PM News –February 28, 2006 #2,521 Editor-Barry Block, DPM,
JD
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---------PODIATRISTS IN THE NEWS--------
DC DPM Provides Plantar Fasciitis Prevention/Treatment Tips
The best way to deal with plantar fasciitis, says HOWARD
OSTERMAN,
team podiatrist for the Washington Wizards, is to prevent
it. This
starts with the shoes, he says. For example, shoes marketed
as cross-
trainers "are typically not [good] for
anything," Osterman says.
Most have mid-foot cutouts, ostensibly to allow for forward,
backward and lateral motion. But the lack of support leads
to
fascial strain. Bipeds also court trouble when they jog in
walking
shoes, which have a forefoot roll bar that "is not
conducive to
running gaits." Running shoes work well for walking,
running and
jogging, he says.
"Ligament injuries . . . take four to six weeks of
treatment to
improve, sometimes more," Osterman says. Limit painful
activities as
much as possible. To keep active patients moving, Osterman
will
sometimes tape the fascia, but don't try that yourself;
taping it
improperly could exacerbate your injury. Insoles like
Superfeet,
Spenco and SofSole are also helpful, both in regular and
exercise
shoes. For repeat sufferers, Osterman recommends
custom-molded
orthotics, which provide tailored arch support and can
correct for
gait problems that could lead to re-injury.
Source: John Briley, Washington Post [2/28/06]
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--------------DIABETES NEWS---------------
Harvard Studying Two New Ulcer Tests
The only way to detect ulcers is to see them -- until now.
Doctors
at Harvard are studying two new tests that identify which
patients
are likely to have ulcers. The first uses MRI technology to
measure
muscle energy in the foot. "The idea is if the muscles
are not
working properly, then these patients will be at risk for
not
healing from their ulcers," says Aristidis Veves,
M.D., research
director of Joslin-Beth Israel Deaconess Foot Center in
Boston.
Another method uses hyperspectral imaging. Doctors use
images of a
patient's foot to measure blood flow and early changes in
oxygen.
Patients with less oxygen in their skin may have a higher
risk of
having an ulcer that won't heal. Podiatrist JOHN GIURINI,
D.P.M.,
also of Beth Israel Deaconess, says, "If we can
determine early on a
patient's ability to heal an ulceration, then we can steer
them in
the right direction to get that ulcer healed."
Source: Ivanhoe Broadcast News, [2/27/06]
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-------------QUERIES--------------
Query: Piezogenic Papules
I have a patient who is 34 year old healthy male who works
in
construction. He has piezogenic papules of both heels. They
irritate
his heel and are unsightly to him as well. I told him I
could remove
the painful ones, but I would not risk removing the others.
I am
wondering what the recurrence rate is and if there is any
way to
repair the herniation with a patch or suture of some sort?
Peter J. Bregman, DPM, Wilmington, MA, foot.guru verizon.net
------------
Query: Red, Sore 2nd & 3rd Toes Bilat
I saw a healthy 40 year old non-smoking female in the office
complaining of sore 2nd and 3rd toes to both feet with
peeling skin
of 3 weeks duration. The 5th toes are becoming reddened. She
has no
history of injury and no past or current medical illnesses.
No
history of arthritis or vascular diseases. The condition
worsened with exercise. The skin at the distal tip of the
reddened
toes are dry and a bit cracked, but not fissured. The
patient has
good arterial and venous circulation. The toes are cool and
the feet
are warm. The tips of the red toes are a bit swollen. X-rays
show
normal bone with no resorption. Could this be due to an
underlying
condition like Reynauds or another minor but as yet
undiagnosed
vascular or arthritic condition?
Bruce Krell, DPM, Chandler, AZ, footdoc352cox.net
------------
Query: Parkinson's Disease
I have a 51 y/o female with Parkinson's disease. She has a
constant
tremor in left foot and has shooting "tingling"
pains in multiple
locations. Is there a peripheral hyperexcitability that goes
with
Parkinson's? I'm starting her on Neurontin. Any other
suggestions?
Larry Aronberg, DPM, Lake Worth, FL, lwp01bellsouth.net
-------- CODINGLINE CORNER --------------
Query: Code for Xerosis
What diagnosis code would you use for xerosis?
Adam Klein, DPM, Lynbrook, NY
Response: ICD-9 706.8 (other specified diseases of sebaceous
glands;
xerosis cutis) is the appropriate diagnosis code for xerosis
(excessive or abnormal dryness of skin).
Harry Goldsmith, DPM, Cerritos, CA
-----RESPONSES / COMMENTS------------
RE: Neurofibromatosis (Sandy Schustek, DPM)
From: Multiple Responses
The large cauliflower-like lesion that Dr. Schustek
describes could
be a verrucous carcinoma, a variant of squamous cell
carcinoma. I
recommend biopsying the lesion before considering treatment.
Gary Friend, DPM, Glenview, IL, drfriendnspodiatry.com
I have had excellent results treating these tumors with
cryosurgery
done through one small puncture and reducing their size to
either
complete resolution or 80-90% reduction. It is minimally
invasive,
and I have patients 2 years out without recurrence.
Steven H. Goldstein, DPM, Livingston, NJ, stevefootdr1cs.com
We've had good success using 1/4' medium Plastazote top
covers on
our orthoses with PPT under the Plastazote in the forefoot,
as well
as a met pad. The MBT rocker sole shoe may prove effective
as it
encourages the person to stand on the arch of the foot and
off the
met region. Adding a Lisfrancs rocker to a standard shoe
also helps.
Robert Schwartz, C. Ped., Eneslow Pedorthic Enterprises, NY,
NY,
rsseneslow.com
-------------
RE: In-Office Nerve Conduction Velocities (Matthew
Etheridge, DPM)
From: Jason Gross, MHA
Dr. Etheridge asked about working with Neurometrix, and the
NC-stat
in particular. We had the NC-stat system in our office the
end of
last year. Not only had we done our due diligence, but we
were also
given a copy of reimbursements from another podiatrist in
the state.
All indications were that Medicare and BCBS (they are the
two largest
carriers in the area) would cover the procedure. It was not
until we
had completed a number of procedures that we realized there
were
going to be reimbursement difficulties.
According to the Medicare medical director for NC (and
contrary to
the information published by Neurometrix) the NC-stat does
not meet
the requirements for reimbursement. Neurometrix does have a
30-day
return policy, but it is almost impossible to have a
definitive
answer on reimbursement issues in that time frame. We did go
ahead
and send the system back, but are still waiting for the
promised
refund.
Jason Gross MHA, jgrossfootandanklenc.com
-----------CLASSIFIED ADS--------
ASSOCIATE POSITION- KANSAS CITY, MO
Excellent opportunity for hard working, ethical podiatrist
to join a
vibrant, successful and growing podiatric medical and
surgical
practice. Dedicated, supportive staff with strong marketing
and
medical knowledge. Must be board eligible/certified. Three
year
residency (RPR/PSR-24) preferred. Partnership opportunity.
Competitive salary, bonus structure, benefits. One thousand
dollar
sign on bonus. Wonderful place to raise a family. Please fax
CV to
816-455-8901.
----------
ASSOCIATE POSITON – CONNECTICUT
Seeking Associate leading to partnership for a growing,
balanced
practice. Multidoctor group. Desiring ethical, personable,
motivated, well-trained and academically oriented physician
to join
ASAP. Willing to wait for the right candidate until July
2006, if
necessary. Board Qualified/Board Certified a must. Base
salary,
benefits, and incentive. Excellent opportunity. Fax resume
and cover
letter to (203)624-6815.
---------
EQUIPMENT WANTED
Handheld/portable 9x6 XISCAN fluoroscopy unit(s) wanted.
These are
older units in use early 90's.
Please contact me at ilovebunionsaol.com
----------
South Florida Podiatrist Needed
Non-surgical podiatrist needed for busy well rounded
podiatry
practice. Some routine care, mostly general foot pathology.
We do
the surgery, you cover the floor. Experienced preferred.
Hourly
salary. Fort Lauderdale and Miami area. E-mail response to
podiatrydocsaol.com
-----------
Podiatry Practice for Sale - NYC
Nassau/Queens Border, 40 year old Practice, General Care -
Net $300K
Good practice for Partnership, 1 Partner in place, Small
Down
Payment, with Pay Out All information to be e-mailed
Serious Inquiries Only!!!! Email: DPM1111optonline.net
---------
ASSOCIATE POSITION – TEXAS
Mature 3-DPM general podiatry and surgery practice in the
Rio Grande
Valley of Texas is seeking a DPM to fill an Associate
position,
partnership will be considered after a period of 2-3 years.
Applicants should have at least 2 years of residency
training and
enjoy diabetic foot and wound care. Diverse patient
populations.
(VA, Community Health Clinics, Hospitals and 3 offices)
Good
practice environment in hospitals and community. Salary,
bonus and
benefit package offered. Interested DPMs should send a
letter of
intent along with a current C.V. to Complete Family Foot
Care, 812
Lindberg Ave. McAllen, TX 78501. Fax 956 971-9109
-----------
ASSOCIATE POSITION- NEW ENGLAND
Associate wanted to start this summer. Routine care,
diabetics,
biomechanics, sports injuries and steady surgery. Buy-in
for
partnership and ownership of building a possibility.
PSR-24.
Office podiatry skills (residency experience, office
observation or
work) important. Surgical training with focus on core skills
(bunions, met. osteotomies, neuromas/neurolysis, tendon
repairs,
some rearfoot) is important. facne11aol.com, give evening
number
(not cell), hospital name and residency director's name.
-----------
EQUIPMENT FOR SALE - ESWT
If you are using or thinking of using ESWT, I have a new
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Call 1-856-229-2939.
---------
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------------
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