I am presently rehabbing a right frozen shoulder that developed following a stroke I had in August. The image above shows the amount of balls I made (6) and missed (many) from 20 feet as I try to get my strength and accuracy back. Possible? I ignored the pain for some many months and now I am paying for that mistake. I have what would be equivalent to posterior tibial tendon dysfunction. My weakness was caused by my stroke, and then the shoulder joint began to gradually shift out of position with the stronger front muscles to the weaker back of the shoulder muscles. I wish I could make an orthotic for this injury like I do for the foot injury. Oh well. Since this will be a regular game to check my progress I will send updates. Rich
Thursday, March 16, 2017
Big Toe Joint Pain: MRI showing Plantar Plate Involvement
This is one of my blog patients (and yes, that is what I call you in my brain as I compartmentalize things). He has been suffering with big toe joint pain, presumably sesamoid, but probably more plantar plate tear. The arrow points to part of the plantar plate in front of the sesamoids by the toes. Some calm down by themselves with sesamoid off weighting, and limited push off for a while. Some remain chronically sore and need surgery to fix the instability created by the tear. Typically, you know what a surgeon will tell you. Read all you can about sesamoid management--off weight the big toe joint, limit the dorsiflexion of the joint, calm the inflammation down (all the white stuff in the image), create a pain free environment. Also, look at my reference on plantar plate testing.
Tuesday, March 14, 2017
Being Part of a Team that Works!!
In my twenties, I was able to be part of a 14 person team that ran 1250 miles as a relay from Oregon to Mexico. There were 10 runners (I am above the T in TO, yes the goofy looking one!!) and 4 alternates. We each ran 125 miles that week. I lost 30 lbs in the training, and another 10 on the trip. Not healthy, but sure what an adventure. It was such a highlight in all of our lives that when we come together randomly at a meeting now, that it want comes into the conversation, something that we are all so proud of. We were a team, divided into 2 groups of 5 runners. When one group ran 70 miles in 10 hours, the other group went ahead and did what they could to rest and eat. Since it was a publicity stunt for California Podiatrists, National Foot Health Week, May 5-12 1981, we also were constantly interviewed by radio, TV, and newspaper.
It remains my biggest athletic feat! My wife and I walked 189 miles in 12 days on the Camino de Santiago in Spain 2015, also a tremendous accomplishment.
Why bring this up? As life has passed along, I have been part of many teams at work, recreational, and family. I started this blog 7 years ago (almost to the minute). I knew when I started it that my life would be changed by it, and that it has. You have all become by blog family, some of you more vocal, but all important. I hope this TEAM we have formed can grow. Behind the scenes, only 10% of the blog gets posted, most of my answers are to individuals alone. So, please do not be afraid to write me, and I am sorry when life slows this part of my life down. I am just as proud of this blog as anything I have done in podiatry, or as a human being, because I have tried to make it truly a gift and always part of my life, not something to do. Thank you for helping me teach, cry, and try to love you, as I know by your kind words you feel for me. I thank you.
Monday, March 13, 2017
Flat Feet with Marked Heel Eversion: Inverted Technique
This patient has pronated flat feet with marked eversion of the heels. The Inverted Orthotic Technique will be utilized to attempt to place the heel bisection line close to vertical. You can measure the angle, and use a 5 degree cast correction for 1 degree of foot correction ratio. If the line is over 7 degrees everted, I stop at 35 degrees to get the patient used to this amount of support. A good starting point.
Sunday, March 12, 2017
Saturday, February 25, 2017
Turf Toe Stable or Unstable: Surgery or No Surgery
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560019/
I just reviewed an MRI and x-rays of a patient with chronic sesamoid injury and there definitely was plantar plate involvement. This is a great article documenting an unstable plantar plate with a 2mm forward position of the non injured sesamoids. The x-rays should be taken in a position where the big toe is bent upwards, called a stress x-ray.
I just reviewed an MRI and x-rays of a patient with chronic sesamoid injury and there definitely was plantar plate involvement. This is a great article documenting an unstable plantar plate with a 2mm forward position of the non injured sesamoids. The x-rays should be taken in a position where the big toe is bent upwards, called a stress x-ray.
Arrow under the big toe joint shows a disrupted plantar ligament (plantar plate) with intense inflammation.
Sesamoid Fracture: Email Advice
Hey Dr. Blake,
Thank you for all the hard work you put into your blog. I injured my sesamoid bone three months ago and your blog is the only thing I've come across with any good information. With that said, I have some questions if you have the time and can help me out.
I am a runner, but take very good care of my feet. I have never had any pain or problems anywhere but my right knee (once, after a half marathon last May). In November, I was on a walking break during an easy run and felt a "crunch" in the ball of my right foot. It was followed by immediate pain and I knew I must've broke something. Went in to have it x-rayed that afternoon, nothing looked off. The doctor said this is normal with fractures and to return in 4 weeks if the pain was still present (didn't mention anything about a boot at this time, just told me to try and keep weight off of it). The tricky thing about the timing of this, though, was that this happened the Thursday before I was set to perform in a musical for the weekend. I worked for 3 months rehearsing and wasn't about to quit right before opening night. So, I danced on it for three days (icing it when I could), and started some serious time off right after the weekend was over. My doctor wasn't thrilled that I chose this, but said I should be fine just for a weekend. 4 weeks later, the pain was still there. I went back and they re-did the x ray, this time there was a fracture visible in the sesamoid bone towards the inside of my foot (I believe you call this the medial sesamoid). He put me in a walking boot and scheduled a follow-up for 6 weeks later. He asked me to limit weight bearing activities, but told me I could swim, stationary bike, or do other things that didn't require my body weight. This appointment was mid-December.
I got along okay for 6 weeks, but I really miss running. I swim 3 days a week and do Pilates once or twice a week, too. When I went in for my 6-week follow up last Monday, the x ray didn't show any improvement at all. I'm feeling very discouraged. He mentioned that I'm a candidate for surgery now that it's almost been 3 months since the initial injury, but I'm wary of that option. My questions for you are:
1.) To me, this seems like a very acute injury rather than a chronic stress fracture. My doctor keeps using the words "stress fracture," but should I be treating it differently if it was a sudden, trauma-induced injury?
Dr. Blake' comment: Both are treated the same at this point. Stress fractures you never see the fracture line, and acute fractures yes. A stress fracture never goes "crunch". So, you have a potentially healing fracture of the tibial or medial sesamoid. The nature of the injury is suspicious of some underlying bone health issue (like Vitamin D Deficiency) so that needs to be checked out. Did you change to a less padded or stiffer shoe just before that could have increase the stress?
2.) What can I be doing to help this darn stubborn little guy heal? I read some of your advice in the sesamoid post "advice when not healing well" and I bought some hapad metatarsal pads and dancers pads for my shoes, but I'm wondering if I need further immobilization?
Dr. Blake's comment: Yes, it is typically get the bone health evaluated and treated if needed. Get the biomechanics secure with off loading in all things, even the removable boot. Spend 3 months in the boot, and if you have attained the 0-2 pain level, begin another 2 to 6 weeks weaning out of the boot with no increase in pain. This usually means experimentation even begins now with orthotic supports, dancer's padding, spica taping, shoe change (possibly Hoka One One). I love of course Exogen bone stim, so see if you can use that for 9 months. It is way too early to consider surgery.
3.) Have you seen runners be able to return to the sport after healing their injury? I'm not finding anything encouraging online and I'm supposed to run my first marathon this November. My training doesn't start until June, but I'm starting to think it's really unrealistic and it's getting me down.
Dr. Blake's comment: Yes, runners get back to running for sure. You should not have any deadlines on your calendar, because that we potentially have you rush through the rehab and take too many risks. Set goals to get better not participate in events right now. Goal #1: Get out of the removable boot in 5-6 weeks into an equally painless environment.
4.) Is it a bad sign to not see any healing in an x ray after 6 weeks? I've been so careful and the only time I haven't been in the boot is when I'm in the pool or the stationary bike at the gym, at home relaxing, or using my Birkenstocks to take my dog for a walk (I don't feel pain when wearing those shoes).
Dr. Blake's comment: X-rays can be 2 months behind showing the actual healing of the bone, so are poor indicators of bone healing at times (and this is one of them). I love MRIs to follow. You need a baseline, and 6 months from now, if you need another one, that comparison baseline can come in handy. Good luck and keep me in the loop. Rich
Again, thank you so much for doing what you do. And if you make it this far, thanks for reading!
Thank you for all the hard work you put into your blog. I injured my sesamoid bone three months ago and your blog is the only thing I've come across with any good information. With that said, I have some questions if you have the time and can help me out.
I am a runner, but take very good care of my feet. I have never had any pain or problems anywhere but my right knee (once, after a half marathon last May). In November, I was on a walking break during an easy run and felt a "crunch" in the ball of my right foot. It was followed by immediate pain and I knew I must've broke something. Went in to have it x-rayed that afternoon, nothing looked off. The doctor said this is normal with fractures and to return in 4 weeks if the pain was still present (didn't mention anything about a boot at this time, just told me to try and keep weight off of it). The tricky thing about the timing of this, though, was that this happened the Thursday before I was set to perform in a musical for the weekend. I worked for 3 months rehearsing and wasn't about to quit right before opening night. So, I danced on it for three days (icing it when I could), and started some serious time off right after the weekend was over. My doctor wasn't thrilled that I chose this, but said I should be fine just for a weekend. 4 weeks later, the pain was still there. I went back and they re-did the x ray, this time there was a fracture visible in the sesamoid bone towards the inside of my foot (I believe you call this the medial sesamoid). He put me in a walking boot and scheduled a follow-up for 6 weeks later. He asked me to limit weight bearing activities, but told me I could swim, stationary bike, or do other things that didn't require my body weight. This appointment was mid-December.
I got along okay for 6 weeks, but I really miss running. I swim 3 days a week and do Pilates once or twice a week, too. When I went in for my 6-week follow up last Monday, the x ray didn't show any improvement at all. I'm feeling very discouraged. He mentioned that I'm a candidate for surgery now that it's almost been 3 months since the initial injury, but I'm wary of that option. My questions for you are:
1.) To me, this seems like a very acute injury rather than a chronic stress fracture. My doctor keeps using the words "stress fracture," but should I be treating it differently if it was a sudden, trauma-induced injury?
Dr. Blake' comment: Both are treated the same at this point. Stress fractures you never see the fracture line, and acute fractures yes. A stress fracture never goes "crunch". So, you have a potentially healing fracture of the tibial or medial sesamoid. The nature of the injury is suspicious of some underlying bone health issue (like Vitamin D Deficiency) so that needs to be checked out. Did you change to a less padded or stiffer shoe just before that could have increase the stress?
2.) What can I be doing to help this darn stubborn little guy heal? I read some of your advice in the sesamoid post "advice when not healing well" and I bought some hapad metatarsal pads and dancers pads for my shoes, but I'm wondering if I need further immobilization?
Dr. Blake's comment: Yes, it is typically get the bone health evaluated and treated if needed. Get the biomechanics secure with off loading in all things, even the removable boot. Spend 3 months in the boot, and if you have attained the 0-2 pain level, begin another 2 to 6 weeks weaning out of the boot with no increase in pain. This usually means experimentation even begins now with orthotic supports, dancer's padding, spica taping, shoe change (possibly Hoka One One). I love of course Exogen bone stim, so see if you can use that for 9 months. It is way too early to consider surgery.
3.) Have you seen runners be able to return to the sport after healing their injury? I'm not finding anything encouraging online and I'm supposed to run my first marathon this November. My training doesn't start until June, but I'm starting to think it's really unrealistic and it's getting me down.
Dr. Blake's comment: Yes, runners get back to running for sure. You should not have any deadlines on your calendar, because that we potentially have you rush through the rehab and take too many risks. Set goals to get better not participate in events right now. Goal #1: Get out of the removable boot in 5-6 weeks into an equally painless environment.
4.) Is it a bad sign to not see any healing in an x ray after 6 weeks? I've been so careful and the only time I haven't been in the boot is when I'm in the pool or the stationary bike at the gym, at home relaxing, or using my Birkenstocks to take my dog for a walk (I don't feel pain when wearing those shoes).
Dr. Blake's comment: X-rays can be 2 months behind showing the actual healing of the bone, so are poor indicators of bone healing at times (and this is one of them). I love MRIs to follow. You need a baseline, and 6 months from now, if you need another one, that comparison baseline can come in handy. Good luck and keep me in the loop. Rich
Again, thank you so much for doing what you do. And if you make it this far, thanks for reading!
Friday, February 24, 2017
YouTube Videos: Summary of 128 for easy access
Dr. Blake’s YouTube Videos
https://youtu.be/hh4wC0RJqjY Achilles Tendon Evaluation for
Flexibility
https://youtu.be/0eAqJ4-oKTM Achilles and Plantar Fascia Stretches
https://youtu.be/wG-1ZiP_GGs Achilles/Calf Stretching for Tough Cases
https://youtu.be/xjsYz_YFGyY Achilles/Calf Strengthening
https://youtu.be/UxTPQ2N7w1Y Achilles Tendon Taping Version
https://youtu.be/xvrQHkGMJ4Y Achilles Tendinitis Taping
https://youtu.be/QDrSFOBICtI Achilles Tendon Weak Area
https://youtu.be/o2s9BtfZvNU Ankle Sprain: Initial Treatment
https://youtu.be/5_qC2FnS2RU Ankle Sprain: Compression Quickly
https://youtu.be/WVYwTQCmMiE Ankle Strengthening Range of Motion
https://youtu.be/8viOmi73Djo Ankle Strengthening with Bands
https://youtu.be/Wa3k5b9kNAM Arch Strengthening
https://youtu.be/NLfzvAJgyJ4 Arch Taping: KT tape
https://youtu.be/shK6SyUuPl4 Arch Taping: Low Dye Classic
https://youtu.be/0sbVVZiNPZQ Arch Taping: Low Dye Modifications
https://youtu.be/41Or2rdpxbY (Arch Taping: Support the Foot)
https://youtu.be/mri8YyPHegc (Balancing)
https://youtu.be/-4OB7wcYTJE Balancing: Single Leg
https://youtu.be/vMiO5N3DqrU Bike Seat Height Changes for Rehab
https://youtu.be/l_4HESXCG40 Big Toe Pain: Spica Taping
https://youtu.be/J6meUHwm880 Big Toe Pain Treatments
https://youtu.be/p4cHoZ1KDDQ Big Toe Pain: Variation of Spica Taping
https://youtu.be/zbJOmxdFbjs Bio-mechanics: Mechanical Causes of Foot
and Ankle Pain
https://youtu.be/lAMOZ5k2yX0 Bow Legs: Gait
https://youtu.be/toNrK040bKQ Bunions: 4 Stages
https://youtu.be/2hlZGJPV_ok Bunion Pain: Or is It?
https://youtu.be/J3js0t8oOYc (Bunions: Strengthening)
https://youtu.be/uD348O7pKwo Bunion Taping
https://youtu.be/sjrAYX0rEms (Bunions: Toe Separators)
https://youtu.be/iLZ-Q1H5hUk Calf Tightness in Achilles Injuries
https://youtu.be/1FQndaBenGc Crutches: How to Wean Off
https://youtu.be/O9_d-CdYVik Crutches: Progression to 1 Crutch
https://youtu.be/12GBUNCyGIA Cushioning Concepts
https://youtu.be/GG-mSjtSwj8 (Dancer’s Pads)
https://youtu.be/smoHY3YZins Falling Problems Helpful Tips
https://youtu.be/sekBTg7cowo Foot and Ankle Strength: General Program
https://youtu.be/-y46cZP26Wk Foot Strengthening with Marbles
https://youtu.be/A_eaB_hfn4o Foot Strength by Playing the Piano
https://youtu.be/k55IwMxSsuc (Functional Hallux Limitus)
https://youtu.be/x1XMMZZf6b0 Gait Evaluation Basics
https://youtu.be/5SBtTbfELUU Gait Evaluation Basics 2
https://youtu.be/0KH0RlTsjRs Gait Evaluation Basics 3
https://youtu.be/9cDKxuAAORo Gait Evaluation Supination
https://youtu.be/Z21MtkhW7e0 Hallux Limitus Guidelines of Treatment
https://youtu.be/FBTeWbdGrzs Hallux Limitus/Rigidus: Self Mobilization
https://youtu.be/plTrtNsmPPY Hammertoes General Treatment
https://youtu.be/KEFpJaMwEtQ Hamstring: Upper and Lower Stretches
https://youtu.be/o3NlbDPukxQ Hamstring Stretches: For Tough Cases
https://youtu.be/5riWj_tIvoM Hannaford Orthotic Manufacture
https://youtu.be/plbBvPASXwM Heel Pain Evaluation
https://youtu.be/WFz_LV_tzdw Heel Pain Treatment PT
https://youtu.be/rib1BXiWh4g (Hiking Boot Lacing for Stability)
https://youtu.be/WRD62QspZtw Hip X-rays post Replacement
https://youtu.be/rI1uUQv7u1k Ilio-Tibial Band Stretches
https://youtu.be/dBfo6Hl_kaU Knee Pain: How to Ice
https://youtu.be/8icTM5kZIyw Knee Pain: Foot Wedges Can Help
https://youtu.be/SiwZYU2rq0w Knee Strengthening: Short Arc Quad Sets
https://youtu.be/K4O3RQKlAxQ Knee Strengthening: Home Based
https://youtu.be/uNDdwCZNo6U Knee Taping
https://youtu.be/Y5YoQKfvoVo Knee Various Positions Gait
https://youtu.be/5NLLjPQuNHM Knee: Weak External Hip Rotators in Gait
https://youtu.be/GY-mJjXmeIc Metatarsal Doming Exercise
https://youtu.be/-v9IrSucQpE Metatarsal Soreness
https://youtu.be/_7qNgYNUrmw Morton’s Neuroma Evaluation
https://youtu.be/a1RDbEs0Le8 Muscle Stimulation for Weakness
https://youtu.be/E0E60NpOSHg Nerve Pain: Low Back Cause?
https://youtu.be/Xs8Cl39LXQg Neural Flossing
https://youtu.be/aPHi8gxF6Bc Orthotic Check by Heel Change
https://youtu.be/w3nAaYs8jpA Orthotic for Supination: Multiple Rx
Variables
https://youtu.be/Xgz8wY-6h_o Orthotic Designs for Supination (custom
mold variations)
https://youtu.be/w3nAaYs8jpA Orthotic Evaluation for Supination in
Gait
https://youtu.be/MTiy0_o99aQ Orthotic Evaluation for Supination in
Gait after Denton Removal
https://youtu.be/hMhrTmWXfDA Orthotic Design Supinators
https://youtu.be/zQBUQRVumQY Orthotics for Forefoot Varus
https://youtu.be/ZzixrdfAsfw Orthotic for Supination: Denton
Modification
https://youtu.be/pKWOKCgJVDQ Orthotic: Inverted Technique 60
https://youtu.be/oqUmY3zyW4Y (Orthotic Mold Corrections for Pronation)
https://youtu.be/T81AJEVPEQI Orthotic Negative Casting to get proper
Impressions
https://youtu.be/7SjkTwynaQM Orthotic Rear Foot Posts
https://youtu.be/JycJlAInFRQ Osgood Schlatter’s Knee: Anatomy and
Treatment
https://youtu.be/g0sD0gUbEMU Phases of Rehabilitation
https://youtu.be/azMR3IAQiO4 Plantar Fasciitis: 3 Important Home
Treatments
https://youtu.be/zPhSGEuzUZs Plantar Fasciitis 5 common treatments
https://youtu.be/t7KkIGlJmTI Plantar Fasciitis: 2 Vital Orthotic
Components
https://youtu.be/mxRsKB2ChjY (Plantar Fascial Stretching)
https://youtu.be/DwUydoeNqWQ Plantar Fascial Stretching
https://youtu.be/F9QJqN9HYdw Plantar Fascial AM stretching
https://youtu.be/lyd9HAv9e9o Plantar Fascial Night Splints
https://youtu.be/JZpcapqBnZg Plantar Fascial Wall Stretch
https://youtu.be/YPyC0ze2gO4 Posterior Tibial Tendon Anatomy
https://youtu.be/w3FXx4OFqec (Posterior Tibial Strengthening)
https://youtu.be/QP3Ud4d39dc Posterior Tibial Strengthening
https://youtu.be/e1JAewWT9Fc Posterior Tibial Taping Version
https://youtu.be/AcSSyBfFocE (Posterior Tibial Taping)
https://youtu.be/g7nRXdHbgcA PTTD: Gait Evaluation
https://youtu.be/PeD-lG3383A PTTD: Gait with Inverted Orthosis
https://youtu.be/7ilOVqF0aPc PTTD: Muscle Testing
https://youtu.be/WqXac2AvrLY Pronation Walking
https://youtu.be/cwHG3sgYPDA Quadriceps Stretches
https://youtu.be/NIHF5S3ngnc Quadriceps Stretch: For Tough Cases
https://youtu.be/bgh7KSRNSSE Rehab: KISS Principle
https://youtu.be/DJBIhb2kQQg (RICE: Initial Injury Treatment)
https://youtu.be/o8Iky7Dc_jY (Running: Walk/Run Program)
https://youtu.be/47XTZ2VnDBs Scar Tissue Breakdown
https://youtu.be/928DwpwEaXE Second Metatarsal Taping
https://youtu.be/y2QniW_jgGQ (Sesamoid Evaluation: Part 2)
https://youtu.be/siF3tVEBof8 (Sesamoid Evaluation: Part 3)
https://youtu.be/8cwW2Bmcc0E (Sesamoid Fracture Treatment)
https://youtu.be/0qFiAyyHuu8 Shin Splints: 4 Types
https://youtu.be/oNuqckWvHEM Shoe Flexion and Torsion Tests
https://youtu.be/yAjm0MF_NwA Shoe Inserts: Interpreting the Signs
https://youtu.be/Lj40hKy-uqI Shoe Power Lacing for Stability
https://youtu.be/25kyQJTlt24 Short Leg Evaluation Standing
https://youtu.be/rEvq-HAi5Y8 Short Leg Heel Lifts
https://youtu.be/3WmO8mnHXN0 Short Leg Full Length Lifts
https://youtu.be/T6TzS1iipFM Short Leg: Making Sure Lifts Stable
https://youtu.be/hjPI7x1RHQg Short Leg: Limb Dominance in Gait
https://youtu.be/1mm1OawtjbI Stretching with Contract/Relax
https://youtu.be/F2vn4xVaQQo (Stretches: 5 Most Common)
https://youtu.be/OfE3f-F_3wY Stretching: 7 General Principles
https://youtu.be/bc2PRrtwemM Supination: What it Looks Like
https://youtu.be/H8jK5kxuNYY Supination: Evaluation in Stance
https://youtu.be/hxsNaBXT_ug Supination Running
https://youtu.be/rRt5hC24Afg Swelling Reduction with Contrast Bathing
https://youtu.be/cRxKVUPyQfM Tailor’s Bunions
https://youtu.be/opnpcyO5vx0 Toe Injuries Buddy Taping
https://youtu.be/K7LOqqRizrQ Toenail Fungus
https://youtu.be/iymbwW30zd8 Walking Aid: Roll A Bout
Monday, February 20, 2017
Incision Health??
Hello Dr. Blake,
I am 18 days post op from a medial sesamoidectomy. My podiatrist removed stitches on day 14. I've been advised to slowly ease in to walking part-time in a well supported shoe. With the remaining 80% of the time in a walking boot.
I am concerned that my incision may not be normal. Looking at other medial sesamoidectomy pictures on the web, they seem to look "cleaner." Below are pictures of my incision at day 18. At times, I'm experiencing sharp pains when I touch parts of the incision. Is my incision normal? Or should I be concerned with the way it appears and feels?
Dr Blake's response:
I am not a surgeon, but the incision meets all the normal criteria: no oozing, no gaps, no infection I can appreciate. Rich Good Luck!
Post Op from a Patient's Perspective
Hi Dr. Blake,
Today I am at exactly 6 weeks post-op for accessory navicular excision and partial post tibial tendon reattachment. My surgery was January 9th. My surgeon has cleared me to start driving, and he said I am allowed to walk without crutches or the walking boot if I want to, starting today.
I am not ready to walk without boot/crutches yet, but I can drive short distances. I have been pretty careful/conservative with my healing, so despite being allowed to put weight on my foot in the boot the past several weeks, I have not done so frequently because it would sometimes hurt and cause swelling. I tend to worry, so I erred on the side of caution while carefully moving/stretching/building back some muscle non-weight-bearing.
I know some surgeons prohibit weight-bearing entirely the first 6 weeks. My surgeon takes the approach that it is better for me psychologically to be more mobile (which I appreciate) and he knows if I am in pain, I will stop. He has assured me that the tendon is very structurally sound and I can't do damage. It's just a matter of pain management. He only had to partially reattach the post-tibial tendon so it is probably more solid than an entire reattachment.
My Achilles' tendon is very stiff and my foot is weak. I have noticeable atrophy up to the lower thigh. I could have been using an exercise bike, but since I haven't had time to procure one yet, I've been doing light motion/pushing exercises on my roll about scooter. I'll be scheduling physical therapy today for the next few weeks.
I rarely need to ice because elevating my foot reduces the heat/swelling. I've been given some heavy duty compression stockings. I don't like them, but I should probably try to wear them when I start walking more.
I am currently able to limp with the boot only, or walk smoothly with one crutch on the opposite side of the boot. Yesterday I noticed when I did a lot of walking with one crutch I had pain/tenderness later. A good night's rest seems to reset me, and I always feel better in the mornings.
The incision looks great and is healing nicely. I decided on my own to use silicone strips to protect it and help it heal better.
I've never seen my leg like this. It's all bone and floppy fat! Even if someone didn't have surgery, I doubt they would be able to walk if they didn't use their leg for 6 weeks.
One thing I would like to comment on is the issue of post-surgical depression, which had been a struggle. I usually beat the winter blues by going shopping and staying as active as possible in the winter. Spending the majority of the worst part of the winter on the couch is challenging. If someone has never had surgery they might not be prepared for the emotional and mental challenges of being weak, vulnerable, bored, etc.
Plus, as I'm sure you're aware, other parts of your body become overworked after a surgery while trying to compensate. My "good" foot is aggravated, and every week I've pulled a different muscle somewhere in my body by mistake! I can't wait to get back into full body workouts! You see, the past 3 years I was more sedentary than I used to be. So I wasn't in the best shape pre-op. I would recommend to anyone undergoing foot surgery to do a lot of strengthening prior to the procedure so it's not such a big impact.
I'll keep you posted. Thanks for your support.
Sunday, February 19, 2017
Our Neglected Feet: Guest Author Gemma Gerb
Out Of Sight, Out Of Mind - The World’s Problem With Foot Care
We treat our faces with semi-obsessive care and attention. We cover our hands in expensive creams that they probably don’t even need. We brush and floss our teeth, we exercise our biceps - we even pamper our hair (and our hair doesn’t actually do anything other than keep us a little tiny bit warmer, and make us look good). But we put our poor feet through an awful lot of casual abuse. We force them into appalling shoes, we mash them up with our gaits, we lock them up in humid boots - and then we act surprised when they start hurting, look strange, or develop skin conditions.
The way we treat our feet simply isn’t fair. Our feet do a hell of a lot for us. If you’ve ever suffered from foot problems, it will have been driven forcefully home to you just how vital your feet are for everyday life. Living with compromised feet is not impossible - but it’s tough. And, with feet, assuming that you can just pop a painkiller and carry on is generally wrong. When feet go wrong, they take time and patience to heal. Blithely walking around as normal with a hefty dose of opioids inside you (as Americans tend to do) is only going to heap damage upon damage. There’s a reason why evolution put so many nerve endings in your toes and soles - it needs you to seriously know about it when you’re in danger of damaging your feet! That’s why stubbing your toe or treading on lego hurts so much.
Our attitude towards feet is strange. We either think they look ‘weird’, or fetishize them, or pretty much ignore them. I’m of the opinion that our peculiar attitude towards feet stems from our habit of hiding them away in shoes, the fact that they’re in contact with the ground, and the fact that they’re far away from our faces (they also smell - but that, in fairness, has a lot to do with the shoe thing). Our peculiar attitude towards feet is probably related to our peculiar attitude towards ‘dirt’ in general. We’re increasingly moving towards an unnatural, hyper-sanitized world in which feet don’t quite seem to fit. And, as the associations of feet become implicitly ‘forbidden’, foot fetishism is on the rise…
But enough cod-psychology. Here’s what we SHOULD be doing to care for our feet.
- Wearing good shoes. Shoes are, hands down, the number one cause of foot damage. High heels, flip flops, poorly-fitting shoes, non-ventilated shoes, worn out shoes...all of these will damage your feet in different ways. If your shoes are too big (or are flip flops), you’ll strain your arches ‘gripping’ them. If you’re a habitual heels wearer, you run the risk of shortening your tendons and damaging the bones of your foot. If your shoes have poor ventilation, you’re creating the perfect environment for fungus and bacteria to thrive - causing problems like athletes foot, verrucas, and pitted keratolysis. Ideally, your shoes should be well fitted, without any pinching, and without your toes butting the ends. They should have a decent amount of support for your arch, but not throw your gait off like high heels do, and they should be reasonably well ventilated.
- Washing and drying your feet. It’s amazing how many people scrub the rest of their bodies assiduously, but don’t bother so much with their feet. Perhaps it’s because washing your feet involves bending down in the shower? Whatever the reason, your feet need washing just as much - if not more so - than the rest of you. And dry them well, to limit the risk of bacteria proliferating in the damp between your toes!
- Trimming your toenails properly. Cut your toenails straight across, and carefully. Cutting at an angle can cause ingrowing toenails.
- Moisturising and/or filing. If your feet have hard skin, you can moisturise them, or file the hard skin away. Do be careful, however, about how deep you file - overdo it and the skin will grow back harder than it was before!
- Changing your socks frequently. Wrapping our feet in socks and then enclosing them within shoes gives fungus and bacteria a fantastic environment to thrive - which causes a nasty smell, among other things! Change your socks frequently to stop this from happening.
Saturday, February 18, 2017
Inverted Technique for Flat Foot Children
Hello Dr.
my daughter has severe overpronation and has been using a sole with your inverted technique for 2 and a half years and she has improved a lot.
her feet is bigger now and need a new sole.
I read somewhere in your blog 3 years ago you have a very good friend in fort Lauderdale fl.
I would like to take my daughter to see someone that know very well your technique, could you please provide his clinic phone number, address and web page, is any? please.
he probably can do a good assessment of my daughter, because the dr in Miami just took her cast and that's it.
in case you know another Dr. in Miami that know very well your technique please let me know also.
thank you very much for your work and dedication, its really making a very good difference in my daughter.
regards,
Dr Blake's response:
Pronation noted in the back of the heel of the right foot. Ruler denoting vertical, and the heel bisection line shows marked eversion which flattens the arch.
This same right heel in the Inverted Technique attempting to center the heel.
http://www.aapsm.org/members-
Mari, above is the members in Florida of the AAPSM. I looked at the list and 5 names popped up. They are not in any order:
Matthew Werd
James Losito
Russell Rowan
Brian Fullem
Joseph Agostinelli
You would have to call their offices and inquire.
You can also get the names of who uses the Inverted Technique alot by calling the 4 Labs I know use it alot:
Root Functional Orthotic Laboratory
Richey and Company
Allied OSI Lab
ProLab USA
The labs would have the doctors names in your area. Please let me know what you found out and thank you for your kind words. I am very happy to hear that the technique is helping your daughter. Rich
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