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Saturday, April 30, 2022

Interview with Dr Ben Pearl on my new book: Practical Biomechanics for the Podiatrist (Book 1)

This is the link for purchasing. I hope you will enjoy it and it will be very helpful. Book 2 of the series will be coming out late 2022 or early 2023. 

Wednesday, April 27, 2022

Lapidus Procedure for Bunions: Normal Results (what are your odds) for the Consumer

Summary of Results:

Lapidus is a very common bunion surgery and the results of this study following patients for 2 years showed the odds. One of the differences from standard Lapidus procedures that this study tried to prove was that they could allow their patients to walk much quicker than standard 8-12 weeks of non-weight bearing, therefore walking in normal shoes on average 45 days post surgery!! This is huge!!
The results are pretty standard for operations at the foot:
1/117 early re-occurence of the bunion (typically want to get 15 years out of this procedure)
11/117 hardware was irritative (considered a complication)
5/117 other complication including 1 non-union
In total, 7/117 were re-operated on to fix issue within the first 2 years post Lapidus

If you match up the results I tell my patients before they get surgery, I think this study is slightly better.
I tell my patients, that 85% of them will be happy they had the bunion surgery (really good from our Podiatry perspective). Of that 85%, 50% of those patients will say excellent results and 35% will say good results from the surgery (good means that they are not perfect, but they are still happy that they went through it). The other 15% get fair to poor results (with this study around 10% which is close). 1-2% of patients are poor due to an infection, non-union, early bunion return, etc. 13% are fair due to some of the issues brought up (hardware irritation, pain more than they like, entrapped nerve, negative effect somewhere else, etc). Poor results tend to be re-operated on to fix what went wrong, and fair results about 50% have a re-operation (7% overall re-operation) and the same number just want to live with the issue. This 7% is almost exactly what the study showed for re-operartion 7/117 which is normal Podiatry surgery odds. So, in summary, I think this study showed that Lapidus patients (fusion across the metatarsal tarsal area) can walk earlier then the standard recommendation since the complication rate does not go above the standard 15% at all. 

Saturday, April 23, 2022

Our Personalities and its Effect on our Foot Care

     The doctor patient relationship is a very sacred thing. When there is a joining of spirits between these two individuals, healing has an easier route to go. A good relationship can be very challenging to find, and I hope both sides work at seeing the various problems that present from the patients' or the doctors' perspective. 
     The above image is merely one representation on how we view the world, and thus affects how we understand issues that involve us. Both the Patient and the Doctor can have the same or different lens that they view the world. This will affect any relationship that they engage in. I will limit this to the Patient's lens that they perceive the doctor patient relationship. There will always be both the good and bad of any perspective. 
     Patients can be very Body centered, which gets them into treatment earlier, but can have them too focused on their illness. But, this is why doctors, family, and friends can be so helpful to allow us (if we grant them permission) to see things differently at times. My body centered patients are probably my best patients at following instructions. They have an incredible drive to heal this body of theirs.
     Patients can be Mind centered. They can present with a problem, and already have read every available article on the topic. This can lead to both a cure, and a lot of confusion. They can both over-think issues, and come up with good conclusions. They have probably taught me the most, since they have tried from their research various gadgets or techniques. They can be so much in their head, that they forget the heart and soul of the matter (and undervalue other's opinions). They can also take the longest to see a doctor, as they typically ignore their bodies and the warning signals it produces. 
     Patients can be Spirit centered which can also detach them from their bodies. They can be over emotional, but also not attached to their problems. They have a hard time with body issues or problems. Since they are also not in their heads, they can be the most trustworthy of patients wanting to give their problem completely over to you. They can also have great perspectives on healing, at least in terms of the length of time it takes to heal.
     Finally, Patients can be Soul centered. How is this different from Spirit centered? Perhaps it is best explained but what it is and is not. The soul is who you are. The soul is not emotional, but greatly affected when the "who we are" is disturbed by injury. Soul centered patients can be the best patients when their injuries affect the very nature of who they are, but also not really care if they feel no threat to their being. 
     Let us take an example of these for approaches to the same injury. The patient sprained their right ankle and will miss 6 weeks of college basketball practice, games and perhaps playoffs. Here is how each of these personality types behave:
  • Body Centered---will follow the treatment plan to the fullest
  • Mind Centered---will read everything about the injury which may help immensely, but may get in trouble believing something other then prescribed, may go doctor shopping
  • Spirit Centered---could be an emotional roller coaster, since not connected to the body may have trouble doing what is prescribed, if they stay positive they can be the easiest patient to help
  • Soul Centered---in this case, this college athlete's being has been threatened, therefore, they will be early for each PT visit, and may ask you for an MRI now, even if you wanted to wait for a month


Thursday, April 21, 2022

Flip Flops for the Summer if you have heel pain: Blog from Dr Menn

Dr Menn emphasizes Oofos, Pure Stride, Birkenstock, and Vionic if you are suffering from Heel Pain. I am in agreement that these are great flip flops to try. 

Saturday, April 16, 2022

CorrectToes and their positive effect on Running

Female Athletes' Foot Changes from Wearing a Foot Orthosis: A Study of Hallux Deviation, Strength, Foot Pressure, and Pain

 This is a new article discussed the use of an insert called "Correct Toes" as being very helpful in patients running. CorrectToes to me are like Yoga Toes that you can run or walk with. Of course, who can be sure that if you have a bunion, and you use anything from a simple toe separator to the more elaborate CorrectToes, that you will not get the same response. Athletes have been telling me for years that toe separators can improve pain and function by aligning the big toe joint better. If you have a bunion, always wear something when you are in some, that attempts to straighten out the big toe joint. 

Foot Pain
Toe Separators

Saturday, April 9, 2022

EvenUp Protects the Spine in Walking Boots and Casts

EvenUp on the left side to keep the spine level

     I am so impressed with this simple device for the opposite shoe that has the cast/boot. This helps the spine and prevents back pain overall. 

Problems with Lapidus Bunionectomy

Dear Dr. Blake,
     I had a Lapidus bunionectomy 2 years ago that is coming back. Will your conservative treatments help this? I have 2 pairs of new orthotics. One pair has a high dome in the mid arch to help with metatarsalgia, specifically 2nd toe pain. The other pair has a higher dome in the medial arch to correct over pronation and PTTD. I just started wearing these hoping to stop the bunion from coming back. Any advice on which pair is better? I have redness where the bunion is coming back and the big toe is starting to drift towards the 2nd toe. The hardware is painful and I would like it removed. Any advice would be appreciated. Thank you. 

Dr Blake's comment: First of all, it is really unusual for a Lapidus to cause a recurrence of a bunion this early post operative. If we share further emails, even a year from now, always remind me of this post on 4/9/22. As you walk, the forces of the ground will always push the big toe towards the second. This is more or less depends on other aspects of your foot biomechanics, shoe gear, activity level, and activities done. Did you have the Lapidus done to help with PTTD? Or were you just having bunion pain? How old are you may I ask? Why is the hardware painful, or when is it painful? Since I do not perform this surgery, you need to ask the surgeon, but most hardware can come out after 6 months post surgery for sure. You need to always wear toe separators to keep the big toe from drifting towards the 2nd toe. A Lapidus immobilizes a joint or two in the arch, so there is more stress at the bunion joint and the joint next in line closest to the ankle. The orthotic devices just have to make you stable, and you may find that the right and left sides feel the better with orthotic devices from different pairs. Are these full length orthotic devices, or ones that stop traditionally behind the metatarsal heads? There are pros and cons to each. Give me some feedback, and I will place any more information on this same post. Rich 

Practical Biomechanics for the Podiatrist: Book 1 Reviewed by Dr Kevin Kirby

Book Review: Practical Biomechanics for the Podiatrist, by Richard L. Blake, DPM, MS
Throughout my years as a podiatry student, podiatry resident and in podiatry practice, I have had the very good fortune to be a student of a number of very gifted podiatrists who were not only inspiring and innovative, but also demonstrated great clinical skill when treating patients. One of the most outstanding of these individuals was one of my biomechanics professors as a podiatry student, Dr. Richard Blake. I am happy to report that Dr. Blake has just published the first of four books on practical biomechanics for the podiatry student, podiatry resident and practicing podiatrist.
My first experience with Dr. Blake was during my podiatry student years in the early 1980s was when he was our Biomechanics Fellow at the California College of Podiatric Medicine. He was a gifted teacher, being able to bring complex biomechanics concepts, examination techniques and foot orthosis therapy concepts to us podiatry students in an easy-to-understand and enjoyable manner.
Furthermore, during that time, Dr. Blake had begun experimenting and developing his innovative custom foot orthosis technique, the Blake Inverted Orthosis Technique, which, to us podiatry students, seemed very impressive in its effectiveness at treating patients with abnormal amounts of foot pronation. Since that time, now four decades ago, I still marvel at the innovation and clinical acumen of my good friend and colleague, Dr. Richard Blake, and am very happy to announce his first book on biomechanics that he has dedicated to his podiatry students at the California School of Podiatry Medicine.
With his recently published book, "Practical Biomechanics for the Podiatrist", which is his first book in an eventual 4-book series on the subject, Dr. Blake covers an introduction to the general principles of podiatric biomechanics, how the podiatrist should approach and evaluate the patient with mechanically-related and non-mechanically-related symptoms, along with sections on gait evaluation and gait abnormalities and the basic components of the foot and lower extremity biomechanical exam.
This 175 page, hard-cover book has numerous color photos and illustrations that help explain the various topics that Dr. Blake discusses within its pages. In reading through the book, I was very impressed at how different this book is from any other previously published book on podiatric biomechanics. Dr. Blake approaches each subject with explanations that will make it easier for podiatry students to help comprehend the complexity of foot and lower extremity biomechanics and will also provide numerous clinical pearls that even the most seasoned podiatrist, who have spent their whole practice career treating foot and lower extremity biomechanical pathologies, will appreciate.
"Practical Biomechanics for the Podiatrist" covers each subject in a very practical manner with numerous case reports of patients from Dr. Blake’s 43 years of practice as a sports podiatrist and foot and lower extremity biomechanics specialist. There are even 138 “Practical Biomechanical Questions” included throughout the book, with answers at the end of the book, that allow the reader to self-test themselves about previously discussed topics.
Overall, I highly recommend Dr. Richard Blake’s first book on "Practical Biomechanics for the Podiatrist" to all podiatry students, podiatry residents and podiatrists who are seeking further knowledge on the evaluation and treatment of mechanically-related pathologies of the foot and lower extremity. The practical information in this book is outstanding and should be on the bookshelf of any foot-health specialist who is seeking to increase their expertise in the evaluation and biomechanical treatment of foot and lower extremity disorders.