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Thursday, March 16, 2017

How is frozen shoulder like posterior tibial tendon dysfunction? Why me!!!

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I am presently rehabbing a right frozen shoulder that developed following a stroke I had in August. The image above shows the amount of balls I made (6) and missed (many) from 20 feet as I try to get my strength and accuracy back. Possible?  I ignored the pain for some many months and now I am paying for that mistake. I have what would be equivalent to posterior tibial tendon dysfunction. My weakness was caused by my stroke, and then the shoulder joint began to gradually shift out of position with the stronger front muscles to the weaker back of the shoulder muscles. I wish I could make an orthotic for this injury like I do for the foot injury. Oh well. Since this will be a regular game to check my progress I will send updates. Rich

Big Toe Joint Pain: MRI showing Plantar Plate Involvement




This is one of my blog patients (and yes, that is what I call you in my brain as I compartmentalize things). He has been suffering with big toe joint pain, presumably sesamoid, but probably more plantar plate tear. The arrow points to part of the plantar plate in front of the sesamoids by the toes. Some calm down by themselves with sesamoid off weighting, and limited push off for a while. Some remain chronically sore and need surgery to fix the instability created by the tear. Typically, you know what a surgeon will tell you. Read all you can about sesamoid management--off weight the big toe joint, limit the dorsiflexion of the joint, calm the inflammation down (all the white stuff in the image), create a pain free environment. Also, look at my reference on plantar plate testing.



Tuesday, March 14, 2017

Being Part of a Team that Works!!


In my twenties, I was able to be part of a 14 person team that ran 1250 miles as a relay from Oregon to Mexico. There were 10 runners (I am above the T in TO, yes the goofy looking one!!) and 4 alternates. We each ran 125 miles that week. I lost 30 lbs in the training, and another 10 on the trip. Not healthy, but sure what an adventure. It was such a highlight in all of our lives that when we come together randomly at a meeting now, that it want comes into the conversation, something that we are all so proud of. We were a team, divided into 2 groups of 5 runners. When one group ran 70 miles in 10 hours, the other group went ahead and did what they could to rest and eat. Since it was a publicity stunt for California Podiatrists, National Foot Health Week, May 5-12 1981, we also were constantly interviewed by radio, TV, and newspaper. 
     It remains my biggest athletic feat! My wife and I walked 189 miles in 12 days on the Camino de Santiago in Spain 2015, also a tremendous accomplishment. 
     Why bring this up? As life has passed along, I have been part of many teams at work, recreational, and family. I started this blog 7 years ago (almost to the minute). I knew when I started it that my life would be changed by it, and that it has. You have all become by blog family, some of you more vocal, but all important. I hope this TEAM we have formed can grow. Behind the scenes, only 10% of the blog gets posted, most of my answers are to individuals alone. So, please do not be afraid to write me, and I am sorry when life slows this part of my life down. I am just as proud of this blog as anything I have done in podiatry, or as a human being, because I have tried to make it truly a gift and always part of my life, not something to do. Thank you for helping me teach, cry, and try to love you, as I know by your kind words you feel for me. I thank you. 
     

Monday, March 13, 2017

Flat Feet with Marked Heel Eversion: Inverted Technique


This patient has pronated flat feet with marked eversion of the heels. The Inverted Orthotic Technique will be utilized to attempt to place the heel bisection line close to vertical. You can measure the angle, and use a 5 degree cast correction for 1 degree of foot correction ratio. If the line is over 7 degrees everted, I stop at 35 degrees to get the patient used to this amount of support. A good starting point.