The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 27, 2010 #4,022 Publisher-Barry Block, DPM, JD

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Toning Shoes Can Exacerbate Existing Lower Limb Problems: IL Podiatrist

Toning shoes are supposed to help you get in shape without hitting the gym and help you burn calories and tone your muscles. But do they really do the job? Toning shoes have a curved sole, which is supposed to help you burn calories and tone your muscles. But the American Council on Exercise says toning shoes are no better than regular exercise shoes. And some people blame the shoes for their health problems.

Dr. Bruce Smit

Podiatrist Bruce Smit says be careful with toning shoes if you have physical issues, such as problems with ankles, knees, or hips. “These things can be exacerbated and they can get an increase in discomfort for complaints that they already have, and sometimes some new complaints as well,” Smit says.

Source: Mary Kay Kleist, CBS-TV (Chicago) [11/11/10]

Flexibility of Hours Makes Profession Parent-Friendly: TX Podiatrist

On Thursday, Nov. 18, the Pre-Health Society invited Nicole Hancock, DPM to speak about her experiences as a podiatrist. Podiatric medicine covers the lower extremities, usually from the knees down, though in some states podiatrists also work on hands. There is currently a great need for podiatrists across the country, especially for the diabetes population. "The great thing about being a podiatrist is, I say to my patients: you limp in and you leap out," Hancock said. "I find that quite rewarding that you can fix a problem with surgery, or fix tendonitis, a temporary thing."

Dr. Nicole Hancock

Hancock said that the schedule of a podiatrist can be made to fit what each specific person wants. Hancock herself is on staff at seven different hospitals and is on call every third week, but she also said that it is possible to do strictly clinic work from eight to five, which might help make a family situation easier for a podiatrist who has children.

Source: Stephanie Stoeckl, University of Dallas News [11/23/10]

HyProCure(R) Key In The Treatment And Prevention Of Foot And Ankle Neuropathy

Dr. Michael E. Graham, podiatric surgeon and inventor of the HyProCure talotarsal stabilization device, recently presented his findings on "Dynamic Effects of Hyperpronation on Tarsal Tunnel Pressures and Posterior Tibial Nerve Strain and the Use of HyProCure" to the annual symposium of the Association of Extremity Nerve Surgeons (AENS) in Fort Worth, Texas. The study was designed to measure both the pressures within the tarsal tunnel that increase during the walking cycle and while standing, and that can lead to pathologic compression of the main nerves serving the bottom of the foot to the tips of the toes.

Dr. Michael Graham

Graham inserted the HyProCure device, a small titanium implant, into the sinus tarsi for a select number of patients suffering with this condition and found that they indeed got better using just HyProCure, without receiving tarsal tunnel surgery. Additionally, his cadaveric research showed that there was a significant reduction in the pressures within the tarsal tunnel and porta pedis, a second tunnel where the nerves dive deep into the foot.

Source: Medical News Today [11/25/10]

AZ Podiatrist Receives Inaugural William S. Baer Award

David G. Armstrong, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) was awarded the inaugural William S. Baer Award as part of a ceremony at the 8th International Conference on Biotherapy (ICB-2010) in Los Angeles. Armstrong commented, "I'm grateful to Dr. Ron Sherman and the rest of the BioTherapeutics Education and Research (BTER) Foundation for this award. I suppose this makes me an International Maggot Man of Mystery-- certainly not Mastery."

Dr. David Armstrong with Baer Award

The Foundation and the Conference are dedicated to biotherapy and biosurgery-- the use of organisms (larvae, bacteriophages, leaches ,and others) to advance surgery. Armstrong, a podiatric surgeon and diabetic foot specialist, is one of the leading surgeon-researchers in the world using these living technologies. Armstrong noted, "I suppose this award should rightly go to our diminutive non-human colleagues who have, after all, paid the ultimate price so our human patients can heal."

Level-10 Meeting Definitions - Part 2

Here's a sample agenda with some definitions:

Patient/Employee Headlines: Here you will very briefly discuss good and bad reports, with no dissertations. You want to find out if your patients and staff are happy. Again, bad reports drop to the issues list under the IDS section of the agenda.(5 Minutes)

To-Do List: You must establish weekly accountability tasks for each member of your team. 9 out of 10 of these items should be dropping off the list or something is wrong. These are usually 7-day to-do items. A to-do list review is from the last meeting (done or not done) and incomplete tasks stay on the to-do list for next week (10 Minutes).

IDS (Identify, Discuss and Solve): You need to attack issues on a weekly basis and make them go away forever. Most practices spend hours on discussing issues and never get to resolutions. The real magic is having a tool to solve issues in a very quick and efficient manner. You start by documenting every issue. You prioritize your issues 1, 2, 3, etc. It’s vital for everyone to be open, honest, and fighting for the greater good, so the solving process can become easier. Solutions will include things to do and they go on the to-do list. Unresolved issues carry over to the next meeting. (45 Minutes)

Source: Dr. David Helfman

Query: Source for Collagen Injection

Where can I order collagen for injection into the foot? 

Nelson William Worden, DPM, Mishawaka, IN

Query: Refurbishment of Orthotics/Adjusting Orthotics

What code should be used (or is there one) for the refurbishment of custom-made orthotics? We ship them out and incur a lab charge of approximately $30. I have tried CPT 99002 (handling, conveyance, and/or any other service in connection with the implementation of an order involving devices [e.g., orthotics]) with little success.

Also, is there a way to bill for the adjusting of a custom orthotic by the physician? We do a lot of this (grinding, padding, etc.) in the office, or is it included in the office visit?

Judy Manley, Office of Marie Schlund, DPM, Itasca, IL

Response: In my office, my own in-house adjustments (grinding, adding padding, etc.) are covered in the basic charge of the orthotic. Any laboratory refurbishing is billed to the patient at the lab fee plus shipping. That is to say, it is a cash service.

Patients are told this fact when they are first given their orthotic. It's simple, and entails knowing that you simply can't bill insurance for everything. Even if there was a CPT code, it does not always mean a service will be paid.

David E. Gurvis, DPM, Avon, IN

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RE: Unusual Fungal Nail Cultures  (Edmond F. Mertzenich, DPM)
From: Elliot Udell, DPM

There was a case report that raised eyebrows in the Journal of Clinical Microbiology, April 2005 titled: "The Polypore Mushroom Irpex lacteus, a New Causative Agent of Fungal Infections."(1)
The case described an immunosuppressed child where the above micro-organism was found to be the cause in a pulmonary abscess. The fungus usually is outdoors and causes decay of wood. The problem, however, with finding this organism in a toe nail culture is that when we culture nail clippings, we are culturing one of the dirtiest areas of the body. Some would liken it to culturing a garbage can. Perhaps the patient was walking barefoot outdoors, or a twig of rotten wood got into the person's shoe and a splinter landed underneath the toe nail. The fungus was there but was it present in the capacity of an invasive organism causing an infection or merely "a spectator minding its own business standing on the toe"?

This is why many practitioners rely more heavily on microscopic scans of nail tissue such as PAS and similar stains where an actual invasion of tissue by hyphae can be observed. If positive, broad spectrum antifungal therapies can be used, and if need be, a back-up culture of that specific tissue can be done.

(1) Walter Buzina, Cornelia Lass-Flörl, et al. The Polypore Mushroom Irpex lacteus, a New Causative Agent of Fungal Infections Journal of Clinical Microbiology, April 2005.

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

RE: PECOS Phase II Delay
Paul Kesselman DPM

Phase II of PECOS implementation has been delayed. CMS announced a delay in implementing PECOS edits for Home Health Care until July 2011 a few weeks ago. While no timeline has been announced, the delay hopefully will be another six months. It seems the government had its timing down just right for a change. This policy is needed, but its implementation was a turkey to begin with!

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

RE: CPeds and Our Turf
From: Dale Feinberg, DPM

I had the pleasure of attending the 2010 North American Pedorthic Congress in Orlando, Florida this past weekend to pick up some required CPed CME credits. This seminar was well-attended, the break-out sessions were standing room only, and there were two completely filled vendor exhibit halls. The range of the lectures was quite impressive and included the following topics:

1) Plantar fasciitis and treatment options
2) The diabetic foot, complications and modern treatment options
3) Custom foot orthotics, casting, fabrication and clinical use
4) Posterior tibial tendon dysfunction, diagnosis, treatments, AFO casting, coding and billing
5) Video gait analysis
6) Surgical repair of PTTD
7) Modern casting techniques for functional orthotics and AFOs

The head of the Canadian Pedorthic Association got up on stage and announced that C-Peds were the experts on biomechanics and prescription foot orthotics and that they should...

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

RE: Parity or Dental Rip-off?
From: Ray Brown, DPM

My daughter had to have four wisdom teeth removed (below the gum level). The procedure took 25 minutes. The bill was $2,385. So rounding the number, this is over $4,000/hour for an in-office procedure. What can you do in your office to generate $4,000/hour? When I compare this to the average bunion involving exposed bone, osteotmies, K-wires, etc,. and we might get $400 to $1,000 and it takes considerable longer (including multiple post-op visits) I can only conclude we need parity with dentistry, not medicine.

Ray Brown DPM, Cornelius, NC, raybrown@bellsouth.net 

RE: APMSA Urges Profession’s Intervention to Avert Residency Crisis
From: Nicholas Brown, DPM, Luke Hunter, 4th Year

Our profession is one that continues to have problems with residency shortages. I graduated from OCPM in 1999 only to find that I was not accepted to any program and had to scramble for a first year spot for a non-surgical program. I was not the only one. I was in the top 20% on my class as were numbers of other students at that time. I find it is absolutely insane to require all programs to switch gears and go into a three-year residency model when we cannot even ensure spots for all podiatry students at this time. I finished a PPMR program and then scrambled again for a one-year surgical program. It was frustrating, it was painful, and it cost me personally and financially. 

If we are going to keep taking students into schools, we need to ensure residency spots.....period. The requirements for a residency program are too stringent and the paperwork to even get one started is restrictive. Sure, the APMA and CPME are willing to help, but the main problem is getting a hospital to agree to the program in the first place. These are trying times and I abhor the thought of someone not getting a program due to regulations and unrealistic timelines set by the powers that be. This is not fair to the students; it is not fair to our profession.  
 
Nicholas Brown, DPM, Wooster, OH, nb78910@yahoo.com

I’d like to point out an observation: There are 534 graduates from the schools this year and 501 spots – that’s really only a shortage of 33 spots for this year’s graduating class. But in this residency application year, there are 42 applicants from beyond the c/o 2011. If we look back to...

Editor's note: Luke Hunter's extended-length letter can be read here.

RE: Pain-killers Darvon, Darvocet Withdrawn at FDA Request (Elliot Udell, DPM)
From: Robert Kornfeld, DPM

My good friend, Dr. Udell, loves to cite instances where patients have opted to have non-traditional cancer therapies that fail to save that patient's life. And this is why I said please do not talk to me about therapies that do not work. There is no consistent literature showing alternative therapies are efficacious for end-stage cancers. Though there is a lot of anecdotal proof that many patients have achieved remission without chemotherapy, radiation, or surgery, this is not where integrative medicine shines. There is, however, very consistent literature showing efficacy for...

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

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

ASSOCIATE POSITION - CALIFORNIA

Busy modern office in Silicon Valley. All phases of podiatry. Office has EMR and digital x-ray. Looking for well trained associate with surgical and biomechanical background with California license. Good opportunity for buy in to the practice. Send resume to dlmed4@gmail.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate to start immediately. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

IMMEDIATE OPENING - GEORGIA

Multi Office Specialty Group seeking a Qualified, Motivated, Surgically-trained Board Eligible/Certified Podiatrist to join our Practice. Must be licensed in the State of Georgia. Salary and Benefits commensurate with experience, etc. Interested Candidates please forward updated CV to: Executiveinfo1@yahoo.com 

PODIATRIST NEEDED - NY (ALBANY/HUDSON)

2 hours North of NYC. Busy podiatric practice all phases of podiatry. Full-time position available immediately/possible part-time considered. competitive salary, fringe benefits package. NYS license required. If interested e-mail resume to footspecialistassopc@yahoo.com or fax to 518-828-9510 or call 518-869-5799 ask for Lori.

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: f-massuda@footexperts.com

ASSOCIATE POSITION - LEADING TO PARTNERSHIP - MARYLAND/DC

High volume, state-of-the-art podiatric practice in prestigious Montgomery County Looking for a highly motivated, well trained podiatric physician to help manage a very busy in-patient and out-patient based practice. Minimum of PSR-36 with interest in hindfoot surgery, ankle reconstruction, and complex wound care. Salary and benefits are commensurate with the position...and exceptional opportunity for the right individual. Please send CV and a letter of interest to adassili@gmail.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

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