Latest / The Driven Athlete / Foot, Ankle, & Injury Treatments w/ Dr. Suzanne Fuchs | Ep 44

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Foot, Ankle, & Injury Treatments w/ Dr. Suzanne Fuchs | Ep 44 · The Driven Athlete

0:00
Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
0:07
Speaker 1: This is the Driven Athlete Podcast.
0:10
Speaker 1: What's up?
0:12
Speaker 1: Y'all?
0:12
Speaker 1: It's your man, dr Kyle.
0:13
Speaker 1: Welcome back to the Driven Athlete Podcast.
0:16
Speaker 1: We've been graced with the presence of Dr Suzanne Fuchs with us.
0:19
Speaker 1: She's a doctor of podiatry medicine.
0:21
Speaker 1: She's a podiatrist right Right Um up in Jupiter.
0:24
Speaker 1: Well, I appreciate you coming in.
0:25
Speaker 1: I know you're busy.
0:26
Speaker 1: You're always on call.
0:27
Speaker 1: You always got patients going on, so appreciate you coming in.
0:29
Speaker 1: Thank you for having me sharing some insights and um share more of your story and what you do and like how you help people, and your perspective and approach on some stuff we want to dive in on, like on what you do.
0:39
Speaker 1: Um, so anyway, tell us, tell us where you're at.
0:42
Speaker 1: You're in Jupiter.
0:42
Speaker 2: Sure, yeah, my office, my primary office, is in Jupiter, florida.
0:47
Speaker 2: Um, we opened there about.
0:49
Speaker 2: I think it's been over five years, almost six years up there.
0:53
Speaker 2: I started when I moved from New York to Florida.
0:56
Speaker 2: I started in Palm beach gardens, but which isn't far, but we moved up to Jupiter and we love it there.
1:01
Speaker 1: Yeah, that's awesome Such a great part.
1:03
Speaker 1: Where in New York?
1:05
Speaker 2: Where.
1:05
Speaker 1: Yeah, before in New York we got.
1:06
Speaker 2: Oh, I was in.
1:07
Speaker 2: It was a big orthopedic group.
1:09
Speaker 2: It's a multi-specialty group orthopedic.
1:11
Speaker 2: We were in the orthopedic department, sports medicine.
1:14
Speaker 2: It's called ProHealth on Long Island, like the North Shore of Long Island.
1:18
Speaker 1: Oh cool.
1:19
Speaker 1: How was that?
1:20
Speaker 2: Well, there were offices in Long Island, then there were offices in Manhattan, so it was kind of in between a bunch of offices, lots of patients, one of those really big group practices.
1:29
Speaker 1: Yeah, I'm sure like we saw everything.
1:31
Speaker 2: Yeah, it was a great experience.
1:33
Speaker 2: I lived in residency for about five years and then I decided to make the move down here.
1:38
Speaker 1: Cool, yeah, I want to ask.
1:39
Speaker 1: So residency in podiatry, like surgery and sports, or what was the specialty?
1:44
Speaker 2: So um, after podiatry school.
1:47
Speaker 2: So I went to Temple University in Philadelphia for podiatry school and then right after that I did a residency.
1:52
Speaker 2: I went back I'm from New York originally, um, and then I got a great residency.
1:57
Speaker 2: It was called North Shore LIJ.
1:59
Speaker 2: It's now called Northwell Um.
2:01
Speaker 2: That is also in New York on Long Island and basically like Queens, long Island border, and that was all surgical, mostly all surgical.
2:10
Speaker 2: We did some wound care, sports medicine, but mostly surgical.
2:14
Speaker 2: So that was a three-year surgical residency after school.
2:18
Speaker 1: Gotcha, and then you practiced there for.
2:21
Speaker 2: And then I practiced in New Yorkhattan and on long island for about four and a half five years and then you moved down here, and then I moved down here.
2:28
Speaker 1: Cool, and that's when you open your practice and I opened.
2:29
Speaker 2: I just came down here, opened up a practice with a partner.
2:34
Speaker 2: We opened up pretty much cold.
2:36
Speaker 2: We wound up without going to details, but we wound up just opening.
2:39
Speaker 2: We didn't buy practice from anybody, we just kind of knew the area a bit and just opened up, just went after it.
2:44
Speaker 2: Zero patients, and now we're here.
2:47
Speaker 1: Cool, that's the same partner.
2:49
Speaker 2: No, that's another story, a different partner.
2:52
Speaker 2: It's much better now.
2:53
Speaker 1: We moved on and it's worked out, yeah, yeah, yeah, I mean, you always want to grow and make moves, yeah yeah.
2:58
Speaker 1: So you're from New New York, originally Long Island.
3:01
Speaker 2: I'm from Long Island.
3:02
Speaker 2: I grew up pretty much on Long Island and then I moved away.
3:05
Speaker 2: I went to Pennsylvania for school, for undergrad and then for podiatry school.
3:11
Speaker 1: Yeah, Where'd you go in undergrad?
3:12
Speaker 2: University of Pittsburgh.
3:13
Speaker 2: Yeah, so I went to Pitt for undergrad and that's where I decided.
3:18
Speaker 1: Football games fun.
3:18
Speaker 2: Football games.
3:19
Speaker 2: I was really more into the basketball at the time, but both Basketball was great.
3:26
Speaker 1: It was so much fun.
3:26
Speaker 1: I mean, they're always a formidable force.
3:28
Speaker 1: You know men's and women's basketball.
3:30
Speaker 1: Definitely that's cool.
3:31
Speaker 2: Yeah, it was really fun School, a great experience.
3:34
Speaker 2: But then when I got the residency in New York, I wound up going back to New York for the opportunity, but I love Pennsylvania.
3:41
Speaker 1: Cool, I love Pennsylvania.
3:42
Speaker 1: Cool, what made you go into DPM school?
3:44
Speaker 1: Pursue that route.
3:45
Speaker 2: Yeah, so long story short, I was always interested in sports.
3:49
Speaker 2: I was thinking about physical therapy, occupational therapy, sports medicine, and I actually had a friend in school.
3:55
Speaker 2: Her uncle was a podiatrist and she was really into podiatry.
3:59
Speaker 2: So I wound up shadowing a podiatrist.
4:01
Speaker 2: It was a woman, she owned her own practice, did sports surgery, and that was kind of on and off for a few months and I really enjoyed it.
4:08
Speaker 1: So cool yeah.
4:09
Speaker 1: So, that one experience, um observation opportunity, and you're like, oh, this is cool, yeah, yeah.
4:14
Speaker 2: Yeah, it was just something you know you can do.
4:16
Speaker 2: You can make people feel better right away and get them moving better, feeling better.
4:20
Speaker 2: You know whether it's an injection or in office procedure or surgery, but you know orthotics, better footwear, just there's so many ways to even in just in your office, to have people feeling better immediately.
4:33
Speaker 2: So that kind of instant gratification was nice too.
4:37
Speaker 1: Like get some results in buy-in day one versus like going in the office chatting, getting an image and be like okay and like come back Exactly.
4:44
Speaker 2: So I like having, I like to see people and then get doing something or giving them something, whether it's in the office or something at home to do to make them feel better, kind of.
4:54
Speaker 2: You know instantly.
4:55
Speaker 2: And some things take as you know, some things just take longer but, at least to start feeling like they're on the right path Exactly.
5:02
Speaker 1: Yeah, like oh, there's some hope, some encouragement.
5:04
Speaker 1: I was going to say, like we were talking like just a minute ago, about how we're similar practices, that we you know, we're out of network Right, so we live and die off of our results.
5:11
Speaker 1: We give people the word of mouth and just the recommendations like hey, they were great, I had a great experience, and what we can provide and part of that being like day one, like trying hard and giving like an actual um benefit and and um result that you can see and be like oh, helpful hope, hopefulness, encouragement, feeling better.
5:31
Speaker 1: Already this makes sense.
5:33
Speaker 1: I'm on board, you know Um and especially like education.
5:38
Speaker 2: I can't tell you how many patients I see that come to me and they're like nobody ever told me this.
5:43
Speaker 2: Nobody ever explained it to me this way, because we're, at, you know, out of network, we, we are have the.
5:50
Speaker 2: We have the time to actually explain to them their diagnosis, the root cause of it and then the plan in detail.
5:57
Speaker 2: You know most people.
5:58
Speaker 2: They say most people don't remember more than maybe 30% of what the doctor tells them, but in our cases we have some more time to make sure that they understand before they leave, which makes the whole treatment process way better, way better, yeah, better results, totally.
6:14
Speaker 1: No, that's awesome.
6:14
Speaker 1: I hear that all the time too.
6:16
Speaker 1: Like nobody's ever told me this.
6:17
Speaker 1: I'm like what?
6:18
Speaker 1: Well, I think about it.
6:19
Speaker 1: Like, unfortunately, with a lot of very robust and busy health care practices, they don't have the time they don't, they're burnt out.
6:28
Speaker 1: Sure, they're worn out, they're hungry and tired and like they're ready to get out of there and they have like 50 more people to see.
6:34
Speaker 1: You know what I mean.
6:35
Speaker 2: Oh yeah, that's what I tell everybody.
6:36
Speaker 2: I'm like it's not.
6:37
Speaker 2: Not, I'm not blaming them, it's actually just the nature of the beast of health care.
6:43
Speaker 2: Unfortunately, that's kind of how it's going.
6:46
Speaker 1: So that was so cool, that one experience with that podiatrist.
6:49
Speaker 2: Yeah, it was just great.
6:50
Speaker 2: I really enjoyed it.
6:52
Speaker 2: I could see myself doing that and I wound up applying to schools and going to visit schools and talking to some other people and it just seemed to kind of fit what I wanted to do.
7:06
Speaker 1: So sports medicine did you going into?
7:06
Speaker 2: podiatry school, were you like I?
7:07
Speaker 1: don't want to be working with athletic athletes.
7:07
Speaker 2: I always had it in my mind.
7:08
Speaker 2: I mean we were, which was good.
7:10
Speaker 2: I mean we were exposed to so many different things.
7:13
Speaker 2: Like I was saying, wound care we do and I still do, like skin care, nail care of the foot, ankle legs, so I still do that.
7:20
Speaker 2: I do actually enjoy that part as well, and a lot of athletes will get ingrown toenails, you know, like skin, skin infections, athletes, foot things like that.
7:30
Speaker 2: But yeah, we were.
7:31
Speaker 2: I was exposed to so many different things elective procedures like bunionectomies, hammer toes but sports was always a passion of mine and I knew pretty much that's kind of the path I want to do.
7:41
Speaker 2: But it did take time to develop that type of practice and to get the reputation.
7:47
Speaker 2: Yeah, so you kind of have to do whatever in the beginning, and it took time.
7:52
Speaker 1: And you niche down.
7:53
Speaker 1: Yeah, I think I mean, and it makes total sense, like once you start doing it, you've noticed I'm sure it's very similar for you like just crushing it, like doing a really great job, and then slowly building, like a word of mouth and niching down and then being known to be, a reputation is built, you know.
8:09
Speaker 2: Exactly.
8:09
Speaker 1: Um, so yeah, why sports Like?
8:11
Speaker 1: What was the motivation?
8:13
Speaker 2: Uh, I, I've always been into sports and myself, you know, I played field hockey and I wanted to not go into college for it, but I was recruited to go to school for it.
8:22
Speaker 2: I just decided not to just focus more on academics.
8:25
Speaker 2: Um, but I was always a field hockey, field hockey.
8:29
Speaker 1: There's a lot of contact in that right there was a lot of contact.
8:31
Speaker 2: I loved it.
8:32
Speaker 2: They wanted me to play lacrosse, but I just cause there's some similarities.
8:36
Speaker 2: Um, so it was a middie played midfield field hockey in high school and I really enjoyed it.
8:40
Speaker 2: Um, and then I saw a lot of the injuries.
8:43
Speaker 2: I had some injuries myself, like a lot of different ankle injuries, foot injuries.
8:47
Speaker 2: So I kind of was interested in that and how to prevent athletes from getting injured, how to heal more quickly, getting back to sports more quickly and then more, just like the longevity of actually staying in sports as you get older, which I've noticed over time.
9:05
Speaker 2: I've just become more interested in two older athletes still playing, you know, because that's what you enjoy doing.
9:12
Speaker 2: I always liked working out and sports, not just for the physical aspect but also the mental.
9:17
Speaker 2: Oh totally so you know for me.
9:20
Speaker 2: I would.
9:20
Speaker 2: My quality of life would be a lot less if I wasn't able to work out and be active in my life.
9:28
Speaker 2: So I I wanted to keep people active.
9:31
Speaker 2: I felt it was very rewarding for myself.
9:33
Speaker 1: Yeah, live vicariously through our patients.
9:34
Speaker 1: Yeah, exactly, it's very, super similar, like I definitely I mean I miss competing, you know of just like really getting after it and getting it, giving it all, being with a group of people that's on the same path as we're on the same and then getting after it With kids.
9:49
Speaker 1: Now it's always I can't just play pickup basketball and football and stuff, but and just in owning a practice, you know, having a practice is busy but, definitely miss that and I live vicariously through a lot of the young patients that we see that in high school and college and stuff and it was like yo, like there is a solution, You're not just like an anomaly for this musculoskeletal, Like there's a we can fix this.
10:10
Speaker 2: Right.
10:11
Speaker 1: Just take some time and like I wish I would have known this stuff for the things I was battling when I was in college and high school and stuff.
10:16
Speaker 1: Same thing, so similar thing, you know.
10:18
Speaker 1: And then for the aging athletes, the aging active weekend warrior people, a common question we get a lot or thing that we hear is they call us and they're like I'm tired of being told to just not work out anymore or like don't run, it's bad for you.
10:32
Speaker 2: Right.
10:33
Speaker 1: Just like there's a shelf life.
10:34
Speaker 1: Just don't do anything now and your your joints won't hurt.
10:37
Speaker 1: You know it's like right, you're doing something different that's causing the pain.
10:41
Speaker 1: Let's fix this root cause and then you can get back to running again and exercising.
10:44
Speaker 1: You're like really I can Like I don't have to stop, you know like totally, it's actually good for you.
10:49
Speaker 2: It's actually better not to just sit and do nothing for six weeks yeah.
10:53
Speaker 2: I tell people that all the time, like wait after your surgery, you didn't move for eight weeks.
10:59
Speaker 2: I'm like that's so bad.
11:00
Speaker 2: I mean the number one thing is early mobilization after even a trauma.
11:06
Speaker 2: Right so to be sitting.
11:08
Speaker 2: When I see people and they're wondering why after their surgery their big toe joint's stiff and now they're having pain because of that and their mobility is less than it was before the surgery, I'm just like you didn't do physical therapy.
11:22
Speaker 1: Nobody give you any exercises?
11:23
Speaker 2: dude?
11:23
Speaker 2: No, I've been sitting for six weeks, eight weeks.
11:26
Speaker 1: Just resting, yeah, and like rest leads to rust, right, exactly, motion is lotion.
11:31
Speaker 1: Let's get this thing going.
11:32
Speaker 1: It is in a non-painful, non-aggressive way, yeah, of course.
11:44
Speaker 2: I mean it depends on each case, but in terms of sports we see sports injuries, ankle sprains, of course, achilles tendonitis, tons of Achilles tendonitis, tendinosis, which is more just like acute on a chronic tear, degenerative, exactly Um speaking of degenerative, like a lot of osteoarthritis, the big toe joint of the ankle um plantar fasciitis.
12:08
Speaker 2: I said heel pain, heel spurs, um we're like posterior tib tendonitis yeah, we see a lot of posterior tib a perineal tendonitis, um tarsal tunnel, different different nerve issues, neuromas, you name it.
12:24
Speaker 2: I mean we, we, it's a pretty like broad practice, but I see a ton of Achilles plantar fasciitis.
12:31
Speaker 2: Posterior tib is a big one.
12:33
Speaker 2: You know flat feet but actually high arch.
12:36
Speaker 2: High arches are more injury prone than flat feet.
12:40
Speaker 1: Well, they're super stiff.
12:41
Speaker 2: Super stiff.
12:41
Speaker 2: You know that cavus type foot ankle sprain, stress, fractures, hammer toes, bunions, plantar fasciitis.
12:48
Speaker 1: Interesting Something I battled when I was little and my nephew now is battling this.
12:54
Speaker 1: He's nine but he has heel pain right at the insertion of the Achilles.
12:59
Speaker 2: Okay, and.
12:59
Speaker 1: I'm like yo, it sounds like Severs, right.
13:01
Speaker 1: What are your thoughts on or suggestions for Severs?
13:05
Speaker 2: Does he sounds?
13:06
Speaker 1: like severs, right.
13:07
Speaker 1: What are your thoughts on or suggestions for severs?
13:08
Speaker 1: Does he wear cleats?
13:08
Speaker 2: does he?
13:09
Speaker 2: Uh, good question, does he?
13:09
Speaker 2: I think he's right does he play, or is he?
13:11
Speaker 1: he's a swimmer, he's a swimmer, but he feels it when he runs and walks.
13:13
Speaker 1: So we're running just like playing outside yeah, yeah, I mean so, so severs.
13:18
Speaker 2: So basically it's um at the posterior heel.
13:21
Speaker 2: You know it's still, it's the growth plate, so it's not closed yet on him.
13:25
Speaker 2: So he may have that pain, inflammation on and off until the growth plate's fully closed.
13:31
Speaker 2: But usually stretching exercises of the Achilles, the plantar fascia, calf stretches, you could use a heel cup.
13:38
Speaker 1: I remember having that when I was a kid.
13:39
Speaker 2: Yeah.
13:40
Speaker 1: Do you see this pretty often, then I do.
13:43
Speaker 2: A lot of kids get that.
13:44
Speaker 2: Boys and girls, I mean even a high impact barefoot like gymnasts, can get it too.
13:49
Speaker 2: Sometimes I'll see ballet dancers, but I would say, more than anything it's cleats, like soccer.
13:55
Speaker 1: Interesting?
13:55
Speaker 1: Yeah, totally so.
13:57
Speaker 1: That's like your wheelhouse A lot of, very a plethora of diagnoses you'll see for people, yes, and then, like you were mentioning earlier, you got y'all do surgery, but you're you're getting more into other regenerative, integrative therapies and approaches.
14:16
Speaker 1: So it's just like diving right into surgery right away.
14:18
Speaker 2: Yeah, I try to.
14:20
Speaker 2: We try to exhaust all conservative therapies before surgery, which you really should do.
14:24
Speaker 2: Some people don't necessarily do that, but that's really how I look at treating foot ankle lower extremity disorders.
14:36
Speaker 2: So a lot of patients will come to us looking for another option and they think they're out of options.
14:38
Speaker 2: I see so many people coming for a second opinion, third opinion, and they are looking for options other than surgery, at least to try to see.
14:47
Speaker 2: And so we do.
14:49
Speaker 2: I do things like certain types of injectables.
14:51
Speaker 2: I think I was telling you before about exosomal injections, which are mesenchymal stem cells which can help regenerate tissue, decrease scar tissue.
15:01
Speaker 2: It's very anti-inflammatory we do it's like shockwave therapy which I'm sure you've heard of for tendinitis, but it's a little bit.
15:10
Speaker 2: It uses sound waves instead, so it's called myofascial acoustic compression therapy and it compresses tissue more than five times the amount of, say, a deep tissue massage.
15:20
Speaker 2: So it breaks down tissue.
15:21
Speaker 2: It's regenerative, helps bring circulation to the area, growth factors to the area to help heal tendons, ligaments, even joints.
15:27
Speaker 2: We've been using it for joints or neuropathic pain.
15:31
Speaker 2: Now it's kind of off-label for that, but it's a way to help improve pain without taking anti-inflammatory steroids, steroid injections or other types of medications.
15:44
Speaker 2: Of course we do orthotics, we do infrared laser therapy and we have some other techniques that we do in the office, but a lot of it is hands-on by the doctors.
15:58
Speaker 2: We don't have medical assistants doing and it's always by myself or my partner, um.
16:03
Speaker 2: So yeah, those are some of the options.
16:05
Speaker 2: That's really cool and for like your you guys you mentioned you like functional exams like to check out yes, the biomechanics their foot, like where they're compensating doing a golf swing or running outside, or we have them kind of tape themselves or record themselves.
16:33
Speaker 2: So we do a full exam.
16:36
Speaker 2: Usually our appointments are about 60 minutes for a new patient, especially an athlete, and this way we're able to get to the root cause of the problem and then come up with the treatment plan, the best action plan, and usually it's not just one thing.
16:51
Speaker 2: It can be physical therapy with orthotics or, you know, at home exercises, or we can show them some exercises to do.
16:59
Speaker 2: You know, it's just, it's usually a combination of things.
17:02
Speaker 2: It's not just here's a pill, here's a, here's a cortisone injection which I rarely give any more cortisone injections.
17:08
Speaker 2: How come here's a cortisone injection which I rarely?
17:10
Speaker 2: give anymore cortisone injections.
17:10
Speaker 2: How come?
17:11
Speaker 2: Well, it's actually been researched to show deterioration of tissue whether you're injecting into a joint.
17:18
Speaker 2: It's more of a Band-Aid, it's more of an instant quick anti-inflammatory and sometimes it's necessary, but I don't really give a lot of those.
17:26
Speaker 2: But I don't really give a lot of those.
17:28
Speaker 1: I've heard from some other professionals are like we got like two free tokens with a steroid injection over a lifespan.
17:35
Speaker 1: You know of like, of like you're going to be fine, nothing like two maybe, um, but it makes total sense.
17:41
Speaker 1: I don't hate injections.
17:42
Speaker 1: If someone's living in an agony and they can't live, it's like yo.
17:45
Speaker 1: Can we get things to settle down and then we can work on stuff when you're feeling better?
17:49
Speaker 2: It's part of like a pain management protocol more than healing or regenerative therapy, it's not regenerative but it is if we're managing pain.
17:58
Speaker 2: If somebody's in like a stage four condition, like a hallux rigidus stage four, which is basically almost fused right.
18:08
Speaker 2: It's like their next option would be a fusion, so to manage, and they, for whatever reason, they don't want to do surgery or they can't right now to manage the pain.
18:16
Speaker 2: That would be maybe a solution for something like that, but so many other things I try to avoid it.
18:22
Speaker 2: You know, obviously you don't really I remember and I won't say who it was, but I remember being in a college and kind of shadowing during residency and attending and they were giving athletes, you know, injections into tendons for pain and things like that.
18:37
Speaker 2: Tortle, you don't want to do that.
18:39
Speaker 1: It was a lot of steroids actually.
18:41
Speaker 2: Yeah, oh, wow, okay and just tape them up and send them out and I'm like, yeah, get out there.
18:45
Speaker 2: I want them to play.
18:47
Speaker 2: They're freshmen in college.
18:49
Speaker 2: There was an athlete.
18:51
Speaker 1: I've been working with that recently chronic knee issues.
18:55
Speaker 1: He also just had ACL surgery, but he's like almost a year out now.
18:58
Speaker 1: But anyway, he was getting better.
19:00
Speaker 1: We were working on some stuff.
19:01
Speaker 1: I was like, dude, we're in a good spot, keep working on this stuff.
19:03
Speaker 1: And when you go to school this summer with the strength coach and the trainer and stuff like that, he called me like a month later after he left and he was like my knee is like way worse.
19:12
Speaker 1: And I was like but you were pain free when we left.
19:15
Speaker 1: We were doing hot, we were doing good plyometric stuff with no pain.
19:18
Speaker 1: It was just weak.
19:20
Speaker 1: We did work on some stuff, built some strength, and now all of a sudden it's like way worse and more inflamed and he's like, yeah, like we were, we were doing this and doing this.
19:25
Speaker 1: He's like, yeah, like we were, we were doing this and doing this and I'm.
19:28
Speaker 1: He was just progressing too fast and the solution that was suggested was to push through it.
19:33
Speaker 2: Yeah.
19:34
Speaker 1: Just just push through.
19:35
Speaker 2: Yeah.
19:36
Speaker 1: At some point as a college athlete you just need to like not be a baby and push through.
19:39
Speaker 1: And I'm like okay For certain things.
19:43
Speaker 1: If you're training and like muscle burn, like no pain, no gain, yeah, and you know you got to go do conditioning and it's hard Totally, but like injury rehab and like tendon issues, like that just leads to chronic lingering, tendinosis.
19:57
Speaker 1: That's like never going away and lingering.
19:59
Speaker 1: I was like, oh man, it sucks.
20:00
Speaker 1: That's not the best, in my opinion, suggestion you know for an athlete.
20:05
Speaker 1: And also, by the way, just take more pain meds to mask what you're pushing through sure take an anti-inflammatory, and then that actually stops the healing process, right.
20:13
Speaker 2: So you need a little bit of inflammation, at least for the first day to three days, right, and then you just keep taking the anti-inflammatories, the steroids keep pushing it.
20:22
Speaker 2: You're going to cause further damage what have you heard from advil?
20:25
Speaker 1: or just I to say brand names, yeah, anti-inflammatory, nsaids, non-steroidal anti-inflammatory, sure, what are your-?
20:34
Speaker 2: Again, pain management.
20:35
Speaker 2: So I rarely tell people to take that.
20:39
Speaker 2: It's very, very rare that I say take an anti-inflammatory, especially an oral, because that can cause a lot of GI issues.
20:45
Speaker 2: So if patients need a little bit of pain management while we start treatment, like you were saying before, even a steroid just to get you past that kind of hump of pain threshold.
20:58
Speaker 2: I usually suggest like a topical anti-inflammatory.
21:03
Speaker 2: At least you could just use it locally.
21:04
Speaker 2: It's not affecting systemic issues.
21:07
Speaker 1: Like Voltaren yeah.
21:08
Speaker 2: Voltaren.
21:09
Speaker 2: We can do compounds.
21:10
Speaker 2: I use a compound pharmacy that will make you know, depending on what the issue is, put a little bit of an anti-inflammatory, sometimes a nerve pain.
21:18
Speaker 2: If it's a there's like a nerve issue like tarsal tunnel, just to get them over that hump I'd rather use a topical anti-inflammatory or pain med rather than oral.
21:28
Speaker 2: But the oral I would say really maybe like 5% of the time.
21:33
Speaker 2: I rarely.
21:34
Speaker 2: It's mostly treatments like we do in our office heat therapy, infrared, the piezo wave, physical therapy, ice heat.
21:49
Speaker 1: It's really really rare that I'll prescribe it Interesting.
21:50
Speaker 1: I'm hearing a lot of more healthcare practitioners and physicians like less were the route of like yeah, just take this over the counter and said you know, um just a lot of the chronic issues that can arise, you know, unforeseen, you know.
22:05
Speaker 2: Yeah, and it's just interesting.
22:06
Speaker 2: Yeah, it's not just locally for because of the injury, but you could cause other.
22:09
Speaker 1: GI liver, exactly, and the restricting of blood flow.
22:13
Speaker 1: Yes, so what are the most challenging patients with some of the cases that you see?
22:17
Speaker 1: What are the most challenging ones?
22:18
Speaker 2: Sure, a lot of the challenging cases are the patients that have had surgery and have issues because of the surgery or recurrence of the problem.
22:29
Speaker 2: So I'll see, like bunionectomies that maybe they walk too soon.
22:34
Speaker 2: Something happened.
22:35
Speaker 2: I don't want to blame whoever it was, but they have a lot of times you'll see the stiffness of the first MPJ joint, the big toe joint.
22:43
Speaker 2: They'll come in they're having worse pain than they had before the surgery and so we'll treat that.
22:48
Speaker 2: We see like some severe.
22:53
Speaker 2: I don't see too many in the jupiter practice but before in residency or when I was working in new york, we would see like more severe um cavus type foot deformities with really bad uh hammer toes, more severe bunions, um uh.
23:09
Speaker 2: The other severe like um tibial tendinitis or not just tendinitis but tendon dysfunction where they really can't push off on the or can't even do like a one limb heel raise.
23:22
Speaker 2: So that's one of the cases that we see that could be pretty bad.
23:27
Speaker 1: It can Super sensitive.
23:29
Speaker 2: Yeah.
23:30
Speaker 1: Posterior tibial nerve.
23:30
Speaker 1: Like right there I can send.
23:31
Speaker 1: It's just very sensitive.
23:32
Speaker 2: Yeah, the tarsal tunnel everything.
23:35
Speaker 1: So talk about explain more for people.
23:37
Speaker 1: Pes cavus and pes planus like super high arch and super flat foot.
23:42
Speaker 2: Yeah, so a pes cavus means a high arch foot.
23:45
Speaker 2: Usually they're rigid.
23:47
Speaker 2: They're usually a bit more rigid than, say, a flat foot.
23:50
Speaker 2: Pes planus means a flat foot, so it's more of like that pancake when you step down that kind of pancake foot.
23:56
Speaker 2: But a cavus or a high arch foot is it's a lot less stable because you're not, there's not as much contact area or full contact surface area, right.
24:07
Speaker 2: So it's kind of like a I usually tell patients a table with three legs instead of four.
24:11
Speaker 2: So you're a lot less stability just overall, which can affect.
24:15
Speaker 2: A lot of patients we see have come in and they don't even necessarily have foot problem but they were referred because the physical therapist may have seen that their knee issues or their lower back or hip issues might be coming from their feet Downstream.
24:28
Speaker 2: Yeah, so usually cavus feet, like I was saying before, they're prone to metatarsal stress, fractures, hammer toes, because it's kind of utilizing the stability of the extensor and flexor tendons to kind of stabilize the foot.
24:43
Speaker 2: So it causes the toes to sort of grab the ground to balance.
24:46
Speaker 2: So hammer toes, bunions, plantar fasciitis, achilles tendonitis, just because of the structure of the cavus foot, the way the talus sits in the ankle is just causes less range of motion of the ankle.
25:00
Speaker 2: So a lot of people have Achilles tendonitis, posterior heel spurs, haglund's deformities, it's just, you name it Cavus foot's like the worst, I tell my patients, like the worst foot to have.
25:11
Speaker 2: There was a podiatrist in New York that used to call it the.
25:15
Speaker 2: What did she call it?
25:15
Speaker 2: Like the aristocratic foot.
25:17
Speaker 2: So it's not a foot where you're supposed to just sit and not play sports and not be.
25:22
Speaker 2: You know hard labor, but the flat foot is a lot more stable.
25:27
Speaker 2: There's more shock absorption, naturally because with pronation you have increased, which is a good thing, to pronate.
25:38
Speaker 2: Just some people pronate or roll in excessively.
25:39
Speaker 2: The posterior tibial tendon may not be functioning 100% or it can be more of a bony structure.
25:43
Speaker 2: The subtalar joint is just over pronated or the calcaneus is more in everted.
25:50
Speaker 2: So the whole foot is is rolling in, which causes or the the arch is rolling in, rather, and the heel rolls in, which causes the feet to like the forefoot to abduct and actually can cause a anterior tilt in the pelvis.
26:04
Speaker 2: So some patients will come in with like lower back pain, sciaticatic pain, and again they may not have any foot pain at that time, but they went to their doctor and they saw that their feet are super flat and they're like, oh, have you ever had this treated?
26:18
Speaker 2: You know, maybe they saw them walk or just noticed it.
26:22
Speaker 1: I mean we with our athletes.
26:23
Speaker 1: We definitely find a huge link between ankle issues, foot and ankle issues and then upstream, like low back and hip, hip dysfunction, usually like a lot of like glute, like glute weakness, glute inhibition and pelvic instability that then, like the knees, will compensate and then just feeds more of an issue down the chain in the in the foot, yeah, the arch collapse and like instability.
26:43
Speaker 1: Um but uh, that's a super common thing, you know.
26:47
Speaker 2: Yeah, it's very cool.
26:48
Speaker 1: I'm always like, like it's interesting.
26:48
Speaker 1: It's like we find a lot of practitioners or some colleagues and stuff they're like so are you a foot up guy or a hip down to the foot guy?
26:56
Speaker 1: and I'm like man, I'm either like both you look at the whole picture it doesn't really matter, like I think it's different.
27:00
Speaker 1: You know they all contribute, you know I mean it contributes.
27:03
Speaker 1: It's a matter of like, what are we going to tackle first?
27:05
Speaker 1: We're not going to neglect one thing or the other, but like definitely can recognize, like there's definitely a link and connection with foot issues and hip, low back instability, pelvic instability issues and vice versa.
27:16
Speaker 2: Yeah, definitely.
27:17
Speaker 2: But anyway, I think it's super important to like we can't neglect that for athletes and active people, maybe for whatever reason, their focus in physical therapy wasn't on the whole person or they really focus more on shoulder or the back and and they forget about the foot and ankle, and I think that's a that can be a real big issue, because they'll fix one thing, like you said, up the chain, but they're not fixing the foundation.
27:43
Speaker 2: So to me, I'm looking at the whole person, but I'm I'm definitely focusing on the foundation, which is the feet.
27:49
Speaker 2: So I always say like, yeah, like a house, you know, if the foundation's off, the whole house is going to be off.
27:55
Speaker 2: So there's been plenty of times people have noticed that even if they didn't have foot or ankle pain and they sent their patients to me.
28:03
Speaker 2: I've even had somebody send for TMJ because they noticed their alignment was off and then maybe one side there was a limb length discrepancy coming from the pelvis and the foot Like one side was more pronated, One side was a little more supinated.
28:18
Speaker 2: So we corrected that with orthotics and their TMJ improved.
28:21
Speaker 2: So it was kind of interesting.
28:22
Speaker 1: That's really interesting.
28:23
Speaker 1: Yeah, yeah, did the dentist refer that person to you?
28:26
Speaker 2: No, it was a physical therapist.
28:34
Speaker 1: It was somebody kind of like how you guys?
28:35
Speaker 1: Practice and they noticed it.
28:36
Speaker 1: Yeah, and they're like I wonder just check to see if this would help check this out.
28:37
Speaker 1: Yeah, yeah, interesting.
28:38
Speaker 1: Um, okay, it was something you mentioned uh tarsal tunnel right is a is a pretty common thing that people bring up a lot.
28:43
Speaker 1: Explain that to the listeners so it's.
28:46
Speaker 2: I kind of explain, because a lot of people they basically know carpal, because a lot of people they basically know carpal tunnel.
28:49
Speaker 2: A lot of people they know have had carpal tunnel.
28:51
Speaker 2: So there is a we call it a retinaculum, which is like a structure that holds together the nerve, the vein.
29:00
Speaker 2: It's on the inside of the ankle, just like the wrist, and so that it could be a neural tumor possibly that can cause tarsal tunnel or it can be.
29:12
Speaker 2: Compression of the retinaculum is just really tight.
29:15
Speaker 2: There could be a lipoma in there, there could be some sort of cyst that's putting pressure on the nerve.
29:19
Speaker 2: So basically there's an issue with the nerve that supplies the tibial nerve, supplies the whole bottom part of the foot.
29:26
Speaker 2: So they can get burning, tingling, numbness, tight pain or even like a sharp pain somewhere at the bottom of their foot, sometimes heel pain, or the inside of their ankle toward the bottom of the foot.
29:39
Speaker 2: Sometimes it could be shooting up as well.
29:40
Speaker 2: So we'll test we do like some tests in our office and if we can't necessarily get a full diagnosis and we need further testing, we'll do studies like an MRI or sometimes we'll send them to a neurologist just to rule out anything.
29:55
Speaker 2: Usually we can tell between the in-office evaluation and possibly an MRI.
30:01
Speaker 2: But yeah, tarsal tunnel is just.
30:03
Speaker 2: It's compression of the nerve or damage to the nerve causing nerve-type pain nervous tingling.
30:10
Speaker 1: So I'm sure people get maybe confused and like, oh, I got plantar fasciitis.
30:13
Speaker 2: Yes.
30:13
Speaker 1: Bottom of the foot pain it's not always plantar fasciitis.
30:16
Speaker 1: How do you differentiate and then explain that Sure, sure.
30:19
Speaker 2: Well the presentation can be different.
30:21
Speaker 2: Again, the type of pain they're feeling and then the testing that we do in the office.
30:27
Speaker 2: There are certain tests like we call tunnel science, basically like tapping on the inside of the ankle and if they feel any numbness, tingling or any type of nerve pain going up or down the foot ankle, that could be a sign of it for studies like an MRI study or nerve conduction studies, things like that.
30:44
Speaker 2: But you definitely want to roll that out.
30:47
Speaker 2: A lot of times plantar fasciitis or heel pain can be from a heel spur.
30:52
Speaker 2: So if somebody has like more pinpoint pain on the medial plantar, medial part of the calcaneus and then you see the x-ray, there's a heel spur there.
31:01
Speaker 2: The plantar fascia is really tight, the Achilles is tight.
31:05
Speaker 2: I mean usually we could tell.
31:06
Speaker 2: I mean usually we could tell.
31:09
Speaker 2: Sometimes people will give like a diet.
31:10
Speaker 2: We can give a diagnostic, like an injection just of some lidocaine to see if that helps it relieves pain.
31:16
Speaker 1: Interesting, yeah.
31:18
Speaker 1: What kind of patient profile do you find?
31:20
Speaker 1: A lot of plantar fasciitis versus a lot of tarsal tunnel.
31:24
Speaker 2: Yeah, plantar fasciitis is a lot more common than tarsal tunnel and again Patient profile for those people.
31:28
Speaker 2: For plantar fasciitis, plenofestiates is a lot more common than tarsal tunnel.
31:30
Speaker 1: And again, patient profile for those people for a plenofestiates.
31:32
Speaker 2: Yeah, oh, it could be, it could be any.
31:33
Speaker 2: I mean it is so common, anybody can have it.
31:35
Speaker 2: I mean, from somebody who, uh, play, or somebody who's who gained weight.
31:41
Speaker 2: I mean we'll see people who they gained like 50 pounds in the last year and they're putting, and they have a super flat foot and they're putting extra, they're wearing like flip-flops all day and they're putting a lot of extra pressure on their um, their arch and their heel.
31:55
Speaker 1: Yeah.
31:55
Speaker 2: You know a lot of people who, over pronate, can put a lot of stress on it, and again with cavus as well, because that just makes it a lot, everything a lot tighter and less mobile.
32:03
Speaker 2: Um, so we can see that uh pregnant women pregnant women?
32:08
Speaker 2: Yeah, definitely pregnant.
32:09
Speaker 1: You know gaining a bunch of weight real quick.
32:11
Speaker 1: Yeah, that makes sense, Exactly.
32:12
Speaker 2: Like changing sport, like if you start playing or running and you really never ran before, you don't wear appropriate shoes for your foot type, you're not doing any type, you just start running and you don't do any strength training.
32:25
Speaker 1: Progressions up to it?
32:26
Speaker 2: Yeah, you don't do any stretching, any mobility.
32:29
Speaker 2: So we People who walk barefoot a lot, we'll see that or who not every some people can walk barefoot, but if you don't know the structure, you don't know that you're prone to certain issues, then it might not be the best to walk barefoot.
32:47
Speaker 1: Excessive undue pressure, exactly, totally.
32:49
Speaker 1: I feel like I've seen a lot of it seems like women more so than men for plantar fasciitis that we've seen.
32:57
Speaker 1: Maybe they're the only ones that actually reach out that could be.
33:01
Speaker 1: And they're always like oh fine.
33:04
Speaker 2: Yeah, they'll take like a pill or just be like I'll ignore it.
33:07
Speaker 2: I mean in general, I think some male patients not all, but some when they have pain and they keep complaining, after some time their significant other or like parents or, you know, wife they'll tell them, like, just go to the doctor.
33:23
Speaker 2: Or if they're already a patient of mine, they'll be like I'm sending my husband to you and then maybe six months later they come to the doctor.
33:29
Speaker 2: But I think that could be why, cause I definitely see about 50, 50 cases, but I think women are a little more proactive with going to the doctor.
33:38
Speaker 1: Yeah, interesting what's like your.
33:40
Speaker 1: The best way you've noticed to treat to get results for plantar fasciitis.
33:45
Speaker 2: It's, it's action plan.
33:46
Speaker 2: Yeah, I mean it really is an action plan.
33:49
Speaker 2: I mean it's never again one thing it's.
33:51
Speaker 2: It's usually let's assess your.
33:53
Speaker 2: I do a biomechanical after that, after I get their foot type, their whole structure, their gait, and then I will find out what they're.
34:01
Speaker 2: I always have them bring their shoes in to what shoes they're wearing most of the time in the house, out of the house for sports and then.
34:09
Speaker 2: So a lot of times it's not the appropriate shoes for them.
34:11
Speaker 2: So we'll start with that.
34:13
Speaker 2: I usually start very conservative.
34:15
Speaker 2: Then we'll start with a plan for mobility, some certain stretching exercises, strength mobility exercises.
34:23
Speaker 2: I explain to them what mobility is, you know, I'm like it's like a deep tissue massage.
34:28
Speaker 2: You could do a foam roller, lacrosse ball massage gun, but it's just basically getting the tissues moving.
34:34
Speaker 2: Then we can stretch, you know, then we can warm up.
34:37
Speaker 2: Stretching is kind of secondary Mobility is like super important range of motion.
34:42
Speaker 2: So we start, like I said, very conservative, things they can do at home.
34:45
Speaker 2: Physical therapy sometimes may be necessary, a lot of times it's necessary, and then we do from.
34:54
Speaker 2: There, might give them other options, like the piezo wave therapy.
34:57
Speaker 2: There might give them other options like the piezo wave therapy, the sound wave therapy, um, heat icing, um, but heat is always.
35:04
Speaker 2: Most people I see are not acutely inflamed, it's more of a chronic or could be an acute on a chronic problem.
35:11
Speaker 2: So most of the time I like heat over ice because it does help with blood flow yeah which that's where we're getting all the growth factors and the healing from.
35:20
Speaker 2: So it's very conservative.
35:22
Speaker 2: And then there's so many options.
35:24
Speaker 2: You know from night splints, orthotics surgery is the last option and I tell people like 99% of the time I don't have to do surgery on folks with plantar fasciitis.
35:37
Speaker 1: It's very rare.
35:37
Speaker 1: What would you do for that?
35:38
Speaker 1: Just like the bereavement, or like the heel spur.
35:41
Speaker 2: There's a, you could open it up like a fasciotomy, but usually there's an endoscopic procedure.
35:46
Speaker 2: But that's inherently could be destabilizing because if you, you basically just cut part of the plantar fascia off of the the plantar medial heel, right.
35:56
Speaker 2: So I mean it's it's rare, but if we try everything, including different types of injectables, we might have to go to that.
36:04
Speaker 2: But I probably do zero to one a year because it's just not.
36:08
Speaker 2: I don't find it necessary for most patients Gotcha.
36:11
Speaker 1: It's just super rare.
36:12
Speaker 2: Yeah, interesting.
36:14
Speaker 1: Something else that we get a lot of questions about right for us, because same population, right active athletic people, and they're like I want to keep working, I want to do this, I'm feeling better and I want to integrate more workouts.
36:25
Speaker 1: I want to run, I want to run, I'm feeling better, I can run now it's like awesome, but I'm too busy, I'm too bad, I don't have time.
36:35
Speaker 1: I got kids and I got other things going on in my house or whatever.
36:38
Speaker 1: So for you, because you're a busy individual right how do you best find to navigate your own schedule to still prioritize your own health, wellness and fitness and nutrition and stuff?
36:48
Speaker 1: What suggestions would you give people?
36:49
Speaker 1: Sure?
36:50
Speaker 2: What works for you.
36:50
Speaker 2: Yeah, I like to keep to a routine, especially during the week.
36:57
Speaker 2: So normally I will try to exercise in the morning and kind of get that.
37:00
Speaker 2: For me that works best.
37:02
Speaker 2: It's just getting out of the way and then I'm the most you know.
37:06
Speaker 2: I just find it wakes me up, it puts me in a better mood, get the endorphins flowing, so usually in the morning.
37:12
Speaker 1: Ready to tackle the day?
37:13
Speaker 1: Yeah, where do you work out?
37:15
Speaker 2: I either do it where I live at home or I go to a gym.
37:19
Speaker 1: Smart.
37:19
Speaker 1: Yeah Well, it's convenient.
37:21
Speaker 2: It's convenient.
37:21
Speaker 2: I try to do whatever is convenient.
37:23
Speaker 2: I mean you can do so much at home.
37:24
Speaker 2: You could either whether it's equipment or doing a YouTube video.
37:29
Speaker 2: Yeah, I mean there's so many options now there's really no excuse.
37:33
Speaker 2: I mean you can do an app for 20 minutes.
37:36
Speaker 2: I focus.
37:37
Speaker 2: I used to run more.
37:38
Speaker 2: I used to run outside more.
37:40
Speaker 2: I was doing 10Ks, half marathons.
37:44
Speaker 2: I never did a full, that's impressive though.
37:46
Speaker 2: But if you just do that and you don't cross train, I was injuring myself.
37:50
Speaker 2: So I really focus on as I've gotten older, I focus more on strength training, and strength training not just for weight loss, but I tell patients cause.
38:01
Speaker 2: I see older patients too.
38:02
Speaker 2: I see all ages.
38:03
Speaker 2: So it's really important for me, as I get older, to be able to be independent, even when I'm hopefully 90 years old, able to get it sounds crazy, but just getting up out of a chair or going to the bathroom, you know, I don't.
38:16
Speaker 2: I want to be independent.
38:18
Speaker 2: So having the strength and focusing on lower body core glutes type of thing and to prevent injuries.
38:25
Speaker 2: So I focus on that.
38:27
Speaker 2: And then, in terms of like nutrition, I definitely have like a routine.
38:32
Speaker 2: I focus on protein, making sure I get like as much clean protein I'm drinking a lot of water, get less, not a lot of sugar, which really causes a lot of inflammation.
38:42
Speaker 2: Um focusing more on um, micronutrients uh, uh, getting enough.
38:49
Speaker 2: Um like salt intake not too much, but for me it actually helps with sugar cravings to hydrate, you know it holds onto the water.
38:57
Speaker 2: better, just drinking water.
38:58
Speaker 2: You're going to go to the bathroom constantly, but um, so I focus on meal prep at all.
39:03
Speaker 1: Like how do you navigate that?
39:04
Speaker 1: I guess it's always hard.
39:05
Speaker 2: Yeah, it's hard to meal prep.
39:06
Speaker 2: I do.
39:07
Speaker 2: I kind of do.
39:08
Speaker 2: I have everything.
39:09
Speaker 2: I like to make smoothies kind of fresh every day, but I have everything ready to go so I can just like add the protein, add the, you know, add blueberries, things like that.
39:19
Speaker 1: So scheduling, getting into routine, scheduling things out what you like is consistent and being consistent, and then efficiency Exactly Less resistance of like making things happen with, like oh this gym is really far away, or like well, I don't know what to do for a workout.
39:34
Speaker 1: It's like yo just YouTube something real quick.
39:35
Speaker 1: Exactly so that's what you suggest.
39:36
Speaker 2: Yeah, or you know, have some weights in your house.
39:38
Speaker 2: You don't have to have like a full floor of different machines and weights.
39:43
Speaker 2: You could do body weight.
39:45
Speaker 2: You could have like a lightweight medium, you know, higher weight at home.
39:49
Speaker 1: I still get a great effective workout.
39:50
Speaker 2: You could do so much and walking is underrated Just getting outside.
39:55
Speaker 2: It's true, I'll go for a walk, getting steps in, you know it's just moving, doing some weights, doing some stretching it's interesting and I'm glad you said that.
40:04
Speaker 1: Uh, a lot of resistance training, like strength training, um.
40:07
Speaker 1: So I'm here like a lot of um, especially females, right, they're like well, I don't want to get bulky, right, it's like you're not gonna.
40:14
Speaker 1: The thing I always suggest people is like do you know how hard it is?
40:17
Speaker 1: it it's hard to get bogey Like there's, there's dudes like think about like this, like men that are in their twenties and thirties, what is the number one goal if they're working out?
40:25
Speaker 1: They want to get big, they want to get jacked, they want to get Instagram jacked Right Totally.
40:29
Speaker 1: And they work very hard and they still really can't get there.
40:33
Speaker 1: And they have like way more physiology set up to build muscle tissue and testosterone as well, and they're still having a hard time.
40:43
Speaker 2: Right.
40:43
Speaker 1: So you think you're going to outpace those?
40:45
Speaker 1: You know it's not going to happen.
40:47
Speaker 2: You know what?
40:48
Speaker 1: I mean.
40:48
Speaker 1: But anyway there's so much benefit to getting the strength training you know, versus just like long duration cardio, but balancing the two is definitely important.
40:55
Speaker 1: But so many more benefits with strength training the muscle density, muscle tissue, you know, development, and then protein to like supply the nutrients for the muscle growth.
41:06
Speaker 2: And not to mention protecting your joints.
41:09
Speaker 1: I mean.
41:09
Speaker 2: I see so many, so many people, even in their sixties already with spine issues, with their back, you know, and if they just strengthen their core a little bit, but their glute strength is like non-existent.
41:21
Speaker 2: You know, I'm like, how's your core strength?
41:23
Speaker 2: I have them sometimes do x other exercises just so I can see, yeah, like um one leg hip thrusts and squats and they can't do it.
41:31
Speaker 2: And I'm like, yeah, and you have no real muscle tone, your glutes, like your hip stability is not there.
41:37
Speaker 2: But if they did that, maybe their back, especially a lot of lower back, l4, l5, s1 totally yeah, no, we, we crush that stuff all the time yeah, like this might help your back pain right
41:49
Speaker 1: what yeah, they're like getting stronger, I'm gonna have to do this yeah, now I have to work out.
41:54
Speaker 2: It's like you get to work out exactly you get to work out and it's a mind, it it's definitely a mindset, I think a lot of that is just getting yourself in that frame of mind.
42:03
Speaker 2: You can tell people so many times, but if they're not there yet and I do I micromanage my patients.
42:09
Speaker 1: I was going to say how do you find the best result to motivate and incentivize patients to be like if you incorporate some of these exercises, some physical stuff, oh, that's patients to be like if you incorporate some of these exercises, some physical stuff.
42:23
Speaker 2: What do you usually say?
42:25
Speaker 2: So I I actually asked them what their goals are.
42:26
Speaker 2: Like what?
42:26
Speaker 2: What do they want out of this?
42:27
Speaker 2: Why are they here?
42:28
Speaker 2: What are their like?
42:29
Speaker 2: Long-term, short-term goals?
42:31
Speaker 2: Like, where do they want to be?
42:33
Speaker 2: Do they want to walk, like three miles?
42:35
Speaker 2: Not, not everybody has the same.
42:36
Speaker 2: Everybody has different goals.
42:37
Speaker 2: Bike a certain amount, walk without pain for a mile I mean, it could be something that we think isn't a big deal, but for them it is.
42:43
Speaker 2: So I find that out and I'm like look, if you don't do this, you won't be able to walk a mile without pain, or you won't be able to do the things that make you happy, or pick up your granddaughter.
42:54
Speaker 2: You know things like that.
42:56
Speaker 2: So I kind of like put a little bit of fear in that this, or also it kind of is a positive because it's like it could be life-changing, right, because they, a month or two from now, I say like you'll be able to pick up your grandchild without pain or you'll be able to go for a walk with your dog.
43:10
Speaker 1: Like, imagine being able to do that stuff without this bothering you.
43:13
Speaker 1: Would that be cool?
43:14
Speaker 1: Oh my God, that'd be amazing.
43:15
Speaker 2: Right, yeah, it's like great.
43:17
Speaker 1: Here's a paint the picture.
43:18
Speaker 1: It sounds like you're painting a picture of like incorporate these things.
43:21
Speaker 1: It's going to help you do that Exactly Of what you want Ultimately.
43:24
Speaker 1: It's like oh, now it makes sense, now I'm bought in, you know.
43:27
Speaker 2: Cause everybody, like I, could think something's important, but you're here.
43:30
Speaker 2: What they want, yeah, and then tie it in with everything else you need to do.
43:46
Speaker 1: I feel like we did it a lot, because it's hard to future frame and project.
43:48
Speaker 1: Imagine your shoulder and eight weeks we see this all the time.
43:51
Speaker 1: If you do these things, we're pretty confident and optimistic that you're going to get better.
43:55
Speaker 1: And imagine, if you do these things and a long enough time horizon, six weeks from now, if you were able to do overhead military press and then also throw the football or throw your baseball with your son and your shoulder didn't hurt, like imagine that.
44:09
Speaker 1: Would that be?
44:10
Speaker 2: cool, exactly Like oh yeah, that'd be awesome, perfect.
44:13
Speaker 1: Here's how we get there.
44:13
Speaker 2: And giving them, like that, six weeks, and when you, when they have that time in their head it actually could make it.
44:18
Speaker 2: Yeah, it could actually make it a lot easier.
44:20
Speaker 1: Yeah, for sure it's realistic.
44:22
Speaker 1: Something else that we've done, like, cause I used to do a lot of personal training too, um, while back, um, and for also patients, it's like well, this is a longer term thing, like we got to work on this, sometimes like oh, or like 16 weeks.
44:35
Speaker 1: I find it like they, they glay, they don't really get it, it's just difficult.
44:40
Speaker 1: But I'm like, all right, what's the next holiday?
44:42
Speaker 1: All right.
44:43
Speaker 1: So imagine, like Halloween, imagine, by Halloween, you're trick-or-treating and you're able to like give a high five Cause you got the best candy bar in the neighborhood and your shoulder doesn't hurt without like Halloween, like oh, that's more reachable, yeah, that's reachable, that's reachable, that's chewable, I got it, yeah.
44:56
Speaker 1: So like holidays, that may, it seems like rabbit, they make sense, you know, for people sometimes because they could picture it yeah that, that that picture in their mind and they have a goal and you're making it real for them.
45:08
Speaker 2: You have to make it real that's awesome.
45:10
Speaker 1: Um, well, I appreciate you coming in yeah, um, I know you're a busy person, like I said so and sharing your insights on a lot of these common diagnoses of foot issues and foot pain, like what it maybe looks like, and the treatments that you all do.
45:20
Speaker 1: If anybody has any questions or they want to reach out to you guys, what's the best way they can hit you up?
45:25
Speaker 2: So our website is wwwluxpodiatrycom.
45:29
Speaker 2: We're on Instagram Lux Podiatry.
45:34
Speaker 2: I'm on Instagram Dr Suzeals.
45:37
Speaker 2: D-r-s-u-z-h-e-a-l-s H-E-A-L-S.
45:41
Speaker 1: Dr Suze Heals.
45:43
Speaker 2: It's kind of a play on words.
45:46
Speaker 1: I see what you did there.
45:46
Speaker 2: Dr Suze Heals those are probably the best ways to get in touch.
45:50
Speaker 2: And our phone number and email is on there as well.
45:53
Speaker 1: Cool, okay, great.
45:54
Speaker 1: Well, thanks for coming in.
45:56
Speaker 1: Yeah, totally, and if y'all have any questions, like definitely, don't hesitate to reach out.
46:00
Speaker 1: We're always open to suggestions, comments, questions, concerns, conflicting opinions, other ideas to do an X, and if you're battling any issues that you feel like you want to chat with us, the best way to reach us is our phone number at 561-899-8725 or our administrative email team at athleteRCcom and definitely reach out to Dr Suze it team at athlete rccom and definitely reach out to dr suze to do it your shoes, heels and if you have any questions, reach out and we'll catch y'all next time.