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PM News

The Voice of Podiatrists

Serving Over 15,677 Podiatrists Daily


December 11, 2013 #4,938 Publisher-Barry Block, DPM, JD

A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
written permission of Barry Block

aetrex

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Medit


PODIATRY IN THE NEWS
Podiatrist Rated 9th Best Job in Healthcare Industry
 
As the Affordable Care Act, better known as Obamacare, kicks in and the population ages, hiring in the healthcare industry is expected to generate the largest number of jobs compared to all other industries by 2020, according to the Bureau of Labor Statistics. To find out which jobs offer the best opportunities in healthcare, job search site CareerCast analyzed survey data that weighed stress, physical demands, and both the current and future employment outlook of 200 occupations. Here's how podiatrists placed. For the full list, click here.
 
9. Podiatrist
 
Overall score: 299
Annual median salary: $116,440
BLS projected growth (through 2020): 20% 
Work environment score: 59
Stress score: 18
 
Source: Norwich Bulletin [12/8/13]

20/20


PM JURY VERDICT REPORTER
Botched Bunionectomy Caused Deformity, Plaintiff Claimed (NY)
 
Case Summary: On Oct. 13, 2006, plaintiff Aysha Siddiqua, 35, a homemaker, underwent the removal of a tailor's bunion, which is a bunion that occupies the outside aspect of a foot's fifth toe. The procedure was performed by podiatrist Defendant, and it addressed the fifth toe of Siddiqua's right foot. Siddiqua subsequently developed a permanent upward deformity of her right foot's fifth toe. She claimed that...
 
Editor's note: The complete Jury Verdict Reporter can be read here. 
 
Result: Plaintiff's award $823,920 
 
Plaintiff Experts: Myron C. Boxer, DPM, Woodmere, NY, Kelvin A. Barry, DPM, Brooklyn, NY 
Defendant's Expert: Thomas DeLauro, DPM, NY, NY
Mail to

ON THE INTERNATIONAL LECTURE CIRCIT
NH Podiatrist Keynotes at Swiss Orthopedic Meeting 
 
(L-R) Drs. Chris Tzioupis, the meeting organizer, Jacque Valotton, Howard Dananberg, and Yvette Dilioson, a French anthropologist.
 
Howard Dananberg, DPM was the keynote speaker at a meeting called "Functional Hallux Limitus: Concepts, and Perspectives" held at the Beau Rivage Palace Hotel in Lausanne, Switzerland on November 29th. In addition to the in-house attendees, the meeting was broadcast live over the Internet to an additional 300+ attendees.   
Dr.Comfort

RETIRED PODIATRISTS IN THE NEWS
Retired Podiatrist Overcomes Seasonal Obstacles of Florida Restaurant Trade
 
Five years ago, Dr. Stephen Kushner brought his food concept to South Florida and envisioned people and venues clamoring for his high-quality soft, salty pretzels made in a retail/commercial Davie storefront known as Philly Pretzel Heaven. But over the past five years, Kushner said he has experienced roadblocks. Kushner said that South Florida food entrepreneurs also need to expect that summers will be slow. 
 
Dr. Stephen Kushner bakes pretzels
 
You must have marketing skills and staying power to survive those months, he said. “What I did to survive was, I began banging on the doors of my biggest clients, urging them to buy more.” Rather than give up, Kushner, a former podiatrist, put in more hours. “I work way harder than (I did) as a podiatrist. There is no comparison. But then again, if you don’t work hard, you aren’t going to be successful in anything.”
 
Source: Cindy K Goodman, Miami Herald [12/9/13]

PinPointe


MEDICARE NEWS
Cost of SGR Repeal Lowered to $116.5 Billion Over 10 Years
 
The holiday markdowns continue. A repeal of the Medicare sustainable growth-rate physician payment formula can now be had for $116.5 billion over 10 years, according to the Congressional Budget Office. The CBO previously put the cost of an SGR fix at $297 billion and then lowered that to $138 billion because of slower projected growth in Medicare spending. 
 
The newest projection is based on a proposed 10-year freeze of physician payment rates. If doctors were to receive annual increases of 0.5%, the cost escalates to $136.1 billion. If no action is taken, the CBO has calculated that the physicians' Medicare payment will be slashed by 23.7% on Jan. 1.
 
Source:  Andis Robeznieks, Modern Healthcare [12/9/13]
arizona

QUERIES (CLINICAL)
Query: 2 1/2 Year Old Toe Walker
 
A 2 1/2 year old girl presented to the office with a chief complaint of toe walking. Her past medical history is unremarkable except for her lack of speech. Clinically, there is no equinus. Muscle mass, tone, and strength appear normal. She is neurologically intact. She can take a few steps with her heels on the ground, but then bounces up onto her toes and walks. I'm open for suggestions on how to proceed diagnostically and from a treatment standpoint.

Care Credit


CODINGLINE CORNER
Query: Coding X-Ray Views
 
Can someone please tell me the best x-ray CPT code for lateral and axial calcaneal views? 
 
Michael Carroll, DPM, Greenwood, IN
 
Response: The proper code for radiographic study of the calcaneus is CPT 73650. The type of views you described would be covered with this code and includes the technical and professional interpretation of the views. 
 
Howard Zlotoff, DPM, Camp Hill, PA
 
Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

neurogenx


RESPONSES/COMMENTS (CLINICAL) - PART 1A

RE: Painful Foot Lumps

From: Bryan C Markinson, DPM. Robert P. Thiele, DPM

These are consistent with panniculitis of which erythema nodosum is one type. Do a 3 mm punch biopsy to the level of the fat. The specimen must include the fat. The TB status of the patient should also be checked. These lesions also may represent an atypical mycobacterial infection. Biopsy is best for definitive treatment.
 
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
 
Consider myxedema related to the thyroid disease. You can biopsy the skin of the mass and send it to a lab. E-mail a digital picture of the foot/leg mass to your lab along with a biopsy specimen and the medical history. I had a few similar cases. If you feel that the lesions are not that superficial, then perform incisional biopsy as you see fit. Let us know the results.

Robert P. Thiele, DPM, Hillsborough, NJ, drthiele@comcast.net

LEDWound


RESPONSES/COMMENTS (CLINICAL) - PART 1B
From: Rahul Patel, DPM
 
Everything you describe including the location on the legs, the duration, and morphological appearance during onset and pre-resolution sounds like it indeed could be erythema nodosum (although I've never seen it on the foot as shown). If suspicious, confirm with a punch biopsy, and refer the patient to an internist for a throat culture (while the lesions are active) and chest x-ray to discern potential etiologies.
 
Rahul Patel, DPM, Flushing, NY, docrahulpatel@gmail.com

Discount Med


RESPONSES/COMMENTS (CLINICAL) - PART 2
From: Mike Piccarelli, DPM
 
This patient would benefit from a Lapidus procedure. Refer it out it if your are not comfortable doing a distal osteotomy. At her age, this does not fully address the problem. 
 
Mike Piccarelli, DPM, Staten Island, NY,  mcpdpm@verizon.net
The Traumatic & Reconstructive Foot and Ankle Surgical Fellowship Program sponsored by the Southeast Permanente Medical Group in Atlanta, Georgia, is now accepting applications for the 2014-2015 training year.
 
Our fellowship program has recently been granted candidate status by the American College of Foot & Ankle Surgeons and offers an exemplary opportunity for advanced lower extremity surgical training. The Southeast Permanente Medical Group (TSMPG) is one of the largest multi-specialty medical groups in Georgia, working with the Kaiser Foundation Health Plan to provide medical care to members in metropolitan Atlanta. The foot & ankle fellow will be provided a broad-based clinical experience focused on adult reconstructive surgery, including sports-related injuries, Charcot reconstruction, total ankle replacement, and traumatic injuries of the lower leg, ankle and foot.
 
Interested senior residents can find a program application and other information on line at: www.acfas.org/fellowshiptucker/ Daniel J. Tucker, DPM, FACFAS, Director, Traumatic and Reconstructive Foot & Ankle Surgical Fellowship, The Southeast Permanente Medical Group, 770-677-6021 Daniel.J.Tucker@kp.org 

RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Paul Kruper, DPM
 
The last time I treated a patient who needed bone surgery of the ankle was... The last time I treated a patient who needed primary care for diabetes, arthritis, or dermatopathology was today, 6 times. New York podiatrists would be far better off professionally and financially to have a full allopathic scope, which would give unlimited potential to expand patient load and employment opportunities. Chasing ankle cases is egocentric and does nothing to fill up the empty spaces in the appointment book.
 
Paul Kruper DPM, Kingsburg, CA, prkruper@yahoo.com

AMERXG


RESPONSES/COMMENTS (NEWS STORIES)
From: Steven King, DPM
 
I agree with Dr. Steinberg, but we can look at this in a different way. Our goal is good foot health. That means we should use some of the education we acquired on healthy nutrition and body mass control during our extensive and expensive schooling. Our patients' primary physicians also need our assistance in continuing re-enforcement of these important tenets of health.
 
If we can get patients excited and observant about what they consume, that's great. Our battles against high BMIs continue. But, if we are making medical claims for the sale of profit-making supplements without proof, then shame on us.
 
Steven King, DPM, Maui, HI, kingetics@gmail.com
Gilllaser Podiatry

YOU CAN'T MAKE THESE THINGS UP
Walk This Way, Says China's Heavy-Metal Shoemaker
 
A Chinese factory worker says walking in huge iron shoes weighing more than 440 pounds each can cure back pain, but faces hefty competition in his bid to build the country's heaviest footwear. "I've been walking with iron shoes for seven years," said Zhang Fuxing, before strapping two crudely welded iron blocks to his feet. "After they reached 400 kilograms (882 pounds), I felt very proud. Next spring, I plan to add 50 kilograms (110 pounds)."
 
Zhang Fuxing in heavy shoes
 
Zhang took a deep breath before each wrenching step in the towering footwear, with every impact leaving him struggling for balance. It took him over a minute to take 10 paces, but he claims to walk up to 50 feet each day in the shoes, which he has gradually increased in weight, and touts them as a cure for back pain and hemorrhoids.
 
Source: Tom Hancock, AFP [12/8/13] via Dr. Jay Sung
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