August 21, 2024 • 31 mins
Running injuries don't have to sideline your passion. Today, we're joined by Dr. Relation from Bluestone Podiatry to discuss the prevention of common running injuries like plantar fasciitis and achilles tendonitis. Dr. Relation is a board certified podiatrist providing surgical and non-surgical treatment of foot and ankle problems. He utilize curamedix shockwave therapy which includes EPAT/ESWT/EMTT therapies as a non-invasive, non-surgical treatment for many runners ailments involving no "downtime".
Bluestone Podiatry is a newly opened practice in Slingerlands, however Dr. Relation has been in private practice for 9 years. Dr. Relation is also a surgical consultant at Family Foot Care in Valatie, NY. He is a Lapiplasty Centurion Center, having performed well over 100 Lapiplasty cases.
Dr. Relations is currently on staff at Bellevue Hospital, Ellis Hospital, St. Peter’s Hospital, St. Peter’s Surgery and Endoscopy Center and New England Laser and Cosmetic Surgery Center. On his free time he enjoys being outdoors, and doing activities such as camping, biking, hiking and golfing as well as spending time with his wife, two children and dog.
If you're in the Capital Region, reach out to Bluestone Podiatry and schedule an appointment today!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:10):
Welcome to Ella Go.
My name is Lisa.
Join me on the journey inhaving real raw and
uncomfortable discussions aboutfitness, health and everything
in between, because, let's behonest, this journey would suck
if we don't get our shittogether.
Welcome back to the ElegoPodcast.
(00:38):
My name is Lisa, I am your hostand today's guest is Dr
Relation.
He is a highly respectedpodiatrist and the owner of
Bluestone Podiatry inSlingerlands, new York.
In addition to his privatepractice, dr Relation serves as
a surgical consultant at FamilyFoot Care in Volatia, new York.
Welcome, dr Relation.
Speaker 1 (01:00):
Hi, hi, lisa, glad to be here.
Hi, I'm at least glad to behere.
Speaker 2 (01:03):
I am so happy to have you here because you know, as a
runner, okay, that our feet areso important to us, right?
And you know we tend to have alot of common injuries when it
comes to running and it comes toour feet, so I cannot wait to
pick your brain.
So what are the common footinjuries that you often see with
(01:30):
runners.
Speaker 1 (01:30):
So runners come in with a variety of injuries, as
you can imagine, and we seeeverything from just general
capsulitis, metatarsalgia of theball of the foot.
Sometimes we see flare-ups ofneuromas.
Most common is plantarfasciitis, achilles tendonitis,
also perineal tendonitis, whichis a tendon on the outside of
the foot, and posterior tibialtendonitis, which is a tendon on
(01:52):
the inside of the foot.
So we see all these thingsevery day in the office.
Speaker 2 (01:58):
Oh, okay, now I'm going to ask you another
question.
Well, that has to do with that,but we're going to wait, okay?
So what is a common mistakerunners make when it comes to
shoes and or their feet that maycause some of these injuries?
Speaker 1 (02:14):
I mean.
Number one I see is not havingthe proper shoe for your foot
right.
So there are a lot of thesespecialty sneaker companies now,
or shoe companies have shoesthat are tailored to different
foot types.
And if you don't know your foottype and you're not and you're
just going online and orderingwhatever you see that that looks
cool, you may not get theproper fit for you.
(02:36):
So I usually recommend going toa reputable shoe store.
Um, personally I know locally.
I sent a lot of patients over tofleet feet over on uh, wolf
road and they tend to have a lotof staff that really can
analyze the foot and make sureyou're in the right shoe.
Companies like Asics, hokaBrooks they'll have especially
(02:58):
on their websites I know Asicsdoes it they have a shoe finder,
have a shoe finder so you putin your foot type, you put in if
you're an over pronator, moreof a neutral foot type or a
supinator, and they'll list awhole bunch of shoes that'll
actually match for you.
Because if you're a supinator,which is a higher arched foot
type, and you go into a shoethat's made for an over pronator
(03:18):
, you're going to be tilted upway too much to the outside,
more propensity to roll yourankle, more propensity to get
the perineal tendonitis, andthen opposite.
If you're more of a pronatorand you're going into a
supinated shoe, you're just notgoing to get that support that
you need, which will lead tomore issues on the medial side
of the foot.
Speaker 2 (03:37):
Do you see that?
Do you see runners that come inand then they don't even you're
talking to them and they'relike I don't even know what
you're talking about, have you?
Do you see that?
Speaker 1 (03:47):
More new runners like that are just starting to get
back into it or starting out forthe first time.
So yeah, experienced runnerstypically don't have that issue,
but but those that are, thatare just trying to get going
with with a new new activity,then they may not know their
their proper style, that theyshould be in for sure.
Speaker 2 (04:08):
Okay.
So besides having the rightshoe, my next question was going
to be like how can runnersprevent foot injuries?
I mean, you see so much outthere like there's these
stretches, there's these tools.
I mean, do you cringe when yousee some of these things?
Speaker 1 (04:26):
these tools.
I mean, do you cringe when yousee some of these things?
Yeah, I mean, there's so manygimmicks out there that you can
find online or on your Instagramreel or wherever you happen to
be browsing.
Really, it's just properstretching.
That's really important.
Starting slow.
Don't just decide I'm going torun a 5K today when you haven't
ran in three or four months orlonger.
It's always about gradualincreases to activity to try and
(04:58):
let the structures in the foot,and the rest of the body for
that matter, kind of get used tothe activity again and
strengthen accordingly.
Orthotics can make a bigdifference to making sure that
the foot is protected moreproperly aligned during the
activity and then recovery.
So afterwards you know if youare having some pain, noticing
it, listening to your body, notpushing through the pain, icing
it afterwards, oranti-inflammatory if you need to
(05:18):
or if you're able to.
So really just paying attentionto your body is really one of
the big key features here.
Speaker 2 (05:26):
Okay, yeah, that makes a lot of sense.
So let's focus on plantarfasciitis and, of course,
achilles tendonitis.
So that's the common runninginjuries, and let's start with
plantar fasciitis.
Why does it happen and whattreatment is available to help
relieve this?
Speaker 1 (05:51):
So plantar fasciitis, or heel pain in general, is one
of the most common things thatwe see every day.
The plantar fascia is aligament that goes from the
bottom of the heel, which theheel is a pretty large bone at
the bottom of the foot.
It has these two littletubercles that come off of the
bottom and the fascia extendsall the way from the heel bone
all the way out to themetatarsal heads and it spans
that whole area kind of like atruss system and every step you
(06:11):
take it's pulling and stretchingright at that heel attachment
and that's the most common spotthat gets inflamed.
You get these little microtears.
Usually it's an overuse typeinjury from either lack of
support or just a suddenincrease in activity.
Or if we're running and hit apothole or drop rolled off a
curb wrong, something like thatcan can spur it off too, but
(06:32):
little.
Usually it's multiple littlemicro traumas that'll happen and
if you imagine that theligaments kind of like a rope
the same thing with the achillesit's like a whole bunch of
strands of collagen that arewound together and you can get
some fraying of those edgesright.
So little tiny tears, you getfraying of the rope.
The body tries to heal it.
So you get inflammation aroundthat no-transcript that comes in
(07:26):
.
First visit we're usuallygetting an x-ray making sure
nothing else is going on like astress fracture in the heel or
something else.
That would be kind of off thewall.
But once we isolate that it'smost likely plantar fasciitis,
we'll start our typical regimenand we can go one of two ways
with treatment.
So the standard treatmentprotocol usually is some kind of
(07:47):
support.
So we tape the.
We do a lot of athletic tapingsstrappings, so we'll do a low
die strapping.
We'll put a pad up in theinstep and the tape itself will
help to lock the subtalar joint,kind of lock the mid-tarsal
joint, lift up and take sometension off of the plantar
fascia so that it's not beingstretched every single step.
(08:08):
Let's the fascia rest.
We start you on a stretching andicing regimen.
Usually I recommend get a20-ounce bottle of Coke, pepsi
water, whatever.
When you're finished with ityou rinse it out, you fill it
three-quarters of water and youfreeze that, put it on the
ground and roll your arch righton there two to four times a day
or whenever it's starting tofeel uncomfortable, and that
(08:29):
just helps loosen it up, massageit and ice it.
At the same time, if thepatient's able to, we'll start
an anti-inflammatory regimen andkind of go from there.
There are also night splintspeople can wear at night, while
they're sleeping, to stretch theheel out.
We dispense those in the office.
There's about a thousanddifferent kinds of night splints
, so we have particular onesthat we like more than others.
(08:51):
If that isn't quite doing it orsomeone comes in and they're
limping, it's really bad.
Sometimes we'll do a cortisoneshot.
But then we also offernon-invasive measures as well.
So there's a whole othertreatment algorithm called EPAP,
(09:18):
which is shockwave therapy, andthat's nice because it's
non-invasive, there is nodowntime, we don't have you ice
it, it's kind, and shock wavesto stimulate the healing process
.
So a shock wave utilizes umpulse activation therapy to
stimulate the microcirculationto the injury, to a focused area
, and it allows that the body'sown regenerative properties to
(09:41):
begin working on the healingprocess.
So was developed for thetreatment of plantar fasciitis
and achilles tendonitis.
It's been around for a longtime, really popular in europe
with soccer players because youwant to keep the players on the
field.
It's in a lot of sports teamsin the US now and I'm fortunate
to have it in my practice aswell to be able to provide it to
(10:02):
my patients.
So it provides a non-invasiveoption which people start
feeling the benefit of after twoor three sessions.
Speaker 2 (10:12):
Okay, I'm already like sign me up, okay, so does
it hurt?
Speaker 1 (10:17):
We typically say it's uncomfortable.
Right First session's alwaysthe most uncomfortable because
we're putting a lot of energyinto the tissue and the tissue
is injured, so you're going tohave some discomfort.
But I can tailor it to thepatient in the moment.
So we start low, we kind ofdial it up as we go and we get
you around a five and a 10 onthe pain scale.
That's what I usually tell mypatients.
(10:38):
And then each subsequent visitbecause we usually do three to
four rounds of treatment onaverage.
Each subsequent visit we cantypically get more and more
energy into the tissue with lessand less discomfort, and then
by the end of our sessions mostpatients are not feeling much
pain at all.
And we offer both EPAT, eswtand EMTT therapy, which is
(11:03):
magnetic therapy.
So I usually combine the twotreatments into one session.
So I start with theuncomfortable part and then we
finish with the relaxingmagnetic therapy.
So and that typically is a nicepain modulator as well.
So that'll actually help to inthe moment reduce the pain too.
Speaker 2 (11:18):
Wow, okay, you mentioned something at the
beginning where you said it wasthe side of the foot.
So what was that called?
Speaker 1 (11:27):
Well, there's.
So you have the medial side,which is like the inside of your
ankle bone.
That's your medial side of yourfoot.
There's the posterior tibialtendon on that side and on the
outside of your ankle bone.
That's your medial side of yourfoot.
There's the posterior tibialtendon on that side and on the
outside of your ankle andthere's two tendons that come
down around the outside, calledyour perineal tendons, and one
attaches to the side of the foot, which is a little kind of a
bump out on the side, andthere's another one that goes
(11:48):
under the foot.
So either one of those can beuncomfortable, depending on
which one you're asking about.
Speaker 2 (11:55):
Well, let me ask you this Could someone because when
you were talking about this Iwas like, maybe that's my
problem, Maybe it's not, becauseit's the side Like could
someone confuse it being plantarfasciitis, when it is really
that?
Speaker 1 (12:11):
Yeah, we see that all the time.
So people come in and they theyit says on my, on my schedule
plantar fasciitis, and they sitdown on the chair and we take a
look at everything and it'sabsolutely not plantar fasciitis
, it's posterior tibialtendonitis or it's perineal
tendonitis.
But they're totally differentpathologies so they require
different approaches totreatment as well.
Speaker 2 (12:30):
And so that person?
It could be either of thosethings, but yet they're feeling
that heel pain.
Speaker 1 (12:36):
You can have some pain radiate.
Some people will say heel pain,but really it's the arch, or
it's the inside of the foot.
So what someone thinks is theirheel may not be what I think is
their heel right.
And then there's also the backof the heel, which is your
Achilles tendon.
So there's several differentstructures right in that area.
Speaker 2 (12:59):
Yeah, I mean, if you look at the foot, so many things
going on.
Speaker 1 (13:04):
Yes, I mean obviously A lot of structures in the foot
.
Speaker 2 (13:08):
Lots of stuff going on.
Okay, so let's talk about theAchilles tendonitis.
Now, what is that and how doesthat happen?
Speaker 1 (13:15):
Well, your Achilles starts.
There's two main tendons thatmake up the Achilles tendon your
gastrocnemius and your soleus.
The gastrocnemius actuallycrosses the knee joint and
attaches to the femoral condyles.
So there's two components there, and if they get tight, if you
think about it, most shoes todayhave a decent heel on,
(13:36):
especially running shoes.
A lot of them have a prettydecent drop.
So then a lot of you know, youthink about women's high heels,
men's work boots, so there's alot of of heels on on shoes now.
So people are functioning withtheir, their heel up, which is
going to let that tendon gettighter and tighter.
And so, as the tendon getstighter and tighter, if someone
(14:02):
gets into a shoe that has alower drop, more minimalist
style shoe we see all this a lotafter COVID People are working
from home, so they're notwearing shoes, and all of a
sudden they're getting all theseAchilles issues because now
that tendon is being stretchedrepeatedly.
We see it a lot with runnerstoo.
Especially if people startdoing hill training, whether
it's a trail running or justrunning on roads that have hills
(14:22):
they're getting a lot morestress than that Achilles tendon
as well, and it's the same kindof thing as the plantar fascia.
It's where the Achilles.
There's two areas.
There's the insertionalAchilles tendonitis, where the
Achilles actually attaches tothe calcaneus on the back of the
heel bone, and that's more likebump pain we call it.
It's like it gets kind ofswollen, gets hot down there,
red right at the the back of theheel, or if you start having
(14:45):
like some partial tearing,there's a zone about one to
three centimeters above theAchilles insertion and that you
can start to get tendinosis inthat area like chronic damage,
because the blood flow isn't asgood there.
Um, so as that gets again,imagine the rope starts to fray
in that location you get thatchronic inflammation that can
(15:07):
kind of build up in there okay,so let's explain this a little
further for those of you knowpeople who are listening and
they're like well, first of all,where's the achilles like?
Speaker 2 (15:16):
so we're talking about right behind the.
Speaker 1 (15:19):
So if we were to look at the foot and we're going to
go look at it, look at it fromthe back of the foot and there's
the heel and it's that it's athick band, that thick band that
you can feel in the back ofyour ankle that goes from your,
your leg, from your calf muscles, that goes down towards the
back of the heel.
That goes from your leg, fromyour calf muscles that goes down
towards the back of the heeland it kind of just meets up
(15:40):
with the heel bone.
And where it meets up with theheel bone is the attachment site
.
And some people that have likea chronic Achilles issue where
they've had pain on and off foryears, can actually start to get
a bump that forms back therefrom a bone spur.
That can start to happen.
So again, we don't know thattill we get an x-ray from a bone
spur, that can start to happen.
Speaker 2 (15:57):
So again, we don't know that till we get an x-ray.
Okay, and you mentionedsomething about there is a
muscle across the knee.
Speaker 1 (16:11):
Yeah, so if you feel the back of your calf, the
muscle back there is called yourgastrocnemius muscle and then
below that's the soleus muscle.
But if you kind of feel upbehind your knee, you kind of
feel there's two bands thatcross the knee joint that all
goes down and attaches to yourheel bone.
So that's all part of yourAchilles complex, right?
So your gastrocnemius muscles.
So when people are stretchingit's really important to do two
different stretches.
You want to stretch out thecalf muscle but you also want to
(16:32):
stretch the hamstrings and getthat whole posterior muscle
complex stretched before andafter you go on your runs.
Speaker 2 (16:40):
Yeah, because it's all connected.
Speaker 1 (16:41):
Everything's connected Absolutely.
Speaker 2 (16:42):
I always tell my runners that Okay, all right.
So orthotics, all right.
So I have a love and hate withthis because I was told to put
orthotics.
I tried them and I'm like theyhurt.
Forget it.
I'm not doing it.
What are your thoughts aboutthat?
Obviously, they're an insertthat you would put in the shoe,
(17:05):
but should someone wait a whileBecause it does feel
uncomfortable and sometimes itdoes hurt?
Speaker 1 (17:11):
Well, were they custom that you tried, or were
they-?
Speaker 2 (17:13):
Custom?
Yeah, hurt well, were theycustom that you tried, or were
they custom yeah?
Speaker 1 (17:15):
custom, yeah, so um, and then also, was it a
chiropractor, or was it apodiatrist or an orthotist?
Speaker 2 (17:22):
okay, because they're all different all different.
Speaker 1 (17:24):
What's that?
Speaker 2 (17:25):
I don't know, all right all right.
Speaker 1 (17:27):
So there's all different kinds of orthotics.
Um, there's your, your off offthe shelf devices.
You're going to get walmart orthe drug store and those are
going to be in Walmart or at adrugstore and those are going to
be really not supportive at alltypically.
They typically are just foam.
They don't do much for you.
Then there's yourmiddle-of-the-road, like a
PowerStep or a Spanko, and eventhose are narrowed down based on
(17:48):
your foot type.
So if you're not in the properdevice for your foot or for your
pathology, your problem thatyou're having it's not going to
feel good.
And then, when it comes tocustoms, you know it.
Really it's a workingrelationship to try and get the
right device for you.
A lot of times we hit it righton the first try.
But they're custom so we can doall different kinds of
(18:11):
modifications.
So if I get somebody to set uporthotics, they try them out and
they go through the break-inperiod properly, because we
typically do a break-in periodwith those.
So as we dispense them, we say,all right, wear them an hour
the first day, two hours thesecond day, et cetera, until
you're in them for a full daywith no pain.
Then address them, Thenintroduce them into your running
(18:32):
or your sport or whateveractivity, Because it's like
getting a new pair of shoes.
You don't get a new pair ofshoes and go out for a 5k.
You're not going to feel verygood the next day so you really
got to break them in, becauseit's it.
if it's changing the alignmentof your foot when it's
functioning, so it's going tochange the way that your foot's
reacting to the ground andchange the way that those
structures are being affected aswell.
So if you had discomfort withthem, we would have you back in.
(18:56):
We could make some minoradjustments.
If that wasn't enough, we wouldsend them back to the lab and
do additional adjustments.
So it should never be painfulto wear an orthotic.
It's either not the orthoticfor you or it wasn't done
properly.
Sometimes there's lab issues,especially with a custom, so I
would work with whoever whoeverdoctor was that that got those
for you to make it right.
(19:16):
But you should never be havingmore pain with the device.
Speaker 2 (19:20):
Okay, all right, that makes a lot of sense.
So let me ask you this what isthe point of it?
Because you mentioned that it'sto realign your foot, can you
get into deep?
Get a little deep with that.
Speaker 1 (19:31):
So I like to describe them as eyeglasses for your
feet.
All right, so your foot if youneed an orthotic, that is then
your foot most likely isn'tfunctioning in the proper
alignment.
So we look at the subtalarjoint, the mid-tarsal joint,
which are joints in the back ofthe foot, below the ankle and a
lot.
If you're, let's say, aperson's flat footed, they're
(19:53):
functioning over pronating andthey're getting pain to the
inside of the ankle or painalong the plantar fascia.
What we do is when I, when Iscan the patient so I use an
iPhone, right, and I have my Iactually will align the foot
into the proper alignment.
I'll feel the subtalar jointput the patient in what's called
neutral, so that's where theyhave the maximum amount of
supination and pronationavailable.
(20:14):
So I put them right in themiddle, where they're supposed
to be hold the patient there ina locked position then take a
scan of the foot.
So when the foot is scanned inthat position, when we get the
device made to the foot in thatposition, when the patient
stands on that, they're going tobe put into that neutral
position which is going to havethe most amount of play, both
supination and pronationavailable to better accommodate
(20:36):
the ground.
And then we can also addmodifications.
So somebody has ball of thefoot, pain like around the
metatarsal heads or just beforethe toes you can get like
neuromas or capsulitismetatarsalgia.
We can put padding up in thereto take pressure off of the
metatarsal heads.
If somebody has an arthriticbig toe joint a lot of runners
(21:00):
have arthritis in the big toe wecan actually do accommodations
to an arthritic to eitherpromote or limit motion in the
big toe joint.
There's a couple of differentmodifications we can do which
can make running a lot morepleasant if there's not as much
grinding bone on bone going onright.
So we can do things to keeppatients active, keep them
mobile, with some of thesedevices.
Speaker 2 (21:16):
Okay.
That's why, when I called youroffice and I said I have plantar
fasciitis, but I'm not stoppingrunning, I'm not going to stop
running, and she was like no, ofcourse not, that's right.
Speaker 1 (21:26):
So when someone tells me that, then we look at the
shockwave because you don't haveto stop your activity.
We usually have.
You decrease it, usually about50%, but we don't stop you,
whereas some of the othertreatments like if we were going
to go with theanti-inflammatory route, the
icing route, we would say okay,stop running, which people
typically don't want to do.
Speaker 2 (21:45):
Yeah, no.
All right, so okay.
So the orthotic really isteaching you to move your feet
to the ground differently, inthe way that it should be, in a
healthy way.
Speaker 1 (22:01):
Yeah, when they're made properly and depending on
the patient, right.
So if you have an arthriticfoot, we're not going to be able
to get you in that exactlyneutral position.
Let's say, the hind foot hasarthritis in it, then we have to
just accommodate.
So there's different styles,right, and that's the benefit of
the custom is we can, we cantreat the patient in front of us
, um, and the other thing that Iusually do, I don't.
(22:23):
Sometimes we don't just jumpinto an orthotic.
The patient comes in.
I usually don't just cast themor scan them on the first visit.
A lot of times we'll experimentwith the taping, right, so I
can, I can do things with thetape and put different pads in
and see how the patient responds.
And if they say, if we try ametatarsal pad, let's say, and
they come in the next week andthey're like, wow, that was
awful, I hated that.
Well, I'm not going to put thatin an orthotic, then right, so
(22:44):
we can make modifications basedon your response to treatment.
Speaker 2 (22:48):
Okay, all right, so I was going to ask you do.
All right, so I was going toask you do you need a?
Speaker 1 (22:57):
different orthotic for, like, running shoes versus
your walking shoes, not usuallyfor running versus walking, but
if we're looking at runningshoes, running, walking and
boots, usually all will fit likehikers.
But if we're looking at a dressboot or a hockey cleat, or
hockey skate I mean, or a soccercleat then, or even a high high
heel, we can make orthotics forall different styles of
footwear and they're not goingto be the same because they're
(23:18):
not going to fit in eachindividual device.
Um, but there are ways to tomake them fit in these different
things.
So so yeah, we wouldn't do.
You would not have the samedevice.
That's like a, a chunkierathletic device that's going to
give me maximum control and putthat into a loafer.
It's just not going to fitnumber one and number two.
It's not going to becomfortable, so we have to.
(23:39):
Usually what I'll do is havethe patient bring whatever shoe
they want the device to fit into, and that way I can take a look
and we can make sure it's goingto work Okay.
Speaker 2 (23:46):
So at what point?
You know you do all of that,and then there's surgery, so
like how bad could it be to getto?
The point of surgery.
Speaker 1 (24:05):
For plantar fasciitis are we talking about?
Um?
So before I started using EPATand the shockwave therapy, I
would say I would do maybe twoor three plantar fasciitis
surgeries a year not very manyand I would see plantar
fasciitis every single day.
Now I can honestly tell you Ihaven't done a plantar fasciitis
surgery in a couple of yearsbecause we are so successful
with the shockwave therapy andwith our other treatments.
So it's.
I used to tell patients it wasa 90% success rate to not have
(24:28):
surgery without surgery, but Ithink we're even higher than
that at this point.
Speaker 2 (24:31):
Oh, my God, I'm so glad.
Speaker 1 (24:37):
And you know if we, if we're looking at surgery,
usually we're going to get anMRI first to make sure.
Okay, are we missing somethingelse here?
Because we usually don't haveto do surgery on this condition?
Speaker 2 (24:42):
Okay, so you're answering my prayers.
I am like super excited.
That's so great to hear I, youknow, it's amazing how much you
know with science and researchin this field has been coming up
.
I mean, I, you know, Iinterviewed a podiatrist back in
2021 and she was coming up withsome like these things I've
(25:04):
never heard of.
And to hear this shock therapy,I went on your website and I was
like, what is this?
And it's non-invasive, becauseobviously nobody wants to do
surgery, because then that wouldmean no, running for a very
long time to recover.
So that's so great that there'sso many things that are out
there to prevent or to help usto not feel this pain, because
(25:27):
that's like, the worst thing isthis pain on our foot and we
love to run.
So, okay, with all that beingsaid, what does it look like to
work with you?
Okay, so we would make anappointment, we come see you and
you and it almost sounds likeyou really take an approach
where it's like, okay, let's trythe baby steps, right, let's
(25:48):
try this first and let's trythat first.
And so is there like multiplevisits, seeing you trying
different techniques that getthe relief that that client or
patient needs.
Speaker 1 (26:00):
It all depends on the condition, right.
So I mean, some people come inand it's a pretty
straightforward thing and we canaddress it with one or two
visits.
Other times it ends up beingsomething where we have to do
multiple shockwave visits orwe're doing orthotics.
But my goal is to get youbetter.
(26:21):
I don't want you to keep comingback every week for the next 10
years.
So I have a different approach.
I don't try and just keeppeople coming in the door.
I want to get them better andget them back out and doing
their activities.
So the first visit I tend totake a good amount get them back
out and doing their activities.
So the first visit I tend totake a good amount of time and
really evaluate the problem andtry and let's try and figure it
out together.
We take some.
We have x-ray right in theoffice so we can kind of get to
(26:43):
the bottom of a lot of thingsright here.
I am a board certified surgeontoo, so if it comes down to it,
we do have surgical options.
I don't shy away from surgery,but it all depends on what the
actual problem is.
But we tend to take the timethat we need to and I listen to
each individual patient, becausesome patients they don't want
(27:03):
to mess around with.
Some people are afraid of shots.
They don't want a needle, theydon't want anything to do with a
shot.
So people can't takeanti-inflammatories because of
the medications that they're on.
So we take all these thingsinto account and then develop a
plan that we both agree on andgo from there.
Speaker 2 (27:18):
Okay.
So, Dr Relation, where can wefind you?
Because obviously I'm alreadyon the schedule.
I hope Sounds good.
But where can we find youphysically, as well as on social
media?
Speaker 1 (27:37):
So the practice is Bluestone Podiatry.
It's at 1882 New Scotland Roadin Slingerlands, which is not
that far outside of Albany.
It's about 15 minutes, so it'slike you're heading towards
Thatcher Park in that direction,a little southwest of Albany,
right on Route 85.
We're in a nice building thathas a primary care in here as
well, so it's pretty easy tofind and the website has
(28:00):
directions, which isbluestonepodiatrycom.
We do have a Facebook andInstagram, linkedin.
We have all the social mediaand it's just Bluestone Podiatry
for each of those things andit's just bluestone podiatry for
each of those things.
And we we're my wife is veryactive monitoring those social
(28:21):
media platforms and respondingaccordingly.
My staff we know where I'm inthe office mondays, tuesdays and
fridays.
Currently I typically operateon wednesdays, so but we my
staff we're growing.
The practice is relatively new.
We opened up in January of thisyear, so I've been in practice
for about nine years, but I liveout this way, so it was time to
(28:44):
open up and do my own thing,and so we're growing.
So we definitely have room,we're accommodating, we're still
getting into some of theinsurances, but we have this
sculling to let people know oncewe're into those.
We are in several at this point, and my staff is well-versed on
where we are.
So I would just say give us acall and be happy to help out
(29:09):
whoever is in need.
Speaker 2 (29:09):
Okay, and we'll put all those on the show notes, all
the links to get a hold of youon the episode show notes.
That's great yeah.
Speaker 1 (29:19):
We also tend to do a lot with the community.
We had a booth at the Sarah Leeformerly Fryhoffer's Run for
Women.
We have a booth at the upcomingCapital Sweatfest that's going
to be over at Frog Alley, whichwe're really excited about to be
involved with these differentcommunity events.
I am the upstate New Yorkclinical director for the Fit
(29:43):
Feet program for the SpecialOlympics.
So every year in the fall we goup into Glens Falls and we help
out with the fall games andscreen the athletes for any foot
conditions.
So we try to be very activewith the local community and
I've lived here my whole life.
Speaker 2 (30:00):
Well, I appreciate you, dr Rilishan, because
there's a difference when youare an athlete and you go seek
help to a doctor, you know, to adoctor, and they are not.
They're not in the realm of youknow running, or they have no
idea what's involved.
I mean, they know your foot,they know your body, but there's
(30:23):
no like understanding of your.
The joy of working out andbeing fit and having you, you
know, be so involved in thatcommunity makes us runners,
athletes, feel more comfortableto be talking to somebody that
understands where we're comingfrom.
So that's why, you know,obviously, when I was talking to
(30:46):
your wife, I was like she, youknow, he definitely has to come
on here, because a lot of peoplewho are listening to the
podcast are athletes, arerunners, and we're always
looking for ways to preventinjuries and find relief.
So, thank you for doing whatyou're doing and I'm sure people
are going to be reaching out toyou on the local 518.
(31:06):
And I'm so happy that you hadthe opportunity to be on here.
Speaker 1 (31:11):
Oh, I thank you so much for having me.
This was a great experience andI'm glad we could be of
assistance.
So thanks so much.
Speaker 2 (31:18):
All right, until next time, everyone, bye you.
Welcome to Ella Go.
My name is Lisa.
Join me on the journey inhaving real raw and
uncomfortable discussions aboutfitness, health and everything
in between, because, let's behonest, this journey would suck
if we don't get our shittogether.
Welcome back to the ElegoPodcast.
(00:38):
My name is Lisa, I am your hostand today's guest is Dr
Relation.
He is a highly respectedpodiatrist and the owner of
Bluestone Podiatry inSlingerlands, new York.
In addition to his privatepractice, dr Relation serves as
a surgical consultant at FamilyFoot Care in Volatia, new York.
Welcome, dr Relation.
Speaker 1 (01:00):
Hi, hi, lisa, glad to be here.
Hi, I'm at least glad to behere.
Speaker 2 (01:03):
I am so happy to have you here because you know, as a
runner, okay, that our feet areso important to us, right?
And you know we tend to have alot of common injuries when it
comes to running and it comes toour feet, so I cannot wait to
pick your brain.
So what are the common footinjuries that you often see with
(01:30):
runners.
Speaker 1 (01:30):
So runners come in with a variety of injuries, as
you can imagine, and we seeeverything from just general
capsulitis, metatarsalgia of theball of the foot.
Sometimes we see flare-ups ofneuromas.
Most common is plantarfasciitis, achilles tendonitis,
also perineal tendonitis, whichis a tendon on the outside of
the foot, and posterior tibialtendonitis, which is a tendon on
(01:52):
the inside of the foot.
So we see all these thingsevery day in the office.
Speaker 2 (01:58):
Oh, okay, now I'm going to ask you another
question.
Well, that has to do with that,but we're going to wait, okay?
So what is a common mistakerunners make when it comes to
shoes and or their feet that maycause some of these injuries?
Speaker 1 (02:14):
I mean.
Number one I see is not havingthe proper shoe for your foot
right.
So there are a lot of thesespecialty sneaker companies now,
or shoe companies have shoesthat are tailored to different
foot types.
And if you don't know your foottype and you're not and you're
just going online and orderingwhatever you see that that looks
cool, you may not get theproper fit for you.
(02:36):
So I usually recommend going toa reputable shoe store.
Um, personally I know locally.
I sent a lot of patients over tofleet feet over on uh, wolf
road and they tend to have a lotof staff that really can
analyze the foot and make sureyou're in the right shoe.
Companies like Asics, hokaBrooks they'll have especially
(02:58):
on their websites I know Asicsdoes it they have a shoe finder,
have a shoe finder so you putin your foot type, you put in if
you're an over pronator, moreof a neutral foot type or a
supinator, and they'll list awhole bunch of shoes that'll
actually match for you.
Because if you're a supinator,which is a higher arched foot
type, and you go into a shoethat's made for an over pronator
(03:18):
, you're going to be tilted upway too much to the outside,
more propensity to roll yourankle, more propensity to get
the perineal tendonitis, andthen opposite.
If you're more of a pronatorand you're going into a
supinated shoe, you're just notgoing to get that support that
you need, which will lead tomore issues on the medial side
of the foot.
Speaker 2 (03:37):
Do you see that?
Do you see runners that come inand then they don't even you're
talking to them and they'relike I don't even know what
you're talking about, have you?
Do you see that?
Speaker 1 (03:47):
More new runners like that are just starting to get
back into it or starting out forthe first time.
So yeah, experienced runnerstypically don't have that issue,
but but those that are, thatare just trying to get going
with with a new new activity,then they may not know their
their proper style, that theyshould be in for sure.
Speaker 2 (04:08):
Okay.
So besides having the rightshoe, my next question was going
to be like how can runnersprevent foot injuries?
I mean, you see so much outthere like there's these
stretches, there's these tools.
I mean, do you cringe when yousee some of these things?
Speaker 1 (04:26):
these tools.
I mean, do you cringe when yousee some of these things?
Yeah, I mean, there's so manygimmicks out there that you can
find online or on your Instagramreel or wherever you happen to
be browsing.
Really, it's just properstretching.
That's really important.
Starting slow.
Don't just decide I'm going torun a 5K today when you haven't
ran in three or four months orlonger.
It's always about gradualincreases to activity to try and
(04:58):
let the structures in the foot,and the rest of the body for
that matter, kind of get used tothe activity again and
strengthen accordingly.
Orthotics can make a bigdifference to making sure that
the foot is protected moreproperly aligned during the
activity and then recovery.
So afterwards you know if youare having some pain, noticing
it, listening to your body, notpushing through the pain, icing
it afterwards, oranti-inflammatory if you need to
(05:18):
or if you're able to.
So really just paying attentionto your body is really one of
the big key features here.
Speaker 2 (05:26):
Okay, yeah, that makes a lot of sense.
So let's focus on plantarfasciitis and, of course,
achilles tendonitis.
So that's the common runninginjuries, and let's start with
plantar fasciitis.
Why does it happen and whattreatment is available to help
relieve this?
Speaker 1 (05:51):
So plantar fasciitis, or heel pain in general, is one
of the most common things thatwe see every day.
The plantar fascia is aligament that goes from the
bottom of the heel, which theheel is a pretty large bone at
the bottom of the foot.
It has these two littletubercles that come off of the
bottom and the fascia extendsall the way from the heel bone
all the way out to themetatarsal heads and it spans
that whole area kind of like atruss system and every step you
(06:11):
take it's pulling and stretchingright at that heel attachment
and that's the most common spotthat gets inflamed.
You get these little microtears.
Usually it's an overuse typeinjury from either lack of
support or just a suddenincrease in activity.
Or if we're running and hit apothole or drop rolled off a
curb wrong, something like thatcan can spur it off too, but
(06:32):
little.
Usually it's multiple littlemicro traumas that'll happen and
if you imagine that theligaments kind of like a rope
the same thing with the achillesit's like a whole bunch of
strands of collagen that arewound together and you can get
some fraying of those edgesright.
So little tiny tears, you getfraying of the rope.
The body tries to heal it.
So you get inflammation aroundthat no-transcript that comes in
(07:26):
.
First visit we're usuallygetting an x-ray making sure
nothing else is going on like astress fracture in the heel or
something else.
That would be kind of off thewall.
But once we isolate that it'smost likely plantar fasciitis,
we'll start our typical regimenand we can go one of two ways
with treatment.
So the standard treatmentprotocol usually is some kind of
(07:47):
support.
So we tape the.
We do a lot of athletic tapingsstrappings, so we'll do a low
die strapping.
We'll put a pad up in theinstep and the tape itself will
help to lock the subtalar joint,kind of lock the mid-tarsal
joint, lift up and take sometension off of the plantar
fascia so that it's not beingstretched every single step.
(08:08):
Let's the fascia rest.
We start you on a stretching andicing regimen.
Usually I recommend get a20-ounce bottle of Coke, pepsi
water, whatever.
When you're finished with ityou rinse it out, you fill it
three-quarters of water and youfreeze that, put it on the
ground and roll your arch righton there two to four times a day
or whenever it's starting tofeel uncomfortable, and that
(08:29):
just helps loosen it up, massageit and ice it.
At the same time, if thepatient's able to, we'll start
an anti-inflammatory regimen andkind of go from there.
There are also night splintspeople can wear at night, while
they're sleeping, to stretch theheel out.
We dispense those in the office.
There's about a thousanddifferent kinds of night splints
, so we have particular onesthat we like more than others.
(08:51):
If that isn't quite doing it orsomeone comes in and they're
limping, it's really bad.
Sometimes we'll do a cortisoneshot.
But then we also offernon-invasive measures as well.
So there's a whole othertreatment algorithm called EPAP,
(09:18):
which is shockwave therapy, andthat's nice because it's
non-invasive, there is nodowntime, we don't have you ice
it, it's kind, and shock wavesto stimulate the healing process
.
So a shock wave utilizes umpulse activation therapy to
stimulate the microcirculationto the injury, to a focused area
, and it allows that the body'sown regenerative properties to
(09:41):
begin working on the healingprocess.
So was developed for thetreatment of plantar fasciitis
and achilles tendonitis.
It's been around for a longtime, really popular in europe
with soccer players because youwant to keep the players on the
field.
It's in a lot of sports teamsin the US now and I'm fortunate
to have it in my practice aswell to be able to provide it to
(10:02):
my patients.
So it provides a non-invasiveoption which people start
feeling the benefit of after twoor three sessions.
Speaker 2 (10:12):
Okay, I'm already like sign me up, okay, so does
it hurt?
Speaker 1 (10:17):
We typically say it's uncomfortable.
Right First session's alwaysthe most uncomfortable because
we're putting a lot of energyinto the tissue and the tissue
is injured, so you're going tohave some discomfort.
But I can tailor it to thepatient in the moment.
So we start low, we kind ofdial it up as we go and we get
you around a five and a 10 onthe pain scale.
That's what I usually tell mypatients.
(10:38):
And then each subsequent visitbecause we usually do three to
four rounds of treatment onaverage.
Each subsequent visit we cantypically get more and more
energy into the tissue with lessand less discomfort, and then
by the end of our sessions mostpatients are not feeling much
pain at all.
And we offer both EPAT, eswtand EMTT therapy, which is
(11:03):
magnetic therapy.
So I usually combine the twotreatments into one session.
So I start with theuncomfortable part and then we
finish with the relaxingmagnetic therapy.
So and that typically is a nicepain modulator as well.
So that'll actually help to inthe moment reduce the pain too.
Speaker 2 (11:18):
Wow, okay, you mentioned something at the
beginning where you said it wasthe side of the foot.
So what was that called?
Speaker 1 (11:27):
Well, there's.
So you have the medial side,which is like the inside of your
ankle bone.
That's your medial side of yourfoot.
There's the posterior tibialtendon on that side and on the
outside of your ankle bone.
That's your medial side of yourfoot.
There's the posterior tibialtendon on that side and on the
outside of your ankle andthere's two tendons that come
down around the outside, calledyour perineal tendons, and one
attaches to the side of the foot, which is a little kind of a
bump out on the side, andthere's another one that goes
(11:48):
under the foot.
So either one of those can beuncomfortable, depending on
which one you're asking about.
Speaker 2 (11:55):
Well, let me ask you this Could someone because when
you were talking about this Iwas like, maybe that's my
problem, Maybe it's not, becauseit's the side Like could
someone confuse it being plantarfasciitis, when it is really
that?
Speaker 1 (12:11):
Yeah, we see that all the time.
So people come in and they theyit says on my, on my schedule
plantar fasciitis, and they sitdown on the chair and we take a
look at everything and it'sabsolutely not plantar fasciitis
, it's posterior tibialtendonitis or it's perineal
tendonitis.
But they're totally differentpathologies so they require
different approaches totreatment as well.
Speaker 2 (12:30):
And so that person?
It could be either of thosethings, but yet they're feeling
that heel pain.
Speaker 1 (12:36):
You can have some pain radiate.
Some people will say heel pain,but really it's the arch, or
it's the inside of the foot.
So what someone thinks is theirheel may not be what I think is
their heel right.
And then there's also the backof the heel, which is your
Achilles tendon.
So there's several differentstructures right in that area.
Speaker 2 (12:59):
Yeah, I mean, if you look at the foot, so many things
going on.
Speaker 1 (13:04):
Yes, I mean obviously A lot of structures in the foot
.
Speaker 2 (13:08):
Lots of stuff going on.
Okay, so let's talk about theAchilles tendonitis.
Now, what is that and how doesthat happen?
Speaker 1 (13:15):
Well, your Achilles starts.
There's two main tendons thatmake up the Achilles tendon your
gastrocnemius and your soleus.
The gastrocnemius actuallycrosses the knee joint and
attaches to the femoral condyles.
So there's two components there, and if they get tight, if you
think about it, most shoes todayhave a decent heel on,
(13:36):
especially running shoes.
A lot of them have a prettydecent drop.
So then a lot of you know, youthink about women's high heels,
men's work boots, so there's alot of of heels on on shoes now.
So people are functioning withtheir, their heel up, which is
going to let that tendon gettighter and tighter.
And so, as the tendon getstighter and tighter, if someone
(14:02):
gets into a shoe that has alower drop, more minimalist
style shoe we see all this a lotafter COVID People are working
from home, so they're notwearing shoes, and all of a
sudden they're getting all theseAchilles issues because now
that tendon is being stretchedrepeatedly.
We see it a lot with runnerstoo.
Especially if people startdoing hill training, whether
it's a trail running or justrunning on roads that have hills
(14:22):
they're getting a lot morestress than that Achilles tendon
as well, and it's the same kindof thing as the plantar fascia.
It's where the Achilles.
There's two areas.
There's the insertionalAchilles tendonitis, where the
Achilles actually attaches tothe calcaneus on the back of the
heel bone, and that's more likebump pain we call it.
It's like it gets kind ofswollen, gets hot down there,
red right at the the back of theheel, or if you start having
(14:45):
like some partial tearing,there's a zone about one to
three centimeters above theAchilles insertion and that you
can start to get tendinosis inthat area like chronic damage,
because the blood flow isn't asgood there.
Um, so as that gets again,imagine the rope starts to fray
in that location you get thatchronic inflammation that can
(15:07):
kind of build up in there okay,so let's explain this a little
further for those of you knowpeople who are listening and
they're like well, first of all,where's the achilles like?
Speaker 2 (15:16):
so we're talking about right behind the.
Speaker 1 (15:19):
So if we were to look at the foot and we're going to
go look at it, look at it fromthe back of the foot and there's
the heel and it's that it's athick band, that thick band that
you can feel in the back ofyour ankle that goes from your,
your leg, from your calf muscles, that goes down towards the
back of the heel.
That goes from your leg, fromyour calf muscles that goes down
towards the back of the heeland it kind of just meets up
(15:40):
with the heel bone.
And where it meets up with theheel bone is the attachment site
.
And some people that have likea chronic Achilles issue where
they've had pain on and off foryears, can actually start to get
a bump that forms back therefrom a bone spur.
That can start to happen.
So again, we don't know thattill we get an x-ray from a bone
spur, that can start to happen.
Speaker 2 (15:57):
So again, we don't know that till we get an x-ray.
Okay, and you mentionedsomething about there is a
muscle across the knee.
Speaker 1 (16:11):
Yeah, so if you feel the back of your calf, the
muscle back there is called yourgastrocnemius muscle and then
below that's the soleus muscle.
But if you kind of feel upbehind your knee, you kind of
feel there's two bands thatcross the knee joint that all
goes down and attaches to yourheel bone.
So that's all part of yourAchilles complex, right?
So your gastrocnemius muscles.
So when people are stretchingit's really important to do two
different stretches.
You want to stretch out thecalf muscle but you also want to
(16:32):
stretch the hamstrings and getthat whole posterior muscle
complex stretched before andafter you go on your runs.
Speaker 2 (16:40):
Yeah, because it's all connected.
Speaker 1 (16:41):
Everything's connected Absolutely.
Speaker 2 (16:42):
I always tell my runners that Okay, all right.
So orthotics, all right.
So I have a love and hate withthis because I was told to put
orthotics.
I tried them and I'm like theyhurt.
Forget it.
I'm not doing it.
What are your thoughts aboutthat?
Obviously, they're an insertthat you would put in the shoe,
(17:05):
but should someone wait a whileBecause it does feel
uncomfortable and sometimes itdoes hurt?
Speaker 1 (17:11):
Well, were they custom that you tried, or were
they-?
Speaker 2 (17:13):
Custom?
Yeah, hurt well, were theycustom that you tried, or were
they custom yeah?
Speaker 1 (17:15):
custom, yeah, so um, and then also, was it a
chiropractor, or was it apodiatrist or an orthotist?
Speaker 2 (17:22):
okay, because they're all different all different.
Speaker 1 (17:24):
What's that?
Speaker 2 (17:25):
I don't know, all right all right.
Speaker 1 (17:27):
So there's all different kinds of orthotics.
Um, there's your, your off offthe shelf devices.
You're going to get walmart orthe drug store and those are
going to be in Walmart or at adrugstore and those are going to
be really not supportive at alltypically.
They typically are just foam.
They don't do much for you.
Then there's yourmiddle-of-the-road, like a
PowerStep or a Spanko, and eventhose are narrowed down based on
(17:48):
your foot type.
So if you're not in the properdevice for your foot or for your
pathology, your problem thatyou're having it's not going to
feel good.
And then, when it comes tocustoms, you know it.
Really it's a workingrelationship to try and get the
right device for you.
A lot of times we hit it righton the first try.
But they're custom so we can doall different kinds of
(18:11):
modifications.
So if I get somebody to set uporthotics, they try them out and
they go through the break-inperiod properly, because we
typically do a break-in periodwith those.
So as we dispense them, we say,all right, wear them an hour
the first day, two hours thesecond day, et cetera, until
you're in them for a full daywith no pain.
Then address them, Thenintroduce them into your running
(18:32):
or your sport or whateveractivity, Because it's like
getting a new pair of shoes.
You don't get a new pair ofshoes and go out for a 5k.
You're not going to feel verygood the next day so you really
got to break them in, becauseit's it.
if it's changing the alignmentof your foot when it's
functioning, so it's going tochange the way that your foot's
reacting to the ground andchange the way that those
structures are being affected aswell.
So if you had discomfort withthem, we would have you back in.
(18:56):
We could make some minoradjustments.
If that wasn't enough, we wouldsend them back to the lab and
do additional adjustments.
So it should never be painfulto wear an orthotic.
It's either not the orthoticfor you or it wasn't done
properly.
Sometimes there's lab issues,especially with a custom, so I
would work with whoever whoeverdoctor was that that got those
for you to make it right.
(19:16):
But you should never be havingmore pain with the device.
Speaker 2 (19:20):
Okay, all right, that makes a lot of sense.
So let me ask you this what isthe point of it?
Because you mentioned that it'sto realign your foot, can you
get into deep?
Get a little deep with that.
Speaker 1 (19:31):
So I like to describe them as eyeglasses for your
feet.
All right, so your foot if youneed an orthotic, that is then
your foot most likely isn'tfunctioning in the proper
alignment.
So we look at the subtalarjoint, the mid-tarsal joint,
which are joints in the back ofthe foot, below the ankle and a
lot.
If you're, let's say, aperson's flat footed, they're
(19:53):
functioning over pronating andthey're getting pain to the
inside of the ankle or painalong the plantar fascia.
What we do is when I, when Iscan the patient so I use an
iPhone, right, and I have my Iactually will align the foot
into the proper alignment.
I'll feel the subtalar jointput the patient in what's called
neutral, so that's where theyhave the maximum amount of
supination and pronationavailable.
(20:14):
So I put them right in themiddle, where they're supposed
to be hold the patient there ina locked position then take a
scan of the foot.
So when the foot is scanned inthat position, when we get the
device made to the foot in thatposition, when the patient
stands on that, they're going tobe put into that neutral
position which is going to havethe most amount of play, both
supination and pronationavailable to better accommodate
(20:36):
the ground.
And then we can also addmodifications.
So somebody has ball of thefoot, pain like around the
metatarsal heads or just beforethe toes you can get like
neuromas or capsulitismetatarsalgia.
We can put padding up in thereto take pressure off of the
metatarsal heads.
If somebody has an arthriticbig toe joint a lot of runners
(21:00):
have arthritis in the big toe wecan actually do accommodations
to an arthritic to eitherpromote or limit motion in the
big toe joint.
There's a couple of differentmodifications we can do which
can make running a lot morepleasant if there's not as much
grinding bone on bone going onright.
So we can do things to keeppatients active, keep them
mobile, with some of thesedevices.
Speaker 2 (21:16):
Okay.
That's why, when I called youroffice and I said I have plantar
fasciitis, but I'm not stoppingrunning, I'm not going to stop
running, and she was like no, ofcourse not, that's right.
Speaker 1 (21:26):
So when someone tells me that, then we look at the
shockwave because you don't haveto stop your activity.
We usually have.
You decrease it, usually about50%, but we don't stop you,
whereas some of the othertreatments like if we were going
to go with theanti-inflammatory route, the
icing route, we would say okay,stop running, which people
typically don't want to do.
Speaker 2 (21:45):
Yeah, no.
All right, so okay.
So the orthotic really isteaching you to move your feet
to the ground differently, inthe way that it should be, in a
healthy way.
Speaker 1 (22:01):
Yeah, when they're made properly and depending on
the patient, right.
So if you have an arthriticfoot, we're not going to be able
to get you in that exactlyneutral position.
Let's say, the hind foot hasarthritis in it, then we have to
just accommodate.
So there's different styles,right, and that's the benefit of
the custom is we can, we cantreat the patient in front of us
, um, and the other thing that Iusually do, I don't.
(22:23):
Sometimes we don't just jumpinto an orthotic.
The patient comes in.
I usually don't just cast themor scan them on the first visit.
A lot of times we'll experimentwith the taping, right, so I
can, I can do things with thetape and put different pads in
and see how the patient responds.
And if they say, if we try ametatarsal pad, let's say, and
they come in the next week andthey're like, wow, that was
awful, I hated that.
Well, I'm not going to put thatin an orthotic, then right, so
(22:44):
we can make modifications basedon your response to treatment.
Speaker 2 (22:48):
Okay, all right, so I was going to ask you do.
All right, so I was going toask you do you need a?
Speaker 1 (22:57):
different orthotic for, like, running shoes versus
your walking shoes, not usuallyfor running versus walking, but
if we're looking at runningshoes, running, walking and
boots, usually all will fit likehikers.
But if we're looking at a dressboot or a hockey cleat, or
hockey skate I mean, or a soccercleat then, or even a high high
heel, we can make orthotics forall different styles of
footwear and they're not goingto be the same because they're
(23:18):
not going to fit in eachindividual device.
Um, but there are ways to tomake them fit in these different
things.
So so yeah, we wouldn't do.
You would not have the samedevice.
That's like a, a chunkierathletic device that's going to
give me maximum control and putthat into a loafer.
It's just not going to fitnumber one and number two.
It's not going to becomfortable, so we have to.
(23:39):
Usually what I'll do is havethe patient bring whatever shoe
they want the device to fit into, and that way I can take a look
and we can make sure it's goingto work Okay.
Speaker 2 (23:46):
So at what point?
You know you do all of that,and then there's surgery, so
like how bad could it be to getto?
The point of surgery.
Speaker 1 (24:05):
For plantar fasciitis are we talking about?
Um?
So before I started using EPATand the shockwave therapy, I
would say I would do maybe twoor three plantar fasciitis
surgeries a year not very manyand I would see plantar
fasciitis every single day.
Now I can honestly tell you Ihaven't done a plantar fasciitis
surgery in a couple of yearsbecause we are so successful
with the shockwave therapy andwith our other treatments.
So it's.
I used to tell patients it wasa 90% success rate to not have
(24:28):
surgery without surgery, but Ithink we're even higher than
that at this point.
Speaker 2 (24:31):
Oh, my God, I'm so glad.
Speaker 1 (24:37):
And you know if we, if we're looking at surgery,
usually we're going to get anMRI first to make sure.
Okay, are we missing somethingelse here?
Because we usually don't haveto do surgery on this condition?
Speaker 2 (24:42):
Okay, so you're answering my prayers.
I am like super excited.
That's so great to hear I, youknow, it's amazing how much you
know with science and researchin this field has been coming up
.
I mean, I, you know, Iinterviewed a podiatrist back in
2021 and she was coming up withsome like these things I've
(25:04):
never heard of.
And to hear this shock therapy,I went on your website and I was
like, what is this?
And it's non-invasive, becauseobviously nobody wants to do
surgery, because then that wouldmean no, running for a very
long time to recover.
So that's so great that there'sso many things that are out
there to prevent or to help usto not feel this pain, because
(25:27):
that's like, the worst thing isthis pain on our foot and we
love to run.
So, okay, with all that beingsaid, what does it look like to
work with you?
Okay, so we would make anappointment, we come see you and
you and it almost sounds likeyou really take an approach
where it's like, okay, let's trythe baby steps, right, let's
(25:48):
try this first and let's trythat first.
And so is there like multiplevisits, seeing you trying
different techniques that getthe relief that that client or
patient needs.
Speaker 1 (26:00):
It all depends on the condition, right.
So I mean, some people come inand it's a pretty
straightforward thing and we canaddress it with one or two
visits.
Other times it ends up beingsomething where we have to do
multiple shockwave visits orwe're doing orthotics.
But my goal is to get youbetter.
(26:21):
I don't want you to keep comingback every week for the next 10
years.
So I have a different approach.
I don't try and just keeppeople coming in the door.
I want to get them better andget them back out and doing
their activities.
So the first visit I tend totake a good amount get them back
out and doing their activities.
So the first visit I tend totake a good amount of time and
really evaluate the problem andtry and let's try and figure it
out together.
We take some.
We have x-ray right in theoffice so we can kind of get to
(26:43):
the bottom of a lot of thingsright here.
I am a board certified surgeontoo, so if it comes down to it,
we do have surgical options.
I don't shy away from surgery,but it all depends on what the
actual problem is.
But we tend to take the timethat we need to and I listen to
each individual patient, becausesome patients they don't want
(27:03):
to mess around with.
Some people are afraid of shots.
They don't want a needle, theydon't want anything to do with a
shot.
So people can't takeanti-inflammatories because of
the medications that they're on.
So we take all these thingsinto account and then develop a
plan that we both agree on andgo from there.
Speaker 2 (27:18):
Okay.
So, Dr Relation, where can wefind you?
Because obviously I'm alreadyon the schedule.
I hope Sounds good.
But where can we find youphysically, as well as on social
media?
Speaker 1 (27:37):
So the practice is Bluestone Podiatry.
It's at 1882 New Scotland Roadin Slingerlands, which is not
that far outside of Albany.
It's about 15 minutes, so it'slike you're heading towards
Thatcher Park in that direction,a little southwest of Albany,
right on Route 85.
We're in a nice building thathas a primary care in here as
well, so it's pretty easy tofind and the website has
(28:00):
directions, which isbluestonepodiatrycom.
We do have a Facebook andInstagram, linkedin.
We have all the social mediaand it's just Bluestone Podiatry
for each of those things andit's just bluestone podiatry for
each of those things.
And we we're my wife is veryactive monitoring those social
(28:21):
media platforms and respondingaccordingly.
My staff we know where I'm inthe office mondays, tuesdays and
fridays.
Currently I typically operateon wednesdays, so but we my
staff we're growing.
The practice is relatively new.
We opened up in January of thisyear, so I've been in practice
for about nine years, but I liveout this way, so it was time to
(28:44):
open up and do my own thing,and so we're growing.
So we definitely have room,we're accommodating, we're still
getting into some of theinsurances, but we have this
sculling to let people know oncewe're into those.
We are in several at this point, and my staff is well-versed on
where we are.
So I would just say give us acall and be happy to help out
(29:09):
whoever is in need.
Speaker 2 (29:09):
Okay, and we'll put all those on the show notes, all
the links to get a hold of youon the episode show notes.
That's great yeah.
Speaker 1 (29:19):
We also tend to do a lot with the community.
We had a booth at the Sarah Leeformerly Fryhoffer's Run for
Women.
We have a booth at the upcomingCapital Sweatfest that's going
to be over at Frog Alley, whichwe're really excited about to be
involved with these differentcommunity events.
I am the upstate New Yorkclinical director for the Fit
(29:43):
Feet program for the SpecialOlympics.
So every year in the fall we goup into Glens Falls and we help
out with the fall games andscreen the athletes for any foot
conditions.
So we try to be very activewith the local community and
I've lived here my whole life.
Speaker 2 (30:00):
Well, I appreciate you, dr Rilishan, because
there's a difference when youare an athlete and you go seek
help to a doctor, you know, to adoctor, and they are not.
They're not in the realm of youknow running, or they have no
idea what's involved.
I mean, they know your foot,they know your body, but there's
(30:23):
no like understanding of your.
The joy of working out andbeing fit and having you, you
know, be so involved in thatcommunity makes us runners,
athletes, feel more comfortableto be talking to somebody that
understands where we're comingfrom.
So that's why, you know,obviously, when I was talking to
(30:46):
your wife, I was like she, youknow, he definitely has to come
on here, because a lot of peoplewho are listening to the
podcast are athletes, arerunners, and we're always
looking for ways to preventinjuries and find relief.
So, thank you for doing whatyou're doing and I'm sure people
are going to be reaching out toyou on the local 518.
(31:06):
And I'm so happy that you hadthe opportunity to be on here.
Speaker 1 (31:11):
Oh, I thank you so much for having me.
This was a great experience andI'm glad we could be of
assistance.
So thanks so much.
Speaker 2 (31:18):
All right, until next time, everyone, bye you.
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