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Sunday, October 2, 2022

Historical Review: Helps You Organize for an Upcoming Visit, and Helps the Health Provider Immensely!

A   What is your Assessment of the problem (what do you think it is)?
What part of your Anatomy is involved?

     When you are seeing a healthcare provider about your symptoms, try to be organized in your thoughts. Standardized questions that you will be asked may not hit on the individual issue you are facing. Perhaps, boring to some who want to have full faith that the medical people will ask the key questions, this self examination that I have started several posts ago may hone in on your injury right from the start. 
     Of these self examination questions, your Assessment of the Problem may be the most important. I have so many patients tell me that they knew the diagnosis was not what the doctor or therapist came up with and stuck with for the year of unsuccessful treatment, but for some reason never spoke about what they thought was going on. Get it out on the first visit.
     This also applies to patient's fears that they need alleviated. The two common fears are cancer when a mass or growth is on the foot, or that the diagnosis will mean they will never walk again. If you have a concern like this, the question can be phrased simply "could be cancer, or will this mean I will have permanent problems?" 
    And lastly, the Anatomy involved should really be honed in before your appointment. Foot and ankle pain that I deal with can be very vague and that works against our finding some answers. At least if the problem involves a big area try to focus on what hurts the most. And, don't be like some of my patients who put their foot up and say it hurts, but can not really advance the discovery from there. In their defense, sometimes feet or ankles only hurt when you are doing something (running, hiking, dance, etc), and stop hurting completely when you stop. But, the more help I can get from the patient's self examination of the problem, usually the better. 

Saturday, October 1, 2022

F: Family History of similar problem? Frequency of pain (how often)?

Family History of similar problem? Frequency of pain (how often)?

     When patients get a problem, one area to review is family history. In my family, my mom and brother both had knee replacements, and my dad and sister have had serious GI problems. Things do run in families. 
     The second F concerns frequency of pain (how often). A patient can present with pain that only occurs at 5 miles into a run, or with each step. Just because a patient presents with pain, really understanding how disabling it is to a patient is easily misunderstood. 

Friday, September 30, 2022

Treating Foot Pain: General Discussion

     So your foot hurts!  Where do you go from here? Probably stay off your foot as much as you can. Probably take 2-3 advils, once or even twice a day. Maybe alittle better, but its is not really getting better. 
Was there an incident that happened, or did the pain come out of the blue? One place to start is in self examination. Pretend the doctor or nurse is asking the questions. I like this order of questioning. If you do see a doctor, I love when patients come in prepared like this. 

The mnemonic goes like this---

Family History of similar problem? Frequency of pain (how often)?

What is your Assessment of the problem (what do you think it is)?
What part of your Anatomy is involved?

I How Intense (use Pain Scale) is the pain? What Irritates (makes it


L With one finger, point to the exact Location of the worse pain?

What Eases the Pain? Does the pain have an Electric sensation with it?

What has been it’s Duration (how long has it been going on)?

O What were all the events surrounding the Onset of Pain? Are there

any Observable skin changes?

P Pain Scale (0-10) Sleeping? Getting out of Bed? During Activity? End

of the day?

Q What is the Quality of Pain (burning, tingling, dull ache, sharp,

numbness, throbbing, pulsating, etc)?

R Is there Redness? Does the pain Radiate and where to?

S How does Shoe gear or barefoot affect it (or high heels, or various

types of shoes)?

What have you done to Treat the problem? What Treatment has

helped? What Treatment has made it worse?

Are there Underlying Health Issues (diabetes, osteoporosis,

arthritis, poor circulation, etc.)?

V Does the pain Vary (better at different times, worse at other times)?

Can you Work? Were you injured at Work? Does this affect your Work


Tomorrow, I will add to this discussion, but I wish all my patients would present with the answers to these questions. 

Dancer's Padding: How To Video

     Dancer's padding was introduced by the French studying ballet injuries in the 1700s. It has a modern term of "Reverse Morton's Extensions". The current supplier for my patients is Amazon, and I can only find the 1/4 inch which you will have to thin out. 

     I use this material constantly in my Podiatry practice, and give supplies to my patients. Any problem with the big toe joint, and some cases of plantar fasciitis, and arch pain, you want to see if this padding helps the symptoms. 
This is demonstrating the Dr Jills Dancer's Padding with Adhesive Gel

Wednesday, September 28, 2022

Practical Biomechanics for the Podiatrist: Book 2 is out in Print

     I am so excited to have finished my second book of this series entitled: Practical Biomechanics for the Podiatrist. This book covers examination techniques very helpful and most of the mechanical treatments for foot injuries. It is probably the most practical book I have written and perhaps a great Christmas present for your favorite podiatrist. LOL I think all my patients would be helped by seeing all the options for their foot injuries and of course so many injuries have 3 or 4 problems going on at the same time. Rich 

Wednesday, July 27, 2022

Strengthening of the Posterior Tibial Tendon

     One of the most severe problems that I treat is the wide spectrum of posterior tibial tendon problems. This can be from posterior tibial caused shin splints, posterior tibial tendonitis due to overuse with a new activity, or posterior tibial tendon failure in adults leading to flat foot. Therefore, anytime I have a patient whose problem is involving the posterior tibial tendon, I begin a life long strengthening program. 
     When a patient over pronates their foot, like in the photo here, they have alot of body parts to pick on.

Why do some patients have knee pain from the over pronation, some posterior tibial pain, some plantar fasciitis, ect? The answer lies I think in the Rule of 3. That means for most overuse injuries it actually takes 3 problems to cause the issue: You see the pronation problem, but a weakness in the posterior tibial tendon is also very common to find. I hope these exercises which isolate the injured tendon can help. 

Key words:
Posterior Tibial Tendon
Ankle Strengthening
Over Pronation

Monday, July 25, 2022

Big Toe Joint Pain: At Times You Limit Motion and At Times You Get the Joint Moving

     Patients present all the time to Podiatrists to help them with pain in their big toe joints. This pain can be traumatic (like sesamoid fractures), or arthritis (some version of hallux rigidus), or due to the simple malposition of the joint. I believe you should try various treatments first before leaping into a surgical fix. I do see surgeries occasionally fail since the wrong surgery was done. You can look at a foot and see a bunion deformity, as in the photo above. You can assume normally correctly that fixing the bunion will eliminate the painful process. But, not always is this the case. Typically, do 5 common treatments for the painful foot before you have the surgery. This can take you 3-4 months. If all your pain is gone by these treatments, I find patients can make a better informed consent on still having that surgery in the future. 
     So, to the title of this blog post I go. What do I mean? In general, we want the big toe to keep moving. Most sports medicine podiatrists agree with this concept. But, during painful episodes, you need to stop the painful motion for awhile. That is paramount to understand. You are only stopping the painful motion, even in the face of arthritis, for awhile and not permanently. Many of my patients therefore need two sets of orthotic devices: one that stops motion, and one that allows motion. Do not stop motion forever if it can be avoided. 

Key Words:
Big Toe Pain
Hallux Rigidus

Saturday, July 23, 2022

Bottom of the Foot Soreness: Think Accommodation

Above is a Spenco insert which has the area of soreness cut out on the right foot. You can mark the sore area with a felt pen or old lipstick on your foot. Then put your foot into the shoe and walk a few feet to see where the mark comes out. Cut an area just bigger than the mark. 2 layers may be appropriate.

Here 1/8 th inch adhesive felt is being used to accommodate a sore big toe joint. Be creative with old shoe inserts that you are not using anymore.

Walk Run Program for Injury Rehabilitation or Beginning Running

The Walk/Run Program

     Most sporting activities require some running. Running can be an excellent return-to-activity conditioning tool. After recovering from an injury, the athlete finds great physical and emotional strength from a gradual buildup of running. Injury rehabilitation can involve crutches, cast, surgery, and rest. Golden Rule of Foot: At some point, when the athlete is back to walking 30 minutes, without pain, and without a limp, a walk/run program can be started.

     The walk/run program that I have used for many years uses a 30-minute time period, based on the more classic 30-minute hard walk test that qualifies the athlete to begin jogging. However, you can start the program based on a 20, 30, 40, or even 50-minute period. It all depends on what you want to get to. I have used the 30-minute program personally twice in my life; once after a back injury, and the other after a knee injury. I found the program difficult since I was out of shape for running, yet safe with its low start and gradual progression. It is not as easy as it looks when you have not run for a while.

There are 10 levels:

• Level 1     Walk 9 min Run 1 min Repeat 3 times for 30 mins
• Level 2     Walk 8 min Run 2 min Repeat 3 times for 30 mins
• Level 3     Walk 7 min Run 3 min Repeat 3 times for 30 mins
• Level 4     Walk 6 min Run 4 min Repeat 3 times for 30 mins
• Level 5     Walk 5 min Run 5 min Repeat 3 times for 30 mins
• Level 6     Walk 4 min Run 6 min Repeat 3 times for 30 mins
• Level 7     Walk 3 min Run 7 min Repeat 3 times for 30 mins
• Level 8     Walk 2 min Run 8 min Repeat 3 times for 30 mins
• Level 9     Walk 1 min Run 9 min Repeat 3 times for 30 mins
• Level 10                    30 min Straight Running

Each level should be done three times minimum, depending on how you feel. Each session should be followed by a rest day to see how you feel. Therefore, completing Level 1 should take a minimum of six days. For example, start walk/run on Monday, rest Tuesday, second session Wednesday, rest Thursday, third session Friday, rest Saturday, and ready to start Level 2 on Sunday as long as Level 1 was fine within the Good Pain         (Level 0 - 2 pain)

Gradually work your way through all 10 levels. Remember to stay pain-free if you pass to the next level, but if your pain starts to come back, rest three days, and go back to the level you were comfortable at for three more sessions. Again try to get to the next level. If you again have trouble, stay for six sessions at the comfortable level, continuing to run every other day. Most patients gradually go through the 10 levels in two months (60 days), but some have taken a lot longer to progress. Remember, if you listen to your body, and don’t push through pain, you should make it very safely.

 The walk/run program works well with even minor injuries where there are questions of when to start running. If you have only been off running for a short time, but you feel anxious about starting running, try this program. In its quickest form, Level 1 the first day, then a rest day, then Level 2, then another rest day, and so on. As long as your symptoms are fine, and you do not push through pain, you can get through the 10 levels in 20 days. This is normally better than running three miles the first day, having a flare-up of symptoms, then stopping running for two more weeks. It allows you to test the waters of running more safely.

 Remember another Golden Rule of Foot: It is better to run 1 second than not at all. Patients ask me all the time if they can start running. If they can walk 30 minutes at a good pace, without pain, and without limping, then they can start running. Any running for most athletes is better than not running. If you cannot do the 1 minute for Level 1 walk/run, try 10 to 30 seconds, running telephone pole to telephone pole in your neighborhood. Getting back into running shape can be safe with a walk/run program. It may require some individualization, but you will go either at the speed you were meant to, or slightly slower. You will get there!!

This was an excerpt from my book "Secrets To Keep Moving: A Guide from a Podiatrist"

Dr Blake's Video on Strengthening for Bunions

     I am not a podiatric surgeon, but someone who tries to delay the need for bunion surgery. This post will not go into the many reasons each patient has for attempting to delay or reduce their chances of needing a bunion correction. This exercise is an evening task and it does a great job making the foot stronger. Added to other conservative bunion treatments, which of course should be done post surgery also, you should develop a treatment regimen of 5 which seem to help individually. They will help even more collectively. Common bunion treatments include: toe separators, Yoga Toes, Correct Toes, wide shoes, Injinji socks, night splints, proximal  padding, etc. You can find other posts in this blog on these and other treatments. 

Abductor Hallucis Strengthening

Sunday, July 17, 2022

A little Plug for My Book on Biomechanics: My Gift to the Next Generation

May 25, 2022rated it 

Think Like A Biomechanist

This is like having a conversation with Dr. Blake. The chapters and divisions are not entirely conventional. As you read, you will learn how Dr. Blake considers the diagnostic and therapeutic possibilities. And you will have a good number of questions to answer.

Luckily the answers to the questions are in the book and also give you the opportunity for insight into Dr. Blake’s methodology. This is more or less theoretically agnostic. You don’t need to adhere rigidly to “Root” biomechanics or be opposed to it. Just keep looking at the insight and vision into a logical approach.

Science deals with successive approximations to obtain a correct answer. Dr Blake explains who biomechanics requires being looked at as a process not a once and done. Your approach may need to be changed and if you’ve made an orthotic that may need modification more than once.

This is book one of a four book series. The only unfortunate thing is that only book one is available. But not even all of the Harry Potter books were available at once. That bit of magic began with one book also.