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I recently got a new batch of 
canthrodin in the office and my 

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wart treatments got infected 2 
times. 

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Hello, welcome to Podiatry 
practice mastery. 

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My name is Don Pelto, I'm going 
to go over the $1,000,000 minute

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here. 
So I had a couple of patients 

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recently. 
After we got some new canthrodin

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in the office, I used to have 
patients leave it on till the 

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following morning. 
Now I'm starting to have them 

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take it off in four to six hours
because I got this big blister. 

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And I got a call this weekend 
and they sent me a picture and 

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it had like pus underneath it. 
So they popped the pus and, and 

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the infection went down. 
But I did have another gentleman

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that I put it on his wart and he
actually had a, a bad infection 

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from it and had to get admitted 
to the hospital. 

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So like these are things that I 
think depending on the, the 

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quality of the products that we 
use. 

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So I think the old Catherine got
a little bit old and didn't 

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wasn't as potent and this newer 
1 is, is more potent for us or 

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maybe just even the vendor. 
So I have to be be careful, be 

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careful because that can, can 
ruin my day and ruin my weekend 

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of getting those calls. 
They're concerned. 

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It was easy to treat, but it's 
just, it's just a frustration. 

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OK, let's go into the day here. 
The, the most valuable patient 

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today was a the shockwave 
patient, a 51 year old female. 

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She had #4 out of 6 for 
Shockwave and then she was 

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scanned for orthotics. 
What I, what I usually do is I 

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tell patients that they're going
to be scanned on the third 

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visit. 
This was actually the fourth 

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visit. 
And the way I explain it is I 

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explain the the shockwave is 
good at getting rid of the pain,

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but to help it not come back and
help the mechanics of the foot 

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is specifically high contouring 
orthotic on that thickened 

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fascia can help reduce the re 
injury rate for the patient and 

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that and that's kind of how I'm 
doing the the orthotic. 

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So that was the most valuable 
patient. 

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Next patient was a this was a 
another cancer in this the 

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second cancer in doing for this 
patient, 40 year old female. 

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Next was a 46 year old man 
bilateral foot pain got X-rays. 

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He he actually went to Six 
Flags, which is great America, 

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one of the amusement parks here 
anywhere. 

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He wore Aqua socks the whole 
day. 

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And I've heard injuries due to 
flip flops. 

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I've never heard injuries due to
Aqua socks, but he was wearing 

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Aqua socks and his feet were 
really hurting, you know, but 

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for the 46 year old guy with 
with he has a 2 year old 

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daughter. 
He's just walking around too 

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much and that's why his feet 
hurt And it took a couple weeks 

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to get better, but now he's 
better. 

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But I don't think he had 
anything else. 

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Next was a 53 year old female 
with a left fracture follow up. 

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She had a fibula fracture after 
PT. 

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She's out of the global so I was
able to get the the office 

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visit. 
She also had some fissures 

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through her heels and I just 
reminded her of how to take care

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of the the fissures at my. 
My routine tends to be the 

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sleeping heel socks at night and
then during the day or in the 

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morning the 40% urea cream with 
a pumice bar for that 

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occasionally. 
Next was a 55 year old female. 

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She came in because her carry 
flex fell off. 

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You know, this would be least 
valuable patient, I guess. 

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I got an office visit out of it.
Had to put the carry flex back 

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on. 
She's a nice, nice patient, but 

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those kind of glut the schedule 
a little bit and I'd like to get

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more of those on. 
Marjorie, my nail tech schedule 

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for that. 
Next was a 76 year old female. 

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She had a new patient. 
She had a left matrix on both 

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edges. 
She's had a couple of ingrowns 

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before in the past and she opted
for that. 

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She had had a couple of just I 
and DS before. 

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Next was that plantar fasciitis 
#4 out of 6. 

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There was a lot of a lot of 
shockwave yesterday. 

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So let me go. 
Might as well go through do all 

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the shockwave here. 
So plantar fasciitis 4 out of 6.

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There was a Achilles tendonitis,
a 60 year old female #2 out of 

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6. 
There was a 68 year old man with

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#4 out of 6 posterior tibial 
tendon. 

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The other one was Achilles 
tendon. 

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Next was a 38 year old female 
with left ankle pain. 

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She had number actually arch 
pain, arch pain. 

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She had #1 out of 6. 
Now this is a funny one. 

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I have some patients someone 
just always want a discount. 

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And this was one, and this is 
one that would like had three 

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phone conversations with Blue 
Cross Blue Shield wanted their 

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shockwave to be covered and 
thinking it would be covered and

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this and that and oh boy, so 
this one, but these ones do also

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do Taekwondo with my kids. 
And so I wanted them to feel 

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like they're getting a deal. 
So I did both feet because she 

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does have it on both arches and 
I did both and I only charged 

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for one. 
I occasionally do that. 

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I, I feel like it doesn't really
take me extra time and I don't 

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always double dip on these, 
these bilateral cases. 

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Next was a 57 year old female 
and #3 out of 6 for Achilles 

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tendonitis. 
Now there was a 45 year old 

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female with left plantar 
fasciitis #5 out of 6. 

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And those were the a lot of the 
the shock waves of the day. 

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Now I'm going to get back into 
that other stuff. 

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Next patient was a 42 year old 
female with bilateral bunions 

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and hammer toes. 
And she was wondering about 

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doing if she had to do anything 
because her mom is a really bad 

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hammer toe. 
So I really just talked to her 

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about shoe changes, did X-rays. 
My shoe recommendations are 

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usually anatomic shoes like 
lems, topos, ultras and I always

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say shoes 1st and then correct 
toes 2nd and then surgery after 

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after they try those things. 
Next was a 25 year old man. 

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This gentleman I think he's a a 
medical student or a post doc or

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a PhD student. 
He had a little red, a little 

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black line on his left 5th 
digit. 

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He was concerned about like a 
mulatto Nikkia. 

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I took a nail sample I think was
more from rubbing. 

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He also had a little mole on his
right 4th toe. 

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And I didn't even biopsy. 
It was just so small. 

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I took pictures of him and I'm 
going to see him in a year. 

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Next was a 61 year old female. 
She traveled all the way from 

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New Hampshire because she had 
ingrown toenails and she saw 

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that we were like one of the 
only ones that actually did Ani 

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fix. 
And so she came all the way for 

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that now. 
Yeah, Mind you, these words were

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kind of curved toenails that 
were curved in on both edges of 

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both Gray toenails. 
And I did the Onifix. 

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I do not do a ton of Onifix. 
I do it occasionally when they 

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need it. 
This hers is really not getting 

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never gotten infected, but they 
just bother her. 

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So I put Onifix on bilaterally 
and then she'll come back when 

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they fall off. 
That's when I I used to have 

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them come in every three months 
and then I would apply another 

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one proximately. 
But at this point I try to keep 

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it on as long as it keeps on 
stays on and if it falls off, I 

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don't charge them to put it on 
it. 

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I, I, I kind of guarantee it for
three months. 

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If it falls off, then I just 
charge an office visit for that 

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one. 
Next was a a 64 year old female 

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with a, a right a foot lesion. 
And I kind of did X-rays did 

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offloading. 
She had a kind of a prominence 

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on the extensor hallucis longus 
just proximal to the to the 

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first met head. 
So I think she has rubbing and 

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bow stringing of the extensor 
that's causing like an ulcer. 

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I think it's because she was 
wearing slip on shoes and then 

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you're just pushing your foot in
there and it was hitting on that

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area. 
So I made a little offloading 

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pad. 
I felt like I was in school 

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again with XM do a ton of 
padding. 

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I did like some felt and 
offloaded it and stuck it on her

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foot with the elastoplast and 
put right and left on it. 

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I felt so crafty. 
OK, next was a Q Tenza consult. 

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This is a, this is a 72 year old
man. 

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He has non diabetic neuropathy. 
You know, these ones are just 

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like willing to do anything for 
the neuropathy. 

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He was thinking about going to 
Columbia for stem cell 

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injections. 
He has seen a number of 

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different providers. 
He's doing some vibration plate.

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I don't exactly know what it is,
some vibration plate where he 

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pays $250 just to vibrate his 
feet. 

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He's considering a nerve 
stimulator and he was referred 

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over from the nerve stimulation 
pain management at a hospital 

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for us to do Q 10s of the 
problem is they didn't preface 

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it that Q 10s usually isn't 
covered for non diabetics. 

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And so I'm going to try to get 
it covered because he's on all 

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these other medications and 
things like that. 

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And he, he, he can feel. 
So it's like a non he, he has 

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symptomatic painful neuropathy 
and so we'll see if that's 

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that's covered for him. 
I'm going to try, try to, we've 

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had some patients, some 
insurances that cover that. 

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Next was my oh, this is, I don't
think I talked about this, but 

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this isn't one of my favorite 
shock waves of the day. 

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This is #4 actually #3 for the 
4th digit fracture. 

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This is a fracture non union 
that's been there for a year and

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a half that didn't get better. 
Really swollen digit after the 

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first and second. 
She's already feeling better. 

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She's she's on #3 for this 
focused only. 

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So when it's a fracture, it's a 
little toe come on, it's a small

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area. 
I'm not going to do radial on 

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that. 
It's just too so. 

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But she's doing focused only for
that one. 

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Next patient was a 40 year old 
female had 4 foot pain quite 

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possible neuroma I she does have
a lot of tight Aquinas and so I 

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talked about anatomic shoes and 
she's going to do the the Pelto 

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special at night, split foam 
rolling, morning stretch and 

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then see her in one month and 
see how she does. 

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And the last patient of the day 
was a 82 year old male for a 

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right right Aquinas as well. 
He had painful Achilles once 

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again, foam rolling and 
stretching. 

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This guy, he was great. 
He was a one of The Pioneers 

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with pickleball. 
So he's like got this pickleball

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shirt and I started talking 
about pickleball and he's like, 

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yeah, Massachusetts. 
He was like 15 years ago, he 

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started to play pickleball and 
he learned it from a guy that 

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played it in Florida. 
And then he made his own little 

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pickleball courts. 
Like they went to the rec center

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and asked them to do the 
pickleball courts. 

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See anyway, he was really, I 
think the main issue is he was 

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tight and he needs some help 
with that, with that tightness. 

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I did not do a night spin 
because he's not having any pain

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getting out of bed in the 
morning, but he's very, very 

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tight. 
So I had to work on foam 

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rolling, stretching, things like
that. 

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If it doesn't get better, then I
will do probably physical 

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therapy for him. 
OK, so that was the day. 

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I hope you guys found this 
beneficial. 

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I am putting together kind of a 
six month challenge for some 

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people that are interested. 
If you want to learn more, you 

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can go to 
podiatrypracticemastery.com. 

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There's, there's, I think 
there's going to be something up

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top that says challenge or it'd 
probably be back slash challenge

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to find that looking for some 
other practices that want to 

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bring their practice to the 
$1,000,000 mark and beyond. 

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And I was thinking, I think the 
best people for this are people 

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that are, are already busy. 
I think there's two, I, I did a,

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a podcast recently. 
I think there's two groups of 

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people. 
The in terms of practices, not 

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people in general, just 
practices, some that are they're

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supply constrained, meaning they
don't have enough supply of 

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patients. 
Those are harder to deal with. 

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Those are harder to like, I 
don't know if you get the best 

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benefit from from the mastermind
because you're not busy enough, 

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you don't have the the the 
number of patients that you can 

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optimize. 
If you're, if you're still 

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trying to get in patients that 
that's your whole focus is like 

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marketing is AdWords newsletter,
getting referrals, everything 

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else like that. 
Once you get to a certain amount

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of patience, then you're looking
to go from like 600,700 thousand

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up to the $1,000,000 mark. 
And then so it's doing that 

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transition. 
Once you're totally busy and you

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don't have any more room for 
patience, then I feel like 

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that's where that's a better 
area to help with to optimize, 

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to optimize your practice 
production. 

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OK, So those are those are 
things that would be the better 

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people for this challenge. 
OK, Once again, hope you guys 

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enjoy this. 
Have a great day, talk to you 

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tomorrow.