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Hi, Don here. 
Welcome to Podiatry Practice 

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Mastery. 
We're helping you bring your 

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

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My MVP or the most valuable 
patient of the day was a patient

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with a 70 year old female. 
She had bilateral plantar 

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fasciitis. 
She had bilateral Aquinas and I 

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went through my treatment sheet.
So basically I took my treatment

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sheet on plantar fasciitis, 
showed her my little 

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presentation of what the fascia 
would look like and, and things 

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like that. 
And she ended up doing bilateral

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night splint with a foam rolling
and morning stretch. 

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She's going to get bilateral 6 
sessions of shockwave on both 

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sides. 
And then I scheduled her for 

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the, the, the orthotics at the 
third visit. 

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So this for me, if I could have 
this all day long, this would be

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a good patient. 
She was motivated, she was 

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ready. 
She had been suffering for a 

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number of months. 
She had had plantar fasciitis in

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the past that got better and she
came back because it came back 

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in her life. 
And her fascia was about 7mm, so

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it was very thick. 
There's a lot of effusion around

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that in the ultrasound. 
So I think the things that help 

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the best in terms of this one, 
we did the X-ray, it didn't help

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that much. 
Showed her the tightness and 

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she'd already been familiar with
the, the night split in the 

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past. 
So she, she actually asked for, 

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can I have one for each side? 
And then when I went through the

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option, she had done well with 
the cortisone last time. 

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But I explained that a lot of 
times cortisone doesn't work as 

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well when it's very, very thick.
And that's where the, the 

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shockwave would come is becoming
better. 

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So I, I used my treatment sheet.
So if you'd like a copy of 

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these, some people have been 
asking me for these, shoot me, 

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shoot me an e-mail, 
don@podiatrypracticemastery.com.

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I can certainly share, share 
this with you, hopefully work in

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your practice. 
I, I basically print it out and 

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I, and I flip it around at a 
clipboard and I go through and I

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just check the boxes with the 
patients. 

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And it has the, the most common 
treatments that I use for most 

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of the conditions. 
And I just have a kind of a way 

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of explaining it. 
Sometimes I use my patient 

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presentations. 
Those are those little 

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PowerPoints. 
Once again, if you want those, 

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just ask as well. 
The PowerPoints I'm using less 

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and less these days, or I'm 
reducing the amount of slides 

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for them. 
And then also on these sheets, 

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there is AQR code from my 
treatment sheets that goes to a 

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blog post that really reviews 
everything for the patient. 

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So it's kind of their their take
home as well. 

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OK, let's go into the rest of 
the day. 

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There was a 58 year old female 
that got 80% better with a 

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cortisone injection and the 
night splint and foam roller. 

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Since she's feeling so much 
better, I'm not going to see her

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back, but I did remind her that 
many times the cortisone can 

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wear off in two to three months.
And if that happens, she'll come

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back and we'll go to the next 
phase, which is most likely the 

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the shockwave for her. 
And the reason this patient got 

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cortisone was basically because 
she's had it in the past and she

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wanted it. 
So she came in requesting for 

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cortisone. 
I do not do a lot of a lot of 

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cortisone. 
You might see a couple today, 

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but I don't do a lot. 
I do more of the, the shockwave.

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Next patient was a swift #4 so 
59 year old female. 

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So usually with the last 
shockwave, which is for me the 

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6th shockwave, and with the last
swift, I'll do an office visit. 

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So these ones, I've been doing 
an office visit plus that 

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procedure. 
That's why that that's the way I

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do it. 
And then they're going to come 

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back in three months. 
Usually with shockwave, they 

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come back in six weeks. 
Next patient was a 48 year old 

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female. 
She had metatarsalgia and she is

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a hiker. 
And I, I talked to her about 

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correct toes and anatomic shoes.
I find for correct toes because 

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we do have them in their office.
I find that if I modify them for

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the patients, it increases their
compliance of getting the 

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correct toes and trying them 
out. 

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So what I mean by that is a lot 
of times if you do correct toes,

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they're the same price no matter
what. 

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They're $65. 
And if you the main correction I

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have to do is I have to trim out
between the 4th and 5th toes. 

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There's a kind of it pushes over
a little toe too much. 

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And so that's what that's the 
most common modification. 

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Sometimes if patients have short
toes, you have to trim them back

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a little bit so they can fit on.
And so doing that modification 

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helps the patient, but it also 
increases compliance of them 

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getting them on the way out. 
Next patient was a 38 year old 

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female. 
This, I guess would be my lowest

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value patient of the day. 
So this patient had an avulsion 

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last week and the avulsion was 
very painful for her. 

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And so she's been taking like 
Motrin and Tylenol and she came 

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in and she came in within the 
global period. 

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So meaning there was an office 
visit. 

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There was really nothing I could
do. 

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And so I was thinking to myself,
how could I, how could I fix 

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this? 
I I'd like to make a page on 

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like A blog post kind of talking
about this just to put her at 

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ease because this is, this could
have been done via text message,

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could have been done via the 
phone or even just setting the 

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expectations that the nail 
avulsion is going to hurt a lot 

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for her. 
But they wanted to come back in 

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these patients. 
They're also going to be setting

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up for shockwave for her. 
And I've been having this trend 

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and maybe it's, I'm the trend 
versus the patients or the 

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trend, but she has bilateral 
plantar fasciitis. 

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And, and I just find that some 
patients they just want, feel 

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like they want a deal. 
So sometimes if one is worse 

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than the one other one isn't 
that bad. 

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I'll, I'll do full session on 
one and I'll just do a little 

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bit on the other one for them. 
I, I just feel like some people,

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they just want to feel like 
they're, I have this patience 

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that some just always want a 
deal. 

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I can tell you in private who 
who there's a certain 

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demographic that are these ones.
OK, next one. 

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This was an MVP patient as well.
So this patient, he had both 

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Epat for his his Achilles 
tendonitis. 

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So he's epat #4 he's going on 
vacation. 

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So I'm going to see him back in 
about six weeks. 

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That's why he only did 4, not 6.
But he also did Swift. 

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So he did Shockwave and Swift. 
This was swift #2 So he still 

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has one more Swift in about a 
month. 

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And so I'll do the the last one 
at that time. 

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He has a number of warts that 
have been there a long time. 

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And and so this is kind of this 
is a good patient if I can more 

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have more of those. 
Next patient was 71 year old 

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female for bilateral foot pain. 
She had left midfoot arthritis 

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and she had been seen by 
another, I think he was a PM and

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R doctor that does like pain 
management. 

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So she had had PRP around her 
ankle. 

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She has a lot of midfoot 
arthritis on the left side and 

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she is not, she has orthotics. 
She is not really wanting 

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surgery, but she wants to be out
of pain. 

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And I was kind of explaining to 
her about this midfoot 

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arthritis, which I think is the 
cause of it. 

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And she has the bone marrow 
edema. 

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And so I talked to her, probably
the best thing for her if she's 

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not wanting to do an AFO, she's 
not wanting to do any big 

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surgical procedures, but she 
wants to be in less pain and not

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wear like a walking boot all the
time. 

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I talked about doing shockwave 
to help with the bone marrow 

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edema. 
So doing focused only shockwave 

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3 to 6 sessions once a year that
can help that bone marrow edema 

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and help her pain along with the
orthotics that she's wearing. 

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The current orthotics aren't 
contouring very high to her 

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arch. 
And so she, I told her she might

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need a newer pair that'll 
contour a little bit higher to 

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take some more of the stress up 
that mid midfoot. 

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OK. 
And next patient was a bilateral

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insertional Achilles tendonitis.
So they did #2 out of 6 for 

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Shockwave. 
So they are starting to feel 

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better. 
She's, she's pleased with this 

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number 3. 
This one was a 50 year old 

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female with #3 out of 6 for 
right plantar fasciitis. 

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And she has a little bit of pain
on the left second met head. 

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So I did a like. 
So I did, for example, I would 

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do 1500 on the right plantar 
fascia and then another 500 on 

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the left second mad head. 
I didn't charge for the other 

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one. 
And the, I think the bilateral 

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Achilles, I think I told you, I 
told, I talked about this last 

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week, But so this one, I, she 
has it on both kind of like the 

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insertional and she only wanted 
me to do one side and I just 

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couldn't in good conscience only
do one side. 

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So I'm adding on the second 
side. 

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So I might be doing the, the 
like hurting myself in terms of 

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financially, things like that, 
but I'm, I'm still, I want 

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patients to get better and I 
just didn't feel comfortable 

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only doing one if both of them 
are really hurting her just 

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because of price. 
So she's paying for one doesn't 

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take me much more time. 
I know there are some doctors 

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that I've talked to, they just 
have like a time slot. 

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And so you do as much as you can
in that time slot. 

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And so, you know, yes, you put a
little bit more wear and tear on

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the on the machine, but I think 
it's better for the patient all 

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around. 
Next patient was Q Tenza number 

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six. 
This gentleman has had six. 

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He's like the the guy that has 
the most Q Tenzes in, in my 

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practice. 
He is doing well. 

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He tends to have less pain when 
he's walking barefoot. 

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He has he's just feeling better,
less pain at night and things 

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like that. 
For the Q 10s, I'm still 

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struggling a little bit with mod
Med in terms of billing because 

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there's some that are buying 
bill and there's others that we 

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they get them from the through 
the pharmacy, the specialty 

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pharmacy. 
So I'm still trying to figure 

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out the different codes to make 
it easier for my note taking. 

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I still have to edit, like edit 
the billing component of that 

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next patient was a 67 year old 
that is a thick second toe. 

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So they had kind of a thickened 
toenail with a hammer toe, a 

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second hammer toe causing the 
thickness and the nails were a 

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little bit hard to trim. 
So I, I debrided those 

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debridement, did the hammertoe 
kind of office visit and I 

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recommended Kara nail gel. 
So I think Kara nail gel works 

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really well for thickened 
toenails for patients. 

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They're maybe not on a call 
icotic, but they're just 

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thickened. 
Next was a patient, 48 year old 

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female that has left second Med 
head pain, got X-rays, got an 

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ultrasound. 
She thought she needed 

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orthotics. 
She thought, well, I need an 

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orthotic like adjustment for my 
neuroma. 

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But really I think she has some 
type of a over over use injury 

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on the second metatarsal. 
I didn't put her in a Cam boot 

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and I'm going to see her back in
a few weeks to see how that 

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feels. 
Next patient was a 71 year old 

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that just had thick second 
toenails. 

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Once again divided those. 
Next was a 76 year old male that

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had X-rays. 
He was post fifth met head 

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resection. 
He he'll see one of my 

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colleagues because I'll be on 
vacation for the next follow up 

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for suture removal. 
He's doing well. 

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Next was a 70 year old female I 
talked about in the beginning 

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for the bilateral plantar 
fasciitis. 

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She did the night splint in the 
bilateral shockwave. 

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Those will be set up for her. 
Carrie Flex was done for a 30 

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year old female. 
I just did 1 nail for her. 

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Another patient that came in and
also a 55 year old that did 

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Carrie Flex on 2 nails. 
I had a interesting patient. 

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I don't have these that many. 
This is a 45 year old guy. 

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He had a superficial white 
onicomycosis. 

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So I was able with like a 
curette just to scrape it off. 

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And so it didn't really 
penetrate that deep. 

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So I recommended him formula 
seven that we have in the office

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for that. 
And there was another patient 

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She actually came in she I've 
been treating her for for with 

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Kanthorid and her warts She's 
using, she was using Aldera and 

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she asked me to prescribe 
something I've never prescribed 

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before. 
Maybe you have, I just haven't. 

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It's podophyllox, which is I 
guess a topical porphylin and I 

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think in my can through that, I 
think it might have that in 

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there as well as one of the 
other ingredients. 

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But she asked to prescribe. 
That's why I prescribe that 

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today for her. 
I've never done that before. 

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I'd like to know anyone else use
that you find it beneficial 

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topically for patients? 
It might be something like we 

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would typically do in the 
office, I'm guessing. 

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So it might be kind of caustic. 
So I don't know if it'll like 

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take the place of what I put on 
like the canther that I put on. 

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Next patient was a 58 year old 
female. 

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She's going to be going on 
vacation and she had like a 

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subluxing peroneals. 
She'd come back after a Cam 

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wearing a Cam boot. 
She's going to be doing physical

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therapy and if it's not getting 
better, we're going to do an MRI

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and another similar patient. 
She had a left peroneal pain. 

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She had previously had plantar 
fascial pain. 

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Now she has kind of pain in the 
peroneals and I did an injection

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because she's going that's one's
going on vacation. 

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So I did it right around the 
peroneal tendon region where 

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there was an effusion in the in 
that area on ultrasound. 

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And then finally, there's a 
little girl, 21 year old. 

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She had an this kind of a digiti
quini varus, the under lapping 

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5th toes. 
She had hiked a lot. 

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She had one of these calluses. 
So I trimmed down the calluses 

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there. 
She had them on the first met 

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head or I'm sorry, the IPJ 
Hallux talked about the anatomy 

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and I for her, I'm I'm going to 
recommend the correct toes. 

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So I modified her correct toes 
and she's going to try those for

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a couple months and I gave her 
some shoe recommendations. 

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So that was the day and I'll 
talk to you until the next one. 

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I am, if anyone's kind of 
following me every day, you 

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might be a little break between 
some episodes, going on vacation

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for a little bit to Brazil, and 
I'll tell you about that maybe 

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when I'm on the road. 
Or I might try to do some other 

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podcasts about different topics 
in the interim here.