serving, profit-driven therapies to the public. By that, Allen, do you mean foot surgery, which as a subject is poorly evidenced, is the profit-driven reason that we have moved as a profession to our current state of affairs?
Do you mean that those in our profession claiming to be biomechanists, making foot orthotics that are no better than OTC, pedorthic, foot-scanned versions should stop advertising that their orthotics do more or are better than middle of the road? Do you mean those of us who only research products whose inventors/manufacturers pay us to research, endorse, and lecture on should give up those income streams? Or do you mean those of us who are patient and podiatry advocates who have anecdotally offered services and products to our patients that are innovative, integrative, alternative, long-term, cost-effective, and difficult to prove that don’t echo mainstream podiatry?
Are we all not profit-driven? What happened to live and let live? What about expanding the scope of podiatry, not isolating it?
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
09/06/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 2
RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Allen Jacobs, DPM)
From: Robert Bijak, DPM
With all due respect, I disagree with one aspect of Dr. Jacobs' chastisement of his colleagues that he claims moan and groan and don't "do something" by serving on various committees.
I do not think that you can blame the membership for not "falling on the sword" for the profession to MAKE UP for the failure of the APMA and the schools. They continue to ask for money, refuse the majorities' will for a degree change, yet want us to join committees that support minutia efforts while ignoring the only remedy that can cure podiatry's perception. Sure, be proud of your DPM for what it is, but please recognize it's not all it should be.
Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com
09/06/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1
RE: APMA Nixes MD/DO Referendum
From: George Stephen Gill, DPM, MBA
After decades of discussion and majority support of the profession, APMA leadership should be able to figure out where this proposal fits on the debate agenda and get on with the process. Thank you, Dr. Block for continued support of this essential evolution for the profession.
George Stephen Gill, DPM, MBA, Englewood, CO, georgestephengill@gmail.com
09/05/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 2
RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Bret Ribotsky DPM)
From: Allen Jacobs, DPM
The commentary by Dr. Ribotsky regarding respect or lack thereof for the DPM degree is, in my humble opinion, correct. If respect for the DPM degree does not begin within our own profession, one ought not expect that respect for the degree from those outside our profession.
Last evening, I was deposed as the treating podiatric physician in a worker's compensation case. The attorney for the opposing side asked me how a podiatrist could challenge the contrary opinion offered by "an orthopedic surgeon with a fellowship in foot and ankle surgery." I simply stated the truth. I went to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
09/05/2011
RESPONSES/COMMENTS (NEWS STORIES ) - PART 1
RE: AZ Podiatrist Recommends Barefoot Exercising in Gym
From: Helen Gentile, DPM
I do personal training as a hobby, and I have never seen a weight room or cardio room that allows anyone to have bare feet. The athletic facilities that I am familiar with don't permit people with open toed shoes, flip flops or sandals to enter. Aside from the obvious hygiene issues, the liability from a foot getting mangled in a machine or a dropped weight injuring a foot far outweighs any potential benefit. Other regions of the country may have different standards, but I would be wary of recommending this practice.
Helen Gentile, DPM, Avondale, PA, hlg60@juno.com
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