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Thursday, January 1, 2026

A Word to those Caring Doctors that are Overwhelmed in Helping Patients: A Quote from Richard Rohr's Daily Mediatations

"For me, it’s hard to know where to begin some days. I become overwhelmed by the sheer quantity of needs that flood my inbox and mailbox, my texts and social media feeds. In search of how to find a way forward, I once stumbled on wisdom tucked into some ancient Jewish writings known as the Talmud. There it says that if someone is suffering and in need, and you can take away 1/60 of their pain, then that is goodness, and the call to help is from God. This is a powerful expression of our being the salt—the preservers, the flavorers, the fertilizers—of the earth.

The fraction—1/60—is loaded with freedom. This liberates us from the pressured thinking that whispers, Everything depends on you. Your one little grain of salt can help with something someone else’s grain can’t. And when all the grains get mixed and sprinkled together, preserving and flavoring and helping others flourish occurs everywhere.

None of us are meant to preserve the whole earth, flavor the whole world, flourish the entire planet on our own. Yet you can begin today by simply asking God to bring to mind someone for whom you can ease 1/60 of their pain.

https://cac.org/daily-meditations/a-little-salt-goes-a-long-way/

Inverted Orthotic Technique: Recent Article on its Effectiveness

https://pmc.ncbi.nlm.nih.gov/articles/PMC10492546/

     This was a well run article on the use of the Inverted Technique and its effects on the ankle, knee, and hip while walking. All the results were positive except a slight decrease in push off ability with the highest device used (25 degrees). No negative effects were seen at the knee or hip (which has been shown before in other studies), but this type of foot orthotic device has a great effect at externally rotating the hip showing that it does positively effect up to the hip. The main effect of this foot orthotic was in providing great stability to the foot and ankle. 


                                     Here the top and bottom of the Inverted Technique is shown

Tuesday, December 30, 2025

A New Non Opiod Pain Med to Watch

https://www.medscape.com/viewarticle/prescriptions-rising-new-non-opioid-analgesic-clinicians-are-2025a10010e3?ecd=wnl_dne1_251230_MSCPEDIT_etid7998270&uac=399573HX&impID=7998270

     Ever since the Opioid crisis hit the medical profession hard, many patients have not been getting new pain coverage in acute injuries or post surgery. This non opioid choice called suzetrigine or Journavx may prove remarkable. 

Tuesday, December 23, 2025

Do You have High Arches? These problems May Be Related.

     



     People with High Arches have the Pes Cavus Foot Type. This differs from Normal Arch or Flat Feet (called Pes Planus). Pes Cavus occurs in 10-15% of the population, and never get good arch support from shoes alone. Due to the abnormal excessive weight better in the heel and ball of the foot, these areas can develop more problems. Therefore, diagnoses of plantar fasciitis (primarily heel pain) and metatarsalgia are common in pes cavus feet. The article below discusses this problem. 


     So, if you have high arches, the weight bearing across the bottom of your feet is not evenly spread. More weight or pressure is centered on the heels and ball, with no weight in the middle of your feet (mid foot). Arch Supports to put some weight in the middle of your feet can be very helpful. My next post will talk about the instability problems produced by pes cavus, the most unstable foot type. 

Keywords: Pes Cavus, High Arches

Monday, July 28, 2025

Sesamoid Fractures Handout Reviewed

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Sesamoid Fracture: What You Need to Know

Dr. Blake’s Patient Handout

Sesamoid fractures—small breaks in the tiny bones beneath the big toe joint—are stubborn injuries that often take months (or even up to 2 years) to fully heal. But with the right strategy, most patients recover well.


Top 10 Initial Treatments

  1. Bone Stimulator (Exogen) – Use daily for 6–9 months to enhance healing.

  2. Boot or Stiff-Soled Shoe – Wear consistently for 3 months to keep pain at or below 0–2.

  3. Ice and Contrast Baths – Ice twice daily + nightly contrast baths (twice on days off) to reduce inflammation and swelling.

  4. Custom Orthotics – Designed during the first 3 months to offload pressure from the sesamoids.

  5. Dancer’s Pads – Learn to make and use these felt pads to relieve pressure (adhesive felt from Moore Medical works well).

  6. Spica Taping – Learn taping techniques for use after the boot phase.

  7. No Barefoot Walking – Always wear protective footwear, even at home.

  8. Stay Fit – Begin safe cardio, core, foot, and ankle exercises as early as possible.

  9. Nutrition Check – Ensure good intake of Vitamin D, Calcium, Magnesium, Zinc, and screen for bone density issues.

  10. Activity Modification – Gradually return to normal activities over 2–6 weeks after the boot; avoid increasing pain.


💡 Key Insights from Dr. Blake

  • Most sesamoid fractures heal, though slowly—be patient.

  • Imaging is crucial: MRIs or CT scans provide clarity, especially 5–6 months after baseline.

  • Sometimes the problem isn’t a fracture—diagnostic accuracy matters.

  • Bone health is key: Evaluate nutrition, vitamin D3, and bone density.

  • Recovery follows 3 overlapping phases:

    • Immobilization

    • Re-Strengthening

    • Return to Activity

  • Avoid phase mismatches: don’t resume activity too soon.

  • Your treatment team should plan for the return-to-activity phase from the start.

  • Protected weightbearing (not non-weightbearing) is usually best—walking helps flush out swelling.

  • Contrast baths are the gold standard for swelling reduction.

  • X-rays alone are not reliable—advanced imaging is often needed.

  • Joint mobility must be preserved: Start pain-free range of motion exercises early.

  • Strengthen early: Even modified strengthening helps prevent long-term weakness.

  • Setbacks are normal—don’t lose hope.

  • If you’re dealing with a fracture, get a bone stimulator early (self-pay if necessary).


📺 Bonus Tools

Visit YouTube and search:

  • “drblakeshealingsole Self Mobilization”

  • “drblakeshealingsole foot and ankle strengthening playlist”


📌 Final Thought

Healing a sesamoid fracture takes time, consistency, and smart treatment choices. Stick with your plan, monitor your symptoms, and don’t hesitate to seek expert care if progress stalls.

Saturday, May 31, 2025

Book 4 is now on Sale of Practical Biomechanics for the Podiatrist

https://store.bookbaby.com/book/practical-biomechanics-for-the-podiatrist3


This book is the end of my series on Practical Biomechanics for the Podiatrist. The information in these books took me 40 years to understand, practice, and see patient responses. This book reviews the topics of:
  • Custom Made Functional Foot Orthotic Devices
  • Computer Assisted Gait Analysis
  • Common Shoe Changes Made
  • 23 Patient Cases showing how to thoroughly look at a patient at each visit and make recommendations
My overall goal is for the student, resident, or those beginning to treat patients from a biomechanical lens. 

Tuesday, May 13, 2025

Biomechanics: Mentoring the New Generation of Podiatrists


    I just received this by email today. I lecture, write, correspond, and mentor the young generation of new podiatrists. It is very rewarding as any of you know who is involved in mentoring. Today I will spend all morning with a 3rd year Podiatry student for more of the same. It is a small but powerful act. 

Sunday, December 22, 2024

Sesamoid Injuries: Thoughts on Chronic Inflammation

Patients with sesamoid injuries deal with three types of pain: mechanical, inflammatory, and neuropathic (nerve-related). I thought this discussion with a patient would be helpful. They are trying to progress from non-weight bearing (NWB) to a weight bearing (WB) removable boot. 

Hi dr Blake, I seem to be finally making some progress as pain has significantly decreased. Starting the day of thanksgiving I have been on a knee scooter 95 percent of the time not stressing my foot at all. When I do need to walk it’s not more than a few hundred steps a day in my walking boot. I’m getting ESWT done weekly and have had a few sessions of dry needling with my PT. My custom orthotics have come in and they have been helping with the sclerotic sesamoid pain on my left foot.  I also have gone back to the gym to try and fight some of the atrophy I have faced all this time by doing NWB leg strengthening exercises. Though the pain has decreased, the inflammation is still present, and especially at the end of the day is it worse. I’m not sure when it is time to transition out of the scooter and into the boot or if I ditch the boot. Because even when I use the boot the inflammation is present. I don’t understand why inflammation is still there if it’s starting to heal, I would imagine if it’s healing the inflammation would subside. So it’s really hard to not get discouraged that maybe I’m not healing after all even though the pain has lessened. I tried to read the blog and find more out about inflammation but was hitting a dead end. Does it sound like I’m on the right track? Thank you


You are definitely on the right track, putting good pieces of this complex puzzle together. Dallas, there are two types of inflammation, acute (right after an injury), and chronic (related to the body's attempt at healing). 
Since inflammation causes symptoms, it is one of the hurdles you have to understand more. Swelling, which I assume you are doing contrast bathing in some regularity, will limit you, but you can still progress. Everything has to be done gradually. If you have been in a good place (0-2) for the last month, begin to transition from knee scooter to boot with your orthotics within the boot. The transition should be 2-3 days at one hour and then progress in 30-60 minute intervals every 3rd day as long as the pain remains low, and your expected increased pain is back to normal the next day. Hope this helps. Rich 

Friday, November 15, 2024

Tiem Bike Shoes with Embedded Cleats

For times when I want to immobilize the bend of the big toe joint for a while, but do not want the unevenness of a removable boot, I use bike shoes with embedded cleat. A patient came in with one the other day that I am using for a plantar fascial partial tear. I also use for sesamoid fractures, plantar plate tears, and hallux rigidus. 

Plantar View with Embedded Cleat

Top View of Tiem Bike Shoe

Cross Section Heel 
Area showing Partial Tear Plantar Fascia


Sunday, August 18, 2024

Great Biomechanics Seminar in November: Please read by Facebook Post

So happy to be invited to give 2 talks in New York this Fall. The seminar will be both in-person and on zoom. It is the best United States Foot Biomechanics Seminar. Hope you can make it if you treat patients. 

https://www.facebook.com/RichBlake72/posts/pfbid07irVmsh715HdTPgft1ZU6UAiyNQugjkf8sSTpnBYbGjDowHRihNVMbcrgTPuW2d8l



Sunday, June 30, 2024

Chronic Sesamoid Pain: Possible Relationship to the Presence of Bunions

This is a great review of something I think about, but probably do not consul patients regarding. The blog patient commented to me how their chronic sesamoid pain could be related to a developing bunion. This is true since bunions are produced by a malalignment of the big toe joint and that malalignment can be a cause of chronic inflammation in the joint. Where does inflammation in the big toe joint tend to settle? Well, gravity pulls the swelling down around the sesamoids. So, one or both sesamoids can hurt on examination even if they are not injured themselves. This can lead to inappropriate sesamoid removal. You can get some idea of the role of the bunion has on the sesamoids by treating both the malignment and inflammation for a good two weeks. This would include toe separators or bunion taping (both can be found in this blog), and contrast baths each evening as a deep flush. You have go two full weeks to check, and not wear tight shoes that shove the bunion in the wrong direction. Hope this helps some of you guys. Thanks to the person who sent me the article!! I will answer them privately. 

https://www.sciencedirect.com/science/article/abs/pii/S1268773111000154

Saturday, April 27, 2024

8 Fitness Myths to Reconsider: Definitely a Worthwhile article

    The 8 Fitness Myths presented are true myths, but I will still keep my 10,000 step rule for myself (as I do long distance walks on a yearly basis). 

https://www.nytimes.com/2024/01/04/well/move/fitness-myths.html

Thursday, February 8, 2024

Sesamoid Fracture presenting as a BiPartite Sesamoid

Only the abstract is linked here. It shows the dilemma patients are left with when they have bi- or tri-partite sesamoids. Fractures are missed and a needless year of suffering is documented here. We fracture at weak spots in bone. The junction between two fragments of bone like a bipartite sesamoid is such a weak spot. In so many cases, the injury is called a normal variant, and the possibility that there is a possible fracture is dismissed. If you have pain in your big toe joint, and the x-ray shows a bipartite or tripartite sesamoid, discuss the probability that this can be a fracture with your physician. 

https://www.jfas.org/article/S1067-2516(18)30550-7/fulltext

Friday, January 19, 2024

NSAIDS (like advil and aleve) can Affect Bone Healing

A well known fact is NSAIDs (non steroid anti-inflammatory drugs) can slow down bone healing. And like anything, one person will be greatly affected and another almost not at all. If you need to decrease inflammation, ice and contrast bathing remain the non drug of choice for home treatments. And of course, Physical Therapy is wonderful with their machines to reduce inflammation. There are also homeopathic remedies, acupuncture, etc. 

https://pubmed.ncbi.nlm.nih.gov/30260913/

Tuesday, January 16, 2024

Sesamoid Fractures: Typical Orthopedic Approach with Comments

     I have just retired. My time now can be more involved in this blog I started almost 14 years ago. One of the injuries I write about, and treated extensively, was sesamoid fractures. I just received emails from two readers about sesamoid injuries. All doctors will treat injuries slightly differently. When I read the article below, I would emphasize the importance of some treatments more. But, overall the article is well written. Exogen bone stimulators are a must to me. 3 months of cast or bike shoe immobilization is very important. Daily contrast bathing. Evaluation of Vit D and overall bone density is crucial. Orthotic devices with off weighting the sesamoid needed. Spica taping to limit big toe bend can get patients back into activity. Avoiding NSAIDS since they can retard bone healing. Ice activity aggravation. Hope this helps. Rich


https://orthoinfo.aaos.org/en/diseases--conditions/sesamoiditis

Tuesday, January 9, 2024

Plantar Fasciitis: Stretching May Be Your Best Treatment

Stretching of the achilles for plantar fasciitis may be the best treatment overall per this article. I have attached a video on Plantar Fascia Stretching for your information. 


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134886/


Monday, January 8, 2024

Sunday, January 7, 2024

Comparison on 15 and 25 Degree Inverted Orthotic Devices on Lower Extremity

The following paper is a good look at the dynamics of 2 Inverted Orthotic Devices (15 degrees and 25 degrees) and the Shoe alone. There are questions around the loss of ankle plantar flexion motion with the 2 inserts vs shoe only which has possible explanations on the positive and negative side. At foot loading, a loss of ankle plantar flexion probably only implies that the orthosis is supporting the arch and less ankle plantar flexion range is needed. But, does a loss in ankle plantar flexion at toe off imply a more inefficient push off or a more stable foot with less plantar flexion needed for push off? The summary of angles in the paper show these findings are less than 1 degree in amount in any direction, but of the the 31 subjects the variation could have been more or less. 
     If you are looking for a good paper on Inverted Orthoses, this one is very good with 60 plus references to sink your teeth into. Rich Blake


 2023; 16: 2613–2623.
Published online 2023 Sep 5. doi: 10.2147/JMDH.S420003


Effect of Different Foot Orthosis Inverted Angles on Walking Kinematics in Females with Flexible Flatfeet

Nour Alsaafin, 1 , 2 Nabil Saad, 1 Shima A Mohammad Zadeh, 1 , 2 and Fatma A Hegazy 1 , 2           






       




Thursday, December 21, 2023

Secrets to Keep Moving: A Holiday 50% Off Offer from Dr Rich Blake

I am pleased to add a 50% off offer on my book Secrets to Keep Moving. This will be for the first 25 using the code GD5YR4 from today to midnight 12/31/23. 


Wednesday, December 20, 2023

Sesamoid Injuries

I have a lot of information to help you manage your sesamoid injury within the pages of this blog. Please go through the Labels/Index to find information. Here is a wonderful comment I just received. Rich

You’re a true gem of a human and doctor. My sesamoid pain began two months ago and it’s stopped me from doing my favorite activities like drumming and climbing. In only a few days of following your advice, I can already feel my foot healing. It’s motivating and giving me the confidence needed to overcome this. I’m surprised and grateful to find a doctor sharing so much knowledge freely and consistently for as long as you have. Thank you Dr. Blake and happy holidays.

Wednesday, December 13, 2023

Secrets to Keep Moving: Page 1 upcoming 2nd Edition

Secrets to Keep Moving: 

A Guide from a Podiatrist


by


Richard L Blake DPM MS


2nd Edition: Proposed 2025


Introduction


     I am happy to embark on a daily adventure to write the 2nd Edition of Secrets to Keep Moving, first published in 2016. As I finish each page of this 200 plus book, I will publish that page on my blog www.drblakehealingsole.com, including this page. The goal of the book is to update, shorten to make it less expensive, and make it center around self help (within reason). I hope to publish it in 2025. I am excited about getting your feedback on pages (comments to each blog post) so I can make multiple revisions before going to publication. I want this book something that you would want to give to a friend with knee pain, or understand all the self treatments for bunions. I am so excited that since this aspect is electronic, I can include videos of techniques or further explanations. Let’s get started.


General Book Organization


      I will have to break the book down into easy to digest injury chapters. These are:

  1. Foot Pain

  2. Leg Pain

  3. Knee Pain

  4. Thigh and Hip Pain 

  5. Low Back Pain

Of course, as a Podiatrist, I can only discuss problems above the leg that I treat conservatively.


Tuesday, December 12, 2023

The Effect of Foot Orthotic Treatment in Posterior Tibial Tendon Injuries

https://pubmed.ncbi.nlm.nih.gov/33040609/

Foot orthoses, together with exercise programs, seemed to improve the effect of orthotic treatment. Foot orthoses with personalized internal longitudinal arch support were more effective than flat insoles or standard treatments in reducing pain.

Sunday, December 10, 2023

Good vs Bad Pain

What are First Line Agents to Help Nerve Pain when Diagnosed?


     Here is a good article summarizing the progression of medicines used to treat nerve pain in patients. We will focus on the first line therapies to help calm down the pain. Here is a summary from the abstract:

"Multidisciplinary conservative care and non-opioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as first-line therapy."

The TCAs most commonly prescribed today include: Anafranil (clomipramine), Asendin (amoxapine), Elavil (amitriptyline), Norpramin (desipramine), and Pamelor (nortriptyline).Two of the most common SNRIs are duloxetine and venlafaxine. Clinically used gabapentinoids include gabapentin, pregabalin, and mirogabalin, as well as a gabapentin prodrug, gabapentin enacarbil. Additionally, phenibut has been found to act as a gabapentinoid in addition to its action of functioning as a GABAB receptor agonist. There has recently been a warning not to use gabapentinoids in patients with respiratory problems. Common topicals are a myriad of compounding formulations with or without Ketamine. OTC topicals I use most are Neuro Eze and Neuro One both with L-Arginine in concentrated form. The transdermal product I use is 5% Lidoderm patches. 
Many patients try other nerve desensitizing treatments first, before drugs, with neural flossing or gliding, Acupuncture, TENS, and Quell units. 

Friday, December 1, 2023

Response Regarding Possible Contact

Congratulations Dr.Blake on your new Biomechanics Book. Coming across your website has given me hope of figuring out a chronic sesamoid(I think) issue. I have Charcot-Marie-Tooth Type1a which I believe is making matters worse for recovering from this. Absolutely no one has been able to help me. Is there any way I could get in touch with you directly? Look forward to hearing back. Thanks!

Response from Dr Blake:
     I am presently working a little with Dr Ajitha Nair in Oakland, California due to my recovery from Open Heart Surgery. She can be reached by email at anair@propelfootandankle.com. Her and I discuss cases once or twice a month also. I hope this avenue can help you. Rich 

PS. Chapter 6 in Book 2 has a detailed description of possible treatments for Big Toe Joint Pain. Some may apply to you. 

Great Article on Choosing Cleats by Dr Spitalny

https://www.hmpgloballearningnetwork.com/site/podiatry/sports-medicine/advising-parents-choosing-right-cleat-young-athletes

Link to my Kevin Root Medical blog posts

https://www.kevinrootmedical.com/community/xenforum/general-discussion

     I have been taking a break this year for 4 things. One is to write a blog post each week for one of the best orthotic laboratories in America. It has been my honor, and has taken a lot of my time. I have attached a link to that medical forum above. The second reason for my break was I needed to have open heart surgery on Oct 11th, 2023. I had my first of 36 cardiac rehab sessions today, so the next 3 months will help build back my strength. I am so happy to be alive. My aortic valve was failing and I literally had 3-4 months left before I would have died. I have known about this for 16 years, but I finally went into heart failure at the beginning of this year. To those who knew about this, thank you for all your prayers and good thoughts. The 3rd reason for my break was I published Book 2 and Book 3 of my Practical Biomechanics for the Podiatrist. Book 1 also came out this year in Spanish. So, I have been busy with things I love. The 4th and best reason for my break was for trips and other celebrations (one in England's Sussex County) with my family. Today is December 1st, 2023. It is the day I vowed to start my blog again. If you will join me, I am grateful. Rich Blake


Thursday, August 31, 2023

Book 3 Practical Biomechanics for the Podiatrist

https://store.bookbaby.com/book/practical-biomechanics-for-the-podiatrist-book-3

     I am so excited about published my third book on Practical Biomechanics. These books, with one more to be completed next year, are an accumulation of my 44 years as a Podiatrist. This book covers injuries from the ankle to low back as treated by a conservative Podiatrist. It also covers the injuries produced by pronation and supination. There are chapters limb length difference, shock absorption problems, weak and tight muscles, and current concepts being used to treat these issues. 

Monday, April 17, 2023

Use this Website to learn Foot Anatomy

https://radiopaedia.org/cases/foot-x-ray-labelling-questions

This is very cool, especially if you are trying to read a radiology report to understand your injury. Rich

Friday, April 14, 2023

Tibial Nerve Test Video

https://youtu.be/qwbDfG71dgU

     So many patients with foot and leg pain may have the tibial nerve as a component. They may think they just have plantar fasciitis, achilles tendonitis, or metatarsalgia. This test can point to nerve involvement, which of course, has certain specific treatments different than standard.