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Monday, January 27, 2020

Stem Cell Injections: Perhaps the Future, but Are They Safe?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070641/

Great Article!! Please read if you have decisions to be made to get stem cell injections for your problem. Rich 

Saturday, January 25, 2020

Midfoot Arthritis: Email Advice

My 88 year old mother was recently diagnosed with midfoot arthritis in both 
feet.  The orthopedic surgeon said she was not a good candidate for 
surgery. Besides ice and heat therapy, would taping, orthodics or rock 
shoes help reduce the pain?

Dr. Blake's comment: you are asking all the right questions. Yes, for midfoot arthritis most patients, even much younger then your mom do well with activity modifications to keep the pain at 0-2, orthotic devices to support the tissue, occasional taping for more support with increase stressful activities, and rocker shoes like New Balance 928. Weight can be a big issue at her age, so she made have to get by with lighter shoes but good stable orthotic devices. Way to be the running of son of the year!! Good luck my friend. Rich
Make sure she ices the top of the foot for 10 minutes twice a day until it begins to feel a lot better.

The following is an excerpt from a previous post:

3. Midfoot Arthritis/Arthralgias

     So many of my patients develop midfoot arthritis as they age. Golden Rule of Foot: Pain and swelling in the middle of your foot if you are over 60 or have had previous injuries to this area is midfoot arthritis until ruled out by MRI, CT Scan, or bone scan. Like any arthritis situation, it has both a conservative treatment side and a surgical fusion side. I have only had to recommend fusions to a handful of all my patients over the years.  

    The top 10 treatments for midfoot arthritis/arthralgias:

1. Ice Pack for 10 minutes twice daily to the top of the foot
2. Contrast Bath each evening home for 20 minutes total as a deep flush
3. NSAIDs only when needed to sleep or when the pain over 4 consistently
4. Learn a daily form of tape from supportthefoot.com or Kinesiotape circumferential arch wrap. Daily until symptoms improve, then as needed, like with long hikes.
5. Removable boot, hiking boot, bike and hike shoe, or post op shoe  when need to limit motion more.
6. Custom made functional foot orthotic devices with high arch support as a cast initially full time, and then just with activities more stressful.
7. Daily Foot and Ankle Strengthening forever. Go to Youtube and type drblakeshealingsole foot and ankle strengthening playlist.
8. Activity Modifications to create pain free environment, and build core strength and get cardio.
9. Physical Therapy or Acupuncture to reduce inflammation.
10. Occasional cortisone shots to reduce inflammation (the least as possible).

https://www.amazon.com/Secrets-Keep-Moving-Guide-Podiatrist/dp/1483586553

Monday, January 13, 2020

Monday, January 6, 2020

When the Pain is Superficial, Think Deep

When the Pain is Superficial, Think Deep

In medical school and residency training we are taught that superficial pain in a muscle/tendon/ligament may be secondary to deeper, more serious problems. The superficial structures may be sore for many reasons, including deep swelling that has surfaced (like after an ankle sprain), or muscle soreness from strain as they compensate to protect the deeper tissues. Hundreds of examples abound, including the diagnosis of Achilles tendinitis, only to later find out that there was a chip fracture in the back of the ankle requiring surgery. The diagnosis of Achilles tendinitis may have been followed with months of physical therapy, casts, orthotics, braces, and medications. A sports medicine practitioner works hard when superficial structures are identified as the cause of pain to at least consider deeper evaluation if the symptoms do not respond. This is where the patient can greatly help their own cause by asking questions about possible deeper structures involved.

Golden Rule of Foot: When the treatment is not progressing, think about deeper structures as the cause of the pain.

Another common scenario (of the reverse) happens all the time, and I will use Judy's story to describe it. In this case, Judy actually developed a superficial tendinitis on the outside of her knee called Ilio-Tibial Band Syndrome. The smart clinician looked deeper with an MRI and found arthritis in the knee. The decision was made, without proof, and not following KISS principles, that the arthritis must be causing the tendinitis, and that the knee required a knee replacement. The patient wisely chose the KISS principle and treated the tendinitis first (on advice from other physicians) to see if the pain would go away, and it did. I have had three major injuries in my life, and all three had a surgical option. Good people recommended good surgeries for me. But I chose to try rehabilitation first, and so far, I am fully functional and have avoided surgery. We owe it to ourselves to try rehabilitation first. In Judy's case, her pain was superficial, and surgery on her deeper arthritis was unnecessary.


The photo above shows the complexity of the knee joint and how soreness in one area may be caused by deeper problems, but perhaps not. So, deep injuries can be mistreated when the care is only directed at the secondary, more superficial soreness. And, superficial injuries with concurrent deeper, non-painful abnormalities can be mistreated when the doctor, therapist, and/or patient mistakenly blames the pain on the wrong structure.

Golden Rule of Foot: Allow time for rehabilitation to succeed or fail, so that you can possibly avoid unnecessary surgery or have the surgery you need with a firm conviction. 

The above has been an excerpt from my book: Secrets to Keep Moving

Retrocalcaneal Bursitis can be Improved with Shock Wave Therapy

Saturday, January 4, 2020

Painful Feet with Heat Exposure: Opinions Needed!!!

Hello, this is Dr. Blake and I need your help. The following are photos from a patient with extreme foot pain at the areas of redness primarily I believe when she is exposed to heat. This can be normal walking more than a mile, or triggered by hot tubs and hot weather. One suggestion is erythromelalgia from a dermatologist friend. She will be getting a biopsy soon. 


Hi Dr. Blake, 
Attached are the photos we talked about today. 

To summarize the issue: 
~ These episodes seem to be triggered by heat (hot weather, hot tubs) and/or moderate amounts of walking/standing - most of these photos were taken while I was on vacation. 
~ 10/10 pain, which can be described as achy, hot, burning, stabbing, and like a "bruised sunburn" on the soles of the feet
~ Extremely painful to walk or put weight on affected feet/foot (resulting in limping and hobbling) 
~ Feet feel warm to the touch most of the time, but especially during these episodes 
~ Usually feels better after a day or two of rest and air conditioning or moving to a cooler climate, but if air conditioning or moving to a cooler climate is impossible, it can stay like this for days/weeks

Please keep me updated on any interesting possible diagnoses! 

Oh, and here's the foot pain forum that I told you about today (full of other people who have something similar going on): https://www.foot-pain-explained.com/painful-red-spots-on-my-feet.html#comments

Thanks for your help,














Here is a response from one of my patients/friends:

I know you can research anything but here's one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871369/

Dr. Steve Pribut wonderful post:

Wednesday, January 1, 2020

My Shoes Must be Short: The Tips of my Toes Hurt

This is a patient who complained about pain at the tip of her second toe. She had bought one pair of half size bigger shoes, which even felt too big, yet her second toe remained sore. She brought in 3 pairs of shoes at her visit and, after removing the shoe insert, I could definitely tell her that the 2nd toe had plenty of room. She had a hammertoe on the 2nd toe and a large callus at the end of the second toe. I felt the 2nd toe was not painful for running into the end of the shoe, but gripping the floor. I fit her for a small right toe crest to lift the tip of the toes off the ground and she felt instantaneously better.