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About Me

San Francisco, CA, United States
I have been a podiatrist for 34 years now and I am excited about sharing what I have learned on this blog. I love to exercise, especially basketball and hiking. I love to travel. I am very happily married to Patty, and have 2 wonderful sons Steve and Chris, a great daughter in law Clare, my new grandson Henry, and a grand dog Felix.

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Thursday, June 16, 2016

Followup Email in a Sesamoid Fracture Patient

Hi Dr. Blake,

Just and update on my foot progress.

1. I continue the running program. I had a couple of set backs, the flu (off for 10 days) and swelling in my knee (off for 7days). I am not a runner so as part of this I am conditioning my cardio vascular health. I am taking 5 times on each stage, instead of 3. And I have added a couple of shorter durations in the middle, so this is taking me a little longer to complete. Yesterday was my first time running 6, walking 4. Completed without incident.

2. I continue to ice after every running session. Just to keep everything in check.

3. I am still using the bone stimulator daily. But since the company reset it, the time has been a little off so some days it records 2 sessions and some days none, but I try to do it the same time every morning.

4.  I am still taking 600 mg calcium and 4000iu d.

5. I foam roll and stretch for 20 minutes after each run. Keeps the legs from cramping up. I did mention that I am not a runner and this is all new for me.

6. I am still wearing the hokas with all the special foot padding.

As for pain, there has been very little, so I think things are moving along nicely. I couple of times about 2-3, but I took some motrin, iced and laid off for a day and it was fine.

I did have a little shin pain around stage running 3 minutes. I just backed off the intensity of the running speed (from between 5.6-6.0 to between 5.2-5.5) and that all went away. I really don't need shin splints while trying to heal my sesamoid.

So for now, that is about it. Is there anything else I should be doing? Or do we need another visit?

Let me know, and thanks for getting me back on my feet.

Dr Blake's comment: 2 MRIs so far have documented delayed union in the sesamoid injured. Imaging is only part of the decision making. We are seeing if the patient can gradually return to activity (which strengthens the bone if the pain does not escalate). So far, so good. She was told to email me in 2 months, since her last physical exam 3 months ago was essentially negative. You can tell by the email that she has mechanical protection, is working on bone health, and is controlling inflammation. 

Monday, June 13, 2016

Sesamoid Fracture: Email Advice

Hello Dr Blake,

I'm 38 yrs old and injured my feet Thanksgiving of 2015. I was doing group fitness classes at my gym that included some high impact on my feet like plyometric lunges and jumping/squats, etc. While the floor is carpeted and well-cushioned, I still ended up with 3 sesamoid fractures. Both on my left, medial on right. 

At first I thought it was soft tissue injury so it was almost 5 months after the injury that I even started to address it. 
I'm seeing a podiatrist who came highly recommended from a great sports medicine practice here in town. 
I am a high arch foot type who lands heavily on my first MT. Left>right. 
Dr Blake's comment: It seems for sesamoid fractures having high arch feet is the worse structure since the first metatarsal is particularly driven into the ground with great force. 

My recent MRI done last week shows osteonecrosis of the medial left. Significant marrow edema of the other 2. 
I was in a boot initially(early April) on my left for 3 weeks which helped some but after getting out of it, the pain quickly returned. 
I've also had custom orthotics for the last month(early May) that so far are not making a real difference. 
At my follow up today she is recommending Bone Growth Stimulator. 
Dr Blake' comment: You definitely want a 9 month course of bone stim to see if that helps. Wait on a new MRI until at least 6 of those 9 months pass. 

I'm also going to have my Vit D levels checked to be sure all is good there. Although my bone density on X-rays appears very normal. 
I want nothing more than to be active the rest of my life and to avoid severe arthritis In my feet. 

Our discussion about surgery left me very discouraged. If she removes the necrotic bone she's concerned about shifting in the joint, and if she removed both, then she talked about fixation of that joint. 
I guess I just wanted to hear that I could remove them and have a fully functional foot after healing. 
I want to be patient, but I also want to know that I'm moving in the right direction. 
Dr Blake's comment: To me, your year of potential healing started when you first went into the removable boot and accomplished a 0-2 pain level. So, be patient, get the Vitamin D, get bone density screen if anyone is concerned, do what you can to weight bear with maintaining the 0-2 pain level. My blog is full of tips. Comment on this blog post. Rich





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Thank you. 

Tuesday, June 7, 2016

How To Treat Runner's Knee Pain

Runner's knee, also called biker's knee, dancer's knee, chondromalacia patellae, etc, etc, has always been treated successfully in sports medicine practices with a multifactorial approach. This article bears that out. Key are exercise, bracing, taping, local treatments (maybe), and foot orthotics. From a podiatrist standpoint, it really means you need to treat the biomechanics. This includes limiting knee flexion, limiting over pronation, changing technique flaws and holding the knee cap in its proper femoral groove. 

http://bjsm.bmj.com/content/early/2016/05/31/bjsports-2016-096268.full

How To Check if Support Hose Cut Off Circulation

http://www.supporthosestore.com/joformen15mm.html

     As a podiatrist I primarily dwell in the world of making lives better, but rarely save a life. Almost weekly I experience patients in the wrong length or fit of support hose, and the consequences of blood clots and pulmonary emboli could be life threatening. I implore all of my readers to look at their loved ones who wear support hose and make sure that their circulation just below the knee is not being cut off. 


Poorly fitting knee high (aka below the knee) support hose in my patient Bruce being treated for a deep vein thrombosis.

The New Rx I scribbled for Bruce to change to Above the Knee Support Hose (aka Thigh Length) with the same pressure.
The pressure is in mm Hg (millimeters of Mercury). Sorry for the scribble.



Will I save Bruce's life with this simple change? Who knows? But, I can sleep well at night for checking. 





Monday, June 6, 2016

Saturday, June 4, 2016

Possible Shoes for Sesamoid or other Metatarsal Problems to check out

Hello Dr. Blake!

Good news!   Yesterday, my doctor repeated sesamoid-xray and compared it to previous xray:   he was suprised/happy that my sesamoid shows signs of healingon xray that he says is often not seen at this point!  He has me continuing w limited weight bearing for another 4-8 wks.  I wanted to share this good news with you!   :-)

Please pardon my previous email as I wanted to take this oppty to clarify that I did not mean for you to spend any time reviewing options; I just meant to ask if you typically recommend ONE particular model for say, Hokas brand, because I didn't know if ONE model or ANY model Hokas is good for sesamoid.

I've done more research and I believe this may help narrow down the choices for fellow sesamoid-sufferers:

Hokas offers one WIDE width shoe:  Hoka One One Bondi 4 Wide.   

Crocs offers the " Crocs RX Ultimate Cloud"; this model is very highly rated and    made of Croslite material (conforms to foot creating a custom fit).  Crocs also offers a few more "Rx" models that may be helpful for fellow sesamoid-sufferers.

Wednesday, I mailed my CT CD/report to you and hope you can review it when you have time.   Thank you again for your help and support, it is greatly appreciated. 





Sincere regards,

Dr Blake's Typical Orthotic Response

Dr Blake's Typical Orthotic Response

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