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Saturday, May 16, 2015 place for athletic shoes discounted

One of my patients told me that this was a wonderful place to get athletic shoes at a discount. Please check it out. It also has everything else, perhaps even the kitchen sink.

Foot Nerve Pain: You Tube Video Comment Reply

Hi Dr Blake, I have excruciating pain in between the 1st & 2nd metatarsal. (4 years ongoing). It only happens when I walk for long, try to run, carry heavy items or wear tight shoes. MRI scans showed nothing, XRays showed nothing. Could it be a neuroma? Massaging it helps alot. The cold also aggravates the pain. Anti inflammatory meds help as well as lyrica for nerves. My guess it is a pinched nerve or a neuroma.

Dr Blake's comment:
With the negative scan, this is typically an L4/L5 nerve root irriation or double crush syndrome. Neuromas are rare in this area. Look into neural flossing/gliding and topical NeuroEze. Have the nerves evaluated by a neurologist or physiatrist for radiculopathy. Definitely try to manipulate the weight bearing with Hapad Longitudinal Arch Pads and try restricting toe motion with toe separators, Budin Splints, spica taping. Ice Pack for 10 minutes twice daily for the next month to see if this is helpful. Hope this helps.

Saturday, May 9, 2015

Big Toe Joint Pain from Running: Email Advice

Hello Dr.,

I do not know if this email is still active, but I wonder if you could give me some advice.  I am a 27 year old active male who, for the last 7-8 years has had big toe pain in my left foot.  It seems to exacerbate on exercise and calm down when I rest it.  It doesn't seem to be getting worse, although it does tend to be quite tender after running.  I have no bone spurs that I can feel, and retain the same ROM as the other foot.  I had x-Rays about 7 years ago when I noticed it and the podiatrist suggested the usual hard sole shoes and orthotics, which I didn't follow through with.  Should I be treating this like a sore joint and avoiding exacerbating activities, or should I be looking into surgery?  If it is the latter, which surgery might retain maximal functionality of the toe ultimately?  I appreciate your time and your response.

Dr Blake's response:
     Thank you so very much for your email. In a situation like this, you have plenty of time to find 3-5 things that help you de-stress the joint and perhaps slow down the joint breakdown. You are way too young to do joint surgery, and there is no surgery out there that makes the joint better. You can make a toe straighter, you can remove bone spurs that get in the way of motion, you can fix or remove broken bones, but unless we had more info, you can not make the joint better by cleaning it out. 
     What typically makes big toe joint better are biomechanical changes (shoes, pads, orthotics, activity modifications), anti-inflammatory measures (icing, PT, contrast bathing, topical and oral meds), immobilization measures (cross training, plates, spica taping, stiff sole shoes, removable boots) and getting further information (xrays, MRIs, bone scans, CT scans).
     My goal for you would be to try one thing a month for the next 7 months (like icing for 10 minutes twice a day). Definitely use the KISS principle: Keep It Simple Stupid by using the least invasive things first. Find 3-5 modalities that help somewhat (10-20%) and make yourself a cocktail for less pain. Hope this works for you. Rich

Tuesday, May 5, 2015

If you think I know what I am doing, read this!! At least I have great patients!!

Hello my most exceptionally wonderful and PATIENT Dr. Blake.  It was so nice to see you again. You always make me feel like we are in this together and that I'm not being left hanging out on a limb all alone!  The last adjustment we made did not seem to help much with off loading the lateral column. I noticed almost immediately that I had lost some of that wonderful support I had been enjoying and am pronating more than I was.  I have had to add arch to both orthotics. Taking the wedge off the topcover helped tremendously but I am still having numb toes and soreness along the lateral side.  I tried the met pads in every possible way and even bought some of the blue hard ones thinking they would be better.  They just seem to press even harder on the nerve.  I knew I had neuromas but apparently they have been dormant for years.  Your website said to try different shoe gear so I bought three different pair from your list and have had no better luck with any of them.  I know you said the fifth mets were dropped so could that be the issue?  You are so knowledgeable so I will not even try to interject my thoughts here.  I really don't want these numb toes to become a permanent fixture but don't know what else to try.  Sorry to be such a pain.
I await your suggestions but amputations and lobotomies are not possible.😁