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Saturday, December 31, 2016

Blister Care: An Exerpt from my Book

Here is an exerpt from Dr. Blake's Book "Secrets to Keep Moving: A Guide from a Podiatrist"

8. Blisters/Calluses

    The top 20 treatment tips for blisters are:

  1. Always drain blisters as soon as possible and use a sterile pin or needle.
  2. Sterilize the needle or pin with rubbing alcohol or passing it through a flame, when letting it cool for 30 seconds.
  3. Before performing the procedure, and try to make Marcus Welby MD proud, make sure you have topical antibiotic, bandaids big enough to cover completely, gauze to collect the fluid, and moleskin or athletic tape to cover the band aid.
  4. Push the fluid towards one side of the blister and puncture the dead top layer of skin keeping the needle/pin parallel with the skin, sort of above the fluid.
  5. Do not push the needle/pin into the live, deep layers of skin below the fluid.
  6. You must puncture the skin 3 to 5 times in different places to ensure that the top will not just reseal over and allow a new blister to form.
  7. Even with the best intentions, 30% of all blisters have to be popped again.
  8. After popping the blister, soak in warm water in a basin with two tablespoons of any type of salt for 30 to 60 minutes (the longer the better) to pull out the fluid. I do like the sound of the SALTS from the DEAD SEA.
  9. After soaking, dry off the blister well, apply topical antibiotic over the holes made by the needle/pin, or any other exposed, open skin, and cover with a band aid(s) bigger than the size of the blister.
  10. Place with firm pressure tape or moleskin over the band aid(s) to give an added push on the roof of the blister to re-seal with the underlying skin.
  11. Take off the dressing twice daily to soak for 30 minutes until all the soreness is gone. It is so important to continue soaking until the soreness is gone to pull out extra fluid and inflammation. This can take 1 to 7 days based on the size and depth of the blister.
  12. Once the soreness is gone, the dressing can be removed except when you are in a situation that a re-blister may occur (perhaps that next hike!).
  13. Keep moleskin or tape over the old blister area for 2 weeks more to protect against re-blister. It is extremely important to massage softening creams or moisturizers into the area for these 2 weeks to re-soften the skin. Massage twice daily for 2 minutes. All the soaking you do in the first week dries the skin and deep tissues.
  14. The goal is to get the skin soft again and the deep tissue not inflamed.
  15. When the blistering process is severe with skin breakdown and exposed deep tissue (loss of the roof), use one of the over the counter medicines in the water while you soak. See if your pharmacy has any one of these powders or liquids: Domboros, Pediboros, Bluboros, and Burrows Solution. Follow the directions for concentrations.
  16. The medicated powders or solutions listed above are so powerful drying agents that you immediately have to twice daily use the softening/moisturizing creams on the skin.
  17. With the severe blistering, more skin protection is also needed like big squares of moleskin attached only to good skin, Silvadene-like silver tainted ointments, and perhaps some padding. The silver ointments are anti-bacterial as well as great for the skin. Ask the pharmacy.
  18. What if the blister is possibly infected? So you pop the blister and pus comes out, immediately see a doctor.
  19. What if the blister has blood? Blood is the food of infection. Blood blisters must be taken a lot more seriously, and drained as quickly as possible. If you think it is getting or is infected, see above and see a doctor.
  20. Every year I have to have an infected blister hospitalized or, at least, see an infectious disease specialist. I hate infections!!


Calluses: Treatment for when they become Painful

Hi Dr. Blake,


I have come to see you in the past at the Sports Center for an ankle sprain. I have a question unrelated to the sprain and would like your advise. When I sprained my ankle I was training for my first half marathon. I started to get a callus on the ball of my left foot and that has now developed a corn on top of it. At first it would not bother me too much but as I continued to train it got worse and worse. Now after my training is over and, I admit, wearing not cushioned enough shoes it has gotten MUCH worse and has become very painful. For the past four weeks I have tried self medicating it with those pad treatments from the drugstore. I think I have tried them all at this point, the Dr Scholls brands, and it is still there and still painful. Now even with no pressure on it, there is still a lingering pain. Is there anything else I could do/try myself or is it time to come in?


I appreciate your time,




Dear Jessica, Thanks for your email.


    Usually calluses and corns only become painful when they have grown too deep into your foot and are now irritating the soft tissue under the skin. It is the corn on top of the callus which is usually the most painful and bores deep into the skin, normally called "seed corns".


    As the picture above notes, these calluses can be like "gluing rocks to your foot", and can be multi-layered with variable depths with each layer. The hardness of the corn irritates the soft tissue under the skin which contains a rich supply of nerves. You can get a deep blister, very painful, underneath the callus, and so deep that it is difficult to reduce. But the blister part is irritated with massage, even gentle massage with a pumice stone.

    It is best to approach these very sore calluses with softening creams (ask the pharmacist for a great hydrator) three times a day, avoid skin irritants like the Dr Scholl's plasters with acid, lay the sore area on an reusable ice pack 15 minutes 3 times daily to reduce soft tissue swelling, try 1 session of 30 minutes cool water soak daily (the longer the better), and gentle removal with a callus scraper (like Ped-Egg) daily for 2-3 minutes to gradually reduce the callus.


    A trip to a Podiatrist would help make the diagnosis of callus, blister, or wart (since many of these painful calluses are actually warts under the callus), and speed up the callus removal by weeks since they can use very sharp instruments, plus place appropriate padding in your athletic shoes to off-weight the painful area.


    No matter what, the callus has become something else, since calluses (which are dead skin) do not hurt. It is how the skin around them reacts that produces the pain. Or is there a wart or deep blister needing other treatments. I hope this helps. Rich


Thursday, December 29, 2016

Tumeric: If you have Inflammation, don't forget the Tumeric

I love some on and off routine with NSAIDs, 5 days on and 2 days off, or 10 days on 4 days off. During the off days, many of my patients have been doubling up on the icing and adding Tumeric. Some are just switching to tumeric for all their anti-inflammatory needs. Make sure you read about it, especially side-effects or contra-indications before taking. Rich

Sunday, December 25, 2016

Peripheral Neuropathy: WalkJoy Device a Possible Help

This product I have no experience with, but I really could not find anything wrong. If any of my readers have some information, please comment on this post. Thank you. Rich

Dr. Blake,

WalkJoy is the only FDA approved device to help reduce falls and foot ulcers for patients with peripheral neuropathy.  We'd love to see if we can help some of your patients.  Attached is a flier and a few testimonials.



Image result for image walkjoy device

Testimonials from Patients

“Life Changing”
Thank you to The Foundation For Peripheral Neuropathy for introducing me to WalkJoy, Inc.  I am a 78 year old retired Plastic Surgeon. I had a major back surgery 9 years ago with total success. Post-surgery, I noted there was a burning in both feet and the surgeon said it could not be repaired. Over the next few years, I was told I had Peripheral Neuropathy, etiology unknown. The burning went away, but I had complete numbness resulting in loss of balance that slowly developed into full blown problems that were debilitating. After two years, my EMG showed destruction of the axons and myelin.
I have been using the WalkJoy for several months now and am thrilled with the results that have been fabulous. I play golf 6 days a week with amazing balance, improving my game and I am using the treadmill with increasing speed. Socially I feel more comfortable in movies and getting up from a table. My general walking has increasing length of strides and my improved balance is life changing for me. I am grateful for the wonderful way my active life has improved.
I sincerely hope more neurologists are made aware of the WalkJoy product to make their patient’s lives much better.                                 Larry R. MD FACS    Palm Beach Gardens, FL

“I feel more stable and in control.”
I am an 80-year-old male and I have had idiopathic axonal sensory peripheral neuropathy for at least 10 years.  It has progressed to the point where I have no sensory nerve response from my toes to below the knees.  As a result, my balance is very poor and I use a cane.  I was becoming sedentary as my ability to maintain my balance declined. I read about the WalkJoy units in my Neuropathy Association newsletter and decided to give them a try.
What a difference they make!  I wear the WalkJoy units nearly full time.  When walking I am able to increase my stride and speed, and I feel more stable and in control. I walk several miles a day for exercise, and my neighbors have commented on my improved mobility.
I feel the WalkJoy units are enabling me to avoid having to use a walker, and ultimately a wheel chair.  I am very pleased with my increased mobility.  Thank you, WalkJoy!"                                                        Lee M.  Modesto, CA

“My first reaction…was astonishment.”
My first reaction to trying out the WalkJoy units was astonishment. Within about a dozen paces, I was walking with an almost normal gait. All without feeling anything detectable from the units.
I am 92 years old and have had idiopathic peripheral neuropathy for at least the past dozen years. I have fallen a few times, and I have to watch my feet when I walk. My excellent physical therapist found that I still have some proprioception (muscle sense) available in my feet, and exercises have helped improve my balance.
The improvement when using WalkJoy is clear and almost immediately evident to me. I now wear them most of the day, every day. There is a temporary residual effect when I take them off, and it takes almost an hour before my walking gait deteriorates. WalkJoy is an excellent product, but it is not, I repeat, not a cure. My balance tests show that without WalkJoy my proprioception is still faulty – especially when I try to stand, unsupported with my eyes closed. Don’t expect miracles.                                                    William T., Ph.D.    Sarasota, FL

“I am able to move with greater ease and balance.”
I have been using WalkJoy for about 6 weeks.  I have peripheral neuropathy so my feet cannot feel the ground.  This has caused me to have poor balance even though I have had balance training in physical therapy.

As soon as I started using Walk Joy my balance improved noticeably.  Smooth, shiny floors (usually marble) have long been a challenge for me, but no longer.  I can now comfortably walk on these floors.  I have also begun to walk my dog again.  I am not as afraid of falling and am more assured when I walk.

I had been frustrated because there is no treatment for the loss of sensation caused by peripheral neuropathy and was thrilled when I learned about WalkJoy.  Thanks to WalkJoy I am able to move with greater ease and balance.                      Janice C.  Falls Church, VA

WalkJoy has truly changed my mothers life.
Walkjoy has truly changed my mothers life. seriously. She had tried so many different treatments and nothing worked. Her doctors told her there was no cure for her neuropathy and that she would just have to learn to live with it. This went on for 4 years! Well they were totally wrong! My mom started using the Walkjoy units every day and felt a change (for the better) almost immediately. It has been around 2 weeks now and she is like a new person. Walking around is not an issue anymore. It has not only changed my mothers life but ours as well!                                                                Margaret B.  New York, NY

“My Dad has not fallen EVEN Once!”
My Dad could not be happier with the WalkJoy after a little more than three months of use. He has not fallen EVEN ONCE! Daddy is very active and walks outdoors every day. He is now back to walking almost a mile down our local road, as well as back and forth from his tractor shed (about 100 yards from the house) many times all day long. All of his leg and foot wounds have healed (I do not know if it is from the correct walking posture or just from not tripping and falling) and he is able to do so much more of what he likes every day.

Robert D. Houston, TX

“Muscle strength and stamina”
After experiencing nearly 20 years of increasing debilitation due to peripheral neuropathy, he was thrilled to feel the sense of balance and control that WalkJoy gave him! 
Three full weeks have passed now and he has not used his electric scooter once! He relies solely on his walker and cane without fear of falling. With each day of renewed confidence in his balance and stability, he has been able to increase his walking and exercise activities. As a result, both his muscle strength and stamina are slowly returning.
WalkJoy is an excellent product with the potential to change lives! We are so grateful to have been introduced to it.
John and CeCe H.  Santa Barbara, CA

Saturday, December 24, 2016

Final Examination Questions from Sports Medicine Classes

  1.   Which of the following treatment modalities is not part of a podiatric sports medicine practice?
  • A) stretching exercises
  • B) Graston massage
  • C) strengthening exercises
  • D) anti-inflammatory treatments
  • E) shoe recommendations
Answer: B

       2.   Which of the below is not part of the phases of rehabilitation?
  • A) Re-Stretching Phase
  • B) Immobilization Phase
  • C) Return to Activity Phase
  • D) Re-Strengthening Phase
Answer: A

        3.   What pain level is considered part of a good healing environment if maintained?
  • A) 0-2
  • B) 3-5
  • C) 6-8
  • D) 3-8
Answer: A

        4.   Which of the following is not one of the categories of the 3 types of pain?
  • A) neuropathic
  • B) inflammatory
  • C) implied
  • D) mechanical
Answer: C

        5.    The weakest link in the chain concept can explain why over pronation can cause knee pain                  and many other conditions. When looking for the cause of an overuse injury, Dr Blake                          recommends finding how many causes?
  • A) one
  • B) three
  • C) five
  • D) seven
Answer: B

        6.   Golden Rules are what you live and practice by. Typically they are unbreakable. Which one                 of these is not a Golden Rule for the podiatry profession?
  • A) Stretching should never be done with pain.
  • B) Good arch support is crucial in managing posterior tibial tendinitis.
  • C) Bunion surgery should always leave the patient with some Hallux Varus.
  • D) When treating a patient in an unfamiliar sport, it is important to learn the mechanics of that        sport.
Answer: C

        7.   When treating an acute injury, which letter is not part of the normal nmeumonic?
  • A) I
  • B) S
  • C) P
  • D) C
Answer: B

        8.   When examining a ligament sprain, which degree is determined when ecchymosis is seen, and joint mobility is excessive in at least one direction?
  • A) 1st
  • B) 2nd
  • C) 3rd
  • D) 4th
Answer: C

         9.   When we make a diagnosis of an overuse injury, the Law of Parsimony tends to at least                         point to one of the causes. Which of the following is not a Law of Parsimony?
  • A) Achilles Tendinitis----loose achilles tendons
  • B) Morton's Neuroma----tight fitting shoes
  • C) Plantar Fasciitis----over pronation
  • D) Peroneal Tendinitis----over supination
Answer: A

       10.   Humans naturally make Vitamin D3. What is the lab test for this?
  • A) 22-alkyvitamin D\
  • B) 25-hydroxyvitamin D
  • C) 27-acetylvitamin D\
  • D) 3-alphavitamin D
Answer: B

       11.   What sport sees the most cases of Ilio-Tibial Band Syndrome?
  • A) Biking
  • B) Hiking
  • C) Alpine Skiing
  • D) Running
  • E) Boxing
Answer: D

       12.   In what ankle position do you strengthen the peroneus longus?
  • A) Dorsiflexion Inversion
  • B) Dorsiflexion Eversion
  • C) Plantarflexion Inversion
  • D) Plantarflexion Eversion
  • E) Plantarflexion Extension
Answer: B

       13.   Which one is not a primary treatment for plantar fasciitis?
  • A) Arch Support
  • B) Strengthening
  • C) Stretching
  • D) Anti-Inflammatory
Answer: B

       14.   Which is not a type of shin splint?
  • A) Anterior
  • B) Deep Anterior
  • C) Lateral
  • D) Deep Posterior
Answer: B

       15.   What is the normal pressure in a leg compartment at rest?
  • A) 0-4 mm Hg
  • B) 10-15 mm Hg
  • C) 30-40 mm Hg
  • D) 40-44 mm Hg
Answer: A

       16.   What is the weakest of the knee muscles?
  • A) Vastus Lateralis
  • B) Vastus Intermedius
  • C) Rectus Femoris
  • D) Vastus Medialis
Answer: D

       17.   In terms of managing heel pain, which statement is false?
  • A) Night splints for plantar fasciits are typically very useful.
  • B) Orthotic design for heel pain is to shift weight into the arch.
  • C) Stretching of the plantar fascia is typically better by counting to 30 versus taking 5 deep breaths.
  • D) All heel stretches should be done with the heel on the ground. 
Answer: C

       18.   The name of the tape method to limit big toe joint motion is?
  • A) Budin
  • B) Spica
  • C) McConnell
  • D) Dye
Answer: B

      19.   What condition is not related to excessive supination?
  • A) Peroneal tendinitis
  • B) Fifth metatarsal stress fractures
  • C) Sinus tarsiitis
  • D) Ilio-Tibial Band syndrome
Answer: C

       20.   The general rule of days cast immobilized versus days needed for rehabilitation are:
  • A) 1:1
  • B) 1:2
  • C) 1:3
  • D) 1:4
Answer: B

Friday, December 23, 2016

Still need to send a Great Christmas Gift: An eBook from Dr Blake!!

With Christmas here is several days, and so many ski, basketball, ballet, and gym injuries, your family and friends will so appreciate Dr Blake's eBook delivered right to their inbox!!

Free eBook to My 126 Followers

Special Book Offer to my 126 Followers to Date!!

12 days ago I placed this great offer and 14 of my followers took me up on this! Please I am happy to send you guys my eBook for free!! Happy Holidays!!

For most of my readers, my health problems have been kept secret. Sort of like this book. But, I had a small stroke in August and could not do a 300 mile walk in Northern Spain I had dreamt about for years. So, it was a year of disappointment and poor health, but I am doing fine. And, I am forever grateful for what I have. I want to thank my 126 followers by offering a free eBook to them if they email me at with an email address to send the eBook. It is a good way for me to say thank you and not take them for granted. They have been very faithful. This offer is only good for them until 1/1/17, and I ask they contact the book retailers with a review that is in their heart. Good or Bad, whatever. This book is who I am. How many get to say that!! Love you all. And thank you. 

Wednesday, December 21, 2016

My Book on Amazon!!! Secrets to Keep Moving: A Guide from a Podiatrist

Since I have brought many many books from Amazon over the years, I am so pleased today that Amazon just released my book. If you do get it, book or ebook, please be kind to write a review so Amazon will like having me. Thank you so very much!!

Happy Holidays!!!

I wanted to take this time to cherish the moment we are in. What ever our plight, we hopefully can feel blessed in some way (even if you are not religious). We all have a spiritual side, some more hidden than others. We all need to stop for moments in our lives and reflect on the goodness we see or feel. The Holidays and the start of a new year are the perfect times to reflect in this way. Thank you all for being a relatively new, but extremely important, part of my life. I try to be a source of common sense in the medical world. I had a health scare this year, a wake up call if I choose to make a change. We all get these from time to time. They are all in some way gifts to us. Sometimes apparent, other times not so. So whatever your religious event this season, vow to stop and cherish your loved ones, those who help you in some way get from day to day, They may be the biggest and brightest and most meaningful gifts you receive. 

From the author of this one blog: Happy Holidays!!

Monday, December 19, 2016

Subtalar Joint: An Illustration from Dr Kevin Kiby

I could spend my whole life studying this one fascinating foot joint. The bottom half of the ankle is the talus bone. Under the talus bone, is the calcaneus AKA heel pain. The joint between the talus and the calcaneus is the subtalar meaning below the talus. I can even get that one!!

Sunday, December 18, 2016

Foundation for Peripheral Neuropathy

This look like a good source of information on peripheral nerves coming off the spinal cord. I look forward to explore over the next few weeks. 
Golden Rule of Foot: Look at a Nerve Wrong and it will hurt for 9 months!

Saturday, December 17, 2016

Sesamoid Blood Supply: Anatomy Discussed

The main blood supply to the sesamoids comes proximally (or from the arch) and plantarly (or from the bottom). Most of the sesamoid fractures do occur centrally where there is deceit blood supply. Right from the start of the injury, the bone swelling, which can cut off that circulation must be managed by creating a pain free environment: off weighting, icing, contrast bathing, elevation, etc.