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Saturday, September 11, 2021

Healing Plantar Fascial Tear Images: Dark, Intact, but Irregular

This is my grandson, and one of my best friends, Henry. Henry is shown here starting Kindergarten about 3 weeks ago. He says his favorite is "Math" because he loves looking for "Patterns". Just an Angel. 


Here is an MRI image for a plantar fascial tear healing well. The plantar fascia is this dense band of fibrous tissue that runs from the heel to the front of your foot. This image is at the 6 month point, therefore a second MRI. The fibrous bands look mainly dark, but very irregular, as this process of healing is a bit different from patient to patient. If you look first at the heel bone, and then 2 inches in front, you can see normal looking dense regular plantar fascia that we hope will happen over the next 6 months. 

Friday, September 10, 2021

Tip for Orthotic Devices in Side to Side Sports: Keep Them Low to the Ground


High level soccer player presented today for his orthotic devices solely for these cleats. The custom orthotic must be low to the ground, so when you flip this over, the heel does not have its typical post or lift. I always joke with the patient when they bring in such bright shoes, that they better be good to wear these!!

Here you can see after flipping over the orthotic device that there is no additional lift that could potentially lift them out of their shoes. This is ideal for any side to side cutting sports where the risk of ankle sprains is higher than running or walking. 



An even closer look at the orthotic bottom (plantar) area. The orthotic device really supports the foot well and distributes weight very evenly around the foot, so stress points are harder to develop which can lead to injury. 

Thursday, September 9, 2021

5th Metatarsal Fracture: 10 Weeks into the Healing Process




10 weeks ago this military vet rolled her ankle avoiding her dog and that abrupt twist fractured her 5th metatarsal base. She was 6 weeks in a removable boot with crutches when I saw her. To protect the bone, and allow her to get out of her boot and back to activity, I made a rush of some custom orthotic devices and taught her how to use KT tape to circumferentially wrap the area. She took 10 days to painlessly wean from the boot, and has been walking for 3 weeks in athletic shoes, tape, and orthotics. Since she walks without a limp, and is controlling her pain within the 0-2 pain level parameters, I started her on an every other day walk run program. She is to email me when she gets to level 5 and then level 10. If you are uncertain about this program, you can type it into the search bar. 
     She had no pain on examination today. I felt no need to xray since the fracture line never looks great on xray for the first 3-4 months. I find I can rehab the patient based on their symptoms. 

Wednesday, September 8, 2021

Foot Pain: Can I Off Weight? Great for the Bottom of the Foot Problems

Today I want to discuss a product I use daily, and many times each day. It is called "Adhesive Felt" with 1/8 inch the preferred thickness for the bottom of the foot. In the photo below, I am protecting a sore 2nd metatarsal with an off weighting horseshoe shaped pad. When the bottom of your foot hurts, consider this remedy. Rich 






https://www.amazon.com/Felt-Adhesive-Orthopedic-Aetna-Corporation/dp/B0053D30TC/ref=pd_sbs_2/137-5657958-3764962?pd_rd_w=NArKX&pf_rd_p=0f56f70f-21e6-4d11-bb4a-bcdb928a3c5a&pf_rd_r=6XJA9FEW5NJ0K863RMX1&pd_rd_r=707526a4-402c-4860-8d21-fd0d0634bb19&pd_rd_wg=XZAPp&pd_rd_i=B0053D30TC&psc=1

Tuesday, September 7, 2021

Ankle Sprain: How to Present the Injury to a Health Care Provider

I just got back from a 6 day trip to see my son and daughter in law and grandson William in San Diego. My wife and I had a marvelous time, but it is time to get to work tomorrow. Perhaps I care share one little photo of William for my readers. 

William is 6 months old and of course I am much older

     This post is about having an ankle sprain and trying to write down all the important things to tell the health care provider when you go in for the visit. However, it could apply to any injury, and it is both for the health provider and you. After the initial pain, and maybe you are still lying there on the ground, you have to start asking why? Why me? Why now? What lead up to this injury? The answers to these and other questions can help prevent other injuries in the future.

#1  What exactly happen? Fall down stairs, land on someone's foot, etc
#2  Has this happened before? Are you prone to sprain your ankles? 
#3  Did you feel that your ankle was weak before your sprain occurred?
#4  Were you doing too much prior to the injury?
#5  Do you have good stable shoes for your ankle?
#6  Do you wear ankle braces during the activity you sprained your ankle?
#7  In what direction did your ankle move during the sprain?
#8  In what direction did your body move during the sprain?
#9  Did the sprain cause you to fall?
#10 Was a pure accident like a slip on slippery surface?

I hope these questions will help you focus on the injury to get at the cause and mechanics of the injury. Rich 

Wednesday, September 1, 2021

Thickened Nails: Sometimes There Is One Growing Underneath!!

Hello, this is my last post for a few days as I visit my grandson William in San Diego. I will be back on Wednesday 9/8. At the end of the post, I will show you a picture of William, so very cute. 
     A patient on Monday presents with a thickened and possibly ingrown toenail. There was no pain, but it did not feel right at all. After doing both some electrical thinning of the nail, and then some manual debridement with clippers, this is what we ended up with. I surmise that this is the normal nail beginning to grow under. I will see her in 3 months and we will see how it grows back. 
     Okay, here is William. So sweet. Definitely like his mom and dad (my son).