1 00:00:01,080 --> 00:00:03,400 Hi here, welcome to Practice Mastery. 2 00:00:03,480 --> 00:00:05,880 We're helping you get your practice to the $1,000,000 mark 3 00:00:05,880 --> 00:00:08,000 and beyond. Before I begin, I just want to 4 00:00:08,000 --> 00:00:10,880 offer you this daily tracking sheet that I have. 5 00:00:11,280 --> 00:00:14,040 This is something that I use every every day in the office. 6 00:00:14,040 --> 00:00:16,680 It's basically a piece of paper. It's a Google doc. 7 00:00:16,960 --> 00:00:20,680 It says daily tracking sheet and it has just reminders of what 8 00:00:20,680 --> 00:00:24,920 I'm trying to optimize for in my practice, such as ultrasound, 9 00:00:24,920 --> 00:00:28,520 swift, orthotic, shockwave, amnio, things like that. 10 00:00:28,680 --> 00:00:32,080 And it has a just a list. I used to I've, I've been kind 11 00:00:32,080 --> 00:00:34,280 of working on different ways. I used to print out my schedule 12 00:00:34,280 --> 00:00:36,920 and and do it on the schedule. I found that just just one piece 13 00:00:36,920 --> 00:00:40,040 of paper makes it really good for keeping top of mind. 14 00:00:40,040 --> 00:00:43,800 What is what is my production? I think if we, what we track 15 00:00:43,800 --> 00:00:47,160 tends to get better. So I tend to track the number of 16 00:00:47,160 --> 00:00:50,160 orthotics, right? That, that's like the main thing 17 00:00:50,160 --> 00:00:52,640 in like these packages that I'm doing of, of Shockwave. 18 00:00:53,120 --> 00:00:56,720 Those are kind of the main like MVPS that I talk about the most 19 00:00:56,720 --> 00:00:59,520 valuable patients each day. But I think as we keep our mind 20 00:00:59,520 --> 00:01:02,880 this, this helps us get to the, get to the, the $1,000,000 mark, 21 00:01:02,880 --> 00:01:04,920 that kind of what we're trying to do here. 22 00:01:04,920 --> 00:01:07,600 And also it helps you realize what kind of what are the 23 00:01:07,600 --> 00:01:10,000 patients that you maybe didn't put in the right slots and what 24 00:01:10,000 --> 00:01:11,560 wasn't the most efficient for your practice. 25 00:01:11,560 --> 00:01:13,160 So I think these are good habits to do. 26 00:01:14,000 --> 00:01:17,200 This is something I do daily and this is how I make this little 27 00:01:17,200 --> 00:01:19,480 little podcast on it. OK, so let me if you want that 28 00:01:19,480 --> 00:01:22,280 you shoot me an e-mail down at Podiatry practice mastery.com. 29 00:01:22,600 --> 00:01:26,840 That's going to be the best way. OK, first patient, 55 year old 30 00:01:26,840 --> 00:01:29,760 female. She was here for epat #9. 31 00:01:29,760 --> 00:01:31,320 So let me tell you her situation. 32 00:01:31,320 --> 00:01:35,920 She has she originally did 6 paid bilateral Shockwave. 33 00:01:35,920 --> 00:01:40,960 So that was my MVP. She has been seeing me once a 34 00:01:40,960 --> 00:01:44,040 month now for these for these other shock waves. 35 00:01:44,040 --> 00:01:47,000 And I did 1 today. I did not charge her. 36 00:01:47,040 --> 00:01:50,440 OK, very rarely do I not charge. She is kind of a neighbor. 37 00:01:51,520 --> 00:01:54,360 I'm treating her, but she has two issues. 38 00:01:54,360 --> 00:01:57,160 She has a on the right side, she has a little bit of pain 39 00:01:57,160 --> 00:01:59,800 proximal to the Achilles insertion and on the left she 40 00:01:59,800 --> 00:02:03,200 has at the medial insertional Achilles tendonitis. 41 00:02:03,680 --> 00:02:05,640 And she also has quite severe Aquinas. 42 00:02:06,080 --> 00:02:09,199 So I think like this is 1. I don't know how much longer I 43 00:02:09,199 --> 00:02:11,680 can do more shockwave. So I kind of let her go at this 44 00:02:11,680 --> 00:02:13,440 point and said, I think, you know, you're much better than 45 00:02:13,440 --> 00:02:15,040 you were before, but you're not 100%. 46 00:02:15,040 --> 00:02:18,960 So this is one that I consider like that that 15% that doesn't 47 00:02:18,960 --> 00:02:21,800 totally resolve with shockwave. And I don't really have many 48 00:02:21,800 --> 00:02:26,400 great other options for her. And she is OK living with it. 49 00:02:26,400 --> 00:02:28,440 She she doesn't have pain most of the time. 50 00:02:28,880 --> 00:02:30,840 Once in a while she gets a little Zing or pain. 51 00:02:30,840 --> 00:02:33,040 So this is this is these are kind of the the struggle 52 00:02:33,040 --> 00:02:35,440 patients. Next patient was a 40 year old 53 00:02:35,440 --> 00:02:39,240 male with a matrix follow up. This patient I did 3 edges, 3 54 00:02:39,240 --> 00:02:41,480 toenail edges and I'm not going to do any follow up. 55 00:02:41,480 --> 00:02:44,240 So just see, you know, with my matrixes, I just do one follow 56 00:02:44,240 --> 00:02:49,440 up at 3 weeks. The next was a 45 year old male 57 00:02:49,560 --> 00:02:53,440 with a right how it's fracture. So we're in the global fracture 58 00:02:53,440 --> 00:02:55,200 period. So all I was able to do for that 59 00:02:55,200 --> 00:02:58,000 was get the X-rays. So for fractures, I'm usually 60 00:02:58,000 --> 00:03:00,960 doing a four week follow up. And then for him, for example, 61 00:03:00,960 --> 00:03:02,400 I'm not going to do another follow up. 62 00:03:03,400 --> 00:03:06,560 Next patient was a 40 year old female left plantar fasciitis 63 00:03:06,560 --> 00:03:10,680 pain originally do X-rays. Then I did an ultrasound to show 64 00:03:10,680 --> 00:03:12,520 the thickness on one side compared to the other. 65 00:03:12,920 --> 00:03:17,280 And then she got the, the my, my Pelto special, which is a night 66 00:03:17,280 --> 00:03:18,840 splint foam rolling in morning stretch. 67 00:03:19,200 --> 00:03:22,400 And then she scheduled 6 shock waves And I talked to her 68 00:03:22,600 --> 00:03:25,720 usually on the third one, we will scan her for orthotics. 69 00:03:26,040 --> 00:03:29,560 So this would be one of my favorite MVP type of patients 70 00:03:29,680 --> 00:03:35,520 for the for the practice. Next patient was a 45 year old 71 00:03:35,520 --> 00:03:37,640 female with right fifth met head. 72 00:03:38,080 --> 00:03:41,120 So she had right fifth met head non union. 73 00:03:41,560 --> 00:03:44,840 She was seen for MIS procedure from a physician in New York. 74 00:03:45,120 --> 00:03:48,160 She went in for kind of like a same day MIS kind of bump and 75 00:03:48,160 --> 00:03:52,920 slide on the 5th metatarsal for a tailor's bunion and she did. 76 00:03:52,920 --> 00:03:55,320 She developed a non union. It kind of shifted over, 77 00:03:55,320 --> 00:03:57,920 endorsed Lee a little too much and it there wasn't enough 78 00:03:58,280 --> 00:04:00,960 contact or there was maybe a little bit too much movement 79 00:04:00,960 --> 00:04:03,720 afterwards. And she had six sessions of 80 00:04:03,720 --> 00:04:07,440 shockwave focused only or non radial. 81 00:04:07,440 --> 00:04:10,720 We're starting to call things non radial only because for us 82 00:04:10,720 --> 00:04:13,600 non radial would either mean the focus shockwave we have or the 83 00:04:13,600 --> 00:04:15,640 soft wave we have one in each location. 84 00:04:15,720 --> 00:04:18,920 So she is much better after these 6 sessions. 85 00:04:18,920 --> 00:04:23,240 I can see Bony consolidation. So we did an X-ray today and we 86 00:04:23,240 --> 00:04:26,400 did just a regular office visit for her. 87 00:04:26,400 --> 00:04:27,880 So she is much better. She's pleased. 88 00:04:28,440 --> 00:04:31,880 This is one kind of a success story for Shockwave in terms of 89 00:04:32,640 --> 00:04:34,240 getting bone healing for non unions. 90 00:04:34,240 --> 00:04:37,200 So she was, she came over, she wasn't really referred over by 91 00:04:37,200 --> 00:04:40,000 her doctor, but she just did this procedure in New York and 92 00:04:40,120 --> 00:04:41,400 it didn't, didn't really resolve. 93 00:04:42,440 --> 00:04:47,560 Next patient was a 43 year old female for teenyapedis Follow 94 00:04:47,560 --> 00:04:49,200 up. This is kind of an interesting 95 00:04:49,200 --> 00:04:51,320 patient. She's the one that I don't know 96 00:04:51,320 --> 00:04:52,640 if I think we all have these patients. 97 00:04:52,640 --> 00:04:55,520 She sends me, I don't know, multiple messages, whether and 98 00:04:55,520 --> 00:04:58,240 somehow she, she got my e-mail and she sends it within the 99 00:04:58,760 --> 00:05:00,440 medical record within the portal. 100 00:05:00,440 --> 00:05:03,960 She sends it via e-mail and, and I still treat her nice. 101 00:05:03,960 --> 00:05:06,080 I think I don't have that many of these patients, but these are 102 00:05:06,080 --> 00:05:07,520 one of these that can kind of drain you. 103 00:05:08,160 --> 00:05:11,640 So this is just an office visit. And she, I recommended Amerigel 104 00:05:11,640 --> 00:05:14,880 Blue for her. So I recommended the that just a 105 00:05:14,880 --> 00:05:18,440 lotion for her feet. Next patient was a 26 year old 106 00:05:18,440 --> 00:05:21,320 man. He had bilateral first 107 00:05:21,320 --> 00:05:24,160 metatarsal, had warts for years and years. 108 00:05:24,840 --> 00:05:29,520 And he, he's, he's in school and going to be traveling. 109 00:05:29,760 --> 00:05:31,440 So I wasn't able to start the treatments. 110 00:05:31,440 --> 00:05:34,760 I put solenocate on there. I didn't want to do the 111 00:05:34,880 --> 00:05:37,600 canthrodin because it just blistered too much and he's 112 00:05:37,600 --> 00:05:40,480 going to go on a trip. I didn't want to start swift 113 00:05:40,480 --> 00:05:42,320 because he's going to be going back to school so he might have 114 00:05:42,320 --> 00:05:44,640 to find someone there where he goes to school. 115 00:05:45,080 --> 00:05:46,680 But he also had a 5th digit fungus. 116 00:05:46,680 --> 00:05:49,560 So I started the fungus treatment process with with 117 00:05:49,640 --> 00:05:53,680 Lamisil and then the fungal kit that my patients get and I 118 00:05:53,680 --> 00:05:55,560 debrided the nail. So you can get a nail debride 119 00:05:55,560 --> 00:05:58,920 and you get the office visit for him and the lesion destruction 120 00:05:58,920 --> 00:06:01,680 for those. There's a two siblings, 12 and 121 00:06:01,680 --> 00:06:04,880 14 that they both had matrices. They were both together at a 122 00:06:04,880 --> 00:06:08,600 follow up appointment. Next was a 40 year old female. 123 00:06:08,600 --> 00:06:12,000 She had a right fracture came from the urgent care. 124 00:06:12,280 --> 00:06:14,040 They thought it was a fracture. They kind of called it a 125 00:06:14,040 --> 00:06:15,760 fracture. I looked at the urgent care 126 00:06:15,760 --> 00:06:17,320 X-rays. I didn't really see the 127 00:06:17,320 --> 00:06:18,400 fracture. So I got new ones. 128 00:06:18,560 --> 00:06:21,000 Those were non weight bearing. I tend to get new ones when they 129 00:06:21,000 --> 00:06:22,440 come in. I'm finding some patients that 130 00:06:22,440 --> 00:06:24,360 are ringing in their phones and they wanted me to look at it on 131 00:06:24,360 --> 00:06:27,320 their phone, but I still find I can see a little bit better. 132 00:06:27,320 --> 00:06:31,000 I can mess with the kind of the contrast and the bone like pop 133 00:06:31,000 --> 00:06:34,520 out the, the on the bone, like there's different bone settings 134 00:06:34,520 --> 00:06:36,800 on my on my X-ray. So I can see a little bit 135 00:06:36,800 --> 00:06:38,040 better. I didn't see any fracture. 136 00:06:38,040 --> 00:06:42,280 I think it was more of a sprain. So X-ray ultrasound to look at 137 00:06:42,280 --> 00:06:44,080 the ligaments and then I did an ankle brace. 138 00:06:44,320 --> 00:06:47,560 I didn't do a Cam boot for this patient only because the, the, 139 00:06:47,760 --> 00:06:51,840 the, the urgent care did their own Cam boots. 140 00:06:51,840 --> 00:06:53,240 So that's kind of a struggle these days. 141 00:06:53,400 --> 00:06:55,360 A lot of patients are coming in. If they're coming from an urgent 142 00:06:55,360 --> 00:06:58,120 care, they're getting a Cam boot there where they might not have 143 00:06:58,120 --> 00:07:01,760 needed a Cam boot. And also I couldn't give them 144 00:07:01,760 --> 00:07:02,960 the Cam boot if they didn't need it. 145 00:07:03,520 --> 00:07:07,840 Next was a 18 year old female. She came back, she has a 146 00:07:07,840 --> 00:07:13,880 onycholytic great toenail and it was, she had some type of trauma 147 00:07:13,880 --> 00:07:15,960 to it. So only like the proximal 1/4 148 00:07:15,960 --> 00:07:17,200 was there and it's kind of thickened. 149 00:07:18,000 --> 00:07:20,840 What I did is I offered her either carry flex, which is this 150 00:07:20,840 --> 00:07:23,760 fake nail I put on for the summer, or Anifix, which is like 151 00:07:23,760 --> 00:07:26,240 this speed bump I put on there to help it to grow a little bit 152 00:07:26,240 --> 00:07:29,080 straighter. She opted for the Anifix. 153 00:07:29,080 --> 00:07:31,200 So I applied that and she's going to come back as needed if 154 00:07:31,200 --> 00:07:34,600 that falls off. Next was a 27 year old female. 155 00:07:35,400 --> 00:07:38,200 She had she had three nails that were very thickened. 156 00:07:38,840 --> 00:07:42,520 I, I did debridement talk to her about Carrie flex. 157 00:07:42,520 --> 00:07:45,080 She's going to come back for my nail tech to do the Carrie flex 158 00:07:45,080 --> 00:07:47,920 on her in a couple of days. But she also did the, the 159 00:07:47,960 --> 00:07:52,080 trybenophan LFTS and the kit. So once again, just a reminder 160 00:07:52,760 --> 00:07:56,600 when I explain this to patients, I have a little treatment sheet 161 00:07:56,600 --> 00:07:59,120 I call it and I just print it out and I go through it and this 162 00:07:59,120 --> 00:08:01,920 is how all of my patients get the ultraviolet light shoe 163 00:08:01,920 --> 00:08:04,840 sterilizer and the biotin, it's all on that treatment sheet. 164 00:08:04,840 --> 00:08:07,640 So once again, if you want my treatment sheet for nail fungus, 165 00:08:07,640 --> 00:08:09,920 if you want to try to use that in your practice, it really 166 00:08:09,920 --> 00:08:12,760 makes things a lot easier. The main three treatment treats 167 00:08:12,760 --> 00:08:16,840 I use are 4 would be wart, nail fungus, Achilles tendonitis, and 168 00:08:16,840 --> 00:08:18,880 plantar fasciitis. So if you want to try using 169 00:08:18,880 --> 00:08:22,080 those, let me know. Just shoot me an e-mail down at 170 00:08:22,080 --> 00:08:25,160 Podiatry practice master.com. I'm happy to send those over and 171 00:08:25,320 --> 00:08:26,520 let me know how it works for you. 172 00:08:27,280 --> 00:08:30,640 Next was a 60 year old male for a matrix follow up. 173 00:08:30,640 --> 00:08:34,360 He's doing fine. Next was a 55th year old 55 year 174 00:08:34,360 --> 00:08:35,919 old female. Now she is one. 175 00:08:35,919 --> 00:08:37,480 This is one that I haven't done that much. 176 00:08:38,720 --> 00:08:46,520 She had a deltoid injury and the MRI showed like a like a partial 177 00:08:46,520 --> 00:08:51,040 tear of the deltoid. And I actually had her see one 178 00:08:51,040 --> 00:08:55,080 of my colleagues because she had a tailored Dome lesion, but it 179 00:08:55,080 --> 00:08:57,320 was a little too small for him to to fix or need to do 180 00:08:57,320 --> 00:08:59,280 anything. So what he recommended is he 181 00:08:59,280 --> 00:09:01,360 recommended 4 sessions of shockwave. 182 00:09:01,360 --> 00:09:03,000 So this is going to help the deltoid. 183 00:09:03,000 --> 00:09:06,920 It's also going to possibly help that that tailored Dome lesion. 184 00:09:06,920 --> 00:09:11,120 So I'm going to, I'm going to set those or she was set up for 185 00:09:11,120 --> 00:09:13,920 me to, to, to do those. She had four of them. 186 00:09:13,960 --> 00:09:17,160 The reason does 4, he does 4 and I tend to do 6. 187 00:09:17,160 --> 00:09:18,640 So that's why she's going to only have 4. 188 00:09:19,080 --> 00:09:22,200 Now, one of the challenges in in our office, and I don't know how 189 00:09:22,200 --> 00:09:25,680 your office is, but for our office, they can prepaid. 190 00:09:25,680 --> 00:09:28,120 So it's good for me because I get the payment under my 191 00:09:28,160 --> 00:09:30,240 billing. So she prepaid the gets a 10% 192 00:09:30,240 --> 00:09:31,920 discount. But the problem is if, if one of 193 00:09:31,920 --> 00:09:33,840 them are done by the other doctor, they don't get that. 194 00:09:33,840 --> 00:09:36,280 So I don't really have a good solution for doing that. 195 00:09:36,280 --> 00:09:38,400 We're not like taking out portion of it and giving it to 196 00:09:38,400 --> 00:09:40,400 the other doctor. I guess it doesn't happen a ton, 197 00:09:40,640 --> 00:09:43,560 but it's just something that I feel a little bit bad that the 198 00:09:43,600 --> 00:09:45,600 the 4th session the other doctor's going to be doing, but 199 00:09:45,600 --> 00:09:47,160 they're not going to get any of the reimbursement. 200 00:09:47,160 --> 00:09:49,400 They'll probably get like the office visit for that for that 201 00:09:49,400 --> 00:09:52,880 last one though. Next patient was a 37 year old 202 00:09:53,040 --> 00:09:57,080 male follow up matrix. Once again, there was no fungus 203 00:09:57,080 --> 00:10:01,560 in the nail sample. Next patient was a 78 year old 204 00:10:01,560 --> 00:10:04,160 female. Their carry flex fell off, had 205 00:10:04,160 --> 00:10:05,680 like a crack on it and so I repaired it. 206 00:10:06,080 --> 00:10:08,880 So what I do with carry flex, Carry flex it it is. 207 00:10:08,880 --> 00:10:12,160 I would love my male type to do more of these because they are 208 00:10:12,160 --> 00:10:13,520 kind of a time drain there there. 209 00:10:13,640 --> 00:10:16,400 Maybe if you do 2 of them it makes a little bit more sense in 210 00:10:16,400 --> 00:10:20,360 terms of profit, but to do it it, it takes a long time. 211 00:10:20,360 --> 00:10:22,640 So with this one, I did them both because they're going to 212 00:10:22,640 --> 00:10:25,440 look better that way, but I only was able to get an office visit 213 00:10:25,440 --> 00:10:26,560 out of this. So if you're looking at like 214 00:10:26,560 --> 00:10:28,600 most valuable patient and least valuable patient, this is 215 00:10:28,600 --> 00:10:30,320 probably one of the least just because the amount of time. 216 00:10:30,520 --> 00:10:32,640 Thankfully, I didn't have a ton of other patients like 217 00:10:33,200 --> 00:10:36,000 stampering around or, or I was able to be efficient enough with 218 00:10:36,000 --> 00:10:37,960 the other ones. Next was a 45 year old female 219 00:10:38,560 --> 00:10:47,200 X-ray ultrasound and did a had plantar fasciitis and, and this 220 00:10:47,200 --> 00:10:49,320 is an interesting patient. I actually saw a we saw her son 221 00:10:49,320 --> 00:10:53,040 in the office receivers and one of my colleagues did shockwave 222 00:10:53,040 --> 00:10:56,640 for the sievers and patient got totally better with the sievers. 223 00:10:57,120 --> 00:11:00,040 And then that's why she came back and she actually said she 224 00:11:00,040 --> 00:11:02,680 wanted shockwave. So she got the Pelto special 225 00:11:02,680 --> 00:11:04,680 night splint foam rolling, running stretch 6 chests and 226 00:11:04,680 --> 00:11:07,200 sister shockwave. And once again, I talked to her 227 00:11:07,200 --> 00:11:09,320 about doing the orthotics at the third third visit. 228 00:11:10,240 --> 00:11:12,520 So that's kind of the, the, the, the way I do it. 229 00:11:12,520 --> 00:11:16,600 The the kind of that MVP patient for these plantar fasciitis next 230 00:11:16,600 --> 00:11:19,880 was a 48 year old fracture follow up of the DIPJ of the 231 00:11:19,880 --> 00:11:22,080 hallux. And this patient also has some 232 00:11:22,080 --> 00:11:26,280 left midfoot gout flare up. And so I was able to do the 233 00:11:26,280 --> 00:11:29,040 fracture follow up and I with a separate and identifiable for 234 00:11:29,040 --> 00:11:31,000 the gout. So talking to that patient about 235 00:11:31,000 --> 00:11:33,160 the gout as well. So this is 1 where usually 236 00:11:33,160 --> 00:11:35,120 you're in the global period for the fracture. 237 00:11:35,560 --> 00:11:37,720 But because there was a new condition with the scout, I was 238 00:11:37,720 --> 00:11:40,080 able to get the office visit for that patient as well. 239 00:11:41,080 --> 00:11:45,560 Next was a 58 year old follow up after 7 shock waves for the 240 00:11:45,560 --> 00:11:49,360 plantar fasciitis. Now this is one that she did 6 241 00:11:49,840 --> 00:11:52,680 she did a 7th at the six week follow up and now she's six 242 00:11:52,680 --> 00:11:56,640 weeks again and she's feeling quite a bit better, but not 243 00:11:56,680 --> 00:11:59,680 100%. So this one, what I did is I did 244 00:11:59,680 --> 00:12:01,720 an eighth and I did not charge her. 245 00:12:01,720 --> 00:12:05,640 So once again, once you get past six, in my opinion, 7-8, I have 246 00:12:05,640 --> 00:12:07,720 AI don't know, maybe it's just my own conscience. 247 00:12:07,720 --> 00:12:10,200 I just feel bad and it doesn't really take me that long. 248 00:12:10,200 --> 00:12:13,880 So I did focused only for her and and and I'm going to see her 249 00:12:13,880 --> 00:12:15,200 back in three months like these ones. 250 00:12:15,400 --> 00:12:17,880 When you invest this much time and, and things like that, I 251 00:12:17,880 --> 00:12:20,960 think sometimes doing a couple of them pro bono is is an okay 252 00:12:20,960 --> 00:12:23,640 thing. Next was a 57 year old female 253 00:12:23,640 --> 00:12:25,440 for I and D with the right great toe. 254 00:12:26,200 --> 00:12:28,400 Next was a 14 year old. This is a patient. 255 00:12:28,520 --> 00:12:33,320 She had a hallux interphalangius bilaterally and the big toe is 256 00:12:33,320 --> 00:12:35,640 kind of hitting against the second toe causing an ingrown 257 00:12:35,640 --> 00:12:38,240 toenail. So I never do this right because 258 00:12:38,240 --> 00:12:40,080 I've done it twice in the last couple weeks. 259 00:12:40,080 --> 00:12:41,480 So I guess shouldn't say never anymore. 260 00:12:41,720 --> 00:12:45,320 But they really didn't want the an Ind or like a partial nail 261 00:12:45,320 --> 00:12:47,400 abulsion. So I trimmed it back and I used 262 00:12:47,480 --> 00:12:49,360 like 1/2 of a Band-Aid to pull the side of the nail down. 263 00:12:49,360 --> 00:12:51,960 I don't do that that much. I just I don't think it works in 264 00:12:51,960 --> 00:12:53,680 the long term, but I just explained to them. 265 00:12:53,680 --> 00:12:55,840 But I also had X-rays bilaterally for this patient 266 00:12:55,840 --> 00:12:57,840 because of the hallux interphalangius. 267 00:12:58,320 --> 00:13:02,400 Next was a 51 year old female for number one out of 6 for 268 00:13:02,400 --> 00:13:05,800 Shockwave to the right heel. And I also talked to her once 269 00:13:05,800 --> 00:13:08,160 again planting the seed. At the third visit, we're going 270 00:13:08,160 --> 00:13:10,720 to scan her for orthotics. Why do I scan for orthotics at 271 00:13:10,720 --> 00:13:12,080 the third visit? Not the first visit. 272 00:13:13,600 --> 00:13:16,600 Usually it's because at the first visit or like by the third 273 00:13:16,600 --> 00:13:19,040 visit, like let's say 3 weeks in when we get the orthotics, 274 00:13:19,120 --> 00:13:24,280 they're never comfortable and it's mostly because of comfort 275 00:13:24,960 --> 00:13:27,520 because by this 5th or 6th visit their foot starts to feel 276 00:13:27,520 --> 00:13:28,920 better. They can tolerate the orthotic a 277 00:13:28,920 --> 00:13:30,560 little bit better. I'm just thinking kind of out 278 00:13:30,560 --> 00:13:32,040 loud. Logistically though, it's 279 00:13:32,040 --> 00:13:34,520 probably better to scan them in the first visit and just not 280 00:13:34,520 --> 00:13:36,320 have them start wearing it till a little bit later because their 281 00:13:36,320 --> 00:13:38,360 foot type really doesn't change. Or it might just be easier to 282 00:13:38,360 --> 00:13:40,440 get get everything done at the at the same time. 283 00:13:40,440 --> 00:13:41,560 I'd like to know what other people do. 284 00:13:41,560 --> 00:13:43,760 Like when do you when do you tend to do your orthotics? 285 00:13:43,760 --> 00:13:46,680 Do you do the first visit? Do you do it a little bit later? 286 00:13:46,920 --> 00:13:48,800 Very rarely do I do orthotics only. 287 00:13:48,800 --> 00:13:51,120 I'm usually doing it in conjunction with something else. 288 00:13:52,160 --> 00:13:54,840 Next patient was a this was a second opinion, a 75 year old 289 00:13:54,840 --> 00:14:01,680 female that had a left 2 to 4 hammertoe and she had a really 290 00:14:01,680 --> 00:14:04,440 kind of a bulbous tip on the 3rd digit with a chronic ulcer 291 00:14:04,440 --> 00:14:08,080 there. And her primary care is going to 292 00:14:08,080 --> 00:14:11,160 send her for an MRI since the other podiatrist did not. 293 00:14:11,640 --> 00:14:12,960 And I talked to her about two options. 294 00:14:12,960 --> 00:14:15,160 One would be flexortonotomies of 2-3 and four. 295 00:14:15,480 --> 00:14:18,200 The other option would be arthroplasties of those due to 296 00:14:18,200 --> 00:14:20,440 her age. I got X-rays. 297 00:14:20,440 --> 00:14:24,040 I didn't see any lytic changes to the tip of that third toe but 298 00:14:24,120 --> 00:14:26,040 there always could be since there was a chronic ulcer there. 299 00:14:26,040 --> 00:14:28,160 So I'm going to wait for the MRI to and she's going to see what 300 00:14:28,160 --> 00:14:31,120 she's going to do next. Was a 71 year old 71 year old 301 00:14:31,120 --> 00:14:37,000 male with a right second toe. Bulbous change. 302 00:14:37,000 --> 00:14:41,240 This gentleman as well, he came in for so he has a BKA on the 303 00:14:41,240 --> 00:14:45,120 left. He had he nagged, he kind of 304 00:14:45,120 --> 00:14:47,480 pulled off his toenail. It got a little infected put he 305 00:14:47,480 --> 00:14:51,680 was put on antibiotics by the urgent care came to follow up 306 00:14:51,680 --> 00:14:53,200 with me. It was looking fine, but then it 307 00:14:53,200 --> 00:14:55,520 didn't look good like a week after it just didn't look good. 308 00:14:56,200 --> 00:14:58,840 So I sent him he had some Cellulitis on his toe and a 309 00:14:58,840 --> 00:15:02,080 little bit going up his legs. So I sent him to the Ed for 310 00:15:03,120 --> 00:15:06,280 treatment and IV antibiotics and I'm hoping he doesn't have to 311 00:15:06,280 --> 00:15:08,320 amputate that toe or amputate anything else. 312 00:15:09,480 --> 00:15:13,040 Next was a 58 year old for a right foot neuritis. 313 00:15:13,040 --> 00:15:15,200 She had some right neuritis that did get better. 314 00:15:15,200 --> 00:15:17,640 She was also placed on Lamisil. It's too soon to tell how it's 315 00:15:17,640 --> 00:15:19,040 doing. I'm going to see her back in for 316 00:15:19,040 --> 00:15:20,640 the Lamisil follow up in two months. 317 00:15:21,080 --> 00:15:23,160 And then finally there's a 15 year old boy. 318 00:15:24,240 --> 00:15:28,720 He had a subaggle hematoma to 2nd 3rd digits bilateral. 319 00:15:28,720 --> 00:15:31,960 He'd previously lost a big toenail because of that. 320 00:15:31,960 --> 00:15:34,200 And I think it all has to do with his soccer cleats. 321 00:15:34,840 --> 00:15:38,960 He's got kind of big feet, a wide, nice beautiful wide foot. 322 00:15:38,960 --> 00:15:41,760 But the problem is I don't know of any anatomic soccer cleats. 323 00:15:41,760 --> 00:15:45,000 So if anyone knows of an anatomic soccer cleat, please 324 00:15:45,000 --> 00:15:47,520 shoot me an e-mail dot at Podiatry practice master.com. 325 00:15:47,520 --> 00:15:49,240 Like what do you recommend for kids? 326 00:15:49,240 --> 00:15:52,640 Because most of these cleats are too small and or too narrow. 327 00:15:52,640 --> 00:15:55,240 I'm sorry, in the toe box. Do you know of any anatomic 328 00:15:55,240 --> 00:15:56,640 ones? Anyway, hope you guys find this 329 00:15:56,640 --> 00:15:59,000 beneficial. If you did, I have $1,000,000 330 00:15:59,000 --> 00:16:00,720 practice Brooklyn that I give away. 331 00:16:01,640 --> 00:16:04,320 As you can tell I like to give give away a lot to help you get 332 00:16:04,320 --> 00:16:05,920 your practice. The $1,000,000 mark can get it 333 00:16:05,920 --> 00:16:08,440 up, put practice mastery, just put in your name and e-mail and 334 00:16:08,440 --> 00:16:11,560 it goes through kind of everything that I look at and if 335 00:16:11,560 --> 00:16:14,520 that you can look at to do that. Okay, until tomorrow. 336 00:16:14,520 --> 00:16:14,840 Thanks.