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Sunday, May 15, 2022

Dr Ronald Valmassy Scholarship for Biomechanics

I have attached here the giving page for the California School of Podiatric Medicine. A scholarship fund to honor Dr Ronald Valmassy is being formed to foster the field of biomechanics for podiatry students. Please consider a gift and specify the location of your donation. 
     As many of you know, Dr Ronald Valmassy, was the head of the Biomechanics Department at the California College from 1974 to 1987. He trained thousands of podiatrists in the classrooms, clinic, lecturing and book writing. He has written the most extensive book on Podiatric Biomechanics in the last 30 years---Clinical Biomechanics of the Lower Extremities published by Mosby in 1996. 
     Biomechanics is the foundation of most of our treatment of patients. Your donation will help continue its emphasis in education. Dr Ron would be very proud of you. Thank you. Rich 

Friday, May 13, 2022

The Inverted Orthotic Technique is now also in eBook Form

Carlos Martínez Sebastian from Spain

Álvaro Gomez Carrión from Spain

     I am very proud of my accomplishments for sure, but humble enough (could be more!) and realistic enough, to know that your true worth is in how much you love (and not what you accomplish per say). This is why I love to teach, I love my students. They bring me great joy!! This is why I love to write and lecture, I love to help build up the collective we in the knowledge I know. It is another act of love. I have written articles, handouts, and of course, medical charts. My first attempt at some more serious writing was "Secrets to Keep Moving" published in 2016 following a small stroke. It was not welled planned, written okay, and never advertised. My next attempt was "The Inverted Orthotic Technique", a technique I have been working on developing for 40 years and which came out in English 2019, Spanish 2020, and Korean 2021. I am happy I could get this in electronic form in 2022. My next book came out this year in 2022 called "Practical Biomechanics for the Podiatrist: Book 1 of 4". This is an accumulation of all of the incredible teachers I have had over the years. These teachers have been Podiatrists,  Orthopedic Surgeons, Physical Therapists, but mainly my wonderful patients. Truly I have learned as much, if not more, from them as any other source of my medical knowledge. So, Practical Biomechanics is a blending of every aspect of my career, and I am so pleased with the love it shares. And, by the way, Carlos and Alvaro are now working hard on the Spanish translation along with writing a chapter themselves on Biomechanical Theories (Book 3). Thank you all for coming along on my journey with me, as you can see, I love to do things with others. Rich ﬞ

Monday, May 9, 2022

Right Achilles Pain: Initiate BRISS

I just saw a patient with Right Achilles pain for 6 months. She had no increase activity or change in medications. I initiated BRISS treatment for tendinitis and advised her to email me in one month about her progress. I found swelling, but no tightness in the achilles (to see if Occam's Law applied). BRISS is a simple acronym to remember to think about all the categories of tendon injury treatment. The acronym stands for:
  • B for biomechanical treatment
  • R for Rest or Activity Modification treatment
  • I for Inflammation Treatment
  • S for Stretching or Flexibility Treatment
  • S for Strengthening Treatment
How did it help start the treatment on our first visit?
B for 1/4 heel lifts in all her shoes, no barefoot next 6 weeks, heeled shoes as much as possible
R for day to day activities only, will consider cross training with bike, elliptical, swimming
I for ice twice daily and contrast bathing for swelling reduction each night
S for gastrocnemius stretching and no negative heel stretching now
S for two positional heel raises with the heels only on one inch book and no shoes each evening

This patient was given an RX for 8 PT visits and will email me in one month. We did talk about posterior sleeping splints, but since she is a poor sleeper, she was worried that it would bother her. So, the splint was not in our initial treatment. 

Wednesday, May 4, 2022

Wrestling with a Painful Foot: Thoughts on Treatment

I have many rules I use when attempting to help someone with a sore foot, and I also need their cooperation in the treatment. First of all, whereas they say periodic dieting is great for our overall metabolism, periodic levels of increased pain should be avoided. Therefore, after the onset of pain you want to reduce the pain to the 0-2 range (still smiling on the pain scale charts) as quickly as possible. This can be accomplished on one end of the spectrum with complete bed rest, and for some simply not running 5 miles. Get the pain down, and hold it down for 2 weeks for a start. 
     Hopefully, by this time you have a doctor or therapist appointment that can lead you further. But beware, all medical recommendations have to be tried by you, and if they increase your pain, stop doing them until this is reported. Some practitioners will have you continue if they deem the pain as "Good Pain". Good Pain is pain that does not linger for 2-3 days after starting, does not cause you to limp, does not come on during an exercise only after. 
     Now, what types of foot treatment should be done? These are general rules but will apply to most of you. The types of treatment, and I recommend one from each category at least, are Mechanical treatments, Inflammation treatments, and Neuropathic (nerve pain) treatments. Mechanical treatments can be walking casts, changing how fast you run, shoe selection, insert selection, padding, taping, braces, etc. There are so many things that can be tried and can vary from visit to visit. 
     Inflammatory treatments in my practice is typically ice in some form and contrast bathing. I try to avoid oral medications in general, but short periods are fine. If you have any swelling or sudden stiffness or sore muscles and tendons, you should be working on the inflammation daily.
     Neuropathic pain can be from local nerve injury, local nerve hyper-sensitivity, and referred from above the foot. Nerves love non-painful massage, warm, short ice no longer than 5 minutes, motion like walking, neural flossing, but not prolonged stretching. Any injury that still has significant pain after 3 months will develop nerve pain in the form of protective neural tension or just hyper-sensitivity. Nerve pain is more intense than inflammatory pain, but shorter in duration. Patients commonly describe level 10 pain bursts for a minute or less that shuts them down. There is a whole branch of PTs specializing in nerves. 
     Therefore, when you are treating a painful foot problem, think about what mechanical, inflammatory, and neuropathic treatments you are doing daily. If you are missing one, add it in. Or, make changes to each type of treatment if the treatment progress stalls. Good luck!!

Sunday, May 1, 2022