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Tuesday, May 25, 2021

General Injury Advice: Email Correspondence

Hello Dr Blake , 

Hope  you and your loved ones are doing well and keeping fit.

I had an injury in my medial sesamoid  of the left foot in 2016 , after a very difficult year things settled with your advice (this patient lives in India) . Used Exogen , Hoka shoes with orthotics. Past years I had pain in the forefoot ,off and on , but nothing I could not manage . Was regular with strength exercises till a year back .Now the gyms are shut .

A few weeks back , I cycled out side for some days . Was fine for a few days but then developed a lot of pain in my foot ( same foot). I have pain in the forefoot and also in the heal ( it’s a heal spur I think)  The  heal pain is worse when after resting I get up and walk. 
Dr. Blake’s comment: This is classic plantar fasciitis and I refer you to the various blog posts on that subject.
I have started with contrast bath.

Need your help as to how to bring down the pain . 
Dr. Blake’s comment: The next 3-4 weeks you want to quiet everything down with the Hokas again, limited activity, a boot for 4 hours a day if you have one, and ice the sore areas for 10-15 minutes twice daily. Stay the contrast baths for evening. 
I am almost 49 years old and a diabetic since many years - I would like to know how can I -

1) bring back the lost muscle to my calf and thigh?
Dr. Blake’s comment: Some of the muscle loss will have to wait until you can do quad and hamstring strengthening in the gym. You can work on your abs with sit-ups, and calf with single heel raises each evening. Do single leg balancing every evening also for 2 minutes and metatarsal doming 3 times a day a set of 10. This will be a good start. 

( lost due to immobility during sesamoid injury & another injury in the right leg atrophied thigh muscles)

2) how to deal with the heal pain and pain in the forefoot?
Dr. Blake's comment: Hopefully, the Hokas can cushion and decrease the bend at the ball of your foot. Hard to know by that description if you should be doing anything else, or what the problem is. 

3)is it okay for me to do heel drop and heel raises?
Dr. Blake's comment: You know I hate heel drops in general. You can do the heel raises but see how the front of the foot feels. Sometimes when you go up onto the ball of the foot in a heel raise you have to off weight a sore area. Exercises should never be painful. 

**When we do calf raises with a well made of books to off weigh the sesamoid , I feel only the sesamoid is suspended and the body weight is still on the sesamoid , is it so?
Dr. Blake's comment: The well is to off weight (so no impact stress), but there will still be tensile force on the sesamoid (therefore you still have to use pain as your guide). 

3) my legs are quite lean overall ,what all exercises are safe for me to do to keep my foot and  leg  strong for the coming years .( keeping in mind the sesamoid foot -left side and the knee with arthroscopy- right side ).
Dr. Blake's comment: You can cycle with low tension at first to see how your knee handles it. You must raise the seat somewhat from normal to be kinder on your knee. You can elliptical, just stay flatfooted to protect the sesamoid. You can walk, and walk, as long as you can do so in the hokas and good orthotic devices. I sure hope this helps you. Rich 

Stay safe and healthy . 

Thanks and regards

The Patient then replied several days later:

Thank you so much for your reply Dr Blake.

Was just now going through your reply.Since you’ve recommended 3 to 4 weeks of limited activity , do I start the leg balancing , metatarsal doming , heel raises and cycling  now or after a month .Is a stationary cycle preferable than going out biking?

         Dr. Blake’s comment: Start the exercises now as I think you can start getting stronger. It is also okay to use any form of biking, inside or out, unless you have a lot of intense hills or treacherous uneven ground to pedal through.  

There are these range of motion and foot strengthening videos on your blog , should I start now ?

         Dr. Blake’s comment: Yes, put listen to your foot while doing them. Also, start with 15 minutes no matter what of the exercises, and 30 minutes of biking to see how you do. Every fourth workout go up 5 more minutes.  


Should I be doing the classic planter fasciitis stretching with toes bent , since I had my sesmoid injury in the same foot? 

         Dr. Blake’s comment: That is correct, avoid this for the time being due to the prolonged stress on the sesamoids.  

What are the exercises and poses I should avoid because I had the sesmoid injury and now I have the planter fasciitis?

         Dr. Blake’s comment: Really any exercise that puts prolonged stress on the ball of the foot. Like the downward dog position or planks. These would have to be modified.  

I was trying to donate to the blog using my credit card but I keep getting the message  - “ Donations to this recipient aren’t supported in this country .” Can this be fixed ?

         Dr. Blake’s comment: I know the link does not work internationally, but I appreciate the good thoughts.  

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.