Blister Care: An Exerpt from my Book

Here is an exerpt from Dr. Blake's Book "Secrets to Keep Moving: A Guide from a Podiatrist"

8. Blisters/Calluses

    The top 20 treatment tips for blisters are:

1. Always drain blisters as soon as possible and use a sterile pin or needle.
2. Sterilize the needle or pin with rubbing alcohol or passing it through a flame, when letting it cool for 30 seconds.
3. Before performing the procedure, and try to make Marcus Welby MD proud, make sure you have topical antibiotic, bandaids big enough to cover completely, gauze to collect the fluid, and moleskin or athletic tape to cover the band aid.
4. Push the fluid towards one side of the blister and puncture the dead top layer of skin keeping the needle/pin parallel with the skin, sort of above the fluid.
5. Do not push the needle/pin into the live, deep layers of skin below the fluid.
6. You must puncture the skin 3 to 5 times in different places to ensure that the top will not just reseal over and allow a new blister to form.
7. Even with the best intentions, 30% of all blisters have to be popped again.
8. After popping the blister, soak in warm water in a basin with two tablespoons of any type of salt for 30 to 60 minutes (the longer the better) to pull out the fluid. I do like the sound of the SALTS from the DEAD SEA.
9. After soaking, dry off the blister well, apply topical antibiotic over the holes made by the needle/pin, or any other exposed, open skin, and cover with a band aid(s) bigger than the size of the blister.
10. Place with firm pressure tape or moleskin over the band aid(s) to give an added push on the roof of the blister to re-seal with the underlying skin.
11. Take off the dressing twice daily to soak for 30 minutes until all the soreness is gone. It is so important to continue soaking until the soreness is gone to pull out extra fluid and inflammation. This can take 1 to 7 days based on the size and depth of the blister.
12. Once the soreness is gone, the dressing can be removed except when you are in a situation that a re-blister may occur (perhaps that next hike!).
13. Keep moleskin or tape over the old blister area for 2 weeks more to protect against re-blister. It is extremely important to massage softening creams or moisturizers into the area for these 2 weeks to re-soften the skin. Massage twice daily for 2 minutes. All the soaking you do in the first week dries the skin and deep tissues.
14. The goal is to get the skin soft again and the deep tissue not inflamed.
15. When the blistering process is severe with skin breakdown and exposed deep tissue (loss of the roof), use one of the over the counter medicines in the water while you soak. See if your pharmacy has any one of these powders or liquids: Domboros, Pediboros, Bluboros, and Burrows Solution. Follow the directions for concentrations.
16. The medicated powders or solutions listed above are so powerful drying agents that you immediately have to twice daily use the softening/moisturizing creams on the skin.
17. With the severe blistering, more skin protection is also needed like big squares of moleskin attached only to good skin, Silvadene-like silver tainted ointments, and perhaps some padding. The silver ointments are anti-bacterial as well as great for the skin. Ask the pharmacy.
18. What if the blister is possibly infected? So you pop the blister and pus comes out, immediately see a doctor.
19. What if the blister has blood? Blood is the food of infection. Blood blisters must be taken a lot more seriously, and drained as quickly as possible. If you think it is getting or is infected, see above and see a doctor.
20. Every year I have to have an infected blister hospitalized or, at least, see an infectious disease specialist. I hate infections!!

 

Calluses: Treatment for when they become Painful

Hi Dr. Blake,

 

I have come to see you in the past at the Sports Center for an ankle sprain. I have a question unrelated to the sprain and would like your advise. When I sprained my ankle I was training for my first half marathon. I started to get a callus on the ball of my left foot and that has now developed a corn on top of it. At first it would not bother me too much but as I continued to train it got worse and worse. Now after my training is over and, I admit, wearing not cushioned enough shoes it has gotten MUCH worse and has become very painful. For the past four weeks I have tried self medicating it with those pad treatments from the drugstore. I think I have tried them all at this point, the Dr Scholls brands, and it is still there and still painful. Now even with no pressure on it, there is still a lingering pain. Is there anything else I could do/try myself or is it time to come in?

 

I appreciate your time,

 

Jessica

 

 

Dear Jessica, Thanks for your email.

 

    Usually calluses and corns only become painful when they have grown too deep into your foot and are now irritating the soft tissue under the skin. It is the corn on top of the callus which is usually the most painful and bores deep into the skin, normally called "seed corns".

 

    As the picture above notes, these calluses can be like "gluing rocks to your foot", and can be multi-layered with variable depths with each layer. The hardness of the corn irritates the soft tissue under the skin which contains a rich supply of nerves. You can get a deep blister, very painful, underneath the callus, and so deep that it is difficult to reduce. But the blister part is irritated with massage, even gentle massage with a pumice stone.

    It is best to approach these very sore calluses with softening creams (ask the pharmacist for a great hydrator) three times a day, avoid skin irritants like the Dr Scholl's plasters with acid, lay the sore area on an reusable ice pack 15 minutes 3 times daily to reduce soft tissue swelling, try 1 session of 30 minutes cool water soak daily (the longer the better), and gentle removal with a callus scraper (like Ped-Egg) daily for 2-3 minutes to gradually reduce the callus.

 

    A trip to a Podiatrist would help make the diagnosis of callus, blister, or wart (since many of these painful calluses are actually warts under the callus), and speed up the callus removal by weeks since they can use very sharp instruments, plus place appropriate padding in your athletic shoes to off-weight the painful area.

 

    No matter what, the callus has become something else, since calluses (which are dead skin) do not hurt. It is how the skin around them reacts that produces the pain. Or is there a wart or deep blister needing other treatments. I hope this helps. Rich

 



Tumeric: If you have Inflammation, don't forget the Tumeric

I love some on and off routine with NSAIDs, 5 days on and 2 days off, or 10 days on 4 days off. During the off days, many of my patients have been doubling up on the icing and adding Tumeric. Some are just switching to tumeric for all their anti-inflammatory needs. Make sure you read about it, especially side-effects or contra-indications before taking. Rich

http://www.webmd.com/vitamins-supplements/ingredientmono-662-turmeric.aspx?activeingredientid=662

Peripheral Neuropathy: WalkJoy Device a Possible Help

This product I have no experience with, but I really could not find anything wrong. If any of my readers have some information, please comment on this post. Thank you. Rich

Dr. Blake,

WalkJoy is the only FDA approved device to help reduce falls and foot ulcers for patients with peripheral neuropathy.  We'd love to see if we can help some of your patients.  Attached is a flier and a few testimonials.

Cheers,

Blain

Testimonials from Patients

“Life Changing”

Thank you to The Foundation For Peripheral Neuropathy for introducing me to WalkJoy, Inc.  I am a 78 year old retired Plastic Surgeon. I had a major back surgery 9 years ago with total success. Post-surgery, I noted there was a burning in both feet and the surgeon said it could not be repaired. Over the next few years, I was told I had Peripheral Neuropathy, etiology unknown. The burning went away, but I had complete numbness resulting in loss of balance that slowly developed into full blown problems that were debilitating. After two years, my EMG showed destruction of the axons and myelin.

I have been using the WalkJoy for several months now and am thrilled with the results that have been fabulous. I play golf 6 days a week with amazing balance, improving my game and I am using the treadmill with increasing speed. Socially I feel more comfortable in movies and getting up from a table. My general walking has increasing length of strides and my improved balance is life changing for me. I am grateful for the wonderful way my active life has improved.

I sincerely hope more neurologists are made aware of the WalkJoy product to make their patient’s lives much better.                                 Larry R. MD FACS    Palm Beach Gardens, FL

“I feel more stable and in control.”

I am an 80-year-old male and I have had idiopathic axonal sensory peripheral neuropathy for at least 10 years.  It has progressed to the point where I have no sensory nerve response from my toes to below the knees.  As a result, my balance is very poor and I use a cane.  I was becoming sedentary as my ability to maintain my balance declined. I read about the WalkJoy units in my Neuropathy Association newsletter and decided to give them a try.

What a difference they make!  I wear the WalkJoy units nearly full time.  When walking I am able to increase my stride and speed, and I feel more stable and in control. I walk several miles a day for exercise, and my neighbors have commented on my improved mobility.

I feel the WalkJoy units are enabling me to avoid having to use a walker, and ultimately a wheel chair.  I am very pleased with my increased mobility.  Thank you, WalkJoy!"                                                        Lee M.  Modesto, CA

“My first reaction…was astonishment.”

My first reaction to trying out the WalkJoy units was astonishment. Within about a dozen paces, I was walking with an almost normal gait. All without feeling anything detectable from the units.

I am 92 years old and have had idiopathic peripheral neuropathy for at least the past dozen years. I have fallen a few times, and I have to watch my feet when I walk. My excellent physical therapist found that I still have some proprioception (muscle sense) available in my feet, and exercises have helped improve my balance.

The improvement when using WalkJoy is clear and almost immediately evident to me. I now wear them most of the day, every day. There is a temporary residual effect when I take them off, and it takes almost an hour before my walking gait deteriorates. WalkJoy is an excellent product, but it is not, I repeat, not a cure. My balance tests show that without WalkJoy my proprioception is still faulty – especially when I try to stand, unsupported with my eyes closed. Don’t expect miracles.                                                    William T., Ph.D.    Sarasota, FL

“I am able to move with greater ease and balance.”

I have been using WalkJoy for about 6 weeks.  I have peripheral neuropathy so my feet cannot feel the ground.  This has caused me to have poor balance even though I have had balance training in physical therapy.

As soon as I started using Walk Joy my balance improved noticeably.  Smooth, shiny floors (usually marble) have long been a challenge for me, but no longer.  I can now comfortably walk on these floors.  I have also begun to walk my dog again.  I am not as afraid of falling and am more assured when I walk.

I had been frustrated because there is no treatment for the loss of sensation caused by peripheral neuropathy and was thrilled when I learned about WalkJoy.  Thanks to WalkJoy I am able to move with greater ease and balance.                      Janice C.  Falls Church, VA

“WalkJoy has truly changed my mother’s life.”

Walkjoy has truly changed my mother’s life…. seriously. She had tried so many different treatments and nothing worked. Her doctors told her there was no cure for her neuropathy and that she would just have to learn to live with it. This went on for 4 years! Well they were totally wrong! My mom started using the Walkjoy unit’s every day and felt a change (for the better) almost immediately. It has been around 2 weeks now and she is like a new person. Walking around is not an issue anymore. It has not only changed my mothers’ life but ours as well!                                                                Margaret B.  New York, NY

“My Dad has not fallen EVEN Once!”

My Dad could not be happier with the WalkJoy after a little more than three months of use. He has not fallen EVEN ONCE! Daddy is very active and walks outdoors every day. He is now back to walking almost a mile down our local road, as well as back and forth from his tractor shed (about 100 yards from the house) many times all day long. All of his leg and foot wounds have healed (I do not know if it is from the correct walking posture or just from not tripping and falling) and he is able to do so much more of what he likes every day.

Robert D. Houston, TX

“Muscle strength and stamina”

After experiencing nearly 20 years of increasing debilitation due to peripheral neuropathy, he was thrilled to feel the sense of balance and control that WalkJoy gave him! 

Three full weeks have passed now and he has not used his electric scooter once! He relies solely on his walker and cane without fear of falling. With each day of renewed confidence in his balance and stability, he has been able to increase his walking and exercise activities. As a result, both his muscle strength and stamina are slowly returning.

WalkJoy is an excellent product with the potential to change lives! We are so grateful to have been introduced to it.

John and CeCe H.  Santa Barbara, CA

http://www.walkjoy.com/

Final Examination Questions from Sports Medicine Classes

1.   Which of the following treatment modalities is not part of a podiatric sports medicine practice?

• A) stretching exercises
• B) Graston massage
• C) strengthening exercises
• D) anti-inflammatory treatments
• E) shoe recommendations

Answer: B

       2.   Which of the below is not part of the phases of rehabilitation?

• A) Re-Stretching Phase
• B) Immobilization Phase
• C) Return to Activity Phase
• D) Re-Strengthening Phase

Answer: A

        3.   What pain level is considered part of a good healing environment if maintained?

• A) 0-2
• B) 3-5
• C) 6-8
• D) 3-8

Answer: A

        4.   Which of the following is not one of the categories of the 3 types of pain?

• A) neuropathic
• B) inflammatory
• C) implied
• D) mechanical

Answer: C

        5.    The weakest link in the chain concept can explain why over pronation can cause knee pain                  and many other conditions. When looking for the cause of an overuse injury, Dr Blake                          recommends finding how many causes?

• A) one
• B) three
• C) five
• D) seven

Answer: B

        6.   Golden Rules are what you live and practice by. Typically they are unbreakable. Which one                 of these is not a Golden Rule for the podiatry profession?

• A) Stretching should never be done with pain.
• B) Good arch support is crucial in managing posterior tibial tendinitis.
• C) Bunion surgery should always leave the patient with some Hallux Varus.
• D) When treating a patient in an unfamiliar sport, it is important to learn the mechanics of that        sport.

Answer: C

        7.   When treating an acute injury, which letter is not part of the normal nmeumonic?

• A) I
• B) S
• C) P
• D) C

Answer: B

        8.   When examining a ligament sprain, which degree is determined when ecchymosis is seen, and joint mobility is excessive in at least one direction?

• A) 1st
• B) 2nd
• C) 3rd
• D) 4th

Answer: C

         9.   When we make a diagnosis of an overuse injury, the Law of Parsimony tends to at least                         point to one of the causes. Which of the following is not a Law of Parsimony?

• A) Achilles Tendinitis----loose achilles tendons
• B) Morton's Neuroma----tight fitting shoes
• C) Plantar Fasciitis----over pronation
• D) Peroneal Tendinitis----over supination

Answer: A

       10.   Humans naturally make Vitamin D3. What is the lab test for this?

• A) 22-alkyvitamin D\
• B) 25-hydroxyvitamin D
• C) 27-acetylvitamin D\
• D) 3-alphavitamin D

Answer: B

       11.   What sport sees the most cases of Ilio-Tibial Band Syndrome?

• A) Biking
• B) Hiking
• C) Alpine Skiing
• D) Running
• E) Boxing

Answer: D

       12.   In what ankle position do you strengthen the peroneus longus?

• A) Dorsiflexion Inversion
• B) Dorsiflexion Eversion
• C) Plantarflexion Inversion
• D) Plantarflexion Eversion
• E) Plantarflexion Extension

Answer: B

       13.   Which one is not a primary treatment for plantar fasciitis?

• A) Arch Support
• B) Strengthening
• C) Stretching
• D) Anti-Inflammatory

Answer: B

       14.   Which is not a type of shin splint?

• A) Anterior
• B) Deep Anterior
• C) Lateral
• D) Deep Posterior

Answer: B

       15.   What is the normal pressure in a leg compartment at rest?

• A) 0-4 mm Hg
• B) 10-15 mm Hg
• C) 30-40 mm Hg
• D) 40-44 mm Hg

Answer: A

       16.   What is the weakest of the knee muscles?

• A) Vastus Lateralis
• B) Vastus Intermedius
• C) Rectus Femoris
• D) Vastus Medialis

Answer: D

       17.   In terms of managing heel pain, which statement is false?

• A) Night splints for plantar fasciits are typically very useful.
• B) Orthotic design for heel pain is to shift weight into the arch.
• C) Stretching of the plantar fascia is typically better by counting to 30 versus taking 5 deep breaths.
• D) All heel stretches should be done with the heel on the ground. 

Answer: C

       18.   The name of the tape method to limit big toe joint motion is?

• A) Budin
• B) Spica
• C) McConnell
• D) Dye

Answer: B

      19.   What condition is not related to excessive supination?

• A) Peroneal tendinitis
• B) Fifth metatarsal stress fractures
• C) Sinus tarsiitis
• D) Ilio-Tibial Band syndrome

Answer: C

       20.   The general rule of days cast immobilized versus days needed for rehabilitation are:

• A) 1:1
• B) 1:2
• C) 1:3
• D) 1:4

Answer: B

Still need to send a Great Christmas Gift: An eBook from Dr Blake!!

With Christmas here is several days, and so many ski, basketball, ballet, and gym injuries, your family and friends will so appreciate Dr Blake's eBook delivered right to their inbox!!

https://play.google.com/store/books/details?id=B-tcDQAAQBAJ&rdid=book-B-tcDQAAQBAJ&rdot=1&source=gbs_vpt_read&pcampaignid=books_booksearch_viewport

Free eBook to My 126 Followers

Special Book Offer to my 126 Followers to Date!!

12 days ago I placed this great offer and 14 of my followers took me up on this! Please I am happy to send you guys my eBook for free!! Happy Holidays!!

For most of my readers, my health problems have been kept secret. Sort of like this book. But, I had a small stroke in August and could not do a 300 mile walk in Northern Spain I had dreamt about for years. So, it was a year of disappointment and poor health, but I am doing fine. And, I am forever grateful for what I have. I want to thank my 126 followers by offering a free eBook to them if they email me at drblakeshealingsole@gmail.com with an email address to send the eBook. It is a good way for me to say thank you and not take them for granted. They have been very faithful. This offer is only good for them until 1/1/17, and I ask they contact the book retailers with a review that is in their heart. Good or Bad, whatever. This book is who I am. How many get to say that!! Love you all. And thank you. 

My Book on Amazon!!! Secrets to Keep Moving: A Guide from a Podiatrist

Since I have brought many many books from Amazon over the years, I am so pleased today that Amazon just released my book. If you do get it, book or ebook, please be kind to write a review so Amazon will like having me. Thank you so very much!!

https://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=Secrets+to+Keep+Moving%3A+A+Guide+from+a+Podiatrist

Happy Holidays!!!

I wanted to take this time to cherish the moment we are in. What ever our plight, we hopefully can feel blessed in some way (even if you are not religious). We all have a spiritual side, some more hidden than others. We all need to stop for moments in our lives and reflect on the goodness we see or feel. The Holidays and the start of a new year are the perfect times to reflect in this way. Thank you all for being a relatively new, but extremely important, part of my life. I try to be a source of common sense in the medical world. I had a health scare this year, a wake up call if I choose to make a change. We all get these from time to time. They are all in some way gifts to us. Sometimes apparent, other times not so. So whatever your religious event this season, vow to stop and cherish your loved ones, those who help you in some way get from day to day, They may be the biggest and brightest and most meaningful gifts you receive. 

From the author of this one blog: Happy Holidays!!

Subtalar Joint: An Illustration from Dr Kevin Kiby

I could spend my whole life studying this one fascinating foot joint. The bottom half of the ankle is the talus bone. Under the talus bone, is the calcaneus AKA heel pain. The joint between the talus and the calcaneus is the subtalar meaning below the talus. I can even get that one!!

Foundation for Peripheral Neuropathy

This look like a good source of information on peripheral nerves coming off the spinal cord. I look forward to explore over the next few weeks. 

Golden Rule of Foot: Look at a Nerve Wrong and it will hurt for 9 months!

https://www.foundationforpn.org/2016/11/09/foundation-for-peripheral-neuropathy-celebrates-10th-anniversary/

Sesamoid Blood Supply: Anatomy Discussed

The main blood supply to the sesamoids comes proximally (or from the arch) and plantarly (or from the bottom). Most of the sesamoid fractures do occur centrally where there is deceit blood supply. Right from the start of the injury, the bone swelling, which can cut off that circulation must be managed by creating a pain free environment: off weighting, icing, contrast bathing, elevation, etc. 

https://www.ncbi.nlm.nih.gov/pubmed/1398368

AASPM: American Academy of Podiatric Sports Medicine to find great podiatrists

I have attached a link to the prestigious organization near and dear to my heart. These are a group of fairly like minded sports podiatrists that care that you keep moving. You can go to the members section to find one near you (unless you are near the north pole!) Rich

http://www.aapsm.org/emails/newsletters-1216.htm

Neural Flossing the Peroneal or Tibial Nerves: Advanced Video with some Caution

I have always taught a very simple sciatic nerve flossing for nerve symptoms. These exercises (by Drs Abelson and Mylanos) are much more stressful to the nerves, but may be able to produce better results. Do any exercise once or twice, and initially avoid the head tilts. Also, initially sit with good support behind your back. Do once a day for several days, then gradually up the exercises to 3 times a day if you see results. Nerves are funny. Positives results mean that numbness gets less, but pain also gets less. Pretty much the nerve is coming back to normal sensation. Because the cause of the nerve symptoms can be a bulging disc in the back, any back symptoms which increase means you need to stop doing the exercise until you are evaluated. Some modification may be more appropriate. These exercise the peroneal nerve. The tibial nerve is done with the foot pointed and flexed back and forth, with the same knee and hip motions or positions. You just take out the foot inversion you see that stretch the peroneal nerve. When patients come in with nerve symptoms, I like gentle neural flossing, topical Neuro-Eze, warmth (not ice), and discovering what positions really make it act up (sitting, sleeping, lifting, etc.) Hope this helps. Rich

https://youtu.be/vk9YElLm57Y

Sesamoid Pain and Need of Night Protection

Hi Dr Blake,

I'm hoping you may have some advice for me.

It appears that i have a lateral sesamoid fracture and according to the MRI possible Avascular Necrosis (the bone round with a central fracture was showing black).  I don't have the images with me at this time, however the sesamoid still appears whole with a fracture line showing down the centre (my podiatrist described it as fragmented?).  He also questioned whether my pain was coming from the avascular necrosis or whether it was A. a disruption of the fibrous connection between the fragmented sesamoid or B. from a tear in the flexor tendon and joint ligament.

Dr Blake's comment: That is alot of possible causes of pain, all plausible, but typically the the treatment right now is the same. As the soreness goes down, they can test the flexor better, and see if it is torn. You can typically tell if it is a complete tear, but the subtle partial tears are tricky. Fractures should coming from impact, where tears for a fall or more stressful non-weight bearing activities. 

At first my dr. thought he would need to put me in a walking boot, however now the swelling has gone i seem to be able to walk ok (usually with pain under a 2) in my sneakers that have been altered (with a dancers pad and arch support) so he has left me in those for a week and asked me to check back in with him to see how i'm going.  I did ask about bone stimulation and hot and cold baths at my appointment (as i'm quite desperate , as we all are, to get my foot well again), but he said at this stage it's probably not necessary just yet.  We went with sneakers over moon boot because last week the pain was not bad at all.

Dr Blake's comment: It is all about timing, although with the threat of avn you definitely should push for a 9 month course of bone stim. The Exogen is  a mere 20 minutes a day. Contrast bathing is also a no-brainer, since you have to keep the swelling lighting up the bone flushed out on a daily basis.

So far i do have confidence in my podiatrist, however i thought i'd get your opinion on a couple of things as i've been reading up on your blog and so far have found the info on sesamoids quite informative and interesting.

What i would like to know is (without seeing the mri), would you normally see how it goes before jumping into using bone stimulation and hot and cold baths or would you prescribe them straight away in order to get on top of the avascular necrosis? 

Dr Blake's comment: Answered above. Great question.

Also, though walking is fine most of the time I seem to keep re-injuring my big toe/sesamoid (to where i can't bear to walk the next day) - not from walking, but from sleeping!  I seem to catapult myself from side to side all night using my injured foot and am waking 3 or 4 times in pain. It seems i do this once a week and the next day i literally can't walk at all from the pain.  I even tried out the moon boot with my altered orthotic (i have one on hand) and it was just as painful as the sneaker only more annoying.  I did this to myself again on Saturday night and by sunday afternoon i was at a level 9 in pain.  This morning (monday) it was still painful and i limped a bit, but now as it's the afternoon i seem to be back to about a 3 (though my whole toe bone still feels tender). Have you come across this before?  Is there any type of protection - support or taping that you could suggest i wear at night on my injured foot to minimise any damage i may do unconsciously?  I generally try to sleep with a wooly sock on my injured foot as a subconscious reminder and elevate it on a pillow, but it doesn't always work.  My feeling is that without these episodes of re-injury during sleep, i would be doing quite well pain wise and probably be on the road to recovery.

Dr Blake's comment: I would definitely recommend a ulcer guard for sleeping. This should protect you. The 2 links below can be bought or shown to the podiatrist for consultation and correct sizing. He or she may have another ulcer protector that they like. 

https://www.mooremedical.com/index.cfm?/Prevalon%C2%AE-Pressure-Relieving-Heel-Protector/&PG=CTL&CS=HOM&FN=ProductDetail&PID=26757&spx=1

http://www.alimed.com/foot-stabilizer.html?atrkid=V3ADWA342718F_20842380364_pla-151151577124__66599241844_g_c_pla__1o6&gclid=Cj0KEQiAsrnCBRCTs7nqwrm6pcYBEiQAcQSznAe0lu6lFnYY5jvYSayESipTJVilbgaUmhyyJrFhK3YaAmu18P8HAQ

Just for a bit of general info: 

- It's been 2 weeks since i first realised i had the fracture after experiencing enough pain to go to a podiatrist. The podiatrist thinks my injury is older than 2 weeks (i think i can trace it back to a year ago when i sprained my foot/ankle and the GP i saw didn't think i needed an xray so i just waited til it felt a bit better then continued on - though i was hobbling around for the first 2 months of the year and it in general has been pretty delicate since - mainly just burning in my arches and ball of foot when jumping or exercising and me being very cautious about rolling it outwards).  

- This time when i injured it, it happened the very day i returned to doing some jumping exercises after i'd taken 2 months off (self imposed) from jumping due to what i thought was turf toe - brought on from my catapulting myself from my mattress in the middle of the night).

- I have seen my naturopath and gotten all the right supplements to help both bone growth and circulation and will be returning to some swimming and light (non weight bearing exercises) this week.

The only problem to sort now seems to be the nightly gymnastics that are hindering any recovery attempts.

Sorry for the long email for only 2 actual questions!

Any help is appreciated.

Cheers,

p.s. i'm 35 and my past history is gymnastics (though that was 20 years ago so i'm sure it's not a fracture from that far back, though who knows - i've injured this exact foot/leg many times over the years).

Dr Blake's comment: I hope the above was helpful. Let me know if I can help more. Happy Holidays!! Rich

Skin and Subcutaneous Fat Atrophy Post Cortisone Shot: Typically a Reversible Complication

Every now and again, a cortisone shot can cause skin and subQ atrophy. I noticeable indent is noted at the site of the injection. I was just asked in an email if this was reversible, and I have always seen it almost completely reverse itself. I have told my patients around 9 months, and this article says 6 months to 2 years.

See the post shot discoloration on the right foot

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903862/

My Book on Sale!! Secrets to Keep Moving: A Guide from a Podiatrist

     I am happy to announce that Barnes and Noble is selling my book or eBook at a reduced cost this Christmas!! I also need desperately for people to buy the book or eBook and write a kind review for Barnes and Noble, Amazon, and other book retailers. The book is very unique because of its non-surgical orientation. I sure hope it helps some people. Rich

http://www.barnesandnoble.com/w/secrets-to-keep-moving-dr-richard-blake/1125000461?ean=9781483586557&st=PLA&sid=BNB_DRS_Core+Shopping+Books_00000000&2sid=Google_&sourceId=PLGoP62465

http://www.barnesandnoble.com/w/secrets-to-keep-moving-dr-richard-blake/1125000461?type=eBook

Heel Pain: Adjusting the Removable Boot

Sometimes I am very proud of myself. This nice lady tore her plantar fascia and was prescribed a walking boot for 3 months. When she came in with the boot, and since her heel was swollen, she was still hurting about at a level 8 out of 10. Here I am using two 1/4 inch pads of adhesive felt from Moore Medical to fashion an off weight bearing pad for her heel on my work bench. With the instructions to land full foot, not heel strike, the pain decreased to the healing 0-2 pain level. She has a lot to do with the inflammation over the next 6 weeks with icing and contrast bathing also. 

You can see the heel is floated with the weight on the 1/2 inch front pad.

Here is the roll of 1/4 adhesive felt I was using. If you don't want to wait, use other materials, like shoe inserts, and try to create the same float idea. You too can be as brillant as I was this day. LOL

https://www.mooremedical.com/Index.cfm?Ntk=all&No=0&Search=Search&Ns=TotalRevenue%7C1&Ntx=mode+matchpartialmax&Ntt=adhesive+felt

Cortisone Helps the Pain from a Neuroma But Not the Numbness: Email Response

I had a cortisone injection a month ago in my neuroma and am super happy that the pain is gone and I can walk several miles in my wide toes shoes with arch supports in :) however I still have toe numbness which I thought meant that the neuroma wasn't quite better since that was my early symptom, before I realized there was an issue with my foot -- the Dr.'s office told me this is normal and additional injections would only cause more numbness -- I would like to understand why this is and they were unable to explain it in a way that made sense to me. thanks

Dr Blake's response: 

Thank you so much for the question. Any abnormal pressure on the nerve from the bones and swelling can cause numbness, pain, or a combo. In your case, the pressure of walking, and maybe some other cause of nerve tension (low back) is causing the numbness, with the pain from the swelling pushing against the nerve. All the cortisone did was to shrink down the swelling, so we know that caused the pain. But, the pressure against the nerve is still there, thus the numbness remains. Hope this helps. Part of your treatment should be metatarsal supports behind the nerve to take some pressure off the nerve, a look at the low back or other sources of nerve irritation, an understanding of what stresses out the sciatic nerve and how to avoid it, and perhaps the numbness will slowly get better. Rich

Navicular Pain: Email Advice

Hi there Dr. Blake!

Searching around the internet I came across your blog and I'm hoping you can help me?

I have been suffering from pain of the navicular bone and all around the navicular bone.  As you can see from the photos, it sticks waaay out, although X-rays have come back "normal"?? 

Dr Blake's comment: I did not receive the attachment with the photos, but an MRI should be done to look at the 3 dimensions of the injury. 

 The attacks began in August (it is now early Dec) and are becoming increasingly frequent.  These attacks begin as twinges in the medial area of my left foot, the area then burns and on occasion swells.  The attacks are leaving me hobbled and unable to weight-bear.  

This doesn't work for me as I am an active primary school teacher, I don't even have a chair at my desk, that's how little I sit!  I'm losing work time and this needs to be fixed.

Dr Blake's comment: The problem could be an accessory navicular, and also nerve pain from the back or ankle in the tarsal tunnel. Some patients just have a large navicular than interferes with the posterior tibial tendon and causes tendinitis.  Other than an MRI, you want to treat the area with taping, orthotics, and shoes for great support, and icing right now for 10-15 minutes three times a day for the inflammation. 

  I have seen a podiatrist and chiropodist who have said that my left leg is slightly longer than the right, which has caused my left foot to flatten and is tearing my posterior tibial tendon.  The attacks seem to come on out of nowhere, no rhyme nor reason which is what confuses me.  If I had such an issue, wouldn't the pain be constant? 

Dr Blake's comment: The neuropathic pain, arising from the nerves, typically behaves like this. The cause can be the pronation, which stretches the nerve as it comes around the ankle. Nerves hate to be stretched. Thus, trying to figure out the right amount of support, whether the nerve can take any compression from the tape, and if there is low back involvement. 

 And where did it come from all of a sudden?  I have orthotics coming in mid-December but am worried that they won't help the situation as I have been wearing drug store arch supports and supportive shoes and I still had an attack after a week or two.  I'm so worried I may not be able to exercise anymore!!  Please help!!!  What can I do to properly diagnose and fix this???  I'm hoping to get in to see an orthopaedic surgeon next. But that could take months!!!

Dr Blake's comment: I sure hope a custom device made for you will be better than store bought!! Did the doc who made them thus what was going on, what the role of the orthotics, if they can be adjusted, etc etc. Definitely keep me in the loop. Rich

Thank you in advance,

Caroline Jordan Injured Foot Exercise Videos

I have just got finished reviewing several of this four part series videos. I am totally loving Caroline. I hope you will also. Remember, many of the exercises whether you are injured or not, may be too difficult. But, go slow, listen to your body, and if she says to do 10, start with 2 and work up. You should never have pain during. If any exercise, Caroline's or mine, flares you up, ice several times a day until you are back to normal before restarting if it feels okay. Enjoy. 

https://youtu.be/rCDRf7bEFNA

https://youtu.be/s-nTG_3OFWs

https://youtu.be/WAiPnEHJ-N8

https://youtu.be/1zyq_vFCxjY

Balance: We All Need to Improve

https://youtu.be/mri8YyPHegc

And a previous video:

https://youtu.be/-4OB7wcYTJE