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Hello down here, welcome to 
Podiatry Practice Mastery where 

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I'm kind of kind of sharing the 
things that are working in my 

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practice to get to the 
$1,000,000 mark and beyond. 

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Hopefully this will give you 
some inspiration for your your 

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practice. 
So today I'm recording day of 

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Tuesday in practice. 
It was a full day so we'll kind 

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of get into this. 
So first patient, she is a 28 

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year old female. 
She was one that had kind of 

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failed trybenafin, she failed 
Diflucan and now she is on 

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itroconazole. 
She is doing well. 

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She has some proximal nail 
clearing finally, and I 

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sometimes don't understand why, 
you know, one doesn't work in 

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the other, but that's why I have
those three that I kind of go 

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through kind of in that order. 
She's getting better. 

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I the nail looked a little bit 
thick. 

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I ground it down. 
I don't normally grind down 

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nails, but in her case I did 
grind them down and they look a 

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little bit clearer kind of at 
the base of the nail. 

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So that was that patient. 
Next patient was a 48 year old 

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female. 
She had a bilateral carry flex 

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with my nail tech. 
So her one of her nails 

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detached. 
So she has only maybe one, I 

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don't know, a small little piece
at the base to attach to so 

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there's not much nail because of
a previous procedure by someone 

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else. 
And she comes in every couple of

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months for this and to get it 
reapplied because she likes the 

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way they look. 
I find if if there really isn't 

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much nail at all, you can't make
the nails that long with the 

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carry flex and it's so nice 
having Marjorie do that for her.

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She also, when I was there 
talking to her, she also had had

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orthotics in the past and she 
requested a pair of orthotics. 

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Now this patient, her, her carry
flex did fall off. 

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So usually if the carry flex 
falls off, I don't charge them 

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the the full application fee a 
second time like a month later 

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because it gets kind of 
expensive. 

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So I tend to guarantee them. 
This is kind of the way I do it.

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I guarantee them for three 
months. 

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If it falls off, I put it on for
only an office visit or Audrey 

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put it on. 
We did an office visit. 

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We also got orthotics and she 
she bought the kit that went 

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with it. 
Next patient was a 68 year old 

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female. 
She had an X-ray, she had an 

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ultrasound and she had pain in 
the second metatarsal kind of 

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had kind of a Bursa underneath 
the second metatarsal head that 

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was painful for her. 
So we did a cortisone on the 

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plantar bursal region with the 
with an ultrasound. 

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Now she has that second hammer, 
so that's kind of going up and 

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over and a little bit 
dislocated. 

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And so we did talk to her about 
relocating that, but it's going 

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to be maybe pinning, but maybe a
planter plate repair for that 

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patient. 
Next patient was a 59 year old 

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female #3 out of four for Swift.
Next patient I just see I do 

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three out of four just so you 
guys know how many I tend to do 

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so how many they have set up. 
The next patient was a 63 year 

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old man for nail fungus. 
He decided not to do the the 

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nail sample. 
He just wanted to get right into

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it. 
And so we did a three month 

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follow up and prescribed that 
your benefit. 

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I looked at his LFTS. 
He showed it to me on his phone.

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He had a little app that would 
that I could look at his LFTS 

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from his from his doctor. 
Next patient was a patient that 

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had X-rays. 
She had some nails, she had some

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nails and calluses and she had a
hammer toe on the left 4th 

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digit. 
And that was kind of bothering 

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her. 
So we looked at that for her. 

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And this is one that kind of a 
challenge when you get these, 

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they probably all get these. 
But this is a patient that said,

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hey, you know this other doctor,
he moved his office and he, his 

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nail care is always covered by 
him. 

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So I want to make sure it's 
covered by you and I and I never

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guarantee that for patients. 
I say I'm too young in my career

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to, to make things up. 
So I said, you know, if it's not

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covered, we charge 75. 
I think we're low. 

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I think I'm going up to 100. 
I'd like to know what other 

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people do, but for if it's not 
covered, but it's 75 currently. 

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We evaluated the digit. 
I did the, the, the nail care. 

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And then we'll, we'll see if 
it's covered by insurance. 

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I doubt it. 
I don't think she has class 

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findings. 
Next was a 21 year old female. 

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She's here for a follow up for 
Cellulitis after nail puncture 

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wound. 
The Cellulitis is getting much 

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better. 
She still has some guarding I 

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think due to the puncture end of
the tissue and things are still 

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painful in there. 
She's still guarded but but 

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feeling quite a bit better. 
Next patient was a 58 year old 

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female. 
She has really a neuropathic 

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foot with Charco and I had her 
go to hang her to get a crow 

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boot and we did an X-ray 
afterwards. 

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So she's doing better in the 
crow for three months. 

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I'm going to keep her in for 
another three months and then 

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transition her into a diabetic 
shoe. 

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Next patient was a follow up 
after 6 epat a 69 year old 

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female. 
She is doing great has no 

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issues. 
She had a little issue with her 

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orthotic being like a rubbing a 
little bit on the lateral side 

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of the heel so I heated them up 
and dropped down the lateral 

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side a little bit and she's 
feeling much better. 

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This is when I did a video on so
I'm starting to do YouTube 

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shorts or I use submagic and I 
record them right in the 

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treatment room for like success,
successful patients or like 

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certain videos that I want 
specifically for our website. 

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So a couple things we've been 
doing lately. 

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I, I do have a virtual assistant
that helps in the website and 

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she's doing some like focused 
web pages on things that I want,

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like orthotics. 
And so when I get a, a good 

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orthotic or shockwave success 
story, then I will make a short 

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and then I can put that on the, 
on the, the website. 

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So the way I do that is I when I
record it, it automatically 

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uploads it to submagic. 
And then I'll, I'll rename it to

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say like, hey, this is a good 
one for the page on orthotics or

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the page on Shockwave. 
And then when the virtual 

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assistant goes in there and they
add the subtitles and the title 

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and they upload it, they'll know
to upload it as well on the 

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YouTube and also on the website 
in that area. 

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So it kind of has a workflow 
pattern and it allows me to make

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the videos without 2 problems. 1
is it doesn't occupy space on my

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phone because it uploads it 
directly to their platform 

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called Sub Magic. 
I do it right from my phone. 

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And the second thing is it it 
allows me to do it in the 

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treatment room with the patient 
versus having to wait or record 

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it at another time. 
I find getting it done right 

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when I'm with the patient works 
better. 

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Next patient was a 58 year old 
female. 

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She had first metatarsal kind of
the plantar medial aspects like 

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a, a neuritis. 
So we did X-ray, recommended 

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some things for that recommended
like a cortisone. 

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She didn't want that but just 
said I would give it time. 

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I think it was a bad shoe that 
kind of aggravated it. 

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Next was a swift 3 out of four 
getting better. 

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Next was a fifth met base 
fracture, got an X-ray doing 

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much better. 
No follow up there within the 

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global period. 
Next was a 82 year old that came

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in for an office visit and he 
had a a portal keratoma on the 

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OR IPK on the right fifth met 
head. 

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So I removed that. 
Next was a 41 year old female 

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that E pat status post A6 
sessions six weeks out. 

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She feel like her, her orthotics
set her back. 

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They're kind of a high arched 
orthotic. 

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And I, I tried to lower them 
down in the office by heating 

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them up, but they may have been 
a little bit too high. 

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So what I did is I said, you 
know, if it if it continues to 

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bother you, I'm going to drop 
down the arch for you. 

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I don't charge if I do that. 
And I also I did a just a 

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another shockwave for her just 
because I was I wanted her to 

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get better and she's already 
paid for six. 

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It didn't really take much extra
time for me. 

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So I did another shockwave on 
her, just the soft wave, only 

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for her. 
She was doing better. 

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I did another ultrasound as well
for her that did still show 

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thickening and effusion within 
the plantar FASA. 

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So might just need more time or 
a few more treatments. 

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Next was a 82 year old man. 
He had a right ankle sprain, he 

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had a little fall, and he had a 
follow up on his nail fungus. 

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He's been taken to benefit as 
well. 

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He's doing well. 
Next was a 65 year old female 

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that had pain and foot swelling.
I recommended an AFO because she

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had some posterior tibial 
tendonitis. 

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She wanted to try her orthotic 
first. 

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She has an older orthotic she 
hasn't been wearing so I gave 

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mostly shoe recommendations for 
that. 

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Next was a 43 year old that had 
She's here at 4 weeks out for a 

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medial kidneyiform fracture 
which is quite odd. 

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And I I want to order an MRI 
because she's not feeling much 

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better and I just want to make 
sure I'm not missing anything. 

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So I ordered an MRI for her. 
Next was a a a patient with an 

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IPJ hallux ulcer getting better.
We we struggle with him with his

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insurance in terms of covering 
collagen. 

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So for him he actually went to 
Amazon and found like collagen 

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powder for $30.00. 
I don't know if it's the same 

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stuff as what I do with the 
Amerigel, but it certainly is a 

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lot less expensive. 
That's what he got and he felt 

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like it worked last time for him
to get it healed. 

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But I think a lot of it has to 
do with his hallux limitis and 

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his his his bio mechanics. 
Next was a 61 year old male got 

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a orthotics bilateral. 
Oh, this was this guy's a 

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butcher. 
So he's butcher, he's on his 

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feet a lot came in many years 
ago for plantar fasciitis. 

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And what I found is certainly 
even though I have a new 

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treatment with the shockwave, 
patients tend to want what 

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worked last time and I tend to 
try that first. 

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So I learned this at a lecture 
about like surgeries, right? 

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If you do an Austin on one 
patient and it worked really 

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well, they're going to want an 
Austin on the other side, even 

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though a Lapidus might be 
preferred. 

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A lot of times they just know 
what to expect and they kind of 

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want the same thing. 
So same thing with orthotics. 

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He had Northwest, so I scanned 
him for Northwest even though I 

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don't use that as much anymore. 
I scanned him for Northwest and 

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he had bilateral cortisone last 
time. 

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That works, so I did bilateral 
cortisone. 

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He also had orthotics, so I made
new orthotics because his 

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current ones are cracked and 
then I also added on their 

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bilateral night splints for him.
So we got bilateral ultrasound, 

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bilateral X-ray, night splints, 
orthotics and the cortisone. 

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So this is an idea of kind of 
like stacking up treatments that

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can be beneficial for our our 
patients. 

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Next was a patient six out of 
six out of shockwave and did an 

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office visit and they'll be back
in three months, actually six 

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weeks for the follow up. 
Next was a 76 year old that an 

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Ind for ingrown toenail and nail
care. 

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Next was a patient 59 year old 
female that had bilateral 

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subtalar joint pain. 
So I did bilateral sinus tarsi 

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injections, no ultrasound 
guidance for that because it's 

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kind of a bigger, bigger joint. 
And then finally there was a 

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patient that had some kind of 
weird kind of foot numbness and 

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pain and I did gabapentin for 
this patient and I'm going to 

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see them back in three months 
and see how they're doing. 

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So that was the day I did do a 
couple of videos. 

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I try to do a couple of videos 
every day. 

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So the thought is there's going 
to be so. 

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And then what my virtual 
assistant does is they batch 

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those videos. 
Another benefit I like to do in 

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Shorts is I don't have to do 
thumbnails. 

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So it saves a little bit of time
on thumbnails and the idea is 

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the best producing videos, then 
you can turn those into like ads

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by putting a little call to 
action at the end of them. 

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This is some I learned from 
Alex, Alex Harmozzi for 

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marketing. 
OK. 

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OK, guys, until next time, have 
a good one.