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Have you heard of something 
called alleviate for doing your 

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own self Graston in the in the 
with the patients themselves. 

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Welcome to Podiatry practice 
mastery. 

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My name is Don Pelto. 
I want to share a new type of a 

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device that we have. 
I don't use a lot of it. 

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I kind of think I probably 
should use more of it, but I 

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don't. 
So this device is called 

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alleviate ALLEVIATE. 
You can look it up. 

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It is a almost like a self 
grasping tool for the bottom of 

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the heel. 
And I had a patient today, she 

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was status post 6 shock waves. 
She came back six weeks later. 

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She's about 50 to 60% better on 
her ultrasound. 

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She had a lot of thickness and a
lot of effusion and so I could 

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tell that the fascia wasn't 
completely better. 

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And I usually at this point, I 
do six weeks the first follow up

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and then I do 12 weeks at the 
next one. 

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And so I give patients they can 
either go to physical therapy at

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this time or this time. 
I thought, well, heck, we should

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try this alleviate thing. 
So the alleviate I'm, I'm going 

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to try it out. 
They have a lot of good reviews 

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and I and I think it's kind of 
an option for patients that have

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painful plantar fasciitis. 
That's what it's marketed to. 

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It was invented by a physical 
therapist. 

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It is a, a device that has like 
almost like tentacle legs that 

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open up like an octopus. 
And then it has kind of two 

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small, a smaller lump and a 
bigger lump in these lumps you 

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put on a almost like a, not a 
gel, but a, a grease, a grease 

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or some type of a oil that can 
help it to massage on there. 

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And, and in the patients do 2 to
3 minutes of deep tissue massage

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in that area to help probably 
the similar things to what like 

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a Graston technique would be 
doing, breaking down the, the 

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heart tissue and stimulating 
blood flow to the area. 

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It's a pretty reasonable tool. 
It's about 70, I think $75.00 

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for the tool. 
They have a kit that you can do 

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the tool massage. 
I think it has a like a ankle 

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brace type of thing and like a 
compression sock. 

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Why don't I use it a ton? 
I don't use it a ton, frankly, 

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because I think I get good 
enough results with the just the

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shockwave and then patients they
may or may not go to PT. 

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So it might be an option to 
avoid because I don't have 

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patients go to PT most of the 
time so I have them if they want

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to do something at home they can
do this. 

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There's just another add on. 
It seems like a good product. 

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I'd like to know if anyone else 
is using it. 

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It's called alleviate. 
OK another question I actually 

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had for people. 
Does anyone do their own 

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charcoal AF OS? 
I had a patient today. 

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This is a 53 year old man. 
He looked like he had a 

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navicular fracture, but I was 
very susceptible for charcoal 

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and he had back and a back 
injury where he is pretty much 

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mostly neuropathic on the right 
side and he developed a charcoal

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foot. 
So he's been in a boot Cam boot 

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and then I'm going to make him a
crow boot. 

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But I was thinking, man, if I 
could start doing these crow 

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boots. 
I know I can with, with my 

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scanner. 
I, I just get a little bit 

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worried if I have to add more 
padding and, and things like 

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that. 
So I'd like to know if anyone 

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else does their own crow boots. 
Shoot me an e-mail down at 

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Podiatry practice mastery.com. 
So this guy, he came back after 

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the MRI did X-rays. 
It's within the global. 

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So it was kind of a low value 
patient, but if I could have 

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done the crow boot, it would 
have been better. 

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But I just I sent him out to to 
hanger. 

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Next patient was a left heel 
pain 45 year old female. 

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She's had it for two years. 
We did an X-ray, did an 

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ultrasound. 
She did not have any Aquinas, 

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but she had pain down there. 
So I set up shockwave times 6. 

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So I'm going to see her back for
that. 

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Next patient was a 59 year old 
man for right medial heel heated

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shockwave there. 
And this was number one out of 

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three. 
And the reason it was one out of

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three is because previously he 
had 10 sessions of soft wave by 

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another chiropractor or it 
wasn't a chiropractor, it was 

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their office and he wanted to do
to do ours because he got some 

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improvement with it. 
I don't know why he didn't go 

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back to them but he wanted to 
see us. 

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Next was a 63 year old female 
for left second. 

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Her second post op suture 
removal for neuroma. 

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She is doing fine but I did send
a message I was on vacation when

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this first post op was done and 
it was another. 

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We have a younger doctor here 
that just starting out and he 

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was, he was kind of complaining 
a little bit when I traveled 

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about like doing my shock waves 
and they made maybe they prepaid

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for them. 
So we didn't get paid or didn't 

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count towards his numbers. 
And I kind of my thoughts to 

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that, as I think when you're not
that busy, like any patient is 

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fine, right? 
When you're, when you're still 

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kind of starting out, I think 
it's good to get the practice 

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with the patients, the FaceTime,
they get to know you. 

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But one thing I, I told him, I'm
like all post OPS would get a 

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Cam boot and they came in a 
surgical shoot. 

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So all pretty much all of my 
post OPS, I don't give him the 

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Cam boot at the hospital because
I want to bill for it. 

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So I actually do it at my first 
post op. 

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And maybe he didn't know that. 
Maybe he didn't think you're 

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supposed to do that for an 
aroma, but it was something that

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I think there was kind of profit
left on the table there. 

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But I think most patients are 
better in a in a camp. 

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But so the simple things, I 
think he it could have helped 

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his billing if he had done that,
but he didn't. 

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Next was that 55 year old female
that I did alleviate for that I 

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talked about in the beginning. 
Next was a 63 year old female 

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for a right ingrown. 
So she had a onycholytic nail 

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about on the right hallux, about
half the nail and it was digging

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into the skin. 
So she had a pyogenic granuloma 

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that was producing on the dorsal
nail bed about halfway down. 

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I did a partial nail evulsion 
back about maybe 3 or 4mm from 

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the area of the granuloma and I 
and I divided that down. 

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So I built for a partial nail 
evulsion on the other side. 

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She also had a previous Onifix 
application to try to get her 

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nail to get a little bit less 
thick. 

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So I, I did, I ground that down 
and I put a second Onifix for 

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that. 
So Onifix I don't do a lot. 

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I've been doing some of these a 
few days. 

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So it's like a speed bump that 
you put on that helps kind of 

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guide and direct the nail. 
It's typically used for ingrown 

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toenails, but I'm also trying to
do it for onycholytic nails and 

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some of these thick WAVY nails 
as an as another option. 

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Next was a 37 year old female 
that had left MRI of her 

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tailless and it showed bone 
marrow edema around the tailless

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and the sub tailor joint region.
I gave her three options for 

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this. 
She's had pain for for quite a 

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while. 
She's quite young. 

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She's a teacher. 
I talked about waiting, giving 

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it more time. 
I talked about possibly doing an

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arthroscopic evaluation of of it
to see if there's like a 

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tailored Dome lesion because 
that's where the bone marrow 

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edema is. 
And I talked about doing 

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Shockwave, she opted she's going
to teach her. 

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So she's going to go go back and
do the teaching and maybe during

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one of her holiday breaks, she's
going to do the sessions of the 

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Shockwave. 
Now this is the downside from 

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this, these ones that I bill 
initially when I saw her, I 

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billed as a fracture code. 
And so this day, all this 

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conversation and things like 
that, there was no office visit 

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because it was still within the 
global period of the, of the 

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fracture code. 
So I think you you do well on 

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some of the fracture codes and 
you don't do as well on some of 

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the other ones. 
Same thing with that other shark

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code that was a fracture code as
well. 

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Next was a 14 year old male. 
He had a little Down syndrome. 

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So we had some hypermobility, 
bilateral flat feet. 

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I did X-rays, talked to him 
about doing orthotics. 

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They have mass health, which is 
a Medicaid plan. 

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So they're, they're going to pay
20% of their visit. 

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So they have a like an 
individual plan and then the 

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mass health. 
And so for them, I, I gave them 

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a prescription to go to hangar 
for the orthotics. 

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I, I do think ours are better. 
So if, if they say hangar 

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doesn't cover them, I 
recommended them. 

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Coming back to me next was a 44 
year old female for a carry flex

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that fell off after two months. 
So I usually guarantee my ANI 

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fixes and my carry flexes for 
three months and if it falls off

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early, I don't charge them for 
the procedure, I just charge 

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them for the office visit. 
So it was a Level 3 office 

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visit, but but like kind of low 
value patient because of that. 

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Next was a 25 year old man with 
a left hallux fracture. 

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He had a little distal avulsion.
He had a fracture code and I 

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also did a nail avulsion on him.
So the nail avulsion fracture 

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code and I'm going to see him 
back in four weeks in a Cam 

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boot. 
Next was a 65 year old female. 

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That was the morning, this is 
the afternoon 65 year old for a 

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left Achilles tendon pain. 
Patient was is going to do foam 

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rolling Meloxicam and they're 
going on vacation. 

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So I give them a Medrol dose 
pack in addition to the Moloch 

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scan just for some breakthrough 
pain if they need it. 

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And I did an X-ray. 
I'm going to see them back when 

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they when they get back but they
weren't on vacation so they need

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something to calm it down. 
Next was a 45 year old man with 

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a second toe fracture follow up 
still within the global. 

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So I just got the X-ray for this
one and he's going to come back 

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in four weeks or he's not going 
to come back at all. 

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He's doing fine. 
So I think some of these, even 

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these fracture follow-ups, I'm 
going to start putting in my 

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like double booking in my 10 
minute slots because they're 

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simpler procedures and they're 
kind of low value patients in 

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terms of it doesn't really take 
that much time and it doesn't 

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take that much thinking. 
So I think it would be a quicker

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slot. 
Next was the left hallux 

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matrixectomy for a 18 year old 
female. 

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Next was a 49 year old female 
with she had a previous 

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cortisone injection in the right
third and 4th inner spaces for 

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neuroma and she didn't want 
surgery, she didn't want 

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cortisone again. 
She's already tried anatomic 

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shoes and so we talked to her 
about doing shockwave. 

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So she did shockwave on those 
intra spaces. 

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So when you do shockwave, I did 
focused only and I did .05. 

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So I do very, very low 
shockwave. 

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They can still feel that you 
have to be if to respect the 

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nerve tissue. 
So nerve tissue is not like 

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fascia tissue or tendon, a lot 
more sensitive. 

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So I did .05 very low focus, 
2000 pulses. 

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This is number 1 of 6 for her. 
So she wants to try to do this 

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treatment non invasive or no 
cortisone and no no surgery. 

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Next was a 24 year old man with 
the right ingrown toenails. 

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I did Ind. 
Next was a 72 year old female 

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did a nail sample. 
The nail was partially detached 

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and had possible fungus. 
I'm going to see them back in 

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three weeks because I wasn't too
sure because of the detachment 

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or the onycholysis. 
I'm not sure if it was like a 

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bacterial infection underneath 
it because it was detached and 

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water gone underneath there or 
if it was real fungus. 

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That's why I didn't actually 
start them on the medication. 

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I'm going to see them back in 
three weeks. 

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Next was a 55 year old man. 
This is a guy that deals with 

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some chronic itching, itching 
slash teeny pedis slash eczema. 

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So he's not sure what he has. 
He had some like scratches on 

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his lower ankles. 
He's a self pay patient and he 

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tried after a couple years to 
send a refer request to the 

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pharmacy. 
So I get this sometimes if I 

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haven't seen patients in a year 
and they asked for a refer 

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request, I tend to have them 
come in because I want to 

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reassess the situation. 
But for this guy I did prescribe

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a an antifungal and A and A and 
a clobetasol to help with that 

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itching for him. 
Next was a a 47 year old female.

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She had I did an ultrasound on 
her. 

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She has plantar fasciitis and 
Achilles tendonitis, but she has

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a normal ultrasound. 
And I think the reason for this 

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is she has very, very bad 
Aquinas. 

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She's very, very tight. 
That's why she's getting the 

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heel and the and the planter 
foot pain. 

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I refer to her for physical 
therapy and she already has the 

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night splint, foam rolling, 
morning stretch, all that other 

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stuff. 
If that doesn't get better than 

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I, I did suggest that she would 
come back for Shockwave. 

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I think Shockwave would would 
benefit, but I think the bigger 

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portion is the, the tightness 
that she has. 

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And kind of the, the, the most 
interesting patient of the day 

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is this 33 year old female. 
So she had a right knee 

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Arthroscopy for a like a, an, an
ACL repair and a meniscus. 

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And she came in, she's about two
months and she was in crutches, 

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not for her knee, but for her 
foot. 

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Her foot was hurting her. 
She had foot pain. 

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She had kind of nerve pain. 
She had pain kind of near the 

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second, third met head digit 
region and she had a lot of 

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tightness. 
So I did a few things. 

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She had tenderness in her calf, 
so I'm going to rule out DVT. 

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I did like a massage ball on her
calf and then when I did it on 

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the calf, some of the foot pain 
went away. 

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So I think some of it could be 
tightness from the knee or like 

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the immobilization or not being 
as active. 

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So she's going to do some foam 
rolling on that area to kind of 

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loosen up that area. 
And then it also could because 

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she had, I think she had a thigh
tourniquet and so some of it 

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could be like a neuroproxy, like
a nerve pain. 

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So she's already on gabapentin, 
100 milligrams. 

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So I suggested she upped that a 
little bit to 300 to see if that

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would help it. 
So it could just be nerve 

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related issues, but I don't know
why it would hurt only at the 

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like a second, third MPGA region
in her foot. 

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There was no other soft tissue 
things. 

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I also considered it could be 
like regional pain syndrome or 

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something like that. 
So I suggested she upped her 

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vitamin C and things like that. 
So I don't know if anyone is 

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great at dealing with chronic 
regional pain syndrome. 

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I am not, but that's how I dealt
with this patient. 

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So I'm going to see her back in 
two weeks because I'm concerned 

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with her that she's going to get
better. 

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So that's the day. 
Once again, if you guys find 

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this beneficial, shoot me an 
e-mail, let me know. 

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00:14:03,680 --> 00:14:06,240
I am putting together a six 
month challenge. 

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For anyone interested, go to 
podiatrypracticemaster.com. 

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We're going to meet once a month
live via Zoom and then we're 

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going to have like this in 
between stuff via WhatsApp. 

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So I think it's going to it 
would benefit anyone that is 

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under $200 a patient and anyone 
that's under a million in 

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personal production. 
I think it would benefit you. 

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It's the the first time we are 
doing this. 

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I'm excited for this first group
of people. 

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We're going to be starting 
probably at the end of this 

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month that's end of August. 
OK, Once again, look forward to 

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that. 
If you had any information or 

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you're interested to shoot me an
e-mail down at Podiatry 

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00:14:41,440 --> 00:14:44,400
practice, master.com help 
helping you. 

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00:14:44,480 --> 00:14:46,560
Maybe this is enough, but some 
people want a little bit more 

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collaboration personally. 
OK, have a great day. 

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See you tomorrow.