Health Care

Ankle & Foot Care Centers Walks Ahead of Its Field

BOARDMAN, Ohio — As she walks through the halls of the Boardman office of Ankle & Foot Care Centers, Dr. Danielle Butto knows that her time at the practice is almost over. A year ago, she joined the podiatry center as a fellow to co-founder Dr. Lawrence DiDomenico, working with patients, assisting with surgeries and helping with research.

“This has been the quickest and best year of my training,” she says. “I’m building on what I learned in residency and taking on more advanced cases to learn how to approach those.”

Later this year, after her fellowship ends, Butto will move on to another job out-of-state, but leaves the door open to return once she feels established in her career.

What gives her confidence in returning, should the opportunity and her career path allow, is that earlier fellows such as Dr. Ramy Fahim and Dr. Frank Luckino III returned to the practice as associates.

“There’s not a lot of people who can do this work, so being able to learn from [DiDomenico] and then take it outside of Youngstown will be great,” she says.

Most helpful, she says, has been learning what wasn’t taught – or only lightly touched on – in medical school, like research and patient interaction. It’s those areas, she says, where she has been most interested under DiDomenico.

“Looking back in history at cases and learning where they came from or where they’ve been – without him and his guidance, I wouldn’t have the skills or confidence to take on these kinds of cases,” she says.

“He approaches everyone from a medical standpoint. He doesn’t look just at deformities, but the person,” Butto continues. “In residency, it’s a different ballgame because you just see people in the operating room and don’t see the work up to it.”

Throughout the 20 offices in northeastern Ohio – the most recent opening was the Ravenna office last November – that personal approach is just part of what DiDomenico has heavily emphasized – both in practice and in selecting whom to hire as doctors, office staff, or even fellows.

“We look at the quality of the person first,” DiDomenico explains. “Everybody has different abilities from a medical standpoint and a surgical standpoint. If they’re a good person, it’s a natural fit for us.”

DiDomenico looks for everyone on the medical staff to have different areas of expertise.

By having doctors with different skill sets, rather than general podiatrists in one office and one office only, they can rotate as needed through the locations to see patients.

It’s that kind of patient care, DiDomenico surmises, that allowed Ankle & Foot Care Centers to grow.

The first office opened in 1994 as DiDomenico merged his practice with Dr. Robert Debiec’s and, shortly after, brought on Dr. Ken Emch. Today, the practice employs about 100, including 20 doctors.

“We hope that it’s through good care and good reputation. Everyone in our group is a good person and that’s how it happened,” DiDomenico says. “We had envisioned getting a little bigger, but never to the size we are today.”

It seems that patients have taken notice of that caliber of care. In 2013, George Lesnansky had a bunionectomy done by DiDomenico. When he returned to work on his radio show, “Happy Polkaland,” after the surgery, Lesnansky told his audience about Ankle & Foot Care and his experiences there.

“It’s his demeanor and his procedures that I was totally impressed with,” says Lesnansky, who goes by “Larry Walk” on his radio show. “He cares about his patients. … It comes through that he cares about everyone like human beings and wants positive results.”

Part of what attracts doctors, says practice administrator Michael Vallas, is the shift in how the nation’s health care system operates. Increasingly, doctors in private practice found managing the business side took more and more of their time as they worked to stay abreast of shifting regulations. That led to some to opt for hospital-based employment and health care groups such as Ankle & Foot Care.

“They don’t want to deal with all the regulations and requirements beyond treating patients,” Vallas says. “From a physician end, it has helped us. We’ve had several docs come on after they see the structure of the practice. There’s something appealing to having those kinds of support aspects in place.”

As practice administrator, Vallas’ job is to manage the business operations, which in turn allows the doctors to focus on patients and their health.

What’s also contributed to the growth of Ankle & Foot Care is the adoption of new techniques, such as shockwave therapy, total ankle replacements and calcaneal osteotomies. In the latter, a section of the heel bone is cut and screws implanted to normalize high or flat arches. Traditionally, DiDomenico explains, the procedure involves large incisions in the leg that divert the blood supply from the heel, lengthening the healing process and opening up more chances for infections.

“We do it through percutaneous techniques with small incisions about this big,” he says, his fingers about half an inch apart. “It works better, it’s easier and it has a quicker recovery.”

Doctors at Ankle & Foot Care have also taken part in numerous studies over the years. This summer, the practice is participating in two studies that examine treatment for diabetic foot ulcers. For patients, DiDomenico says, the advantage of being involved in such studies is multifaceted.

First, he says, their care is often paid for by the organization conducting the study. Second, studies like the current ones don’t deal with experimental treatments; everything is already FDA-approved. And finally, it keeps the practice on the front line of new techniques, improving care down the line.

“It gives us all [an] education and helps us contribute to making things better,” he says.

What makes Ankle & Foot Care attractive to companies looking to test products and organizations conducting studies, Vallas notes, is the size of the practice.

“Having that kind of number is easier for the companies who want to do the research,” he says. “You’re dealing with one set of physicians and patient bases. We push ourselves to be on the leading edge of treatment and doing these allows us to offer some treatments that aren’t really available in the area.”

And over the years, the staff at Ankle & Foot Care has pushed the practice’s impact beyond the office doors, bringing education and charity work to the area. The annual Holiday Shoe Drive, begun in 1998, collects more than 500 pairs of shoes donated to the Salvation Army. A year later, the first Diabetes Golf Benefit was held, benefiting the Diabetes Partnership of the Mahoning Valley and the American Diabetes Association. In its 18 years, the outing has raised almost $100,000 for the societies.

More recently, DiDomenico and others in the practice started a local chapter of the Save A Leg, Save A Life foundation. The meetings attract a range of health care professionals who exchange their ideas on caring for limbs.

“Everybody has a subspecialty and it can be hard to keep up in your own field, let alone other fields,” DiDomenico says. “We might have a vascular surgeon who can come in and tell us about this new procedure that can do things easier and quicker and safer. New devices and procedures come out all the time and we have a duty to inform our patients.”

What drives most of the outreach work, which also includes support groups and fundraising walks, is the doctors, Vallas says.

“Most of our docs are from this community. They’re from here. They grew up in the community,” he says. “We try to be engaged with the community.”

Pictured: Ankle & Foot Care Centers stays on the front edge of podiatry by using the newest procedures and participating in studies, co-founder Dr. Lawrence DiDomenico says.

Published by The Business Journal, Youngstown, Ohio.