Have you heard of something called alleviate for doing your
own self Graston in the in the with the patients themselves.
Welcome to Podiatry practice mastery.
My name is Don Pelto. I want to share a new type of a
device that we have. I don't use a lot of it.
I kind of think I probably should use more of it, but I
don't. So this device is called
alleviate ALLEVIATE. You can look it up.
It is a almost like a self grasping tool for the bottom of
the heel. And I had a patient today, she
was status post 6 shock waves. She came back six weeks later.
She's about 50 to 60% better on her ultrasound.
She had a lot of thickness and a lot of effusion and so I could
tell that the fascia wasn't completely better.
And I usually at this point, I do six weeks the first follow up
and then I do 12 weeks at the next one.
And so I give patients they can either go to physical therapy at
this time or this time. I thought, well, heck, we should
try this alleviate thing. So the alleviate I'm, I'm going
to try it out. They have a lot of good reviews
and I and I think it's kind of an option for patients that have
painful plantar fasciitis. That's what it's marketed to.
It was invented by a physical therapist.
It is a, a device that has like almost like tentacle legs that
open up like an octopus. And then it has kind of two
small, a smaller lump and a bigger lump in these lumps you
put on a almost like a, not a gel, but a, a grease, a grease
or some type of a oil that can help it to massage on there.
And, and in the patients do 2 to 3 minutes of deep tissue massage
in that area to help probably the similar things to what like
a Graston technique would be doing, breaking down the, the
heart tissue and stimulating blood flow to the area.
It's a pretty reasonable tool. It's about 70, I think $75.00
for the tool. They have a kit that you can do
the tool massage. I think it has a like a ankle
brace type of thing and like a compression sock.
Why don't I use it a ton? I don't use it a ton, frankly,
because I think I get good enough results with the just the
shockwave and then patients they may or may not go to PT.
So it might be an option to avoid because I don't have
patients go to PT most of the time so I have them if they want
to do something at home they can do this.
There's just another add on. It seems like a good product.
I'd like to know if anyone else is using it.
It's called alleviate. OK another question I actually
had for people. Does anyone do their own
charcoal AF OS? I had a patient today.
This is a 53 year old man. He looked like he had a
navicular fracture, but I was very susceptible for charcoal
and he had back and a back injury where he is pretty much
mostly neuropathic on the right side and he developed a charcoal
foot. So he's been in a boot Cam boot
and then I'm going to make him a crow boot.
But I was thinking, man, if I could start doing these crow
boots. I know I can with, with my
scanner. I, I just get a little bit
worried if I have to add more padding and, and things like
that. So I'd like to know if anyone
else does their own crow boots. Shoot me an e-mail down at
Podiatry practice mastery.com. So this guy, he came back after
the MRI did X-rays. It's within the global.
So it was kind of a low value patient, but if I could have
done the crow boot, it would have been better.
But I just I sent him out to to hanger.
Next patient was a left heel pain 45 year old female.
She's had it for two years. We did an X-ray, did an
ultrasound. She did not have any Aquinas,
but she had pain down there. So I set up shockwave times 6.
So I'm going to see her back for that.
Next patient was a 59 year old man for right medial heel heated
shockwave there. And this was number one out of
three. And the reason it was one out of
three is because previously he had 10 sessions of soft wave by
another chiropractor or it wasn't a chiropractor, it was
their office and he wanted to do to do ours because he got some
improvement with it. I don't know why he didn't go
back to them but he wanted to see us.
Next was a 63 year old female for left second.
Her second post op suture removal for neuroma.
She is doing fine but I did send a message I was on vacation when
this first post op was done and it was another.
We have a younger doctor here that just starting out and he
was, he was kind of complaining a little bit when I traveled
about like doing my shock waves and they made maybe they prepaid
for them. So we didn't get paid or didn't
count towards his numbers. And I kind of my thoughts to
that, as I think when you're not that busy, like any patient is
fine, right? When you're, when you're still
kind of starting out, I think it's good to get the practice
with the patients, the FaceTime, they get to know you.
But one thing I, I told him, I'm like all post OPS would get a
Cam boot and they came in a surgical shoot.
So all pretty much all of my post OPS, I don't give him the
Cam boot at the hospital because I want to bill for it.
So I actually do it at my first post op.
And maybe he didn't know that. Maybe he didn't think you're
supposed to do that for an aroma, but it was something that
I think there was kind of profit left on the table there.
But I think most patients are better in a in a camp.
But so the simple things, I think he it could have helped
his billing if he had done that, but he didn't.
Next was that 55 year old female that I did alleviate for that I
talked about in the beginning. Next was a 63 year old female
for a right ingrown. So she had a onycholytic nail
about on the right hallux, about half the nail and it was digging
into the skin. So she had a pyogenic granuloma
that was producing on the dorsal nail bed about halfway down.
I did a partial nail evulsion back about maybe 3 or 4mm from
the area of the granuloma and I and I divided that down.
So I built for a partial nail evulsion on the other side.
She also had a previous Onifix application to try to get her
nail to get a little bit less thick.
So I, I did, I ground that down and I put a second Onifix for
that. So Onifix I don't do a lot.
I've been doing some of these a few days.
So it's like a speed bump that you put on that helps kind of
guide and direct the nail. It's typically used for ingrown
toenails, but I'm also trying to do it for onycholytic nails and
some of these thick WAVY nails as an as another option.
Next was a 37 year old female that had left MRI of her
tailless and it showed bone marrow edema around the tailless
and the sub tailor joint region. I gave her three options for
this. She's had pain for for quite a
while. She's quite young.
She's a teacher. I talked about waiting, giving
it more time. I talked about possibly doing an
arthroscopic evaluation of of it to see if there's like a
tailored Dome lesion because that's where the bone marrow
edema is. And I talked about doing
Shockwave, she opted she's going to teach her.
So she's going to go go back and do the teaching and maybe during
one of her holiday breaks, she's going to do the sessions of the
Shockwave. Now this is the downside from
this, these ones that I bill initially when I saw her, I
billed as a fracture code. And so this day, all this
conversation and things like that, there was no office visit
because it was still within the global period of the, of the
fracture code. So I think you you do well on
some of the fracture codes and you don't do as well on some of
the other ones. Same thing with that other shark
code that was a fracture code as well.
Next was a 14 year old male. He had a little Down syndrome.
So we had some hypermobility, bilateral flat feet.
I did X-rays, talked to him about doing orthotics.
They have mass health, which is a Medicaid plan.
So they're, they're going to pay 20% of their visit.
So they have a like an individual plan and then the
mass health. And so for them, I, I gave them
a prescription to go to hangar for the orthotics.
I, I do think ours are better. So if, if they say hangar
doesn't cover them, I recommended them.
Coming back to me next was a 44 year old female for a carry flex
that fell off after two months. So I usually guarantee my ANI
fixes and my carry flexes for three months and if it falls off
early, I don't charge them for the procedure, I just charge
them for the office visit. So it was a Level 3 office
visit, but but like kind of low value patient because of that.
Next was a 25 year old man with a left hallux fracture.
He had a little distal avulsion. He had a fracture code and I
also did a nail avulsion on him. So the nail avulsion fracture
code and I'm going to see him back in four weeks in a Cam
boot. Next was a 65 year old female.
That was the morning, this is the afternoon 65 year old for a
left Achilles tendon pain. Patient was is going to do foam
rolling Meloxicam and they're going on vacation.
So I give them a Medrol dose pack in addition to the Moloch
scan just for some breakthrough pain if they need it.
And I did an X-ray. I'm going to see them back when
they when they get back but they weren't on vacation so they need
something to calm it down. Next was a 45 year old man with
a second toe fracture follow up still within the global.
So I just got the X-ray for this one and he's going to come back
in four weeks or he's not going to come back at all.
He's doing fine. So I think some of these, even
these fracture follow-ups, I'm going to start putting in my
like double booking in my 10 minute slots because they're
simpler procedures and they're kind of low value patients in
terms of it doesn't really take that much time and it doesn't
take that much thinking. So I think it would be a quicker
slot. Next was the left hallux
matrixectomy for a 18 year old female.
Next was a 49 year old female with she had a previous
cortisone injection in the right third and 4th inner spaces for
neuroma and she didn't want surgery, she didn't want
cortisone again. She's already tried anatomic
shoes and so we talked to her about doing shockwave.
So she did shockwave on those intra spaces.
So when you do shockwave, I did focused only and I did .05.
So I do very, very low shockwave.
They can still feel that you have to be if to respect the
nerve tissue. So nerve tissue is not like
fascia tissue or tendon, a lot more sensitive.
So I did .05 very low focus, 2000 pulses.
This is number 1 of 6 for her. So she wants to try to do this
treatment non invasive or no cortisone and no no surgery.
Next was a 24 year old man with the right ingrown toenails.
I did Ind. Next was a 72 year old female
did a nail sample. The nail was partially detached
and had possible fungus. I'm going to see them back in
three weeks because I wasn't too sure because of the detachment
or the onycholysis. I'm not sure if it was like a
bacterial infection underneath it because it was detached and
water gone underneath there or if it was real fungus.
That's why I didn't actually start them on the medication.
I'm going to see them back in three weeks.
Next was a 55 year old man. This is a guy that deals with
some chronic itching, itching slash teeny pedis slash eczema.
So he's not sure what he has. He had some like scratches on
his lower ankles. He's a self pay patient and he
tried after a couple years to send a refer request to the
pharmacy. So I get this sometimes if I
haven't seen patients in a year and they asked for a refer
request, I tend to have them come in because I want to
reassess the situation. But for this guy I did prescribe
a an antifungal and A and A and a clobetasol to help with that
itching for him. Next was a a 47 year old female.
She had I did an ultrasound on her.
She has plantar fasciitis and Achilles tendonitis, but she has
a normal ultrasound. And I think the reason for this
is she has very, very bad Aquinas.
She's very, very tight. That's why she's getting the
heel and the and the planter foot pain.
I refer to her for physical therapy and she already has the
night splint, foam rolling, morning stretch, all that other
stuff. If that doesn't get better than
I, I did suggest that she would come back for Shockwave.
I think Shockwave would would benefit, but I think the bigger
portion is the, the tightness that she has.
And kind of the, the, the most interesting patient of the day
is this 33 year old female. So she had a right knee
Arthroscopy for a like a, an, an ACL repair and a meniscus.
And she came in, she's about two months and she was in crutches,
not for her knee, but for her foot.
Her foot was hurting her. She had foot pain.
She had kind of nerve pain. She had pain kind of near the
second, third met head digit region and she had a lot of
tightness. So I did a few things.
She had tenderness in her calf, so I'm going to rule out DVT.
I did like a massage ball on her calf and then when I did it on
the calf, some of the foot pain went away.
So I think some of it could be tightness from the knee or like
the immobilization or not being as active.
So she's going to do some foam rolling on that area to kind of
loosen up that area. And then it also could because
she had, I think she had a thigh tourniquet and so some of it
could be like a neuroproxy, like a nerve pain.
So she's already on gabapentin, 100 milligrams.
So I suggested she upped that a little bit to 300 to see if that
would help it. So it could just be nerve
related issues, but I don't know why it would hurt only at the
like a second, third MPGA region in her foot.
There was no other soft tissue things.
I also considered it could be like regional pain syndrome or
something like that. So I suggested she upped her
vitamin C and things like that. So I don't know if anyone is
great at dealing with chronic regional pain syndrome.
I am not, but that's how I dealt with this patient.
So I'm going to see her back in two weeks because I'm concerned
with her that she's going to get better.
So that's the day. Once again, if you guys find
this beneficial, shoot me an e-mail, let me know.
I am putting together a six month challenge.
For anyone interested, go to podiatrypracticemaster.com.
We're going to meet once a month live via Zoom and then we're
going to have like this in between stuff via WhatsApp.
So I think it's going to it would benefit anyone that is
under $200 a patient and anyone that's under a million in
personal production. I think it would benefit you.
It's the the first time we are doing this.
I'm excited for this first group of people.
We're going to be starting probably at the end of this
month that's end of August. OK, Once again, look forward to
that. If you had any information or
you're interested to shoot me an e-mail down at Podiatry
practice, master.com help helping you.
Maybe this is enough, but some people want a little bit more
collaboration personally. OK, have a great day.
See you tomorrow.