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Monday, August 30, 2021

Academy of Neurologic Physical Therapists

     I am always sending my patients with some sort of nerve pain to seek the advice of a physical therapist specially trained in nerve pain. It took years to find out that these physical therapists had a national organization. Even though I find the website a bit confusing, any physical therapy office in your town may have an associate member. Ask the office if any of their providers are members of ANPT, or at least have a sub speciality in nerves. 
     When dealing with acute or chronic problems, I find that some many patients have a primary or secondary nerve problem. A chronic problem can develop nerve hypersensitivity needing nerve treatments, or an acute injury may be to the nerve primarily. There are easy problems like tarsal tunnel and Morton's neuroma which need nerve attention in treatment, but there are more subtle problems like chronic achilles pain or heel pain that are produced by the local nerve. 
     I always teach that there are 3 sources of any pain issue: mechanical, inflammation, or neuropathic. It is the neuropathic pain that does not respond to as well to mechanical and anti-inflammatory treatments and may need some nerve TLC. 

Sunday, August 29, 2021

Use of Sleeping Splints for Plantar Fasciitis

Good morning Readers, 
     It is a beautiful Sunday morning in San Francisco, although the Fires in the West of USA are frightful!
I pray for all those that have lost their homes to these fires. 

     The question today concerns the efficacy of the posterior sleeping splints for plantar fasciitis. I have attached a link to a video I did long ago still applicable.

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I use it for the patients with morning soreness when they wake up. It is important to find out how long they have symptoms when they arise. A simple case of plantar fasciitis normally hurts for 5 minutes or so. I am surprised when I ask when the patients say that it can take an hour or so. I have even had patients tell me the pain either never feels better, or they never have morning soreness. In both these cases, if your diagnosis is plantar fasciitis, you may be wrong. There are so many other causes of foot pain incorrectly diagnosed as Plantar Fasciitis. 

So, plantar fasciitis is normally diagnosed by historical review, but a good examination is also important. I have left the link from my video on Heel Pain Examination. 

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Can Plantar Fasciitis occur in other areas of the foot? For sure!! But, a non-heel diagnosis of plantar fasciitis is always suspect. 

Saturday, August 28, 2021

What is this Quick Tape? More Diagnostic for Plantar Fasciitis than an MRI for most cases!

Good Morning my wonderful readers! Yesterday I put in a plug for Quick Tape from a company near Seattle, Washington called Support The Foot. For my treatment of any heel and arch problem that I believe may be plantar fasciitis, or sometimes it is the patient who believes the most in that diagnosis, I will use Quick Tape as a treatment and as diagnostic tool. If the pain goes away while you are taping, or at least feels a-lot better, you most likely have Plantar Fasciitis. The taping is worn for about 2-3 months on average, each piece lasting a week. If the tape does not help, I begin to look for another cause of pain like nerve issues, stress fractures, and torn something. Even though not 100% accurate, it is pretty close. It is very easy to get by ordering from the website. Good luck!
Here are my students at the California School of Podiatric Medicine showing off their Quick Tape after learning the technique

I love to teach, and being in private practice, my teaching is primarily with my patients. However, I have had the great luck or fortune, to have some involvement with the school since I was a student, each and every year for the last 45 years (one year longer than I have been married). I will try to keep those 2 streaks going!!

Friday, August 27, 2021

Can I Start this Blog Over Again and a Plug for Quick Tape?

      Those of you who read each one of my posts I deeply thank you. This is my 12th year writing, and I do want to feel what is was like when I started in March 2010. I have definitely had an overall collapse in blog enthusiasm since Covid hit my reality last year. I could no longer work at the hectic pace of my youth. I am now a part time (50%) practicing podiatrist as of July 1st 2021. I am 67 years old. I have worked for 40 years trying to help people doing something I love. I wish I could thank all my teachers for helping me become a Podiatrist. The job is 24/7 365 days a year, and I am both exhausted by it and honored by serving my patients as well as I could. I will retire completely from private practice on 1/9/24 my 70th birthday. I love my little community hospital. We are one!
     In each blog post from here on, there will be something of me personally. I make no apologies. I am a deeply spiritual being, and practice podiatry from my heart. Podiatry is a profession of health. I wish all my students at the California College of Podiatric Medicine could fully understand their impact. 
     So today, I am starting again. I hope to go 12 more years, and perhaps start again. Most of my practice life is in the words of this blog, so how can I talk one day longer. We will see.

My wife Patty in blue and I just visited a friend in Sun Valley Idaho. We walk and walk where ever we go. My wife was wearing Quick Tape from for her chronic plantar fasciitis. I converted from the more difficult Low Dye Taping to Quick Tape for this problem now 7 years ago. 
Please help me with this change of direction. Comment below when you can. Rich 


Friday, August 13, 2021

Customizing OTC inserts: Quick Way to Begin to Change Mechanics

Podiatrists are always designing custom inserts to change a patients mechanics in some way to help their problems. Sometimes that correction is direct (like off loading a sore area seen with the horse shoe shape blue pad), and sometimes that correction is indirect (like the white metatarsal pad to help center the foot). Here I have added 3 adjustments to this Dr Scholl's inserts. The patient initially had the gray appearing heel wedge to help with pronation forces. When the patient returned, both his knee and low back had felt better with pronation control, but he was having new problems with the front 2nd metatarsal. The blue padding was then to help that. Once the inserts wear out, because I take photos of all of these inserts, I am able to re-make them if the patient sends into the office a new pair. Ah, biomechanics!!

Monday, August 9, 2021