The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 14, 2009 #3,518 Publisher-Barry Block, DPM, JD

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We've just mailed the April 2009 issue of Podiatry Management. This month's Cover story examines the issue, "Will There be a DPM Shortage?' This 252-page issue includes our annual Who's Who Buyer's Guide.  In addition, you'll  find our usual assortment of features, including our columns, and a CPME-approved CME.

April-May 2009 Podiatry Management

NY Podiatrist Provides Tips for Healthy Pedicures

The first thing most women do before exchanging their winter boots for summer sandals is make an appointment with their pedicurist. It is the beginning of summer and the start of the busy season for most nail salons, but sometimes this professional grooming ritual can have an unwanted and lasting effect. "Toenail fungus infections can last for years if not treated properly," says Dr. Tzvi Bar-David, attending podiatrist at NewYork-Presbyterian Hospital.

Dr. Tzvi Bar-David

Here are Dr. Bar-David's tips for having healthy pedicure sessions this summer and happy feet all year round:

* Bring your own instruments. This includes bringing your own sandals to avoid contracting fungus-like athlete's foot.
* Avoid deep cuts. Do not let your pedicurist cut deep into the corners of your nails.
* Don't use sharp instruments on calluses. Do not have your calluses cut. Instead, use a pumice stone.

Source: HealthNewsDigest.com

Temple Podiatrists Use Research to Design a New "Form and Function" Shoe Line 
 

Some women would kill for a great pair of Manolos. Some men would easily pay more than $100 for a pair of Jordans. But what about a new pair of McGuire and Whitneys? Temple podiatrists James McGuire and Kendrick Whitney recently joined the shoe design business with the release of their R’n’R — rest and recovery — shoe, the first commercially available shoe to be designed by university-backed researchers.
 

Drs. James McGuire (left) and Kendrick Whitney (photo Jeanne Lockner/TUSPM)

The R’n’R is a product of Creative Footwear Technology, a venture between the two doctors and local entrepreneur Richard Posoff that uses the latest in foot and ankle research to produce a foot-friendly therapeutic shoe.

“Most shoes on the market today are designed by artists and not scientists who know something about how the foot works,” said McGuire. “Our goal was to enhance the way shoes are designed, by looking at research-based findings and putting out a better shoe, one that’s designed with both function and form in mind.”

Source: FirstScience.com [4/11/09]
 

Women’s Marathon Hopes Surgery by CA Podiatrist Will Get Her Back on Track

Paula Radcliffe has not given up hope of regaining her marathon title at this summer's World Championships in Berlin. Radcliffe underwent surgery three weeks ago to remove a bunion from her right foot. Doctors now believe the bunion was the cause of all her recent problems, including a fractured toe that she sustained on a training run in the United States last month which forced her to withdraw from this month's London Marathon. A toe tendon injury also ruled her out of the 2008 race.

Dr. Amol Saxena

Her operation was performed by leading foot surgeon Amol Saxena, whom she consulted about her long-term problems following her victory in New York. Last week, she was examined by another foot specialist in Munich and was told her recovery was on schedule.

Source: Simon Hart, The Telegraph [4/10/09]
 

Query: Vascular Testing Systems

Can anyone recommend a company selling vascular testing systems (arterial and venous) for the office. I am hoping to train my staff to be able to perform vascular exams. 

Richard Silverstein, DPM, Havre de Grace, MD
 

Query: Neuroma Injection - CPT 64455 - Medicare

Does anyone know if Medicare (or any other insurance company for that matter) is accepting the new neuroma injection code 64455?

Bill Hineser, DPM, Arvada, CO

Response: TrailBlazer, the J4 MAC Medicare carrier, modified their injection LCD on January 1st to accommodate the two new injection codes, CPT 64455 and CPT 64632.

As for the private insurers, you could always check their individual websites. All, however, should eventually adopt these two new codes as well.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Aldara  for Plantar Verruca (Gary Kantrowitz, DPM)
From: Multiple Respondents

I use Aldara 5% cream on my problem warts, and I have had surprising success. The product comes in a box of 12 packets and I usually have the patients apply the medications every OTHER day and cover the warts with duct tape.  
 
Rich Hofacker, DPM, Akron, OH, Cavsdoc26@att.net

I used this product when it first came out with very little success on plantar warts. Since it was first introduced, there have been some problems with the medication as it activates the person's immune system and has caused some severe local and systemic reactions from its use. I no longer use it. There are postings on the Internet concerning side-effects that range from local pain, swelling, muscle aches and flu-like symptoms and even questions about its use in immunosuppressed patients. It is not indicated for plantar warts, I would just be careful if you decide to use it.
 
Kathryn Riffe, DPM, Trenton, TN, happy_heart54@hotmail.com

I have been prescribing Aldara cream 5% to all of my patients with plantar warts for the last few years. I have them apply it to the wart once daily for a week and then, if the wart is plantar, they begin applying it twice daily. If the wart is not on the plantar aspect of the foot, I usually have them continue with once daily application.  It is supplied in ampules that come in a box of 12-24. 

I have the patients open an ampule and apply the cream and then place the ampule in a ziploc bag so they can continue to use the cream without it drying out. I have found it to be very effective and it does not cause redness and peeling to the surrounding skin as occurs with other topicals. If the patient has been using the Aldara cream for a few months and there is not significant improvement, I usually add Efudex to the treatment and have them apply one in AM and the other in the PM. This usually works to eradicate the wart within 1-2 months.

Melissa Smith, DPM, Alexandria, VA,  melissa.o.smith@gmail.com
 

RE: Re-injury of Ruptured Tendons (Kevin Lam, DPM)
From: Dwight L. Bates, DPM, Dan Haley, DPM

It is a little late to consider this now, but the re-injury may have been prevented by physical therapy to regain afferent function and improve proprioception. 

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

Casting and non-weight bearing would be a poor choice. Surgery to anchor the PL tendon to the 5th metatarsal base again is probably the best option.  You may not have enough good tendon to work with this time around, so consider slide lengthening the PL tendon if you need length after resecting bad tendon at the rupture site. A screw (with or without washer), Mitek-type anchor, or drill hole through metatarsal base, and suture PL back onto itself are re-attachment options. Clear bone of soft tissue and fenestrate or roughen area at reattachment site. A Topaz procedure (pulsed radiofrequency) in the PL would greatly aid the strength of repair upon healing. If the anterior talo-fibular ligament is gone, I'd harvest some of the peroneus brevis tendon for a free graft repair (secondary repair) of ATF and use Mitek G-II type anchors for attachment of the new ATF graft. The remaining stump of the PB would then be sewn to the PL.

Use a post-op posterior splint, 90 degrees to leg, STJ neutral, NWB for 3-4 weeks. Then use daily passive ROM exercises and put the patient into a CAM walker boot, PWB at 25% body weight with crutches post-op  on week 4. Use active-passive ROM and 50% body weight POW  on week 5, and  75% body weight POW on week 6, then full active ROM exercises and 100% body weight with CAM boot post-op week 7. The patient can use a bathroom-type scale to learn to estimate body weight pressure. 
 
Dan Haley, DPM, Reynoldsburg, OH, Dhaleyman@aol.com
 

RE: Blue Cross and Blue Shield Federal Employee Program
From: David Mullens, DPM, JD

Anyone who provides services to patients who are covered through the Blue Cross and Blue Shield Government-wide Service Benefit Plan, also known as the Federal Employee Program (FEP), should conduct an internal audit to make sure you are not being paid less than the Medicare fee schedule allows for your geographic area of practice. This is particularly important for those of you who practice in large urban areas where Medicare payments are higher. 
 
Recently, a podiatric surgeon/client had an audit of his 2008 insurance payments. The doctor’s California Blue Shield Federal Employee Program payments should have been paid based on “Santa Clara” County Medicare fee schedule, but instead were based on the “Rest of California” Medicare fee schedule. You can and should protest all of these underpayments.

David Mullens, DPM, JD, Palo Alto, CA, dmullens@mullenslawoffice.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com 

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

SEEKING ASSOCIATE POSITION - NEW JERSEY

I am a hard-working, compassionate, highly-trained and motivated podiatrist interested in a full-time or part-time position. Graduated from a PM&S-36 residency program. Extensive training focused on wound care, limb salvage, reconstruction, trauma and elective procedures.  Currently hold an active NJ license. Email: ft.n.ankle.dr@gmail.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment at Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER, 2009. Must have completed PSR-36 or similar. Submit applications to: Adam Landsman, DPM, PhD alandsma@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: May 1, 2009.  Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers. Women and minorities are particularly encouraged to apply.

PODIATRIST NEEDED FOR MIAMI-DADE COUNTY

Multi office practice needs doctor of podiatry for full time and/or part time for private office, clinics, and nursing homes. Great opportunity to grow with and unlimited income potential. Offices in Miami, Hialeah, Westchester, and Cutler Ridge. Email to feetdoctor@aol.com

ASSOCIATE POSITION - CENTRAL VIRGINIA

Join a solo surgeon in a two office private practice, modern facilities with EMR and digital x-ray, reconstructive and trauma surgery.  Excellent starting salary and benefits. Position leads to partnership. Submit letter of introduction and CV to jdisabato@vfasa.com

ASSOCIATE POSITION - ILLINOIS
 
Podiatrist needed to provide care for elderly population in Long-Term Care and Assisted Living Facilities. Must be ethical, hard-working, interested in geriatric care and willing to travel. e-mail resume to poddoc2328@hotmail.com

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we are in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PART-TIME NON-SURGICAL PRACTICE FOR SALE - NORTH JERSEY    
 
23 yo practice recently relocated to a spectacular newly-constructed and equipped storefront next to a busy supermarket with ample parking and senior citizens in vibrant downtown. Accepting Medicare and Blues only with great potential. Perfect for expanding to full-time, a second office or new practitioner with means and office experience.  Priced to sell. Financing possible. E-mail interest with contact to Mikedup1215@yahoo.com 

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