Foot and Ankle Problems By Dr. Richard Blake

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

2026-01-01T09:07:00.000-08:00

"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

2026-01-01T08:44:00.000-08:00

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

A New Non Opiod Pain Med to Watch

2025-12-30T07:45:00.000-08:00

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.

Isometric Exercises Help Lower High Blood Pressure

2025-12-27T05:20:00.000-08:00

Here is an excellent article highlighting the benefits of using isometric exercises to lower high blood pressure !

https://www.aarp.org/health/healthy-living/best-exercise-to-lower-blood-pressure/?cmp=EMC-DSM-NLC-OTH-WBLTR-2002400-2095010-9862504-NA-12262025-Webletter-MS5-NA-BTN-NA-Health&encparam=whSL9LXkRLAnqPiCm04mAeD4JatvP4Rvj23BXPQkKL4=

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

2025-12-23T07:56:00.000-08:00

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.

https://www.sciencedirect.com/science/article/abs/pii/S0268003305000720

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

Pointy Medieval Shoes

2025-10-30T17:34:00.000-07:00

https://historyfacts.com/world-history/article/why-did-medieval-people-wear-pointy-shoes/?email=sffootdoc%40aol.com&lctg=1c5f8784-7c0f-4c65-899b-901945273a2e&sub_level=L1&sub_source=email_daily&utm_campaign=3106504896&utm_content=email_daily&utm_medium=email&utm_source=19746354

LDN a great Help for Many with Fibromyalgia

2025-10-30T09:10:00.000-07:00

https://www.medscape.com/viewarticle/label-treatment-helps-many-fibromyalgia-2025a1000tjm?ecd=wnl_dne1_251030_MSCPEDIT_etid7837059&uac=399573HX&impID=7837059

Sesamoid Fractures Handout Reviewed

2025-07-28T12:03:00.000-07:00

flow.

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

Bone Stimulator (Exogen) – Use daily for 6–9 months to enhance healing.
Boot or Stiff-Soled Shoe – Wear consistently for 3 months to keep pain at or below 0–2.
Ice and Contrast Baths – Ice twice daily + nightly contrast baths (twice on days off) to reduce inflammation and swelling.
Custom Orthotics – Designed during the first 3 months to offload pressure from the sesamoids.
Dancer’s Pads – Learn to make and use these felt pads to relieve pressure (adhesive felt from Moore Medical works well).
Spica Taping – Learn taping techniques for use after the boot phase.
No Barefoot Walking – Always wear protective footwear, even at home.
Stay Fit – Begin safe cardio, core, foot, and ankle exercises as early as possible.
Nutrition Check – Ensure good intake of Vitamin D, Calcium, Magnesium, Zinc, and screen for bone density issues.
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.

Video discussing Sesamoid Fractures and use of Xrays

2025-06-25T13:22:00.000-07:00

https://www.youtube.com/watch?v=I-SQjmo-hIc

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

2025-05-31T20:00:00.000-07:00

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.

Biomechanics: Mentoring the New Generation of Podiatrists

2025-05-13T05:32:00.000-07:00

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.

Article on Sesamoid Surgery and Return to Athletics

2025-03-16T11:52:00.000-07:00

https://journals.sagepub.com/doi/10.1177/0363546520962518

Sesamoid Injuries: Thoughts on Chronic Inflammation

2024-12-22T06:50:00.000-08:00

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

Tiem Bike Shoes with Embedded Cleats

2024-11-15T06:24:00.005-08:00

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

Good article about the Positive Effects of Daily Walking

2024-10-31T07:07:00.000-07:00

https://www.runnersworld.com/runners-stories/a62696452/30-day-walking-challenge/?fbclid=IwY2xjawGQbW5leHRuA2FlbQIxMQABHW29s2RxeMd0VQo3ghdUvW-ioWTrLQRmY9OvGDj5T8_eJAIZYzQRQ8kJ8w_aem_-1wG9vqnua-UH4t2-AiJ4Q

Great Biomechanics Seminar in November: Please read by Facebook Post

2024-08-18T07:01:00.000-07:00

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

Recurring Bunions: Great Article on some Predisposing Factors

2024-07-03T09:28:00.000-07:00

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322783/

Chronic Sesamoid Pain: Possible Relationship to the Presence of Bunions

2024-06-30T10:30:00.000-07:00

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

8 Fitness Myths to Reconsider: Definitely a Worthwhile article

2024-04-27T13:36:00.000-07:00

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

Ice Submersion for Acute Injuries

2024-03-22T20:07:00.000-07:00

Great video on Diagnosing Plantar Plate Tears on MRI

2024-03-16T08:29:00.000-07:00

https://youtu.be/JQxweI_KJzY

Excellent Article about Rotating Different Types of Shoes: Great Common Sense

2024-02-28T21:35:00.000-08:00

https://run.outsideonline.com/gear/the-three-different-shoes-every-runner-needs/

Sesamoid Fracture presenting as a BiPartite Sesamoid

2024-02-08T21:04:00.000-08:00

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

NSAIDS (like advil and aleve) can Affect Bone Healing

2024-01-19T08:34:00.000-08:00

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/

Sesamoid Fractures: Typical Orthopedic Approach with Comments

2024-01-16T18:52:00.000-08:00

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