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Tuesday, August 18, 2015

Ankle Swelling Advice

I hurt my right knee a while back. Since my right knee was injured, my automatically put all my weight onto my left leg. I've been doing it for so long that now I have fluid in my ankle. It's the size of a silver dollar. I asked a Dr if I can have it drained but he rejected because it's small. It hurts when it's cold and it seems like it's growing. I don't want arthritis to go to my ankle. Should I get another doctor's opinion or am I stuck with it?

Dr Blake's response: 

Fluid like this can be from stress produced by limping. Drain it, but still limp, and all the fluid comes back. It can be a separate problem, like a ganglion cyst, which can be easily drained. See my blog for treatment of ganglion cysts at So, I would definitely get another opinion, and if it is causing disability of any sort, see if you can get an MRI. I have attached a video on contrast bathing that can help with the swelling. Do it for 10 straight evenings and see if the swelling subsides.

Tuesday, August 11, 2015

Julie Lopez Shoes: High Heels with Some Thoughtfulness

Perhaps the shoe industry of high heel wearers is starting to go in the right direction. Anyone with personal experience please comment. Please also see my video below of the pros and cons of high heel shoes. 

Sunday, August 9, 2015

Foot Pain after Fall: Email Advice

Hi. About 5 months ago, I fell down some stairs in my house. At the time my foot and ankle became swollen but it wasn't that big of a deal. Over the past couple of weeks, my foot has given me a fit. I can barely walk on it without a limp. It hurts to put much pressure on it and it is very swollen. It hurts on the top of my foot and my ankle. I've gone to the doctor and he gave me an X-ray and said that he saw no fracture or arthritis and he gave me a steroid forinflammation. Its no better.

Dr Blake's response:  
That would be a difficult connection to make since over 4 months went by and your ankle was fine. However, if you have been relatively inactive for the last 4 months, and now are increasing the activity coinciding with this flare, then they could be connected. Definitely ask for an MRI to look for a hidden bone or ligament injury. Probably should begin treating with a removable boot (like an Anklizer) until the results are in. Good Luck. Rich

I thought I would throw in this unbelievable video.

Ease Diabetic Nerve Pain with Vegan Diet

Saturday, August 8, 2015

Calmare Pain Therapy: Patients Please Tell Us Your Stories!!!

Chi Running: A Concept of Smooth Running to Consider When Injured

This is a wonderful video on the concepts behind Chi Running. As I treat my athletes, I will many times need them to change from heel strike or forefoot strike, to a gentler midfoot strike espoused in Chi Running. It may not be where they end up, but it can help in the rehabilitation at hand. 

Complex Regional Pain Checklist

Complex Regional Pain Syndrome Checklist

*    Identifying the Source of pain (this is mainly to rule out other possible causes of pain)

*    Mechanical Means of Breaking Pain Cycle (crutches, limited activity, Roll aBout scooters, accommodative padding, etc) Sympathetic nerve blocks are crucial as soon as possible.
*    Oral Medications to Break Pain Cycle (typically lyrica, neurontin, cymbalta, elavil, etc)

*    Topical Medications/Applications to Break Pain Cycle   (lidoderm patches, compounding meds, Neuro-Eze, and many, many more)

*    Alternative (acupuncture, Calmare Pain Therapy, biofeedback, etc)

*    Nutritional (Alpha Lipoic Acid, Vitamins C, B6, B12, Inositol, Natural Thyroid Supplement, omega 3 fish oil, etc)

*    Rehabilitation of Limb Function (understanding of chronic and acute pain, when to push through pain and when to honor pain).
*    Being Productive as possible (pain is overwhelming, need to focus part of the day on some productive task)
*    Co morbidities (psychiatic counseling should be started immediately

*    Other (Ketamine Infusions, meditation, prayer)

Tuesday, August 4, 2015

Video Regarding Going en Pointe for the First Time in Ballet

When I treat young ballet students, I will eventually get the question of when can pointe work begin. I must work with the advice of the dance instructor, or use one of the dance medicine instructors here at Saint Francis. The 2 criteria that our Golden Rules (unbreakable) are 3 years of experience and great biomechanical technique. The 3rd criteria is age. Typically the dancers should be 12 with growth plates closed. Some dancers are skeletally mature while still 11 (rare) and some 13 or 14 (not that uncommon). Taking x rays to see if growth plates are closed in the feet is reasonable, for making the wrong decision is very dangerous. 

Sunday, August 2, 2015

Another Reason from my walk tonight that Walking is better than Driving!!

Weight Loss Benefits with both High and Low Intensity Workouts

As a podiatrist, I struggle to recommend weight loss programs, even though I know the patient's weight may be a factor in their condition. This article discusses that both high intensity and low intensity workouts are extremely good at weight reduction. Patients, however, that are diabetic or pre-diabetic due need to add high intensity into their workouts eventually.

Thursday, July 30, 2015

A Happy Marathoner: A Podiatrist's Good Day's Work

This was a nice email from a patient that worked with me to be able to run the SF Half Marathon (from injury to 13.1 miles!!). This is the gratification both the patient and doctor feels in seeing this through from start to finish. Running a Full or Half Marathon for the first time is an amazing athletic feat and the runners are so full of pride. Congratulations to all the runners out there that 2015 has brought (or will bring) about their first full or half marathon. My patient below is excited about training for another 4 months from now!!!

Hi Richard,

I hope all is well with you. I thought sharing the good news with you as I just competed my first 1/2 marathon (13miles) and this is mainly due to your services providing me the right podiatric soles! So I am very happy of accomplishing this first challenge which seemed to be a bridge too far at the beginning!

Thanks again!

Saturday, July 25, 2015

Inverted Orthotic Technique Patent Request for the Kinetic Blake!!

After designing an orthotic device in 1981, it is fun now seeing it being used in various designs, etc. Here is a patent design for a product called the "Kinetic Blake"!!!

Insect Bite: Email Quite

I took my 2 year old to the park and she came back with what looked like a mosquito bite on her foot. I disinfected it with alcohol.She complained about it but I thought it would heal on its own.However a few days ago there was a bump where the mosquito had bitten her. This morning she woke up with what appears like a bruise.Her foot is swollen around the bite and has a blue and purple color spread all around her foot. She seems to be experiencing some discomfort. What should I do?

Dr Blake's comment: In this situation, with a spread of possible infection, I would definitely go to the ER. They will access things, and probably place her on antibiotics. Warm Water soaks for upwards of an hour can be helpful and drawing out an infection. You can repeat this every few hours. You can also use a damp warm face cloth against the skin, and then wrap this with saran wrap around the entire area. This is called a Koch Mason dressing. Check her temperature now and every few hours. If her pediatrician is available, let him or her know. Do not mask the pain with any medications for now. See what the ER docs have to say. I hope this helps her. Rich

Friday, July 24, 2015

Bunion and General Foot Strengthening Exercise

This exercise I teach for bunions, but it can be a next level exercise after conquering 30 reps of  the more simple metatarsal doming for foot strengthening. Remember to do these in the evening, and never through pain. 

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