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Saturday, January 7, 2017

Barefoot, but Need Some Support and Protection

Nike Studio Shoes

There may be many times that you need less shoe, but still good support. Nike Studio shoes can fill that need. It may be that you are recovering from a bad case of plantar fasciitis, and around the house you like to go barefoot. It may be that your goal is getting back to dance barefoot, but you need a transition plan. This line of shoes can be very helpful. Rich

Wednesday, January 4, 2017

Low Back Surgery Nightmare: Email Advice

Dr Blake's comment: This kind young lady just had a quack do back surgery without actually doing the surgery. I have heard stories like this, but this is a first for me. I present the story because we all have to be cautious with surgery. Most surgeries are very helpful, but problems can occur. Major foot and ankle surgeries I love my patients to get 2 or 3 opinions. But, she did not do anything wrong, and now has to start all over again. She has to heal from the first unsuccessful non-surgery both physically and emotionally before she can attempt to do it all over again with another physician. I am sorry as a human for her suffering, and I am sorry as a doctor that this doctor brought a disgrace on the profession I love. Remember to take many opinions. Yelp the doctor to see the reviews. Part of the sadness is that this doctor obviously does not care. This surgery in face of low back pain with sciatica is very successful overall. I am sorry and I hope your healing and new surgery goes very well. Rich

I'm responding to your kind invitation from You Tube..So here goes!

I have had low back pain with sciatica symptoms for years but I wasn't willing to go through the process of steroids and medications that are a band aid and certainly not healthy either!

I had gone to several different Drs with my symptoms and actually most of them scared the hell out of me with their "solutions" so I suffered for 5 years,but on those years I also went to different chiropractic care facilities and massage therapist, along with physical therapy with some good results but nothing permanent so it started looking like surgery may be an option! 

I finally found a neurosurgeon who seemed caring and trustworthy!
I saw him a couple of times and finally felt comfortable with having this l5s1 microdiscectomy
Easy he said,you'll be fine he said!
Recovery will be max 6 weeks!

I decided to go ahead and do this even though his personally owned spine hospital is 4 hrs away from me!
First of all I wasnt even sobered up from the anesthesia and was led out of the facility 2 hrs after I was checked in....My husband and I stayed at a local hotel till morning and we drive home...that was a nightmare in and of itself !

Anyway I did to the letter post op instructions for the time frame he claimed,including physical therapy at 6 weeks!
About 2 weeks post op I'm still in horrible pain and no relief in site, I called and left messages and pretty much begged for some answers!

I only (and only then) got a phone call at 3 weeks post op. Why? Because I gave his business a bad review on Facebook! 
I got chewed out by his Facebook administrator to NEVER post bad things about him!
In the meanwhile I found a local neurosurgeon to see me but I had to wait 90 days for ab appointment! 

Legal reasons  (not his circus,not his monkey ) So my recovery is still not going as planned, even the great help I got from my physical therapy! 
90 days has finally passed and I go to the new neurosurgeon with my MRIs pre and post op! 
One was done the day before surgery the other was done 2 weeks post op at my local emergency room! 
Ya I ended up in the ER !

So the new surgeon is doing his exam along with his PA and reading my report on this case!
He takes a look at both MRIs and compares the 2 and looks at me with a very serious face and asks,is this guy old or something?  Not kidding! 
I said no why,he pointed out that the 2 MRIs are identical and that even though his report says he'd done a microdiscectomy,there was no l5s1 repair! The annular tear is still there and the disc is still protruding! 

What he did do was take stem cell from my right iliac crest and injected the cells into the disc space! 
That is ALL that as far as we can tell was done!
I knew things couldn't be ok from the start and this confirmed my suspicions! 
In essence I was a guinea pig that is out $
Legal action ....pphhh! TORT REFORM BILL! 

True story:
I thought I was smarter than this!
Hope this isn't to boring!
Thanks for asking what the deal was!

Tuesday, January 3, 2017

Accessory Navicular: An Accessory You Can Do Without!!

Hi Dr. Blake!

I have no idea if you will find this email, but at the very least, it is nice to write out the issues I have been having. I came across your blog while researching the accessory navicular and how to conservatively treat the area. I am a 27 year old, highly active/athletic female. 

Back in July, while playing beach volleyball (to be clear, this was beer league volleyball, nothing too intense!), I suddenly had a sharp pain in my mid foot after landing from a jump. I have sprained my ankles a few times before, but this pain felt different. It was a sharper, more directed sensation right where (I thought was) my "arch bone", which I now know is the navicular bone. I kept playing, which was dumb. I then continued to ignore the soreness, as I figured it was just a minor tweak, nothing more (I would rate the pain in the morning about 5-6 out of 10). Over time, the pain reduced but I could not run. I am - well, was - an avid triathlete. I couldn't train any more because even walking more than 10 mins would be painful. Upon resting, pain would improve. After about 2 months of nothing getting better (and I know, I am kicking myself for not going sooner), I saw a physiotherapist for about 8 sessions to get some exercises to improve the situation, as my foot looked flatter than usual and with my previous ankle injuries, rehab was the key to tightening/strengthening the area back up. I have been doing inversion/eversion with resistance, along with standing on a bosu ball, standing on one foot, then icing & voltaren (diclofenac gel) etc. X-rays didn't reveal anything remarkable, other than an accessory navicular.

Finally, after getting an MRI and seeing the doctor, I was told I have a 'crack' between an accessory navicular bone and the true navicular bone, and the PTTD partially attaches to the accessory navicular. The extra movement of the accessory navicular is causing the pain, so it would seem.
Dr Blake's comment: That is common in a mis-step and that junction between the accessory and parent navicular bones can be the weak link in the chain. 

So, I've started wearing an aircast with my orthotic in there, and will do so for the next 4 weeks (has been on for 2). I don't feel much improvement so far, and I had a brief stint where the aircast was causing a lot of irritation of the tendon, as it would swell and appear elevated through my skin. The cast was occasionally unbearable to wear...I have made some adjustments, but the only thing that has seemed to help is to deflate the aircast a little bit (though, now it feels like my foot is moving too much in there). 
Dr Blake's comment: Since this is such a vital part of your treatment, get a removable boot that works. A medical supply store typically has some selection. You can see if ordering an Anklizer  on Amazon and you can have it in a couple of days. 

I guess my question is this - if the bone didn't heal for 6 months, and if the boot doesn't allow it to heal, how will I know when surgery is the next best option? 
Dr Blake's comment: You will know in about 6 months. The steps you need to go are: 3 months in the removable boot, followed by 2-6 weeks weaning out of the boot. As you wean out of the boot, you need good orthotics that support the area, and learn at least 2 versions of taping (both somewhere on the blog). Strengthening steps with active range of motion, isometrics, progressive resistance, isotonic, and functional should begin now. You can strengthen each evening, with a little pain, as long as you can ice for 10 minutes after, and the next day you have no residual. Since you fractured the juncture, your health plan may approve an Exogen bone stimulator for the next 6 months. I always feel that these will heal, a few do not, and each month you should see improvement: less swelling, less pain, more function, more strength, etc. Hope this helps some. Each step can take some planning. I am happy if you want some more info. Give me more specifics. Rich

I hope this finds you in good health, and happy 2017!

Monday, January 2, 2017

Metatarsal Fracture with Displacement: Email Advice

Hi, Dr. Blake. 

I am a 60 year old with a fracture that does not seem to be healing even at the 7 weeks mark. A hard bench had hit my foot when I slipped from it in the gym, to cause the fracture. It's a mid shaft fracture with a bit of displacement like 3mm. Does that make sense? 
Dr Blake's comment: Thanks for the email. If you could take some photos of the images that would sure help, but 3 mm of displacement will take a while to heal, especially because it is at the mid-shaft where the bone heals slower than at the ends. 

Since I have experienced no pain with my foot in an air cast since day one, being quite active at home, and having an outing where I need to walk at least twice a week , my doctor asked me to wean off the air cast slowly starting on Dec 29.
Dr Blake's comment: I am answering this on Jan 2nd, but the advice would be the same for any weaning process. You give yourself between 2 and 6 weeks to go from boot to shoe. You start with one hour the first day out of the boot, then 2 hours the second day, etc. You can not have any more pain out of the cast than in the cast. You should be in the 0-2 pain environment and you can not deviate from this. I love to have the patients in a softer shoe, with lacing that can be adjusted, and arch supports to spread out the weight. The pace should initially be slower out of the boot. Try 10 minute ice pack 3 times a day to control the inflammation for the first 2 weeks. 

I have been trying to do that but I am concerned that I may not be doing so in the right way. I have read through your blogs but have this question. When I try to walk on this fractured right foot, I tend to be compensating by walking flat footedly. I am not putting my heel down first and pushing off from the front of the foot. In a way, I am limping.
Dr. Blake's comment: It is probably okay to flat foot this until you are out of the boot completely or, at  least, for 2 weeks. You definitely do not want to walk only on the outside of your foot, but try to gradually place all your weight down on the flat of the foot (heel should take alot of weight) like a slow march. The pushoff will come, but I think you have to be completely out of the boot for a week or so, and doing great, before I would risk an active pushoff. 

Also, my foot swells up as soon as I have walked 10-15 steps. Pain level has been 0,1 or 2.  Its just slight soreness, when I walk without the air cast.
Dr Blake's comment: The swelling is the body's protection, so pain will be your guide more on when to get off it! Understand that you have to have the boot with you at all times, in case you have to put it on. If you put it on for relief, than you have to wait 2 hours before trying to go without it. Standing is the worse for the swelling. If you are a sweller, see my video on contrast bathing and start at 1 minute warm water and 1 minute cold water for 10 cycles. That is a 50% heat to ice ratio and really gets the circulation going. If you are still swelling, you can try 1 hot, 3 cold cycles still for about 20 minutes. You need a big athletic shoe for this process because you want to wear inserts, or at least compression socks for the swelling. 

Please advise as to how I should place my foot down etc, how much swelling is okay, and whether I should ice my foot after the activity. I am taking vitamin D, calcium, and magnesium, and have just been given Prolia injection.

Dr Blake's comment: If you needed to take Prolia, then I assume you have some level of osteoporosis. This is going to take a while to heal a midshaft displaced fracture. Do not set time limits. The next period is to maintain the 0-2 pain levels and get out of the cast. Walk slow and flat footed so the heel can take some weight. See if you qualify for an Exogen bone stimulator to help the healing. Send me some images if you would. Definitely see about a Sole OTC arch support and a cushioned athletic shoe like the Brooks Ghost or the New Balance Fresh Foam 1080. I have had these go 6-9 months, so forget rules at may apply to someone else. Good luck. Rich

Thank you every so much. Waiting to hear from you ..

And this little piggy went to the market, ....

I have the cutist ever grandson Henry, and he loves me (which melts your heart and soul)!! Here we are having fun with this little piggy!! 

Adidas Jake Blauvelt Snowboarding Shoe

Adidas Jake Blauvelt Snowboarding Shoe

I feel that this year I am going to find shoes, good shoes, for this podiatry blog to highlight. So, I am going to dedicate some effort to post you guys various shoes that I find. Here is an outstanding shoe designed by Adidas for the great international snowboarder Jake Blauvelt. 

Sunday, January 1, 2017

Happy New Years 2017 from Dr Rich Blake

I wanted to take a moment to wish you all around the world Happy New Years!!! My wife Pat and I had to honor the occasion with a celebration of all the wonderful times in 2016 and to look forward to this new year 2017. We went to the famous Palace Hotel in San Francisco for some dancing and had a blast. Happy New Year to all my friends out there!! Rich

Saturday, December 31, 2016

Blister Care: An Exerpt from my Book

Here is an exerpt from Dr. Blake's Book "Secrets to Keep Moving: A Guide from a Podiatrist"

8. Blisters/Calluses

    The top 20 treatment tips for blisters are:

  1. Always drain blisters as soon as possible and use a sterile pin or needle.
  2. Sterilize the needle or pin with rubbing alcohol or passing it through a flame, when letting it cool for 30 seconds.
  3. Before performing the procedure, and try to make Marcus Welby MD proud, make sure you have topical antibiotic, bandaids big enough to cover completely, gauze to collect the fluid, and moleskin or athletic tape to cover the band aid.
  4. Push the fluid towards one side of the blister and puncture the dead top layer of skin keeping the needle/pin parallel with the skin, sort of above the fluid.
  5. Do not push the needle/pin into the live, deep layers of skin below the fluid.
  6. You must puncture the skin 3 to 5 times in different places to ensure that the top will not just reseal over and allow a new blister to form.
  7. Even with the best intentions, 30% of all blisters have to be popped again.
  8. After popping the blister, soak in warm water in a basin with two tablespoons of any type of salt for 30 to 60 minutes (the longer the better) to pull out the fluid. I do like the sound of the SALTS from the DEAD SEA.
  9. After soaking, dry off the blister well, apply topical antibiotic over the holes made by the needle/pin, or any other exposed, open skin, and cover with a band aid(s) bigger than the size of the blister.
  10. Place with firm pressure tape or moleskin over the band aid(s) to give an added push on the roof of the blister to re-seal with the underlying skin.
  11. Take off the dressing twice daily to soak for 30 minutes until all the soreness is gone. It is so important to continue soaking until the soreness is gone to pull out extra fluid and inflammation. This can take 1 to 7 days based on the size and depth of the blister.
  12. Once the soreness is gone, the dressing can be removed except when you are in a situation that a re-blister may occur (perhaps that next hike!).
  13. Keep moleskin or tape over the old blister area for 2 weeks more to protect against re-blister. It is extremely important to massage softening creams or moisturizers into the area for these 2 weeks to re-soften the skin. Massage twice daily for 2 minutes. All the soaking you do in the first week dries the skin and deep tissues.
  14. The goal is to get the skin soft again and the deep tissue not inflamed.
  15. When the blistering process is severe with skin breakdown and exposed deep tissue (loss of the roof), use one of the over the counter medicines in the water while you soak. See if your pharmacy has any one of these powders or liquids: Domboros, Pediboros, Bluboros, and Burrows Solution. Follow the directions for concentrations.
  16. The medicated powders or solutions listed above are so powerful drying agents that you immediately have to twice daily use the softening/moisturizing creams on the skin.
  17. With the severe blistering, more skin protection is also needed like big squares of moleskin attached only to good skin, Silvadene-like silver tainted ointments, and perhaps some padding. The silver ointments are anti-bacterial as well as great for the skin. Ask the pharmacy.
  18. What if the blister is possibly infected? So you pop the blister and pus comes out, immediately see a doctor.
  19. What if the blister has blood? Blood is the food of infection. Blood blisters must be taken a lot more seriously, and drained as quickly as possible. If you think it is getting or is infected, see above and see a doctor.
  20. Every year I have to have an infected blister hospitalized or, at least, see an infectious disease specialist. I hate infections!!


Calluses: Treatment for when they become Painful

Hi Dr. Blake,


I have come to see you in the past at the Sports Center for an ankle sprain. I have a question unrelated to the sprain and would like your advise. When I sprained my ankle I was training for my first half marathon. I started to get a callus on the ball of my left foot and that has now developed a corn on top of it. At first it would not bother me too much but as I continued to train it got worse and worse. Now after my training is over and, I admit, wearing not cushioned enough shoes it has gotten MUCH worse and has become very painful. For the past four weeks I have tried self medicating it with those pad treatments from the drugstore. I think I have tried them all at this point, the Dr Scholls brands, and it is still there and still painful. Now even with no pressure on it, there is still a lingering pain. Is there anything else I could do/try myself or is it time to come in?


I appreciate your time,




Dear Jessica, Thanks for your email.


    Usually calluses and corns only become painful when they have grown too deep into your foot and are now irritating the soft tissue under the skin. It is the corn on top of the callus which is usually the most painful and bores deep into the skin, normally called "seed corns".


    As the picture above notes, these calluses can be like "gluing rocks to your foot", and can be multi-layered with variable depths with each layer. The hardness of the corn irritates the soft tissue under the skin which contains a rich supply of nerves. You can get a deep blister, very painful, underneath the callus, and so deep that it is difficult to reduce. But the blister part is irritated with massage, even gentle massage with a pumice stone.

    It is best to approach these very sore calluses with softening creams (ask the pharmacist for a great hydrator) three times a day, avoid skin irritants like the Dr Scholl's plasters with acid, lay the sore area on an reusable ice pack 15 minutes 3 times daily to reduce soft tissue swelling, try 1 session of 30 minutes cool water soak daily (the longer the better), and gentle removal with a callus scraper (like Ped-Egg) daily for 2-3 minutes to gradually reduce the callus.


    A trip to a Podiatrist would help make the diagnosis of callus, blister, or wart (since many of these painful calluses are actually warts under the callus), and speed up the callus removal by weeks since they can use very sharp instruments, plus place appropriate padding in your athletic shoes to off-weight the painful area.


    No matter what, the callus has become something else, since calluses (which are dead skin) do not hurt. It is how the skin around them reacts that produces the pain. Or is there a wart or deep blister needing other treatments. I hope this helps. Rich


Thursday, December 29, 2016

Tumeric: If you have Inflammation, don't forget the Tumeric

I love some on and off routine with NSAIDs, 5 days on and 2 days off, or 10 days on 4 days off. During the off days, many of my patients have been doubling up on the icing and adding Tumeric. Some are just switching to tumeric for all their anti-inflammatory needs. Make sure you read about it, especially side-effects or contra-indications before taking. Rich

Sunday, December 25, 2016

Peripheral Neuropathy: WalkJoy Device a Possible Help

This product I have no experience with, but I really could not find anything wrong. If any of my readers have some information, please comment on this post. Thank you. Rich

Dr. Blake,

WalkJoy is the only FDA approved device to help reduce falls and foot ulcers for patients with peripheral neuropathy.  We'd love to see if we can help some of your patients.  Attached is a flier and a few testimonials.



Image result for image walkjoy device

Testimonials from Patients

“Life Changing”
Thank you to The Foundation For Peripheral Neuropathy for introducing me to WalkJoy, Inc.  I am a 78 year old retired Plastic Surgeon. I had a major back surgery 9 years ago with total success. Post-surgery, I noted there was a burning in both feet and the surgeon said it could not be repaired. Over the next few years, I was told I had Peripheral Neuropathy, etiology unknown. The burning went away, but I had complete numbness resulting in loss of balance that slowly developed into full blown problems that were debilitating. After two years, my EMG showed destruction of the axons and myelin.
I have been using the WalkJoy for several months now and am thrilled with the results that have been fabulous. I play golf 6 days a week with amazing balance, improving my game and I am using the treadmill with increasing speed. Socially I feel more comfortable in movies and getting up from a table. My general walking has increasing length of strides and my improved balance is life changing for me. I am grateful for the wonderful way my active life has improved.
I sincerely hope more neurologists are made aware of the WalkJoy product to make their patient’s lives much better.                                 Larry R. MD FACS    Palm Beach Gardens, FL

“I feel more stable and in control.”
I am an 80-year-old male and I have had idiopathic axonal sensory peripheral neuropathy for at least 10 years.  It has progressed to the point where I have no sensory nerve response from my toes to below the knees.  As a result, my balance is very poor and I use a cane.  I was becoming sedentary as my ability to maintain my balance declined. I read about the WalkJoy units in my Neuropathy Association newsletter and decided to give them a try.
What a difference they make!  I wear the WalkJoy units nearly full time.  When walking I am able to increase my stride and speed, and I feel more stable and in control. I walk several miles a day for exercise, and my neighbors have commented on my improved mobility.
I feel the WalkJoy units are enabling me to avoid having to use a walker, and ultimately a wheel chair.  I am very pleased with my increased mobility.  Thank you, WalkJoy!"                                                        Lee M.  Modesto, CA

“My first reaction…was astonishment.”
My first reaction to trying out the WalkJoy units was astonishment. Within about a dozen paces, I was walking with an almost normal gait. All without feeling anything detectable from the units.
I am 92 years old and have had idiopathic peripheral neuropathy for at least the past dozen years. I have fallen a few times, and I have to watch my feet when I walk. My excellent physical therapist found that I still have some proprioception (muscle sense) available in my feet, and exercises have helped improve my balance.
The improvement when using WalkJoy is clear and almost immediately evident to me. I now wear them most of the day, every day. There is a temporary residual effect when I take them off, and it takes almost an hour before my walking gait deteriorates. WalkJoy is an excellent product, but it is not, I repeat, not a cure. My balance tests show that without WalkJoy my proprioception is still faulty – especially when I try to stand, unsupported with my eyes closed. Don’t expect miracles.                                                    William T., Ph.D.    Sarasota, FL

“I am able to move with greater ease and balance.”
I have been using WalkJoy for about 6 weeks.  I have peripheral neuropathy so my feet cannot feel the ground.  This has caused me to have poor balance even though I have had balance training in physical therapy.

As soon as I started using Walk Joy my balance improved noticeably.  Smooth, shiny floors (usually marble) have long been a challenge for me, but no longer.  I can now comfortably walk on these floors.  I have also begun to walk my dog again.  I am not as afraid of falling and am more assured when I walk.

I had been frustrated because there is no treatment for the loss of sensation caused by peripheral neuropathy and was thrilled when I learned about WalkJoy.  Thanks to WalkJoy I am able to move with greater ease and balance.                      Janice C.  Falls Church, VA

WalkJoy has truly changed my mothers life.
Walkjoy has truly changed my mothers life. seriously. She had tried so many different treatments and nothing worked. Her doctors told her there was no cure for her neuropathy and that she would just have to learn to live with it. This went on for 4 years! Well they were totally wrong! My mom started using the Walkjoy units every day and felt a change (for the better) almost immediately. It has been around 2 weeks now and she is like a new person. Walking around is not an issue anymore. It has not only changed my mothers life but ours as well!                                                                Margaret B.  New York, NY

“My Dad has not fallen EVEN Once!”
My Dad could not be happier with the WalkJoy after a little more than three months of use. He has not fallen EVEN ONCE! Daddy is very active and walks outdoors every day. He is now back to walking almost a mile down our local road, as well as back and forth from his tractor shed (about 100 yards from the house) many times all day long. All of his leg and foot wounds have healed (I do not know if it is from the correct walking posture or just from not tripping and falling) and he is able to do so much more of what he likes every day.

Robert D. Houston, TX

“Muscle strength and stamina”
After experiencing nearly 20 years of increasing debilitation due to peripheral neuropathy, he was thrilled to feel the sense of balance and control that WalkJoy gave him! 
Three full weeks have passed now and he has not used his electric scooter once! He relies solely on his walker and cane without fear of falling. With each day of renewed confidence in his balance and stability, he has been able to increase his walking and exercise activities. As a result, both his muscle strength and stamina are slowly returning.
WalkJoy is an excellent product with the potential to change lives! We are so grateful to have been introduced to it.
John and CeCe H.  Santa Barbara, CA