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Sunday, January 30, 2022

Adding Stiffness to the front of a Shoe: Help for Many Problems in the Front of Our Feet

     My retired partner, Dr Jane Denton, known world wide of the Denton Modification for over supination, continuously used this metatarsal stiffener. It is a 1/16 to 1/8 inch thickness of out sole material. All chronic pain in the area may be helped with this shoe modification. When patients tell you that they feel better as the shoe stiffness increases, this may be something that a shoe cobbler can add to a more flexible shoe. It should be done on both sides (even if the pain is on one side). It can always be removed if not helpful, or after the need for stiffness passes. 

1/8 inch Stiff Out Sole Material Applied to Add Stiffness for Painful Metatarsals

The Stiffness has to be created with 1/16 to 1/8 inch Material only. This increases someone's falling odds due to separating the ground from the foot, so has to be broken in to gradually. The patients that it works for are really pleased that they can wear some normal looking shoes. 

Monday, January 24, 2022

Chemotherapy Can Destroy Nails and Hair: Ice to the Rescue

Many of my patients have had to have chemotherapy and their nails have never been the same. Using an ice bath, head cap, etc, while having the chemotherapy infusion, can greatly help some patients. The theory is that you freeze the hair or nail cells while the chemo is working, thus preventing damage. Thank you Susan for bring this up to me. 

Squeaking Orthotics: JSuede helps

My small lab at Saint Francis Memorial Hospital has a roll of JSuede, from JMS Plastics, for the patients complaining of squeaking from the orthotic rubbing against the synthetics of the shoes

Here, both the bottom of the orthoses and the top of the JSuede is glued and stuck together.
This very thin material can help without increasing bulk too much

Sunday, January 23, 2022

Virtual Walks are really fun!!!

Totals after the first 5 days (out of 9) in this Virtual Walk

     The last 9 days I have been virtually walking from Canterbury England to Rome, Italy. 34 people from mainly England are participating. We made it the 1200 miles to Rome and are starting to head back. All of our miles count towards the total walked, but they also tell us our ranking among the other walkers. I have moved from 3rd to 6th place over the week. I am a competitor by nature, and this has been fun and motivating to walk daily more than 10,000 steps over 5 miles. I have one more walk today and it is over. We will not make it back to Canterbury as a group, but I will not have to fly from anywhere either. 
     The website I am using for this virtual walk is It is a charity event to raise money for the maintenance of this historical walk. Canterbury to Rome has been a well travelled route since 500 AD. It goes by boat across the English Channel and then through France and the lowest part of the Swiss Alps. 

Friday, January 21, 2022

Adding Stiffness to the Front of an Orthotic Device

     The image above was taken after I applied a very thin piece of suede leather. This is stretched before tacking down to stiffen the bend across the metatarsal heads. This is a very useful technique when trying to treat metatarsalgia symptoms, Morton's neuroma symptoms, hallux limitus and rigidus symptoms, and all without adding alot of bulk in that painful area. 

Wednesday, January 19, 2022

Good Rx: A Good Way to Get Some Prescriptions at a fraction of the cost

     This company has saved hundreds of my patients a lot of money while buying prescriptions. Please be aware of it. 

Monday, January 17, 2022

Sunday Night Musings of a Personal Nature

A View of Sunset in San Francisco from my walk tonight!

     I am working on a book for the last five years. Months will pass and not a word is placed on a page, and then I get really productive. I am writing this podiatry book for my students at the California School of Podiatric Medicine in Oakland, California. The Podiatry school is part of the incredible medical graduate programs run through Samuel Merritt University. 
     The book title is Practical Biomechanics for the Podiatrist and really focus' equally on both basic treatments and more sophisticated. In medical school, the emphasis is on teaching high tech, so I plan on cornering the market with KISS techniques (Keep It Simple Stupid). 
      I am basically trying to teach the thought process of helping patients throughout the whole injury. My book, however, has gotten too big, and too time consuming, that I have now broken it down to 4 books with book 1 coming out this year. Wish me luck!
     RETIREMENT!! Well, I was going to retire at 65, and now I just turned 68. So, from today on, I am sticking to my #70 birthday on 1/9/24. At my age, you worry about illness' that will suddenly bring you down at any age. I started working at Saint Francis Memorial Hospital when I was 27 years old!! Long time in one place, but I have loved it. 
     Unfortunately, Saint Francis is not finding a replacement for me. Most of my present patients will have to find someone over the next 2 years. It will be a great 2 years!!


Sunday, January 16, 2022

Lecturing: A Way of Giving Back

     Of course, I am the handsome guy to the left as you look at the photo!!LOL
Why am I showing you this? I am at the end of my career, and giving back as much as I can is very very important to me. This photo is for some online presentations in Spain. I will talk to almost anyone, in fact any one, who will listen. I believe in my careful blend of biomechanics and sports medicine. Patients get better, or get a better understanding of their problem. Patients and I are partners in healing. 
     This year I am lecturing at the California School of Podiatric Medicine through April, and then again in October and November. I am also lecturing at our state's meeting in Los Angeles in June. I may give an online lecture in Oman in March or April, and I hope to be invited back to New York next year. 
     What sticks in my side always was that one of my mentors, Dr John Weed, died at 54 while working at a busy office. I watched him work for over 13 years, a truly gifted and loving individual. He was excited about retiring some day so he could write of all his discoveries. Podiatry truly missed out. He died 30 years ago, and I still miss him a lot. As I try to give back to my profession, I wish he had been given the opportunity. 

Thursday, January 13, 2022

Common Foot Pads used to Off Weight Sore Areas

Adhesive Felt used to off weight ball of foot
Typically the padding is placed on the undersurface of the shoe insert

Adhesive Felt used to off weight the 2nd and 3rd metatarsals where they bear weight

Wednesday, January 12, 2022

MRIs: Their Usefulness in Patient Care of the Foot

     Those of you whom regularly read my blog know that I love MRIs and even serial MRIs when I am following an injury. Unfortunately, the quality of the MRIs is getting poorer, and the amount of the foot that is imaged is becoming less and less. That does not mean you can not get great MRIs but you may have to ask for the highest Tesla (magnetic strength) in your area. 
     Why is a negative MRI just as important in general as a positive MRI? Negative MRIs rule out bone injuries, ligament injuries, and cartilage injuries. Negative MRIs suggest that a patient may have nerve pain if all other causes of the problem have been ruled out. 
     In the MRI above, even though you are given only one of the 144 slices, the 2nd metatarsal phalangeal joint had a lot of inflammation. That is the white you see under the 2nd and 3rd metatarsal heads. Other slices confirmed no plantar plate injury (the ligaments under the metatarsal heads at the ball of the foot area). 
      When you see inflammation, you have to think that this area is being stressed. The inflammation is the bodies' way of healing itself. Inflammation brings in nutrients for healing, therefore very important for healing. Inflammation though is always an all or nothing response. The body feels like it is under attack, and it will send in the calvary, armed forces, and Knights Templar (even Luke Skywalker). All or nothing!! Fight or flight phenomenon. The guist is that the inflammation can be more than it needs. Chronic inflammation, still sitting around from a relatively minor injury, still hurts alot. The patient then wonders why they have not healed, even when they have. I see this phenomenon over and over.
     Inflammation also means something may be happening internally, like micro-tearing in the ligaments. I can not see it in the MRI, but the patient can not get rid of the inflammation by any means (PT, contrast bathing, ice massage, acupuncture). 
     In this individual, negative MRI except some inflammation (radiologists call this edema). Initial treatment to address the inflammation alone was nonproductive. Treatment switched to restricting joint motion with Budin Splints, and the pain got better real quickly from there. 
     I tell my patients that positive or negative MRIs are data points in their treatment plan. We have to react to the information, make changes when they are not improving, and follow the progress month by month. 

Sunday, January 9, 2022

Happy Birthday Me!!

     Yes, it is my birthday today. If I was born yesterday, I could of shared Elvis Presley's big day. But no, I got Richard Nixon. It was a cool birthday until the world found out he was a crook (along with other things). But, I digress!
     Thank you all for reading this blog. I can not believe the blog is also celebrating its birthday in March. 13 years for the blog, and 68 for me!! 

Saturday, January 8, 2022

Customizing an OTC Insert: The list is endless and limited by our Imaginations!!

Sole is one of the common OTC arch supports I recommend in my office

In this case, the front was just too hard for the patient so I removed it for softer material

The cut or transition was just behind the metatarsal heads (ball of the foot)

Here the Arch only part with be glued onto a full leather top cover. 

Using the original front, the leather can be trimmed to be an exact replica of the original

Now a soft material like 1/8 inch poron is applied as the new front

Thursday, January 6, 2022

Bunion Protection in Tight Shoes

Here is 1/4 inch adhesive felt (which can be used for 3-4 days) is placed behind the bunion prominence (never over) while wearing shoes

Wednesday, January 5, 2022

Metatarsal Pads: Proper Placement

Hapad Longitudinal Small Metatarsal Arch Pads are my preferred Pad.
These pads spread the weight over a large area and can be thinned by peeling layers off.
Hapad Metatarsal Pads can be used in 2 directions just before the sore area on the foot. This is the common direction.

This is a common modification of the small Hapad metatarsal pads with the thickest part under the 2nd metatarsal head. These adhesive felt pads also can be easily adjusted.

Sunday, January 2, 2022

Soccer Cleat and Foot Pain

     One of the common problems I see when treating soccer players is that the painful area is right over one of the cleat positions. I need a convincing argument to explain that they need to change their cleats or shave down at least half of the offending cleat. The fear of losing traction or gaining instability by removing at least part of the cleat is often the reason they would prefer to switch the type of cleats that they wear in the long run. 

Saturday, January 1, 2022

Plantar Plate Injuries Algorithm


How Are We Built to Function? Loose and Unconnected, Perfect, or A-little of Both

     Daily in my evaluation of the structure and function of patients that present to my office, the patients can feel something is off. It can feel a little like these Tinker Toys to both patients and new doctors learning the trade. There are so many rules of what is ideal, but patients are typically not seeking to be ideal. They only want their symptoms to feel better, and their bodies to feel more stable or in better alignment. 
     I am a huge proponent of gait evaluation. During gait evaluation, many of the uniqueness' of an individual can become obvious. As you watch someone walk or run, you will see patterns of function that may be related to symptoms or may be related to great health. When patients come in with a problem, and I watch them walk and/or run, I think they are a bit disappointed when I tell them that they are fine (stable, smooth, efficient). They are looking for answers to their issues, but it can not be found in gait. Other patients come into the office with foot pain, and when I watch them walk, you can tell why their knee or back hurts and how you can help. They had not even mentioned these areas because they were in a Podiatrist's office. 
     When I teach podiatry students, I always emphasize to walk every patient walk or run as the clues can be literally amazing.