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Thursday, December 31, 2015

Happy New Year!!!

Dear Dr. Blake,

Knowing that we are now published poets,
has served me quite well,
wouldn't you just know it,
I've another poem yet to tell!

"Ode to the Podiatrist & A Happy New Year!"

January 1st is coming,
kicking off another year,
may your feet keep you walking, running,
and joy produce your only tear,

Healthy feet are a treasure,
both right and left,
they have you dance with good measure,
while carrying your heft,

Ode to the great Podiatrist,
who keeps them healthy and strong,
this warm gratitude you can't miss,
for it would just be all wrong,

Stand tall as tree,
but never forget,
your healthy feet support thee,
Here's to the Best Year Yet!

Happy New Year Dr. Blake!  I hope you and your family have a wonderful 2016.


Please enjoy Adele's new song: Water Under the Bridge

Sunday, December 27, 2015

Accessory Navicular: Email Advice

Hi Dr Blake!

I'm a young adult with flat feet, extreme high arch and accessory navicular.
It all started 6 years ago when I had pain right at the extra bone. I did ballet at the time and soon after, the pain was unbearable to the point of sharp pain at the bone every step I took. At that time, my treatment was icing, taping, ankle guards, orthotics and pain killers everyday. I even had 3 sessions of physiotherapy every week for 2 years. I experienced numerous ankle sprains through walking in a day where my feet either sprains inwards or outwards (even while wearing ankle guards and orthotics) and was literally unable to run. I even tried chinese healing to reduce the swelling. It got to the point where I'm  so used to the pain because I experience it with  every step i took. I saw an orthopedic surgeon who failed to pick up the accessory navicular problem and thus did nothing with it.
Dr Blake's comment: High Arch feet when unstable can be extremely difficult to treat and need an expert in making podiatric custom orthotic devices. 

I stopped ballet 2 years ago and the pain at the bone got better. I stopped wearing ankle guards a year ago. I've been on orthotics and very expensive arch support shoes for 5 years (24/7) but I notice that my ankle still severely slops/falls inward when walking. There is also some pain involved. So I'm  wondering if it's  time to consider surgery if this is a problem that may continue for the next 40 to 50 years.
Dr Blake's comment: Glad you are feeling better. Yes, surgery to remove the accessory navicular should be an option to give you a stronger arch. But, it is complicated, and requires that you find several surgeons and get their opinions on whether it will help you. I am hopeful you are doing a daily home strengthening program for your arch, especially the posterior tibial tendon. Also, if you have a complication with the surgery, is that a risk you are willing to take? 

Lastly, Sorry for the long question and i appreciate  your time taken to read and answer my question.
Thanks and Regards,

Thursday, December 24, 2015

A Podiatry Christmas Poem

 'Twas the eve before Christmas
and Dawn took a look,
she took a look at her cold bare foot,

You see, the stockings had been hung by the chimney with care
and this made Dawn's foot to be chilly and bare!

Alas, the report she sent Santa, Doc Blake and all,
was that her foot was healed, heel, toe and all!

Dear Dr. Blake:

Merry Christmas to you.  You had asked me to send you an update in December.  This might not be in the format you expected....but none the less the foot is fine.  Thank you so much for your excellent care.

Dr Blake's Christmas Response:

Thank you so very much Dawn
As I am watching the rain green up my Lawn
Thank you so very much Dawn
This poem will surely make you Yawn

Your great news brought tears to my eyes
I could tell that they weren't mere lies
And for this I will take note and Rise
Yet, I know with your feet, this is probably not goodbyes.

Love, Rich

Wednesday, December 23, 2015

Possible Hypermobility Problem: Email Advice

This was an email I just received as I am catching up on emails as a Christmas present to myself (sick I know, but somehow therapeutic to my soul). Merry Christmas and Happy Holidays to all my readers. Rich

Dr. Blake: 
I was on the and saw your comment on the hypermobility of the first ray joint. 
I have bilateral foot pain for many years.  My left foot has the hypermobility more so than the right.  I have a bunion on the left.  I have had many orthotics made within six years none of them really helping.  The first podiatrist I went to in 2007, made this huge orthotics and made me wear motion control sneakers with them.  I was told that my feet were not to move in the sneakers, I feel this was a big mistake.  Perhaps this made the problem worse.  I never had this problem until I started wearing orthotics.  I also have a problem with my left hip (weak hip, core and pelvic).  My gait has is really off. 
It was not until last year when I visited an orthopedic doctor who said I have a lot of hypermobility in the forefoot and that my ligaments and tendons are too weak to support my weight.  After visiting at least six podiatrists, not one of them ever mentioned this problem with my feet.  The orthopedic doctor wants to fuse the bones in my feet.  After getting a second opinion from another orthopedic (Mass General) who said absolutely no to the fusing and not knowing how to help.  I really don’t know what to do.  My feet literally throb from pain and I feel as I am grasping the ground and my big toe joints hurt so much as they are being pounded into the ground.  I have been everywhere looking for help and cannot get the help I need.  I visited a foot doctor in Worcester and he could not figure out what to do, except offer me another pair of orthotics, but he never mentioned the hypermobility of the first ray joint. 
I have been on Dr. McClanahan’s site and purchased a pair of correct toes and have followed him on getting out of orthotics and going to minimal shoes and exercising my feet.  My feet are in so much pain from exercising and they are not getting any better.  I am so discouraged and just cannot believe no one can help. 
I was wondering if you would know of any foot doctor in the Boston area who would have been the expertise to helping me get out of pain without surgery or orthotics. 
May I ask you would strengthening the feet help with the hypermobility or am I wasting my time.  My lower legs, calves hurt so much, I have been told that the certain muscles are not functioning, as well as my glutes.  From being an athletic person to not being able to walk without pain is very discouraging.
I would appreciate if you could possible help finding a doctor who could help. 
Thank you. 

Dr Blake's response: 
     Thank you so very much for your email and I am very sorry for your struggles. There are many types of hypermobility, from mild to severe, from static to functional. Sounds like you have a severe case, although at times mild cases just spin out of control. Typically when rehabing a patient with hypermobility you find you need longer immobilization, longer periods of re-strengthening, and it takes longer to return to activity. It is a careful balance. Not too many podiatrists or orthopods believe that hypermobile patients should go without orthotics and learn ways of joint taping or splinting that helps. I have never had a hypermobile patient had a joint fused, and I am not sure what that would do to the stresses on all the other joints in the lower extremity. I would find a local PT who deals with Ehlers Danlos patients to help you first, and they may have a suitable podiatrist for you. To me, orthotics devices are crucial, although not with motion control shoes. You should see if by orthotic devices, activity modifications, anti-inflammatory measures, and perhaps assistive aids, you can re-establish a pain free environment of 0-2 pain levels. Then, spend the next year getting your feet stronger, not be walking in minimalist shoegear, but by a calculated home/gym strengthening program done daily under the instructions of the PT. I sure hope this helps you. Rich

Big Toe Joint Splint for Hallux Rigidus/Limitus Pain

Recently a patient was getting some considerable amount of pain relief with this device for her Hallux Rigidus pain. Hope it helps some of you. Rich 

Hi Dr. Blake
Thanks for working with me this afternoon!   I am looking forward to have better working feet! 

Here is the info about the toe guard.  This is the one I ordered from amazon.

here is the company ..they have  a variety of items.  EVOSHIELD

take good care and have a happy new year!