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New York
Joined July 2009
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FootAndAnkleMD retweeted
De las mejores explicaciones de la postura de esgrima inmediatamente tras un TCE.
Súper importante saber reconocerla si sois médicos de campo en deportes de contacto, o si trabajás en emergencias.
Dante Moore’s head injury explained with fencing posture and impact convulsions. #concussion #football #dantemoore
FootAndAnkleMD retweeted
Stark is a wonderful example of how a seemingly simple regulatory idea can become pervasive.
The original goal was straightforward: limit physician self-referral to reduce unnecessary services and save money. It began with laboratory referrals in 1989 and later expanded to imaging and other services.
Over time, that became a complex framework reaching into physician ownership, compensation, employment, office leases, equipment arrangements, and more. Routine business relationships can require extensive review to determine whether they fit an exception.
That compliance infrastructure has a measurable cost. In 2017, the American Hospital Association estimated that hospitals, health systems, and post-acute providers spent $38.6 billion annually complying with nine categories of federal regulation. That figure includes many requirements beyond Stark. Within that total, fraud-and-abuse compliance, which includes Stark and the Anti-Kickback Statute, cost an average community hospital approximately $340,000 annually. These are historical estimates, not current costs or a Stark-only total.
For an independent practice, this becomes very concrete. Providing office imaging, sharing ancillary revenue, or entering certain leases and hospital agreements can require legal review, documentation, and ongoing attention to Stark’s exceptions. Those arrangements may be perfectly legitimate, but establishing and maintaining compliance still takes resources.
A small practice pays those expenses from the same budget used for staff, equipment, and physician income. These costs and associated compliance risk can make remaining independent harder while giving larger organizations an advantage. Any serious assessment of the law should account for that effect.
Before celebrating another law intended to save money or protect physicians, we should ask what it costs to comply, what legitimate activity it discourages, and whether it makes independent practice harder to sustain.
The intended benefit is only part of the calculation.
FootAndAnkleMD retweeted
I’m often asked whether bunion correctors work.
The answer isn’t a simple yes or no. Some patients tolerate them, while others find them uncomfortable. But patients should understand what they can and can’t do.
A bunion is a structural deformity involving bone malalignment and soft tissue imbalance. Stretching the soft tissues alone can’t reliably correct the underlying deformity.
quelle surprise
US nonprofit hospitals spent $7.8 billion on management consultants from 2009 to 2023, but contracts were not associated with meaningful changes in finance, operations, or quality of care. 🧵
ja.ma/4d46zfq
FootAndAnkleMD retweeted
The irony I find myself returning to is that MRI technology has not made us better diagnosticians. It has, in many cases, made us worse ones, because the image is so concrete and the language of the report so authoritative that it takes deliberate effort to resist anchoring to it.
When the MRI arrives before the history is fully taken, the finding shapes what questions get asked and which ones don't. Bias abounds throughout the encounter.
The encounter organizes itself around what the scanner found rather than what the patient experienced, and that is very difficult to undo once it has happened.
Don't look at the scans first... the basics matter. Take a history... confirm it with an exam, then see if the MRI findings make sense in the same context.
FootAndAnkleMD retweeted
In today's #WhatsNewAtArthrex, Noman A. Siddiqui, DPM, provides a step-by-step surgical demonstration of the Arthrex MIS Bunionectomy System with the triangulation guide, focusing on critical anatomic landmarks, fluoroscopic cues, and practical tips and tricks. The goal is to shorten the learning curve, improve OR efficiency, and deliver consistent correction, helping surgeons build confidence in adopting and performing minimally invasive bunion surgery.
Learn more: arthrex.info/41GQwz4
FootAndAnkleMD retweeted
Regarding Elon's assertions concerning the future role of surgeons in the operating theater, I am inclined to concur with his perspective. While the precise timeline may be subject to discussion, my current experience as a spine robot user leads me to believe that these future capabilities are indeed attainable. Initial applications are focused on navigation and navigated instrumentation; however, we should also consider the potential for access automation or tissue preparation. The current unavailability of these technologies does not preclude their future development.
This study presupposes that a calcaneal "spur" is a contributing factor in plantar fasciitis symptoms. Is the paradigm shifting?
bit.ly/41YGlpq
FootAndAnkleMD retweeted
ORIF combined with subtalar arthrodesis provided good rates of subtalar union and good functional outcomes, with results similar or better than those following ORIF alone or delayed arthrodesis.
#ORIF #Arthrodesis #Fracture #Trauma
ow.ly/2UwR50Ytsgt
ALT Example of open reduction and internal fixation combined with primary subtalar arthrodesis in a 76-year-old male. Lateral radiographs a) preoperatively, b) immediately postoperatively, and c) six months postoperatively. The patient fulfilled the following of Schepers’ criteria: Böhler angle < 0°, age > 65 years, and with comorbidities.
FootAndAnkleMD retweeted
Classic physical exam finding of dislocating peroneal tendons. Can be associated with chronic lateral ankle instability and pain or may be due to an acute retinacular tear. #orthotwitter #MedEd @AOFAS @AAOSmembers #peronealtendons
FootAndAnkleMD retweeted
Its important to inspect the articular cartilage. Medial talar dome OCDs are likely underreported—not rare. Be it thru an arthrotomy or arthroscopy, take the time to inspect, flush the hematoma, and document cartilage injury. #orthopedics #anklefracture @orthotraumamd
FootAndAnkleMD retweeted
“Don’t tell dad”! 10yrs ago my daughter was pregnant with her first child(who is pictured here with him in front of her). My wife and I took our very first trip alone in 25yrs for our anniversary. In middle of night my wife wakes me up saying our daughter’s leg was swollen,blue and in extreme pain. My daughter told my wife not to wake or bother me, but of course she immediately did. I immediately sent her to the ER for US to rule out DVT. Study was inconclusive and sent to her OB. I talked to her OB who proceeded to tell me it was common for pregnant women to have unilateral leg swelling and pain in pregnancy because of increased blood volume. She said she was pregnant not handicapped. My daughter was seen by her in the office and told all was fine and this was normal. We were 4,000 miles away. I felt helpless and this OB dismissed my daughter’s symptoms. My daughter still in college, tried to go to class and got crutches to walk to class. When I heard this and after the OB convo, I sent my daughter to my friend, a vascular surgeon, who scanned her himself. He diagnosed her with foot long DVT in her left femoral vein. Immediate hosp admit and placed on heparin drip. The OB never returned my calls after this. My sons went to her beside and we flew home. Fast forward and my daughter carried her son to term and delivered a healthy little boy, first grandchild. Months later my vascular friend said there is a rare condition called May-Thurners and she could have it. She went for a Venogram and sure enough she had it and got a stent. She’s fine and has had two more children. I share this story to raise awareness of May-Thurners as often the first symptom is death. Any unilateral left sided pain and swelling in a female patient should be taken seriously. I believe a vascular srgn should do initial work up as ER and US can be neg or inconclusive. I’m convinced had I not been a surgeon,comfortable enough to push back and not accept info given,my daughter and grandson may have died. This condition has likely seen us more than we see it. Be on alert with female patients with left sided leg pain and swelling. Please share and raise awareness of #Maythurner
@farkomd @AnahitaDua
FootAndAnkleMD retweeted
10 year old healthy girl with left sided knee pain, 2 weeks. She localises pain to lateral aspect thigh and knee
Diagnosis?
#orthotwitter
#orthox
The phrase “Turf toe” doesn’t reflect the severity of injury and how disabling it can be. It involves a tear of the planter plate of the big toe. With instability here, it becomes impossible to “toe off” with any significant strength. This is critical for running and throwing.
FootAndAnkleMD retweeted
This past weekend, our research team attended the New York State Society of Orthopaedic Surgeons Annual Meeting and presented some of our scoliosis-based research projects. So proud of their amazing work! 👏
#Orthopaedics #Scoliosis #Research #NYSSOS #HealingSpinesAndMinds #InnovationInMedicine
