Foot and Ankle Problems By Dr. Richard Blake

Friday, April 11, 2014

Playlist on Short Leg Syndrome

Dr Roy Corbin, father, friend, and podiatrist extraordinaire just passed away

I need to honor my dear friend Dr Roy Corbin who passed away last night (4-10-14) in Bangor, Maine. Roy was a great podiatrist, but would want you to know how much he loved his two boys more than anything else in the universe. Roy was kind, soft spoken, easy to laugh, generous, and always taking care of you. I met Roy when we both served on the Board of the American Academy of Podiatric Sports Medicine together 1987 to 1993. He loved his University of Maine that he showed me so proudly. A New Yorker by birth, but a true native of Maine by desire. He was a gifted dedicated Podiatrist that would do anything for his patients and staff. His staff was his family. He spoke of them (when I used to make his orthotics) with love. Few people have touched me as much as Roy. He was gentle and humble, and quietly went along his business with great passion. Thank you Roy, I am only one of thousands who did not get a chance to tell you enough what you meant to us. My great sorrow for your family and friends. You will be sorely missed. We all loved you. Dr Rich Blake

Tuesday, April 8, 2014

Arch Taping with Kinesiotape (KT)

You need to watch how to apply kt tape. They give great tips! I'm a massage therapy student and we use kinesiology tape, but I've been using it a few years. Have tried it the way you've shown and the way kt tells you how and kt tapes tips seem to work better. Also this tape is not waterproof, it is like fabric it absorbs water but dries fairly fast; however the adhesive cannot be removed with just water (needs oil based product to remove). Not trying to be a snob just trying to help. Love the one strip taping technique, saves a little money and makes a great and simple support!

Dr Blake's reply:

No snobbery noted and thank you. I will try to find the KT tape video. Thank you so very much. It will help so many people. Rich Blake

Here is my original video that sparked this comment.

Here is one version of KT for arch pain. I sure hope it helps some of you guys.

Tuesday's Patient Question of the Week: How to deal with Bunion Surgery Complications?

Dear Dr. Blake,

I imagine you must get many of these emails. I stumbled upon your blog by reference of an enthusiastic patient of yours. Coincidentally, I live in the Bay Area.

I have a series of complications which has led from flare-up to constant chronic pain and immobility. I have eliminated all exercise except swimming and lifting weights. Walking and standing are hard; I used to be very active. I have a slight build so my weight is not an issue. I am just wondering how to proceed, how to find an expert, whether surgery is appropriate (I am scared of this as I have had 6 in all but I do not want this current condition to be my new norm). My summary, if I may indulge you, is as follows:

Image of a bunion patient whose previous surgery had failed and the toe collapses towards the 2nd toe and off the big toe joint causing arthritic pain.

After no luck with orthotics for painful bunions, in March 2002, I had my left foot worked on ( a bunionectomy). In June, 2002, I had my right foot bunionectomy-same doctor- an orthopedic surgeon. One outcome of that surgery is that the big toe bone has become shortened and my first metatarsal head is misaligned with the second and third.

The bunions came back five years later; in August 2007 and December 2007, I had my left then right foot done respectively, by different surgeons. The surgery, shaving rather than cutting the bones, was much easier to recover from.

Dr Blake's comment: Bunion surgeries vary immensely, and typically the longer the post op course, and the more bone work done, the longer the bunion correction will hold. There are also so many factors like severity of pronation, width of foot, general ligamentous looseness, and bone structure to name a few that can help determine the longevity of these surgeries. Surgeons have their preference, but in discussing with them, see if you can determine why they choose a particular type for you. Definitely get a second opinion and do not mention what the first surgeon plans on doing. See if they are on the same page or miles apart.

In 2011, I developed bone spurs and was diagnosed with hallus ridigus which amounted to a 40% loss of mobility in my foot due to arthritis so I had surgery on the bone spurs (by my big toe). My left foot was worked on in August 2011.

Dr Blake's comment: Surgery on any joint weakens the joint leading to gradual onset of potential problems in the future. This is typically very slow process, so it is unusual that arthritis set in after your second surgery. I am assuming that there was no mention of arthritis in the first and second surgeries. Something does not make sense, but you have what you have right now. Bone spur surgery on the big toe joint, AKA joint cleanout, AKA joint arthroplasty, AKA cheilectomy is definitely a very skilled procedure and needs some luck in going to work. I highly recommend this surgery over implant or fusion for Hallux Limitus since it works well normally (at least for many years).

The doctor also removed screws in my feet from the previous surgery and he shaved a “bunionette” off the right side of my left foot, so in August I had two parts of my foot worked on. I was healing okay until I tripped about six weeks later and broke my middle toe on that same foot. This set me back immensely.

My second bone spur surgery was in March, 2012 on my right foot.I was healing well, in general, and was running by fall of 2012 just a little. I did lots of yoga until I injured my left foot in January 2013. I took time off and by March, got a cortisone shot in my left foot. I had had one in 2012 at some point for swelling. I began physical therapy in March/April of 2013 and had been seeing my PT currently once every two weeks. I'm now upping it to once a week.

Current problems since June: Metatarsalgia, sesamoiditis, arthritis, poor flexion in the ankle due to tight calves (and on my feet all day due to teaching), thin padding on the bottom of the feet and stressed metatarsal heads, minor pain from Taylor's bunion on right foot. Left foot, overall, is much worse than right. I tried a chiropractor this summer with no positive outcome. I sometimes get acupuncture and massage. I'm also wearing a metatarsal pad, mainly on my left foot (Jill's Gels) and am now trying toe stretchers. I have rocker-bottom shoes and have been unsuccessful with new orthotics.

Another orthopod is recommending surgery to align the metatarsal heads. I have a second opinion upcoming with another orthopod. I am also considering a visit to the Mayo Foot/Ankle Clinic in Arizona. I will do anything to get my mobility back. If you have any advice as to who to see or how to proceed, I would be so grateful. I am very lost on this journey.

Best Regards and thank you for what you do.

Sara (name changed)

Dr Blake's response:

Hey Sara, thank you so very much for your email. I will try to help you. Your journey is not unusual unfortunately for many patients that have bunions and probably some underlying arthritis. But, it has been alot of surgery for you. I would be cautious about more surgery at this point, since something must be amiss. Someone has to explain how you got to this point in so much pain. And then explain what can be done for it. Since your pain is so widespread across your left foot, you should be in a removable boot for 3 months to place that foot in the Immobilization Phase of Rehab. During that 3 months, get MRIs (if affordable) on both feet to see what is wrong. Have someone into orthotics figure out how to off weight sore areas. Daily ice both feet 3 times daily for 10-15 minutes to cool them down, and take NSAIDs. Try to analyze the % of pain from each area. When you present to the medical profession with these issues, it is overwhelming. Focus on one problem (the most problematic) if possible and get that well, then move on to lesser problems. See a pain specialist if you are having trouble with day to day activities, or if the present docs can not help with the pain. Pain causes more pain, and you can get into vicious cycles. Check the information on this blog on handling nerve pain. I hope this helps somewhat. Rich

Monday, April 7, 2014

Monday's Image of the Week: Use Velcro to Prevent Orthotic Slippage

The 3 images below demonstrate the use of velcro (rough side on orthotic devices, soft side on the shoe) to prevent the orthotic device from slipping around in the shoe. For some shoes, only the heel velcro is crucial.

Sunday, April 6, 2014

You Tube Video Summary: An Initial Attempt to Organize for You

· Nerve Pain
1. Neural Flossing for Nerve Pain/Hypersensitivity https://www.youtube.com/watch?v=Xs8Cl39LXQg
2. Peroneal Nerve Damage https://www.youtube.com/watch?v=KZFHR_Ldv7E
3. Foot Nerve Pain: Can it come from your Low Back? https://www.youtube.com/watch?v=E0E60NpOSHg

· Hammertoe
1. Hammertoes: Discussion of Treatment Options https://www.youtube.com/watch?v=plTrtNsmPPY
2. Sore Big Toe Taping and Padding Routine https://www.youtube.com/watch?v=J6meUHwm880

· Treatment Tips
1. Toenail Fungus Common Treatment Tips https://www.youtube.com/watch?v=K7LOqqRizrQ
2. Bunion Care Tips
https://www.youtube.com/watch?v=brBH0ZEyJBk
3. Plantar Fasciitis: Common Treatment Tips https://www.youtube.com/watch?v=tfqvi-slHz0
4. Bunions and Non Surgical Treatment
https://www.youtube.com/watch?v=aJgL-h77vrM
5. Blister Treatment https://www.youtube.com/watch?v=3X2L5spGyUI
6. Athletic Injuries: Generalizations on Treatment https://www.youtube.com/watch?v=q91qhbGKjsg
7. Shin Splints: Brief Discussion of Types and Treatment https://www.youtube.com/watch?v=v_Kg52p2hiU

8. Blisters: Self Care
https://www.youtube.com/watch?v=M88MpqQS3OI
9. 5 Common Treatments for Plantar Fasciitis
https://www.youtube.com/watch?v=W03wmryuYjQ
10. RICE Treatment Following Ankle Sprains
https://www.youtube.com/watch?v=o2s9BtfZvNU
11. Swelling: Reduce with Contrast Bathing
https://www.youtube.com/watch?v=rRt5hC24Afg

· Self Help
1. Self Help: How to Ice the Knee
https://www.youtube.com/watch?v=dBfo6Hl_kaU
2. Ankle Sprain: Applying Compression Correctly https://www.youtube.com/watch?v=5_qC2FnS2RU
3. Tailor's Bunion (AKA Bunionette) Self Help https://www.youtube.com/watch?v=cRxKVUPyQfM
4. Scar Breakdown Self Help Principles
https://www.youtube.com/watch?v=47XTZ2VnDBs
5. Ankle Taping Following Sprains or With Pain and Instablity
https://www.youtube.com/watch?v=F3PyQT9ftnA
6. Hallux Rigidus/Hallux Limitus: Self Joint Mobilization https://www.youtube.com/watch?v=FBTeWbdGrzs
7. Power Lacing for Stability
https://www.youtube.com/watch?v=Lj40hKy-uqI

· Rehabilitation
1. Foot and Ankle Rehabilitation https://www.youtube.com/watch?v=g0sD0gUbEMU
2. Crutches: How to Wean Off Crutches https://www.youtube.com/watch?v=1FQndaBenGc
3. Proper Seat Height in Stationary Bike for Injury Rehabilitation HDhttps://www.youtube.com/watch?v=vMiO5N3DqrU
4. Roll A Bout: Help for Injured Feet and Ankles https://www.youtube.com/watch?v=iymbwW30zd8
5. Injury Rehabilitation Principle: KISS or Keep It Simple Stupid
https://www.youtube.com/watch?v=bgh7KSRNSSE

· Posterior Tibial Tendon
1. Posterior Tibial Tendinitis
https://www.youtube.com/watch?v=T47lVsjMEJg
2. Posterior Tibial Tendon Anatomy https://www.youtube.com/watch?v=YPyC0ze2gO4
3. Posterior Tibial Taping Technique https://www.youtube.com/watch?v=e1JAewWT9Fc
4. Posterior Tibial Tendon Dysfunction: Muscle Testing of Involved Tendons
https://www.youtube.com/watch?v=7ilOVqF0aPc
5. Posterior Tibial Tendon Dysfunction with Correction https://www.youtube.com/watch?v=c3WFMcIX_V0
6. Posterior Tibial Tendon Dysfunction treated with Inverted Orthotic Technique
https://www.youtube.com/watch?v=PeD-lG3383A
7. Posterior Tibial Tendon Dysfunction
https://www.youtube.com/watch?v=g7nRXdHbgcA

· Morton’s Neuroma
1. Morton's Neuroma Discussion https://www.youtube.com/watch?v=SoGxR8za59w
2. Evaluation of Morton's Neuroma Pain
https://www.youtube.com/watch?v=_7qNgYNUrmw

· Pain
1. 5 Mechanical Causes of Foot Pain and Leg Pain https://www.youtube.com/watch?v=zbJOmxdFbjs
2. Heel Pain: Various Physical Therapy Techniques
https://www.youtube.com/watch?v=WFz_LV_tzdw
3. Physical Examination of Heel Pain
https://www.youtube.com/watch?v=plbBvPASXwM
4. Help for Sore Metatarsals or Bottom of Foot Sore Spots https://www.youtube.com/watch?v=-v9IrSucQpE

· Drblakehealingsole
1. drblakeshealingsole https://www.youtube.com/watch?v=ybuYIwKL03w

· Podiatry Quiz
1. Podiatry Quiz #4: When to Advance from 2 Crutches to 1 Crutch
https://www.youtube.com/watch?v=O9_d-CdYVik
2. Podiatry Video Quiz #3: What types of Pain should be Avoided?
https://www.youtube.com/watch?v=jN9G_kpxJeY
3. Podiatry Video Quiz #2: Why is the sun important for bone healing?
https://www.youtube.com/watch?v=1V7SGNwIM-Y
4. Podiatry Quiz #1: Achilles Tendons and The Zone of Ischemia
https://www.youtube.com/watch?v=Ym4Sc1r6A-k

· Evaluations
1. Evaluation of Excessive Supination in Stance
https://www.youtube.com/watch?v=H8jK5kxuNYY
2. Basics of Walking Gait Evaluation https://www.youtube.com/watch?v=5SBtTbfELUU
3. Gait Evaluation Demonstrating Shoulder Drop and Limb Dominance
https://www.youtube.com/watch?v=g5uKSXobyt0
4. Gait Evaluation: Basics of Walking Gait Discussed https://www.youtube.com/watch?v=0KH0RlTsjRs

· Plantarfascitis
1. Plantar Fasciitis/Heel Pain: 2 Vital Components of any Orthotic Device
https://www.youtube.com/watch?v=t7KkIGlJmTI
2. Plantar Fasciitis: 3 Important Daily Treatment Areas
https://www.youtube.com/watch?v=azMR3IAQiO4
3. Plantar Fasciitis: The All Important Wall Stretch https://www.youtube.com/watch?v=JZpcapqBnZg

· Bunions
1. Bunion Pain: Or Is It?
https://www.youtube.com/watch?v=2hlZGJPV_ok
2. Bunions: 4 Stages of Development
https://www.youtube.com/watch?v=toNrK040bKQ
3. Taping for Bunions https://www.youtube.com/watch?v=uD348O7pKwo

1. Miscellaneous
1. High Heel Shoes: Biomechanical Considerations https://www.youtube.com/watch?v=VWaMbMvFM1Q
2. Children's Flat Feet: Dr Ronald Valmassy discusses the Role of Pre-Fabricated Orthotic Devices
https://www.youtube.com/watch?v=tlDEfeIYAnA
3. Falling?? Some Common Sense Help to Avoid Falls https://www.youtube.com/watch?v=smoHY3YZins
4. Shoe Flexion Test: A Must Exam for Shoes
https://www.youtube.com/watch?v=GgLauvtD0Ok
5. Melanomas: Use Ample Sunscreen on Your Toes https://www.youtube.com/watch?v=vr6i52TBji4