Fall 2012 - Canadian Federation of Podiatric Medicine

Volume 6 • Number 2 • Fall 2012 

the official publication of the Canadian Federation of Podiatric Medicine 

Dermoscopy 

for Identification 

of Foot Melanoma 

Page 6 

Secrets of Success: 

“Be Prepared” 

Page 15

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2 the Canadian podiatrist • Fall 2012

CFPM CONTACTS 

PRESIDENT 

Ian McLean – Alliston, ON 

1-888-706-4444 

CEO 

Stephen Hartman – Waterloo, ON 

1-888-706-4444 

BOARD OF DIRECTORS 

Vish Ramcharitar – Brampton, ON 

Sonia Maragoni – Alliston, ON 

Ian McLean – Alliston, ON 

Sally Brodrick – Winnipeg, MB 

Vicki Werkman – Oakville, ON 

Tony Farrugia – Beeton, ON 

Brian Johnson – St. John, NB 

Axel Rohrmann – Regina, SK 

Michael Turcotte – Cornwall, ON 

Julie DeSimone – Sudbury, ON 

COMMITTEES 

Education Committee 

TBA 

Research Committee 

Vish Ramcharitar (Chair) 

Assistant Development 

Vicki Werkman (Chair) 

Seal of Approval 

Sonia Maragoni; Ian McLean 

Insurance 

Stephen Hartman (Chair) 

Membership 

Sonia Maragoni 

National Issues 

Brian Johnson (Chair) 

Conference 

Stephen Hartman (Chair) 

International Committee 

Stephen Hartman 

the Canadian Podiatrist 

Editor 

Cindy Hartman 1-888-706-4444 

Advertising & Classifieds 

Cindy Hartman 1-888-706-4444 

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www.podiatryinfocanada.ca 

In this issue... 

Volume 6 • Number 3 • Fall 2012 

President’s Message: 

Ian McLean ............................................ 4 

Dermoscopy as a Technique for the 

Early Identification of Foot Melanoma 

By Ivan R Bristow and 

Jonathan Bowling .................................. 6 

CFPM Attends the Canadian Life 

and Health Insurance Association 

Conference ......................................... 11 

2012 CFPM Annual Conference ........ 12 

CFPM Live Auction and Comedy 

Show with Award Ceremony .............. 13 

2012 CFPM Oscars ............................ 13 

Secrets of Success: “Be Prepared” 

with Proper Employee Performance 

Documentation By Lynn Homisak ..... 15 

CFPM/AAPPM Practice 

Management Seminar ........................ 16 

Understanding Your Insurance 

By Mark Holman ................................. 17 

CFPM Open Forum .............................. 17 

AGM Announcement ........................... 17 

Winter Getaway Seminar 2013 ........ 19 

Are You Losing Clicks 

to Competitors? .................................. 23 

Recent Licensing Changes 

in New Brunswick 

By Dr. Brian Johnson ........................... 24 

Reggie Love to Speak at 

the CFPM Annual Conference ........... 30 

Classified Ads ..................................... 36 

The CFPM to Join JFAR ....................... 38 

Upcoming Events ............................... 39 

Dermoscopy for I.D. of Foot Melanoma 

Are You Losing Clicks to Competitors? 

page 6 

page 23 

disclosure 

The Editor and Board of Directors of the 

Canadian Federation of Podiatric Medicine 

do not accept responsibility for opinions 

expressed by contributors to the Journal; 

and while every effort is made to ensure 

accuracy, they cannot accept responsibility 

for any inaccuracies in the information 

provided. 

Reggie Love to Speak at the 

CFPM Annual Conference 

page 30 

© Canadian Federation of Podiatric Medicine, 

Fall 2012 

Publication Number 42242022 

the Canadian podiatrist • Fall 2012 3

Message from the President... 

by Ian McLean, B.Sc., D.Ch., B.Sc. Podiatric Medicine, President the Canadian Federation of Podiatric Medicine 

I 

like what I do. 

Surprisingly I get asked whether I like my 

job quite frequently by patients, friends and 

colleagues and happily, so far I am able to reply 

positively to this question. That’s not to say there 

are not days where I want to tear out what little 

hair I have left on my head or go running to the 

calendar to check to see if it is a full moon after 

the day I just experienced. 

I think these kinds of responses are particularly common for those of 

us who work in private practice, where everyday you are required to run 

a medical clinic and a business simultaneously. However, almost every 

person I see thanks me for what I have just done for them and it is this 

kind of positive feedback that we as chiropodists/podiatrists receive on 

a daily basis, that makes us do what we do and practice our craft to our 

greatest ability. 

However, practicing podiatric medicine at its highest and most 

professional level has become a concern as other medical professions 

and non-medical groups have began to take greater notice of our 

successes in treating our patients and are trying to use this success to 

their advantage. What I am talking about is the disturbing trend in other 

groups, medical and non-medical, recruiting chiropodists and podiatrists 

and paying them only to write prescriptions for orthotics, for patients they 

have not or will not be seeing and following through with their care. This 

is a practice that has to stop. 

As the president of the Canadian Federation of Podiatric Medicine, 

one of my duties is to represent chiropodists/podiatrists at the annual 

Canadian Health and Life Insurance conference and the insurance fraud 

conference, and the first question everyone asks is about orthotics. The 

number one fraudulent claim that insurance companies are now seeing 

is for orthotics and orthotic shoes. Some claims are now even falling into 

the realm of organized crime, opening up “orthotic clinics” and buying 

into legitimate clinics only to bill as much as they can on the clients 

insurance, providing a “free shoe” with an over the counter insole and 

then closing the shop down to move on to the next neighbourhood under 

a different name. Insurance companies are very concerned and when 

they react as we have seen in the past, it tends to be in large strokes, 

perhaps eliminating orthotics from their coverage, despite the fact that 

we are not the main culprits in committing this fraud. 

One of my duties representing the CFPM is to make sure that the 

insurance companies know that we as chiropodists/podiatrists are the 

best practitioners to provide this valuable medical service to the public. 

That there are guidelines to what an orthotic is or is not and to how 

they should properly be made and dispensed and that we are regulated 

and there are consequences for us as the practitioner for not following 

the accepted guidelines. Because of these facts we alone should be 

entrusted to the examination, diagnosis and treatment of the feet and to 

provide orthotics as required as part of a complete and comprehensive 

treatment plan and that the other non-regulated professionals should be 

limited or excluded. It is a constant battle but the CFPM is committed to 

educating the insurance companies on this matter. 

This is why I find this new trend so troubling as it is your name, 

reputation and most importantly to the insurance companies your 

registration number that you are putting out there by getting involved 

with less than honest practices. Don’t get me wrong, relationships or joint 

practices with other practitioners such as physicians, physiotherapists 

and chiropractors can be mutually beneficial and provide the best level 

of care for the patient, if you as the chiropodist/podiatrist are allowed 

to practice at the level of care that you would expect and that you are 

examining and providing a complete treatment plan for that individual. 

Not just signing your name to a piece of paper. 

You worked hard for those degrees, take care of them! 

Please join the CFPM if you are not yet a member, or if you are a 

member send this article to a friend who is not and ask them to join. 

We need your support and numbers to continue to represent your 

interests with insurance companies and government. And please also 

join your provincial organization, this is not a conflict, we at the CFPM 

work together with these groups to further the unique challenges each 

province faces. 

For example in Ontario, the CFPM is committed to helping the Ontario 

Society of Chiropodist prepare for the upcoming HPRAC review, which 

the aim is to adopt the one title of podiatrist in this province and expand 

the scope of practice to include x-ray, lab tests, osseous surgery and 

medical procedures up to and including the ankle, based on the Alberta 

podiatry style of practice. We at the CFPM will do whatever we can to 

help this positive advancement. 

Finally, if you know of any organizations who are practicing less than 

honestly or find yourself in a situation that you are uncomfortable in, 

please call the CFPM office and we will do what we can to make sure the 

situation is handled properly. 

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Dermoscopy as a Technique for the 

Early Identification of Foot Melanoma 

Ivan R Bristow 1 & Jonathan Bowling 2 

1 

School of Health Sciences, University of Southampton, UK 

2 

Department of Dermatology, The Churchill Hospital, Oxford, UK 

Corresponding Author: 

Ivan Bristow 

Building 45 (SHPRS) 

University of Southampton 

Highfield, Southampton 

SO17 1BJ 

Email: ib@soton.ac.uk 

abstract 

Malignant melanoma 

is the most common 

primary malignant tumour 

arising on the foot. Where 

improvements in the 

prognosis have been 

observed for patients with 

melanoma elsewhere on 

the skin, pedal lesions 

are still frequently delayed 

in presentation through neglect or misdiagnosis. Detection 

of foot melanoma relies on the health care practitioner’s 

skills and observations in recognising early changes. Recent 

publications have documented the use a dermoscopy as a 

tool to improve recognition of such suspicious lesions. This 

paper reviews current literature with a special emphasis of 

its potential applications on plantar and nail bed melanoma. 

Data from these studies suggest that the technique is a useful and 

significant adjunct to clinical examination, which ultimately may lead 

to earlier recognition of this aggressive tumour. 

INTRODUCTION 

Figure 1 Superficial spreading 

melanoma on the ankle 

Cancers involving the skin account for a third of all human cancers. 

According to the World Health Organisation, malignant melanoma 

(MM) accounts for an estimated 132 000 new cases annually 

and around 66 000 deaths. Globally the incidence of the disease 

continues to rise, particularly in Caucasian populations [1]. As there 

is no effective treatment for the disease, improving survival still 

remains around earlier detection of malignant lesions. The thinner 

the lesion at diagnosis, the better the prognosis [2]. There is some 

evidence to suggest that patients are presenting earlier and that the 

mean melanoma thickness at diagnosis is declining [3], although risk 

factors such as older age, male gender and low educational level still 

predict higher thickness at presentation [4-6]. 

Melanoma and the foot 

Malignant melanoma is the most common primary, malignant 

tumour of the foot [7] accounting for between 3-15% of all cutaneous 

melanoma [8]. Whereas improvements have been seen in the 

prognosis for some patients with melanoma, pedal lesions are still a 

major concern. The three most common types occurring on the foot 

are the superficial spreading (figure 1), nodular and acral lentiginous 

melanoma (ALM – figure 2). ALM is particularly prevalent on the 

foot as it has a predilection for the soles and nail beds [9]. In 

addition, it is a sub-type of melanoma that affects all skin types 

[10]. Day [11] identified MM on the foot as an independent risk 

factor for disease recurrence. This was examined further by 

Hsueh and colleagues [12] who reviewed 652 cases of cutaneous 

melanoma and analysed data comparing anatomical location to 

survival rates. Controlling for other variables including tumour 

thickness, their results 

confirmed that primary 

melanoma on the foot had 

a 5 year survival rate of 

77% compared with 94% 

and 95% for lesions on the 

calf and thigh respectively. 

They concluded that the 

prognosis deteriorated the 

further the lesion was from 

the trunk. 

From the available data, 

the reason for this is not 

clear but is probably less 

likely to do with the physical 

nature of the tumour and more to do with delays in presentation 

and diagnosis. Prognosis, in part, is worsened in foot melanoma as 

lesions frequently present later and are therefore thicker at diagnosis 

[13]. Reasons for patient delays have been well studied [5, 14-17]. 

Richard et al studied 590 melanoma patients and reported a number 

of factors that predicted thicker lesions including melanoma which 

were out of the patients view (such as the plantar surface of the foot). 

From a medical perspective longer physician delays in diagnosis 

have also been observed with acral lesions [18]. Misdiagnosis could 

also explain a reduced prognosis in patients with acral melanoma. 

Bristow and Acland [19], reviewing 27 cases of acral lentiginous 

melanoma on the foot suggested a misdiagnosis rate of 33% whilst 

other workers have reported much higher rates of up to 60% in 

melanomas of the foot [20]. Metzger and co-workers [21] in a review 

of delayed diagnosis of melanoma highlighted that many acral 

melanoma are initially presented to non-dermatologists because 

patients do not suspect the problem to be a melanoma. As such 

Figure 2 Acral lentiginous melanoma 

Continued next page 


Continued from previous page 

clinicians are less aware of the condition; 

mis-diagnosis would be more of an issue. 

Illustrating this, many papers have been 

published highlighting foot melanoma 

misdiagnosed as other conditions such 

as fungal infection, onychomycosis, 

ulceration, haematoma and other more 

common foot pathologies [20, 22-27]. 

Figure 3 Dermatoscopes 

Detection of melanoma 

The value of educating patients and practitioners through melanoma 

awareness campaigns cannot be emphasized too strongly and 

various initiatives have tried to heighten the public awareness and 

monitoring of skin. Equally important is the role of the practitioner 

in screening patients - physician detected melanomas have been 

shown to be significantly thinner at diagnosis than those detected by 

patients [6]. The ABCD rule, devised in 1985 by Freidman [28] has 

been well used as a mnemonic in skin assessment for recognising 

change in melanocytic naevi. Its value in foot melanoma has been 

questioned as acral lesions do not exhibit the typical features of 

malignant melanoma elsewhere on the skin [19, 21]. Therefore at a 

clinical level, the decision to monitor, excise or refer on a suspicious 

lesion can be a difficult one. 

Dermoscopy 

Visual examination of a suspicious skin lesion such as a melanoma 

can be significantly enhanced by the addition of surface microscopy. 

This was first recognised by Scottish Dermatologist Rona MacKie 

who in 1971 published a paper which demonstrated pre-operatively, 

the high predictive value of close examination of melanoma [29]. The 

difficulty arises however in that evaluation of the skin under normal 

conditions, with a standard magnifier, is limited due to surface 

reflection and refraction. To overcome this the dermatoscope is a 

simple, and relatively cheap, hand held magnifying device (typically 

10x) which uses an oil medium or cross-polarised light allowing the 

viewer to observe structures deeper in the skin, not normally visible to 

the naked eye (figure 3). Since the 1980’s the idea of “dermoscopy” 

began to gain momentum and its popularity as a tool aiding clinical 

decision making increased, particularly in Europe as more research 

evidence was published. In 1990, around 13 papers were published; 

in 2007 it had risen to over 500. 

It should be emphasized that the dermatoscope itself is not a 

diagnostic tool but acts to aid decision making in when confronted 

with a suspicious lesion, allowing the practitioner greater confidence 

when deciding whether to refer, excise or leave a skin lesion. 

The use of the dermatoscope was initially the exclusive realm of 

the dermatologist, experimental and early work gave rise to extensive 

descriptions of patterns and features visualised in melanocytic 

naevi, melanoma and other skin tumours. This then moved to the 

formalisation of the technique into various algorithms such as 

pattern analysis [30],the 7-point technique [31], the modified ABCD 

technique [32] and the Menzies method [33]. Two early metaanalyses 

of the dermatoscopic technique were published concluding 

that it increases sensitivity and specificity for the diagnosis of 

melanoma when compared to the naked eye when in the hands of 

an experienced clinician [34, 35]. 

In 2004, it was recognised that in order to achieve a decrease 

in morbidity and mortality, dermoscopy should be a screening 

test that is available to all practitioners involved in skin screening 

providing it was accurate, easily to apply and inexpensive. Such a 

test would have the aim of highlighting suspicious lesions earlier and 

allow the practitioner to refer patients onto a specialist for further 

evaluation [36]. Using a randomised controlled trial methodology 

Westerhoff and colleagues [37] demonstrated it was possible to 

train a group of non-dermatology expert general practitioners and 

significantly improve their clinical recognition skills compared with 

a control group. Argenziano et al [38] reported similar findings with 

a cohort of 73 primary care physicians. In the UK, courses have 

been running for a number of years and include a range of health 

care practitioners. The most recent meta analysis of dermoscopy 

[36] has encompassed a review of literature including those studies 

conducted on practitioners with minimal training in the technique and 

has still concluded a relative diagnostic odds ratio for dermoscopy 

compared with naked eye examination to be 15.6 (CI 95%; 2.9-83.7, 

p=0.01). It therefore seems pertinent to explore the technique as an 

extension of scope of practice within podiatry. To date the authors 

are unaware of any published literature documenting its application 

within this profession. 

The three point technique 

The three point technique was developed by Soyer et al [36] who 

recognised that dermoscopy could be a screening tool for all those 

involved in skin care. As a result it is a simplified technique to screen 

Figure 4 Dermatoscopic features of benign melanocytic 

naevi on plantar skin (after Miyazaki et al [52]) 

Continued page 28 


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The CFPM Attends the Canadian Life and 

Health Insurance Association Conference 

OOn May 1 - 3, 2012, 

the CFPM attended 

the Canadian Life 

and Health Insurance 

Association Conference in Gatineau, Quebec. CFPM board member, 

Mike Turcotte and CFPM President, Ian McLean proudly represented 

our national association at the CFPM booth. The CFPM attends this 

annual meeting in order to build positive and lasting relationships 

with members from the insurance industry who determine insurance 

policies and manage insurance claims. Attendance at the CHLIA 

conference is part the CFPM Insurance Committee’s plan to educate 

and collaborate with members of the insurance industry. This is an 

excellent opportunity for the CFPM to educate the individuals from 

the insurance industry on the many beneficial services of chiropody 

and podiatry in Canada. 

From left: Ian McLean, CFPM President and Mike Turcotte, CFPM Board 

Member. 

The Breakfast Club 

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Menu prepared for CFPM Staff Attendees only: 

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Join us on Sat, Oct. 

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Generous portions of sparkling discussion and 

seasoned topics 

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Sprinkled with a blend of: 

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2012 CFPM Annual Conference 

This year’s program offers chiropodists, podiatrists, office 

staff and other health professionals the opportunity to 

attend a dynamic, educational conference that is essential 

to your professional development. The CFPM Annual Conference 

contains lectures and workshops led by an impressive array of 

experts in various fields related to podiatric medicine. The 2012 

conference promises to provide something for everyone with 

renowned international speakers, interactive seminars and hands on 

workshops. Topics include diabetes, arthritis, dermatology, research 

and various equipment demonstrations. 

Highlights of the CFPM 13th Annual Conference 

Dr. Tim Daniels, MD, FRCSC: He is Associate Professor 

at the University of Toronto and an active staff member 

at St. Michael’s Hospital. He is involved with teaching at 

all levels and is active in both clinical and biomechanics 

research. His current elective practice includes 95% of 

foot and ankle pathology. 

Lecture Topics: 

• Ankle Arthritis – Biomechanics, gait, pathophysiology and 

treatment 

• The Diabetic Foot 

Dr. Ivan Bristow PhD, MSc(Oxon), FCPodMed, FHEA: 

Dr Bristow is a lecturer in the Faculty of Health Sciences, 

University of Southampton. Since the commencement of 

his career, he has held a strong interest in dermatology 

establishing the first foot dermatology clinic in the UK 

in1992 at the Dermatology Department in Oxford. Since that time 

he has continued his career, obtaining a Master’s Degree from the 

University of Oxford and promoting podiatric dermatology within the 

UK working with dermatologists and general practitioners on various 

education programmes. 


• Melanoma and the Foot 

• Warts 

• Skin Assessments 

• Non-mechanical hyperkeratosis 

Dr. Alan M Borthwick PhD, MSc, FChS, FCPodMed, 

FHEA: Dr Alan M Borthwick is a Senior Lecturer in the 

Faculty of Health Sciences, University of Southampton, 

UK. His research has largely focused on the contemporary 

and historical sociology of the allied health professions, 

and in particular the profession of chiropody/podiatry. He has 

authored over 70 publications, holds the Meritorious Award of the 

Society of Chiropodists & Podiatrists in the UK, and is an honorary life 

member of the Prince Edward Island Podiatry Association, Canada. 


• Setting Research Priorities in Chiropody/Podiatry 

• Challenging Medicine: How to Influence the Agenda in Foot 

Surgery 

• Healthcare workforce redesign: Changing Role Boundaries 

Across the Anglophone World 

And for Assistants... 

Tina Del Buono: Tina has been a medical office manager 

for 15 years. She is a Certified Podiatric Medical Assistant, 

Certified Medical Transcriptionist and holds a limited 

technician license for leg x-ray. She is a Past President of 

the American Society of Podiatric Medical Assistants and 

currently holds the board position of Scientific Chair. 

Lecture topics include: 

• Your Professional Future 

• Ethics in the Workplace 

• Risk Management and the Podiatric Assistant 

• And more 

Plus workshops designed specifically 

for assistants: 

• Basic Anatomy and Biomechanics Review 

• Risk Identification 

• Simple Orthotic Modifications 

• Basic Shoe Fitting 

• Disinfection and Sterilization 

And much, much more 

full agenda can be found on the CFPM website at www.podiatryinfocanada.ca 

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CFPM Live Auction and Comedy Show 

with Award Ceremony 

Friday, Oct. 26, 2012 8:30 – 10:30 pm 

London Convention Centre Rm 

In the world of standup comedy, public speaking and television, 

the name James Cunningham is synonymous with excellence and 

professionalism. Comedy fans have probably seen James on The 

comedy Network, CTV or CBC performing one of his Just for Laughs 

gala sets, one of his two “Comedy Now” specials or on “Comedy Inc”. 

He was also featured on NBC’s “Last Comic Standing”. James is a 

comedy club favourite who has been headlining across Canada for 

the past 15 years. James has also performed with Howie Mandel, 

Craig Ferguson, Steve Wright, Demetri Martin, Jeff Foxworthy and 

John Pinette. He recently hosted sixteen shoes for The Power Within 

across Canada where he shared the stage with President Bill Clinton, 

Sir Richard Branson, Ben Affleck, Barbara Walters, Deepak Chopra, 

Quincy Jones, Hilary Swank, Martha Stewart, Andre Agassi, Suze 

Orman, Dr. Oz, Kenneth Cole and Anthony Robbins to name a few. 

If you have not heard of the show “Funny Money”, perhaps your 

teenage children have. 

James created 

the show to teach 

students the basics of 

financial literacy using 

humour and audience 

participation. The 

award-winning show 

now reaches over 

100,000 high school, 

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students across North James Cunningham 

America annually. 

James’s new book The Funny Money Manual (a companion to 

the show) has just sold out its first printing in Canada. James can 

currently be seen hosting the TV series “Eat St.” on Food Network 

Canada and Cooking Channel in the US. 

2012 CFPM Oscars 

Celebrate and acknowledge exemplary CFPM Members in 

chiropody and podiatry across Canada. The CFPM is now 

accepting nominations in 5 categories to honour outstanding 

members. These members will be honoured with awards which will 

be presented during the CFPM Annual Conference (October, 26, 

2012). 

Accepting Nominations in 5 Categories: 

1. AWARD OF DISTINCTION: Nominees must demonstrate how he/ 

she has advanced the profession of chiropody or podiatry in their 

community. Through their clinical practice the nominee must 

provide excellent customer and clinical services and provide 

outstanding public education of the profession. He/she must be 

considered a leader in the profession. 

2. COMMUNITY INVOLVEMENT AWARD: The nominees must 

demonstrate extraordinary community involvement such as 

volunteerism which does not necessarily need to be related to 

the profession. 

3. BEST WEBSITE AWARD: Nominees of this award must exhibit an 

attractive, innovative and educational website for their clinic. 

4. STUDENT MENTOR AWARD: 

Nominees must provide 

a nurturing and didactic 

environment for chiropody or 

podiatry students. 

5. OUSTANDING PODIATRIC 

ASSISTANT AWARD: The 

nominee must be a CFPM Assistant Member who provides 

invaluable support to the podiatrist or chiropodist. 

Nomination Process 

• Nominees must be CFPM members in good standing. 

• Application consists of 250 words or less describing their 

competency in the appropriate category. 

• Please one application per category. 

DEADLINE FOR APPLICATION IS SEPTEMBER 15, 2012. 

Awards will be presented at the CFPM 13th Annual Clinical 

Conference on Friday, Oct. 26, 2012 at the Awards Ceremony 



Secrets of Success: “Be Prepared” with 

Proper Employee Performance Documentation 

By: Lynn Homisak, SOS Healthcare Management Solutions, LLC - www.soshms.com 

I’m no boy scout, but there are many instances 

where “being prepared” has its advantages in the 

workplace. The employee performance review 

is one of them. If you do not currently document 

employee performance, keep reading. This column 

will not focus on the purpose of a performance 

review as much on the importance of maintaining 

good employee records as a reliable reference tool to use during your 

review; or if the situation arises…to protect yourself and the practice 

in a potential HR lawsuit. 

When speaking to assistants about annual performance reviews, I 

advise them on the concept of preparedness – by suggesting they keep 

a simple daily/weekly “to do” list. If they had to rely on their memory 

alone, it’s highly unlikely that they can recall accomplishments from 

a year ago, especially surrounded by the pressure associated with 

being “reviewed.” So I explain that once they carry out and cross off 

the various tasks on their list, it not only becomes a plausible record 

of their time and activities, but also a list of things they’ve done. I 

recommend that after assessing and consolidating this year-long list; 

that they select the top 5 accomplishments and refer to them when 

asked about contributions they’ve made to the practice. Likewise, 

doctors should also keep notes regarding employee activities to 

support their comments, both good and bad. Being prepared on both 

ends provides a much more “structured” meeting as opposed to each 

party slapping together some general comments just minutes before 

they meet. 

I can already sense that heavy sigh that comes with the question… 

“In addition to documenting my clinical notes, you also want me to 

document employee activities?” The simple answer is yes. I refer back 

to my opening comment, yes for the practical reason described above, 

and yes for legal reasons. This is preventative medicine. Keeping 

comprehensive employee records benefits you, your staff and your 

practice. When doing so, keep these 5 quick and easy tips in mind: 

1. Date all entries to keep track of consistent and/or improved 

behavior over time. 

2. Keep entries free of opinion, theory, emotion and assumption. 

While something you saw or heard may have made you angry 

or surprised, stick to recording factual incident(s) as they happened 

and what action was taken. Your reactionary comments 

will only detract from and distort the facts. 

(Example B): Wrong: 

Lisa has been leaving 

early a lot lately. I think 

she is determined to 

bulldoze my practice. 

Not only is she bossy, 

her work is slipping 

more and more and I 

have a feeling that the 

staff doesn’t like having 

her around. 

Right: 

1/25/12: Mary and Steve complained that 

Lisa is not collecting patient co-pays at the 

front desk. They claim that if confronted, 

she yells and tells them to mind their own 

business. I reviewed our day sheet with 

Lisa today and found that co-pays were not 

collected in 10 of 25 patients. I reminded 

Lisa of our collection policy, gave her a 

verbal warning and advised her that I will recheck 

her work in 7 days for improvement. 

3. Give specifics, but keep your entries as brief as possible. 

Vague comments are far less credible than those which can 

be directly linked to a specific incident. 

(Example A): Wrong: 

Sharon has either left 

work early or come in 

late every week for the 

past 4 weeks. 

Right: 

1/25/12: Sharon left 15 min. early; said her 

father was in the hospital. 

2/1/12: Sharon left 30 min. early because 

her daughter was sent home from school. 

2/2/12: Sharon arrived 55 min. late due 

to “traffic.” Issued verbal warning that this 

cannot continue. 

2/29/12: Sharon left 15 min. early today. 

No excuse. Issued 2nd verbal and 1st 

written notice. Reviewed disciplinary policy 

with her. 

4. Be consistent across the board. If you have a criticism 

about one employee make sure you also address other 

staff showing similar unacceptable behavior; otherwise you 

will appear biased. Likewise, ALWAYS avoid any references 

to age, sex, religion, etc. in writing…just as you would in 

conversation. 

5. Be fair and equitable. Don’t be overly-anxious to document 

only harsh criticisms and bypass worthy accolades. Remember 

to give staff credit (verbally and in writing) for the things 

they do that are worthy of praise. And again, provide detail. 

(Example C): Wrong: 

A patient told me today 

that Kara was an 

“exceptional medical 

assistant.” 

Right: 

2/12/12: Our patient, Mrs. Latona, made a 

point of telling me today that Kara was “an 

exceptional medical assistant” because she 

offered to help a struggling patient with her 

support stockings. I thanked Kara for taking 

an extra opportunity to please our patients. 

Performance reviews are often viewed as irritating time wasters 

and poorly executed reviews are just that. There is a simple 

solution. You and your staff both need to commit and ‘be prepared’ 

for meaningful discussion by properly documenting activities 

and performance throughout the year. Then a review becomes a 

fantastic opportunity to make corrections, hand out praise, discuss 

recommendations, set action plans and refocus your practice 

objectives. How ‘bout it? Are you prepared? 

Ms. Homisak, President of SOS Healthcare Management Solutions, 

has a Certificate in Human Resource Studies from Cornell University 

School of Industry and Labor Relations. She is the 2010 recipient of 

Podiatry Management’s Lifetime Achievement Award and recently 

inducted into the PM Hall of Fame. Lynn is also an Editorial Advisor 

for Podiatry Management Magazine and recognized nationwide 

as a speaker, writer and expert in staff and human resource 

management. 


CFPM/AAPPM 

Practice Management Seminar 

On July 13 & 14, 2012 a large group of Canadian practitioners 

met in Toronto to learn about podiatric practice management. 

They were treated to informative and entertaining speakers 

from the AAPPM (American Academy of Podiatric Practice 

Management). Attendees of this wonderful seminar had the 

opportunity to learn how to: 

• Maximize revenue & enhance patient satisfaction 

• Work more efficiently 

• Better market your practice 

• Create a podiatry office TEAM 

• Deal with difficult patients and improve patient outcomes 

CFPM / AAPPM 

Practice Management 

Seminar 

Le Meridien King Edward Hotel 

July 13-14, 2012 • Toronto, Ontario 

SpO n SOr E d by: 


Toronto, Ontario 

Speakers Cindy Pezza and Dr. Jon Purdy 

AAPPM CFPM Agenda-FINAL.indd 1 

12-01-19 9:30 AM 

Speaker Dr. John Guiliana 

Speakers Rem Jackson, Dr. Andrew Schneider, Chad 

Schwarz and Stephen Hartman, CFPM CEO 

“Survivor – Podiatry Edition” winners: Tony Abbott and 

Jenny Sinclair with Dr. John Guiliana and Rem Jackson 

Thank you to our generous sponsors of this event: 


Understanding Your Insurance 

By Mark Holman, B.A., C.A.I.B., R.I.B. (Ont.), Vice President, Holman Insurance Brokers Ltd. 

As the endorsed Insurance Broker of the CFPM 

Holman Insurance Brokers Ltd. would like to 

help provide understanding and education to 

your complex insurance needs. 

DO YOU HAVE QUESTIONS, 

WE HAVE ANSWERS 

Q. Is infection due to blood borne 

pathogens covered by the professional liability insurance 

policies? 

A. There is no coverage usually for any condition directly or 

indirectly caused by blood-borne pathogens or ones that can 

be spread by contamination. 

Q. Is there coverage for use of CO2 laser treatments? 

A. CO2 laser are commonly used by Podiatrists and Chiropodists 

as a safe and effective treatment for soft tissue oblation i.e.: 

warts, Keratoses etc. Since this falls within the scope of 

practice, it is covered under our Holman Insurance Brokers 

Ltd. Policy policy. 

Q. I understand that I am not insured unless I charge a fee for 

services. Is this correct? 

A. No, it is not correct. A fee, however, does establish that a 

contract is in place and can help protect the rights of both the 

patient and the practitioner. 

For further information regarding the above or any 

other insurance matter, please feel free to contact 

Mark Holman at 

mark.holman@holmanins.com 

Your endorsed 

Insurance Broker 

of the CFPM 

or Elizabeth Holman at 

elizabeth.holman@holmanins.com 

1-800-567-1279 

or visit our website at www.podiatricinsurance.ca 

CFPM 

Open Forum 

Please join us for an Open Forum Meeting on Thursday, 

October 25 at the London Convention Centre from 7 - 9 pm, 

the evening before the CFPM Annual Conference. 

All delegates of the CFPM Annual 

Conference are invited to 

share ideas, concerns 

and ask questions at the 

Open Forum. This is your 

chance to meet with other 

practitioners and discuss 

the issues that affect YOU. 

Please forward your 

questions or comments 

to the CFPM prior to this 

meeting to: 

cfpmexe.dir@cfpmcanada.ca 

or fax 519-888-9385. 

Agm 

Announcement 

The Annual General Meeting is scheduled for 

Saturday, October 27 from 5:15 - 6:30 pm at the 

London Convention Centre. The AGM is open to CFPM 

members only and is an opportunity to review the 

CFPM initiatives, finances and upcoming objectives. 

Photo credit: Canadian Society for Chemical Engineering 



Winter Getaway Seminar 2013 

February 16-18, 2013 

World Class Skiing, World Class 

Venue, World Class Lectures! 

Mont Tremblant is the #1 Ski Resort 

in Eastern North America and the 

Traveller’s Choice Destination Winner 

for 2011. 

Mont Tremblant is the highest peak in the 

Laurentians and has something for all ski and 

snowboarding enthusiasts! First and foremost, 

snow: the mountain receives on average 380 

cm (12.47 feet) of snow each year and has 

the most powerful snowmaking system in 

Eastern Canada. Its 95 trails and 3 snow parks 

offer spectacular views and thrilling runs. And 

there’s no need to be an expert to take part: you 

can rent equipment on site and/or take lessons 

with one of the ski school’s 450 instructors. 

Finally, the pedestrian-only village at the base of 

the mountain guarantees a memorable aprèsski 

experience! 

At the base of Mount Tremblant, the resort 

transports you to a world that combines 

European ambiance with Québécois hospitality. 

In the quaint mountain village, known for its 

legendary joie de vivre, countless activities, 

world-class sporting and cultural events, fine 

dining and incomparable nightlife. 

It was here at this spot nestled along the 

shore of Lac Mercier that the first skiers came to 

unwind after hurtling down the slopes of the “trembling mountain.” 

Today, you still feel the connection with history in this picturesque 

village without giving up any of your modern conveniences. In these 

days of luxurious duvets and cafés, cultural and artistic activities, 

and excellent restaurants, the village of Mont-Tremblant is also close 

to the region’s main attractions. 

Winter 

Getaway 

Seminar 

Fairmont Hotel, Mont Tremblant, Quebec 

February 16-18, 2013 

Sponsored by: 

Program Lectures Include: 

• Advanced biologics and clinical applications 

• Wound care management in podiatry 

• Diagnostic ultrasound workshop 

• ABC’s of AFO’s 

• Marketing: take your practice to the 

next peak 

• 2013 social media and internet 

marketing update 

•Implementing nursing footcare into 

your practice 

• Roundtable discussion 

Featuring Dr. Andrew Schneider, 

D.P.M. 

Dr. Andrew Schneider is in private 

practice in Houston, TX. He is a 

member of the Board of Trustees and 

a Fellow of the American Academy of 

Podiatric Practice Management. Dr. Schneider 

has been published in APMA News, Podiatry 

Management, and the Journal of Medical 

Practice Management on topics relating to 

internet marketing and practice management. 

He is co-author of Social Media for the 

Health Care Profession: The New Shingle 

for Today’s Medical Practice published by 

Greenbranch Publishing. 


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Are You Losing Clicks to Competitors? 

A 

website is one of the most 

important investments you 

can make for your practice 

today. If you have a website, but 

you aren’t seeing a return, you may 

be wondering why your site has 

generated little traffic since its 

launch. The Internet marketplace 

is overcrowded and highly 

competitive, and while you made a 

great decision to launch your site, you may 

have forgotten a few crucial details that will 

play a major role in whether a patient clicks 

on your site or your local competitor’s site. 

So, how do you ensure your current online 

marketing plan is attracting new patients 

and not sending them to your competition? For 

starters, make sure you’re not making some of these 

common but deadly mistakes. Continue reading for quick tips on 

righting these wrongs if they seem familiar. 

1. Poor first impression 

When visitors come to your site, what do they see? Are they presented 

with an attractive, easy-to-use homepage, or are they faced with an 

outdated design that is difficult to navigate? If your site hasn’t been 

refreshed in a few years, then you may want to consider a facelift so 

that first time visitors aren’t turned off by your initial presentation. 

Instead, your website should compel potential patients to keep 

reading and to contact your office for more information from the 

moment they land on your welcome page. All of your important 

information, such as leading services, office contact information 

and links to your patient education and social media sites should be 

clearly displayed on a clean, eye-catching homepage. 

2. Ineffective search strategy 

Even if you have a fabulous looking site with great content, your 

website will offer little value if potential patients never find it. When 

a prospect searches for a podiatrist in your town, the search engines’ 

search results display those sites that best match the search query. 

These sites are those that have been optimized for these particular 

search terms. 

You can’t expect to be on the first few pages of Google without 

some degree of search engine optimization, especially if you live in 

a highly populated city. Work with your medical website provider to 

map out a search plan for your website that will help you climb the 

rankings and ultimately attract more clicks. 

3. Negative online reviews 

One of the biggest turn-offs for a potential patient searching for a new 

podiatrist is a bad patient review. One or two unhappy patients’ 

opinions won’t destroy your reputation, but if they are the only 

reviews you have or if they outnumber your positive reviews, then 

patients are going to assume your services aren’t worth their 

time or money. 

You’ll never make every patient happy, 

and you will never be able to totally 

stop a dissatisfied patient from 

writing something negative about 

you online. You can, however, 

fervently begin asking your most 

loyal patients to start talking 

about you on the Internet. If they’ve 

already had a few great experiences 

then they will be more than happy to 

provide a positive review. Help them achieve this 

by directing them to review sites. Hand them an instruction card with 

a link to your review sites, or have your website provider set up a 

mobile reviews page that allows patients to review you from their 

smartphone right in your office. 

Don’t allow a few wrong turns totally derail your online marketing 

plan. If you have a website, revisit its design and navigational features. 

Do a few searches for podiatrists in your town and determine whether 

or not your website is even making an appearance on the first page of 

the search results. And finally, browse online directories and review 

sites for mentions of your name. Harmful reviews may be residing on 

popular sites for all of your potential patients to see. For assistance, 

talk to your website provider or find a new company who specializes 

in websites and online marketing for podiatrists. 

Building a successful web presence is easy when you team with 

an expert in medical web design and online marketing. The CFPM 

and Officite have partnered together to offer professional website 

development and online marketing for Members at a discounted 

rate. Officite offers premier designs, easy self-editing capabilities, 

search engine marketing, reputation management, mobile websites 

and social networking—designed to educate and attract new 

patients while creating a prominent presence for your practice in 

the marketplace. To learn more, visit www.officite.com/cfpm or 

call 888-817-4010. 


Recent Licensing Changes 

in New Brunswick 

Dr. Brian Johnson, Chairman of National Issues Committee 

The New Brunswick Podiatry Association 

has successfully lobbied the New 

Brunswick Government for changes to 

the 1983 Podiatry Act. 

In terms of obtaining a License to practice 

podiatry in New Brunswick, the requirement to 

take a licensing examination has changed from 

a requirement to an option. A candidate “may” 

be required to take a licensing examination. 

If a candidate has successfully completed a licensing examination 

in another Canadian Province and is deemed to be in good standing, 

in most cases a licensing examination will not be required. 

PODIATRY PRACTICE OPPORTUNITIES IN 

NEW BRUNSWICK 

The Province of New Brunswick has a population of approximately 

750,000 people. 

The New Brunswick Podiatry Association has eight members, not 

all of whom practice full time. There are presently no podiatrists 

practicing in the northern half of the province. Although a French 

speaking area, most people are bi-lingual. There is an opportunity for 

one or two podiatrists to practice in communities such as Miramichi, 

Bathurst, Edmundston and Campbellton. 

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Continued from page 7 

suspicious lesions and it particularly useful for the novice. Through 

the dermatoscope, it assesses individual lesions on three criteria: 

(i) Asymmetry of colour and dermatoscopic structures 

(ii) Presence of an atypical network 

(iii) Presence of blue-white structures or veil 

Each criterion, if present scores 1 point. Any lesions scoring 

two or above should be considered for biopsy and warrant possible 

excision. A summary of the technique can be found in table (1). A 

preliminary study of 231 pigmented skin lesions showed that after 

one hours training six inexperienced dermatologists were able to 

improve their sensitivity in recognising skin cancer from 69.7% 

to 96.3% [39]. In a later study with 150 participants, Soyer [36] 

demonstrated 91% sensitivity, with those in the cohort declaring 

no experience in dermoscopy still achieving 87% sensitivity for 

melanoma. Further studies are required to confirm this finding. 

Dermoscopy and the foot 

The dermatoscope has been found useful for the examination of the 

skin, but the foot has offered a particular challenge to the technique, 

firstly, because of its thickened acral plantar surface which gives an 

altered presentation of pigmentation [40] and secondly the nail unit 

which frequently presents with pigmentation due to a range of causes 

including haematoma and melanoma. On plantar (and palmar) skin 

the blue-white veil is rarely observed although asymmetry of colour 

and shape should still be considered. 

In addition, other dermatoscopic observations of acral and volar 

skin have been reported. Saida, Myazaki and colleagues identified 

3 specific pigment patterns determined as normal in benign 

melanocytic naevi of plantar skin parallel furrow, lattice-like and 

fibrillar pattern [41-43] (figure 2). In each of these the pigment is 

located in the furrows of the plantar dermatoglyphics. The patterns 

arise as a reflection of normal melanin columns in the stratum 

corneum in a vertical (parallel furrow) or slanting fashion [40]. 

Malignant melanoma has been shown to exhibit different 

patterns on the palmar and plantar surfaces. Saida [42] and workers 

reported, in concordance with the three point algorithm asymmetry 

and irregular (variegate) colour was a common feature. Furthermore, 

in malignant melanoma pigmentation is frequently accentuated 

on the ridges of the dermatoglyphics and not furrows as in benign 

lesions [44] (Figure 3). To test the hypothesis Saida and colleagues 

[45] reviewed 712 melanocytic lesions in acral areas, to determine 

the specificity and sensitivity of these patterns in determining the 

presence of malignant melanoma. The parallel ridge pattern showed 

a positive predictive value of 93.7% (the proportion of patients 

with a proven melanoma who exhibited a parallel ridge pattern) 

and in benign melanocytic lesions the positive predictive value of 

the parallel furrow pattern and lattice like pattern were very high at 

93.2% and 98.3% respectively (the proportions of patients diagnosed 

with a benign melanocytic naevus who showed the parallel furrow 

pattern).The study was carried out on a Japanese cohort although 

later studies have confirmed the findings in Caucasian populations 

[46, 47]. 

Dermoscopy and its potential in assessing nail 

pigmentation 

In addition to the application of the dermatoscope in assessing 

pigmented plantar lesions, its utility in assessing nail pigmentation 

has been discussed [48]. A patient presenting with longitudinal 

melanonychia always presents a diagnostic challenge to Podiatrists 

due to its various causes such as ethnicity, drugs, trauma and 

occasionally melanoma. Biopsy of such lesions has the potential 

to cause permanent scarring to the nail unit. Ronger et al [49] 

discussed the role of the dermatoscope in nail pigmentation and 

suggest it as a tool to decide if a nail biopsy should be performed. 

Subsequent publications have explored this concept further. Braun 

and colleagues [50] describe the dermatoscopic features of the 

different causes of melanonychia and have proposed an algorithm. 

In a similar manner Jellinek [51] suggests it has a role in assessing 

nails prior to biopsy and again proposes an algorithm. Neither of 

these have been formally tested to identify their true validity but 

with time one would expect further development in this area as 

experience increases. 

Figure 5 Melanin distribution patterns on acral skin 

Conclusion 

Current evidence still demonstrates a rise in the incidence of 

melanoma, the most lethal form of skin cancer. Without an effective 

treatment, early detection and excision are vital to improve the 

prognosis and survival. Lesions located on the foot have been shown 

to be prone to more diagnostic delays and misdiagnosis compared 

with tumours elsewhere on the body, subsequently resulting in a 

Continued page 33 


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Reggie Love to Speak at 

the CFPM Annual Conference 

The CFPM is excited to have Reggie Love participate in 

the CFPM 2012 Annual Conference as he speaks about 

his journey to the White House as President Obama`s 

personal aide. 

Reggie Love has packed a tremendous amount of life into 

his 30 years. In this soaring yet humble talk, he shares the 

lessons that have grounded and guided him. Like most of us, 

Love is many things to many people. To President Obama, he 

was a tireless personal aide. To sports fans, he’s the former 

captain of the Duke Basketball team. To others, he’s the quiet 

guy working toward his MBA. Love sees himself as someone 

who has been graced with good luck. More important than having good luck, though, 

is being self-aware enough to recognize and harness it. Imploring us to make the most 

of opportunities, Love gently updates a classic inspirational talk about preparation and 

success. 

Look for Reggie Love and many more exciting speakers at the CFPM 2012 Annual 

Conference in London, ON, Oct. 26 - 27, 2012. 

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CONFERENCE 

October 26-27, 2012 

London Convention Centre 

300 York Street, London, Ontario 

www.londoncc.com 

The Canadian Federation of Podiatric Medicine 

LONDON 

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poorer prognosis. Dermoscopy is a simple and inexpensive means 

of visualising pigmented lesions and has been shown to improve 

diagnostic accuracy. Although originally considered a technique for 

specialist dermatologist, later developments have suggested that 

the dermatoscope can be a useful screening tool for health care 

professionals involved in skin care. On this basis, dermoscopy is 

potentially a new extension to the scope of practice in Podiatry. In 

theory, podiatric practice would be well suited for screening pedal 

lesions. Many patients are routinely seen, particularly the elderly 

(the age group where most melanoma are observed). The addition 

of dermoscopy at initial patient assessment may increase not only 

practitioner awareness but also offer an excellent opportunity to 

discuss self examination with patients and reinforce the public 

health message. In its short history the dermatoscope has shown 

to be effective in highlighting melanoma whilst reducing excisions 

of benign lesions, but its true capabilities are still being discovered. 

Continued research, in time, should uncover its true potential. 

Competing interests 

None declared 

Authors contributions 

IB designed the review, performing the literature search and first 

drafts of the paper. JB undertook subsequent drafting and the 

addition of clinical photographs. Both authors read and approved 

the final manuscript. 

References 

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3. Buettner P, Leiter U, Eigentler T, Garbe C: Development of prognostic factors and 

survival in cutaneous melanoma over 25 years. Cancer 2005, 103:616-624. 

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a high tumour thickness in patients with melanoma. Br J Dermatol 2007, 156:938- 

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5. Schmid-Wendtner MH, Baumert J, Stange J, Volkenandt M: Delay in the diagnosis 

of cutaneous melanoma: an analysis of 233 patients. Melanoma Res 2002, 

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19. Bristow I, Acland K: Acral lentiginous melanoma of the foot: a review of 27 cases. J 

Foot Ankle Res 2008, 1:11. 

20. Fortin PT, Freiberg AA, Rees R, Sondak VK, Johnson TM: Malignant melanoma of 

the foot and ankle. J Bone Joint Surg Am 1995, 77:1396-1403. 

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Res 1998, 8:181-186. 

22. Dalmau J, Abellaneda C, Puig S, Zaballos P, Malvehy J: Acral Melanoma Simulating 

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23. Gregson CL, Allain TJ: Amelanotic malignant melanoma disguised as a diabetic foot 

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J Am Acad Dermatol 2003, 48:183-188. 

27. Valdes A, Kulekowskis A, Curtis L: Case Report: Amelanotic Melanoma Located on 

the Lower Extremity (letter). Am Fam Physician 2007, 76:1614. 

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35:130-151. 

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Dermatol 1971, 85:232-238. 

30. Pehamberger H, Steiner A, Wolff K: In vivo epiluminescence microscopy of 

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31. Bahmer FA, Fritsch P, Kreusch J, Pehamberger H, Rohrer C, Schindera I, Smolle J, 

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32. Stolz W, Riemann A, Cognetta A: ABCD rule of dermatoscopy: a new practical 

method for early recognition of malignant melanoma. Eur J Dermatol 1994, 4:521- 

527. 

33. Menzies SW, Ingvar C, Crotty KA, McCarthy WH: Frequency and morphologic 

characteristics of invasive melanomas lacking specific surface microscopic 

features. Arch Dermatol 1996, 132:1178-1182. 

34. Bafounta ML, Beauchet A, Aegerter P, Saiag P: Is dermoscopy (epiluminescence 

microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis 

using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 

2001, 137:1343-1350. 

35. Kittler H, Pehamberger H, Wolff K, Binder M: Diagnostic accuracy of dermoscopy. 

Lancet Oncol 2002, 3:159-165. 

36. Soyer HP, Argenziano G, Zalaudek I, Corona R, Sera F, Talamini R, Barbato F, 

Baroni A, Cicale L, Di Stefani A, et al: Three-point checklist of dermoscopy. A 

new screening method for early detection of melanoma. Dermatology (Basel, 

Switzerland) 2004, 208:27-31. 

37. Westerhoff K, McCarthy WH, Menzies SW: Increase in the sensitivity for melanoma 

diagnosis by primary care physicians using skin surface microscopy. Br J Dermatol 

2000, 143:1016-1020. 

38. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, Barbato F, Carrera 

C, Ferrara G, Guilabert A, et al: Dermoscopy Improves Accuracy of Primary Care 

Physicians to Triage Lesions Suggestive of Skin Cancer. J Clin Oncol 2006, 

24:1877-1882. 

39. Johr R, Soyer HP, Argenziano G, Hofmann-Wellenhof R, Scalvenzi M: Dermoscopy. 

The essentials. London: Elsevier; 2004. 

Continued next page 



40. Kimoto M, Sakamoto M, Iyatomi H, Tanaka M: Three-Dimensional Melanin 

Distribution of Acral Melanocytic Nevi Is Reflected in Dermoscopy Features: 

Analysis of the Parallel Pattern. Dermatology (Basel, Switzerland) 2008, 216. 

41. Saida T: Malignant melanoma in situ on the sole of the foot. Its clinical and 

histopathologic characteristics. Am Journal Dermatopathol 1989, 11:124-130. 

42. Saida T, Oguchi S, Ishihara Y: In vivo observation of magnified features of 

pigmented lesions on volar skin using video macroscope. Usefulness of 

epiluminescence techniques in clinical diagnosis. Arch Dermatol 1995, 131:298- 

304. 

43. Saida T, Yoshida N, Ikegawa S, Ishihara K, Nakajima T: Clinical guidelines for 

the early detection of plantar malignant melanoma. J Am Acad Dermatol 1990, 

23:37-40. 

44. Oguchi S, Saida T, Koganehira Y, Ohkubo S, Ishihara Y, Kawachi S: Characteristic 

epiluminescent microscopic features of early malignant melanoma on glabrous 

skin. A videomicroscopic analysis. Arch Dermatol 1998, 134:563-568. 

45. Saida T, Miyazaki A, Oguchi S, Ishihara Y, Yamazaki Y, Murase S, Yoshikawa 

S, Tsuchida T, Kawabata Y, Tamaki K: Significance of dermoscopic patterns in 

detecting malignant melanoma on acral volar skin: results of a multicenter study 

in Japan. Arch Dermatol 2004, 140:1233-1238. 

46. Altamura D, Altobelli E, Micantonio T, Piccolo D, Fargnoli MC, Peris K: 

Dermoscopic patterns of acral melanocytic nevi and melanomas in a white 

population in central Italy. Arch Dermatol 2006, 142:1123-1128. 

47. Malvehy J, Puig S: Dermoscopic patterns of benign volar melanocytic lesions in 

patients with atypical mole syndrome. Arch Dermatol 2004, 140:538-544. 

48. Tosti A, Argenziano G: Dermoscopy allows better management of nail 

pigmentation. Arch Dermatol 2002, 138:1369-1370. 

49. Ronger S, Touzet S, Ligeron C, Balme B, Viallard AM, Barrut D, Colin C, Thomas L: 

Dermoscopic examination of nail pigmentation. Arch Dermatol 2002, 138:1327- 

1333. 

50. Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, Gaide O, French LE, 

Laugier P, Saurat JH, et al: Diagnosis and management of nail pigmentations. J 

Am Acad Dermatol 2007, 56:835-847. 

51. Jellinek N: Nail matrix biopsy of longitudinal melanonychia: Diagnostic algorithm 

including the matrix shave biopsy. J Am Acad Dermatol 2007, 56:803-810. 

52. Miyazaki A, Saida T, Koga H, Oguchi S, Suzuki T, Tsuchida T: Anatomical and 

histopathological correlates of the dermoscopic patterns seen in melanocytic nevi 

on the sole: a retrospective study. J Am Acad Dermatol 2005, 53:230-236. 

Membership Has 

Its Privileges 

Membership with the Canadian Federation of Podiatric Medicine 

is affordable and logical. In addition to the many practical benefits, 

the CFPM is hard working to unite the profession and encourage 

achievement of its members. General membership is available to 

practitioners who are eligible for licensing in a Canadian province. 

Annual membership fees: 

• General Membership: $250 

• Assistant Membership: $75 

• Student Membership: $0 

To view all CFPM membership benefits and apply for 

membership visit our website at www.podiatryinfocanada.ca or 

call 1-888-706-4444. 

2012 Edition 

Supplier 

Reference 

2012 Guide to 

Corporate Partners 

Products & Services 

• Podiatric Equipment & Supplies 

• Office Management Software 

• Orthotic Laboratories 

• Footwear • Websites 

• Podiatric Therapies 

• Dermatology 

Practice Management 

Seminar 


CFPM / AAPPM 

Le Meridien King Edward Hotel 

July 13-14, 2012 • Toronto, Ontario 

SpO n SOr E d by: 

Tables 

Table 1 

The three point checklist 

Table 1: The three point checklist [36] 

Feature Significance 

Asymmetry Examined in both axes, using 

the dermatoscope. Colour and structures 

are assessed. Significant asymmetry of 

colour or structures within the lesion are 

recorded as a score of 1. 

Atypical pigment network Many naevi 

have a uniform reticular pattern to the 

pigment distribution resembling chicken 

wire or a honeycomb structure with regular 

brown or black lines. An atypical network 

is recorded as a score of 1 if the network 

is irregular in thickness, irregular holes, or 

irregular colours. 

Blue structures or blue-white veil The 

presence of any blue structure observed 

including a blue-white veil scores 1. 

Any lesion scoring two or more should 

warrant further investigation – 

referral / excision 

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Classified Ads 

Part Time Chiropody/Podiatry Position 

Available – Waterloo, ON 

Foot Works is looking for a registered 

chiropodist/podiatrist for a one year contract, 

one day a week. Eligible candidates must 

possess excellent surgical and communication 

skills. Experience is not necessary, but a definite 

assess. Must also be focused on providing 

exceptional customer service and be a positive 

and contributing team member. Outstanding 

compensation with an opportunity to earn up to 

$100/hour. Please send resume to Stephen 

Hartman at shartman@xplornet.com. 

Full Time Chiropody Position Available – 

Midland, ON 

COME PRACTICE IN COTTAGE COUNTRY! 

All Chiropodists and Podiatrists are welcome 

to apply – including new graduates! We are 

keen to hire a high energy candidate that would 

like to build a career with us. Located just 90 

minutes north of Toronto, Midland offers a tight 

knit community atmosphere and recreational 

opportunities that are unlike any other. With 

beaches, trails and boating in the summer, and 

skiing and snowmobiling in the winter, living on 

the shores of the Georgian Bay is like bringing 

your cottage home! Advanced Foot & Orthotic 

Clinic in Midland, Ontario is currently seeking 

a FULL TIME REGISTERED CHIROPODIST. All 

Chiropodists and Podiatrists (including new 

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clinic requires an individual that provides the 

highest quality of Chiropody care with the 

utmost attention to customer service. Our 

clinic will provide you with support staff, up to 

date equipment, and a warm and friendly work 

environment. Interested candidates are asked 

to please e-mail your resume to: 

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Full Time Chiropody Position Available – 

Kingston, ON 

Full time staff Chiropodist needed in our growing 

practice in Kingston, On. New graduates are 

welcome to apply. Great salary, generous 

benefits and flexible work schedule. New office, 

lasers, Optogait video gait analysis, support 

staff and all modern equipment. Must be highly 

motivated, honest and able to work as a team 

player in this family practice foot clinic. Please 

send resumes to kfc673@hotmail.com. 

Part Time Chiropody Position Available – 

Burlington, ON 

Dundas Foot Clinic in Burlington, Ontario 

is currently seeking a part time registered 

chiropodist. Our growing clinic requires an 

individual that provides the greatest quality 

and variety of Chiropody care and also focuses 

on customer service. We treat a wide array 

of patients from pediatrics to seniors. We are 

looking to hire a candidate who would like to 

build a career with us. Previous experience is 

an asset however new graduates are welcome. 

Interested Candidates are asked to e-mail their 

resume to: dundasfootclinic@rogers.com or fax 

at 905-340-3668. 

Part Time Registered Chiropody Position 

Available – Toronto, ON 

PART TIME REGISTERED CHIROPODIST 

DOWNTOWN TORONTO (can lead to full time). 

All Chiropodists (including new graduates) 

are welcome to apply! Our clinic requires an 

energetic, pleasant and professional individual 

that provides the highest quality of Chiropody 

care with the extreme attention to customer 

service. We have support staff, up to date 

equipment, and a friendly work environment. 

Interested candidates are asked to please 

e-mail your resume to: 

customerservice@stepbystepfootcare.com 

(no phone calls please). 

Part time Chiropody Position Available – 

Niagara Area 

Feet First Steps for Health program provides 

foot care services to seniors and others with 

diabetes that are at moderate to high risk for 

lower limb complications. The program is funded 

through the Hamilton Niagara Haldimand Brand, 

Local Health Integrated Network Aging at 

Home Strategy and is run through the North 

Hamilton CHC. 

Chiropodist: part time for the Niagara Area 

Does the opportunity to work as part of a 

dynamic interdisciplinary team and provide 

care in innovative ways excite you? Do you 

value job flexibility along with a competitive 

salary, assistance for ongoing educational 

and an excellent benefits package? Are you 

interested in working in the beautiful Niagara 

peninsula with seniors and persons with barriers 

to accessing the health care system? Are you 

looking for an opportunity to provide excellent 

care without worrying if clients can afford to 

pay for your service? Are you wishing to gain 

experience with chronic disease management 

and group interventions? Do you have 

experience working with diabetic feet and are 

you eligible for registration with the College 

of Chiropodists of Ontario; Then this position 

is for you! 

SUMMARY OF FUNCTIONS: 

The Chiropodist will provide foot care services 

in the Health Centre and affiliated health care 

institutions, as well as to coordinate the day-today 

chiropody services at the Niagara Satellite 

Clinics. The Chiropodist’s approach to client 

care is evidenced based and innovative and 

utilizes current therapeutic techniques within the 

determinants of health framework. This position 

works within an inter-professional team-based 

model in terms of both the clinical practice and 

program planning aspects of its responsibilities. 

A systems perspective and attention to 

continuous quality improvement are essential to 

the success of this position. 

MAJOR DUTIES: 

1. Provide general chiropody services. 

2. To be a resource person to the staff, students 

and community regarding foot care. 

3. To develop, implement and evaluate 

chiropody health promotion activities in 

the Community, including increasing the 

awareness of this service. 

4. To provide clinical instruction to learners, 

and students of chiropody and other health 

professions. 

5. To design and maintain a system to 

coordinate chiropody and orthotic activities 

provided at the Health Centre and at other 

affiliated health care institutions. 

6. To be a member of the multi-disciplinary team 

of health professionals providing family care 

to clients and to the community. 

7. Such other activities as may be assigned. 

SPECIFIC TARGETS: 

All Chiropodists will have a target of twelve (12) 

clients seen (units of service) per full clinical day 

worked. The average appointment length will 

be 30 minutes with the exception of procedures 

which require more time. Time will be scheduled 

for non-direct client care as needed and activity 

will be encountered in the EMR. 

QUALIFICATIONS: 

1. Registered with the College of Chiropodist of 

Ontario under the 1994 Chiropody Act. 

2. Possess excellent assessment, organizational 

and problem-solving skills. 

3. Availability of transportation to outlying clinics. 

4. Excellent communication and interpersonal 

skills. 

5. Enthusiasm to serve a diverse community. 

6. Ability to work independently. 

7. Proficiency in the use of personal computers 

and software. 

RESPONSIBLE TO: 

Health Wellness Team Director 

North Hamilton CHC 

Please respond in confidence by 

Aug 30th 2012 

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North Hamilton Community Health Centre 

438 Hughson Street North 

Hamilton ON L8L 4N5 

Email: hamill@nhchc.ca 

Fax (905) 667-8859 

Phone (905) 523-0090 ext 3014 

www.northhamiltonchc.org 


Classified 

Continued 

Equipment for Sale 

For Sale: 

“Footwork” gait analysis system. 

2 Electronic pressure plate gait analysis 

systems. Extremely user friendly, with 

great graphical output. 

1 is unused. $3000.00 

The other has 154 gait recordings on it 

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$2600.00 

These were procured for a clinical study 

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please go to the following web sites: 

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www.amcube.co.uk/pdf/Footwork_ 

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Contact: bennefoot@gmail.com 

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Chiropody/Podiatry Clinic for Lease – 

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Fully furnished chiropody/podiatry clinic 

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chairs, new ESWT unit, two new laser/gpulse 

units, shoe display room, gait room, 

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Position Available – Toronto, ON 

Our foot clinic team is growing and we 

are looking for a principled, honest, 

enthusiastic practitioner. Someone who 

wants to be part of a team that prides 

itself on practice excellence. We had over 

120 new patients last month. You must 

be willing to go above and beyond what 

might normally be expected in practice, 

but the rewards are immense. Our clinic 

is located 50 yards from the Broadview 

Subway and is state of the art. We have 

laser, shockwave, computerized painless 

injections, ultrasound, X-ray, Dopplar, 

interferential, 3-D laser casting and a 

paperless office. Must be hard working 

and a team player. This is not a 9 - 5 

job. This position is for 4 days per week. 

Mondays, Thursdays, Friday and Saturdays. 

Please call Dr. John A. Hardy at 

416-716-0976. Please visit our 

website at www.academyclinics.com 

for more information about our clinic. 

Part Time Chiropody Position 

Available – Orillia, ON 

The Orillia Foot Clinic and Wellness 

Centre is looking for a Chiropodist 

for a part time opportunity. New 

graduates and seasoned Chiropodists 

are welcome to apply. Interested 

applicants, please email your resume 

to: orilliafootclinic@gmail.com 

Full Time Chiropody/Podiatry Position Available – Sudbury 

The DeSimone Foot & Ankle Centre is looking for a Chiropodist or Podiatrist 

full time. We are looking for an honest, integral and enthusiastic Chiropodist/ 

Podiatrist to join our patient centered team. New graduates are welcome to 

apply but must possess excellent surgical and communication skills. They 

must be prepared to work in a TEAM based environment and focus on high 

customer service. We will provide you with full support staff including casting 

technician, chair side assistant, reception and shoe fitting technicians. Newly 

built, state of the art facility. Send resume to juliejdesimone@gmail.com 


The CFPM to Join JFAR 

The CFPM has been officially invited to participate 

in the Journal of Foot And Research (JFAR) with 

the Society of Chiropodists and Podiatrists (UK) 

and the Australasian Podiatry Council. The CFPM 

is excited to join this international venture. It is an 

honour to be included in this #1 ranked foot and ankle 

journal. The CFPM will nominate one member to join 

the JFAR Board of Management and the JFAR Editorial 

Advisory Board. 

Journal of Foot and Ankle Research, the official journal of the 

Australasian Podiatry Council and the Society of Chiropodists and 

Podiatrists (UK), is an open access, peer reviewed, online journal 

that encompasses all aspects of policy, organisation, delivery and 

clinical practice related to the assessment, diagnosis, prevention 

and management of foot and ankle disorders. 

Journal of Foot and Ankle Research covers a wide range of 

clinical subject areas, including diabetology, paediatrics, sports 

medicine, gerontology and geriatrics, foot surgery, physical therapy, 

dermatology, wound management, radiology, biomechanics and 

bioengineering, orthotics and prosthetics, as well the broad areas of 

epidemiology, policy, organisation and delivery of services related to 

foot and ankle care. 

The journal encourages submission from all health professionals 

who manage lower limb conditions, including podiatrists, nurses, 

physical therapists and physiotherapists, orthopaedists, manual 

therapists, medical specialists and general medical practitioners, 

as well as health service researchers concerned with foot and 

ankle care. 

To find out more about JFAR go to http://www.jfootankleres.com/ 

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Upcoming Events 

2012 

Sept. 12 – 14, 2012 

The Symposium on Advanced 

Wound Care 

Baltimore, Maryland 

www.fall.sawc.net 


Podiatry New Zealand Biennial 

Conference 

Aotea Centre, Auckland, NZ 

www.podiatry2012.org.nz 


Southwest Foot & Ankle 

Conference 

Frisco, TX 

www.txpma.org 


Insights and Advancements in 

Foot & Ankle Surgery 

Philadelphia, PA 

www.podiatryinstitute.com 


18th Annual Las Vegas Seminar 

Las Vegas, Nevada 

www.internationalfootankle.org 


Update 2012 

San Diego, CA 


Oct. 11 – 13, 2012 

SOCAP Scientific Meeting 

Glascow, Scotland 

www.feetforlife.org 

Oct 11 – 13, 2012 

Diabetic Limb Salvage 

Washington, DC 

www.dlsconference.com 


ACFAOM Annual Conference 

Orlando, Florida 

www.acfaom.org 


Manhattan Getaway, Northeast 

Regional Conference 

New York 

www.kent.edu/cpm 


2012 ACFAS Practice 

Management 

Arlington, VA 

www.acfas.org 


Superbones West Conference 

Las Vegas, NV 

www.superboneswest.com 


No Nonsense Meeting 

New Orleans, LA 

www.gtef.org 


31st Hawaii/Big Island Seminar 



APMA Region One Conference 

Danvers, MA 

www.apma.org 


CFPM 13th Annual Conference 

London, ON 



Diabetic Foot & Ankle Surgical 

Symposium 

Coconut Grove, FL 

www.acfas.org 

Nov. 1 – 4, 2012 

Complications, Infection and 

Wound Management 

Fort Myers, FL 



Hallux Valgus & Related Forefoot 

Deformities 

Sanibel Island, FL 

www.podiatryinstitute. 

com 


Canadian Association of Wound 

Care Conference 

London, ON 

www.cawc.net 


AAPPM Fall Practice 

Management Workshop 

Ft. Lauderdale, FL 

www.aappm.com 


40th Annual Clinical Conference 

King of Prussia, PA 

www.goldfarbfoundation.org 


Desert Foot – High Risk Diabetic 

Foot Conference 

Phoenix, AZ 

www.desertfoot.org 

2013 

Jan. 11 – 13, 2013 

AAPPM Million Dollar Practice 


Ft. Lauderdale, FL 

www.aappm.com 

Jan. 16 – 20, 2013 

SAM/FPMA Annual Meeting 

Orlando, FL 

www.fpma.com 

Jan. 19 – 26, 2013 

Southern Caribbean Cruise 

Seminar 


Jan. 25 – 27, 2013 

New York Clinical Conference 

New York, NY 

www.nyspma.org 

Jan. 31 – Feb. 2, 2013 

Lake Tahoe Ski Seminar 


Feb. 7 – 9, 2013 

Podiatry Institute Annual Winter 

Conference 

Park City, Utah 


Feb. 16 – 18, 2013 

CFPM Winter Getaway Seminar 

Mont Tremblant, QC 


Feb. 27 – Mar. 3, 2013 

AAPPM Midwinter Conference 

Pittsburgh, PA 

www.aappm.com 

Mar. 21 – 24, 2013 

Mid West Podiatry Conference 

Chicago, IL 

www.midwestpodconf.org 

Apr. 18 – 21, 2013 

Valley of the Sun 

Phoenix, AZ 


May 2 – 5, 2013 

AAPPM Spring Practice 


Pittsburgh, PA 

www.aappm.com 

May 2 – 5, 2013 

Surgical Pearls by the Sea 

Newport, RI 


May 3 – 10, 2013 

Taste of Tuscany 

Florence/Tuscany, Italy 

www.gtef.org 

May 16 – 19, 2013 

Reconstructive Surgery of the 

Foot & Ankle 

Atlanta, Georgia 


June 2 – 6, 2013 

Australasian Podiatry Biennial 

Scientific Conference 

Sydney, Australia 

www.apodc.com.au/ 

conference2013 

June 20 – 23, 2013 

The Western Foot & Ankle 

Conference 

Anaheim, CA 

www.thewestern.org 

June 27 – 30, 2013 

Footprints in the Sand 

Hilton Head, SC 


Jul. 11 – 14, 2013 

AOSSM Annual Meeting 

Chicago, IL 

www.sportsmed.org 

Jul. 21 – 25, 2013 

APMA Annual Scientific 

Conference 

Las Vegas, NV 

www.apma.org 

Aug. 8 – 11, 2013 

Pacific Coast Conference 

Portland, OR 


Aug. 4 – 10, 2013 

International Association for 

Indentification 

Providence, Rhode Island 

www.theiai.org 

Aug. 20 – 31, 2013 

Rhone River Cruise Seminar 

Paris to Barcelona 


Aug. 23 – 25, 2013 

Current Concepts in the 

Management of Foot and Ankle 

Disorders 

Overland, KS 


Sept. 26 – 29, 2013 

Reconstructive Surgery of the 

Foot & Ankle 

San Diego, CA 


Oct. 4 - 5, 2013 

CFPM 14th Annual Conference 

Toronto, ON 


Oct. 4 – 6, 2013 

Insights & Advancements in Foot 

& Ankle Surgery 

Atlantic City, NJ 


Oct. 13 – 20, 2013 

32nd Annual Hawaii/Kauai 

Seminar 


Oct. 17 – 19, 2013 

2013 World Congress 

Rome, Italy 

www.fipnet.org 

Oct. 18 – 20, 2013 

APMA Region One Conference 

Danvers, MA 

www.apma.com 

Nov. 7 – 10, 2013 

Hallux Valgus and Related 

Forefoot Surgery 

Fort Myers, FL 


2014 

Jul. 10 – 13, 2014 

AOSSM Annual Meeting 

Seattle, WA 

www.sportsmed.org 

Jul. 24 – 27, 2014 


Conference 

Honolulu, Hawaii 

www.apma.org 

Aug. 10 – 16, 2014 


Identification 

Minneapolis, MN 


2015 

Jul. 23 – 26, 2015 


Conference 

Orlando, FL 

www.apma.org 

Aug. 2 – 8, 2015 



Sacramento, CA 


2016 

Aug. 7 – 13, 2016 



Cincinnati, OH 


2017 

Aug. 6 – 12, 2017 



Atlanta, GE 



For more than 40 years, Langer Biomechanics has been 

the leader in lower extremity orthopedic innovation. This 

tradition continues with the launch of “game-changing” 

new products and technologies in 2012. 

To maintain momentum in 

your practice, contact Langer today 

Biomechanics 

Langer Biomechanics, Inc. | 800.645.5520 | www.langerbiomechanics.com

Fall 2012 - Canadian Federation of Podiatric Medicine

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