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Please consider a donation if you feel the blog has helped you. A $5 donation will help me pay for the blog artwork, guest writers, etc. $15 has been donated in February 2017. I am very grateful. Dr Rich Blake



Saturday, February 18, 2017

Inverted Technique for Flat Foot Children

Hello Dr.
my daughter has severe overpronation and has been using a sole with your inverted technique for 2 and a half years and she has improved a lot.

her feet is bigger now and need a new sole.
I read somewhere in your blog 3 years ago you have a very good friend in fort Lauderdale fl.

I would like to take my daughter to see someone that know very well your technique, could you please provide his clinic phone number, address and web page, is any? please.

he probably can do a good assessment of my daughter, because the dr in Miami just took her cast and that's it.

in case you know another Dr.  in Miami that know very well your technique please let me know also.

thank you very much for your work and dedication, its really  making a very good difference in my daughter.


Dr Blake's response:

Pronation noted in the back of the heel of the right foot. Ruler denoting vertical, and the heel bisection line shows marked eversion which flattens the arch.

This same right heel in the Inverted Technique attempting to center the heel.

Mari, above is the members in Florida of the AAPSM. I looked at the list and 5 names popped up. They are not in any order:
Matthew Werd
James Losito
Russell Rowan
Brian Fullem
Joseph Agostinelli

You would have to call their offices and inquire. 
You can also get the names of who uses the Inverted Technique alot by calling the 4 Labs I know use it alot:
Root Functional Orthotic Laboratory

Richey and Company

Allied OSI Lab

ProLab USA

The labs would have the doctors names in your area. Please let me know what you found out and thank you for your kind words. I am very happy to hear that the technique is helping your daughter. Rich

Sunday, February 12, 2017

Thinking About Bunion Surgery: What is the next Step?

Hi Dr. Blake,

I am a 65 year old very active woman.  I have been a runner for over 40 years, and in more recent years have added cycling, hiking, and yoga.  I did a 600 mile walk in Europe last summer, and a 500 mile walk in Europe 2 years ago.

I have a bunion on my right foot near my big toe and also have arthritis in the big toe.  My bunion has now progressed to pain such that I can't walk more than a mile without a lot of pain.  I have come to the realization that it is probably time for surgery.

I live in the San Francisco Bay Area and am not sure how to find a podiatrist for the surgery - one with lots of experience, well regarded, metal vs plastic implant?, etc.  I was a Kaiser patient until December when I turned 65 and now have insurance that I can use more universally.  Where is the best place to go for a bunion surgery in the San Francisco Bay Area?  Can you recommend a skilled bunion podiatrist?  Probably sounds funny making such a big deal about a bunion surgery.  But I have tried to put it off as long as possible and want to go to the best.

Thank you so much for your help.  I would not have been able to run for 40+ years without the skill and care of podiatrists.

Best Regards, 

Dr Blake's Response:

Thank you so very much for your email. I would definitely get the opinion of 3 surgeons. Please start with my partner Dr Remy Ardizzone, very skilled and use to dealing with athletes. I have no trouble if you end up going somewhere else, but it is a great starting point. To me, the problems sounds like you need arthritis surgery, and the bump of the bunion also removed. If they only do the bunion, and leave a lot of arthritis, you will be very unhappy. But, with your x-rays in hand, get these opinions and see what makes sense. Find out the type of surgery, the post op course, and what you can expect to do afterwards (can you ever run again?) I hope this helps. Rich

Thursday, February 2, 2017

Possible 1st Plantar Plate Tear

Hi Dr. Blake,
First of all, thank you so much for all of your hard work on your blog and for taking the time to answer these types of emails.

My story is a frustrating one so I'll try to start from the beginning and provide as much detail as possible.
I'm a tap dancer who rehearses weekly for about 2 hours twice a week. I've been tap dancing since I was 2 years old and it is truly my passion. I've never been injured as a dancer.

This past November I attended a tap workshop in which I was dancing pretty much non stop for 6 hours straight for 2 consecutive days. By the last class of the second day I had some pain in the ball of my foot but chalked that up to normal for the amount of pounding my feet had taken, and didn't think much of it. The next day something in my left foot didn't feel right. I wouldn't say it hurt but it felt somewhat unstable. I still didn't think too much of it until the next day it down right hurt when I walked on it a certain way. I could still walk but I was limping a bit. There was also some swelling. I called and made an appointment with a sports medicine physician in my area who deals a lot with foot injuries. I also shifted to wearing only birkenstocks and sneakers at this point.

In my initial appointment, the doctor did x rays which showed no fracture and had me go up on my toes which at this point had become impossible for me. I instantly felt intense pain with this action and a grinding or buckling sensation in the big toe joint. He prodded around the bottom of my joint and ended up diagnosing me with sesamoiditis and tendinitis of the FHL. He put me in a walking boot for 4 weeks and gave me oral steroids to reduce inflammation and told me to start physical therapy when the swelling went down. I followed these instructions and did start to have improvement. My foot felt 90% better by Thanksgiving and I was feeling optimistic. At this point he had told me I could start weaning out of the boot.

I think I became overzealous and decided to spend the first weekend of December bringing my winter clothes downstairs from storage. I spent the whole day going up and down stairs in my Birks and not the boot. By the end of the day I knew something was wrong as my foot had swollen again so I put myself back in the boot and wore it throughout the holidays  and scheduled a follow up with my doctor at the first of January.

At this point he recommended I wear the boot but try to wean out of it as I'd been in it for almost 4 weeks and go back for more physical therapy. I did this and the swelling did go down but I still could not walk normally. I persisted with physical therapy for 3 weeks and was able to go up on my toes again but still had issues with the toe off phase of normal walking. In PT I was able to do 3 sets of 10 reps of heel raises on my injured foot at a time, but when I'd try to walk normally I'd feel a twinge of pain in the ball of my foot between my big toe and second toe.
Dr Blake's comment: Definitely some good overall improvement. 

At home I was doing stretches for my calf muscles and hamstrings. I decided to try some stretches from ballet and did a pliƩ in second position. Upon so doing I felt something pop between my big and second toe and later pain, and then it was swollen again. I scheduled another appointment with my doctor who continued to say this was sesamoiditis, wanted me to buy a pair of custom orthotics that would run me $260 because my insurance wouldn't cover them and wanted me to buy steel plates for my shoes. He refused to do an MRI and gave me no further instructions and told me not to use the boot anymore.

In my frustation I decided to seek a second opinion - this time, from a very highly regarded orthopedic surgeon specializing in the foot and ankle. He promptly ordered an MRI as I heard that should have been done a long time ago for proper diagnosis. He told me to continue wearing the boot until further notice. His PA called me with the results today and told me that the MRI showed significant damage to the plantar plate and at this time he was thinking surgery was going to be the best option.

 I have the MRIs on a disc and could send them to you for review. My question is, in your opinion, am I past the point of conservative treatment being helpful? Is surgery really my only option. As a dancer it has pained me to be out for this long and I am aching to be dancing, or even doing moderate physical activity of any type. Any insights or recommendations would be so appreciated.
Dr Blake's comment: Yes, send the MRI to Dr Rich Blake 900 Hyde Street San Francisco California, 94109. Plantar plate tears of the 1st or 2nd joints are uncommon, and can take a long time to heal, if they do. Some patients prefer the conservative route and do well, while some go straight to surgery to a faster rehabilitation (but no surgery is without potential complications). Let me confirm the diagnosis. You should be back in the removable boot for 3 months. I think your initial injury was healed or almost healed, and the plie caused possibly a new injury. Or you changed a partial and healing tear, to a complete tear. Anyways, back into the boot. Let's see if the MRI makes everything clear or muddy, and go from there. Rich