Managing Nail Fungus, Fractures, and Orthotics Effectively

Hello down here, welcome to Podiatry Practice Mastery where I'm kind of kind of sharing the things that are working in my practice to get to the $1,000,000 mark and beyond. Hopefully this will give you some inspiration for your your practice. So today I'm recording day of Tuesday in practice. It was a full day so we'll kind

of get into this. So first patient, she is a 28 year old female. She was one that had kind of failed trybenafin, she failed Diflucan and now she is on itroconazole. She is doing well. She has some proximal nail clearing finally, and I sometimes don't understand why, you know, one doesn't work in the other, but that's why I have those three that I kind of go through kind of in that order. She's getting better. I the nail looked a little bit thick.

I ground it down. I don't normally grind down nails, but in her case I did grind them down and they look a little bit clearer kind of at the base of the nail. So that was that patient. Next patient was a 48 year old female. She had a bilateral carry flex with my nail tech. So her one of her nails

detached. So she has only maybe one, I don't know, a small little piece at the base to attach to so there's not much nail because of a previous procedure by someone else. And she comes in every couple of months for this and to get it reapplied because she likes the way they look. I find if if there really isn't much nail at all, you can't make the nails that long with the carry flex and it's so nice having Marjorie do that for her.

She also, when I was there talking to her, she also had had orthotics in the past and she requested a pair of orthotics. Now this patient, her, her carry flex did fall off. So usually if the carry flex falls off, I don't charge them the the full application fee a second time like a month later because it gets kind of expensive. So I tend to guarantee them. This is kind of the way I do it. I guarantee them for three months.

If it falls off, I put it on for only an office visit or Audrey put it on. We did an office visit. We also got orthotics and she she bought the kit that went with it. Next patient was a 68 year old female. She had an X-ray, she had an ultrasound and she had pain in the second metatarsal kind of had kind of a Bursa underneath the second metatarsal head that was painful for her. So we did a cortisone on the

plantar bursal region with the with an ultrasound. Now she has that second hammer, so that's kind of going up and over and a little bit dislocated. And so we did talk to her about relocating that, but it's going to be maybe pinning, but maybe a planter plate repair for that patient. Next patient was a 59 year old

female #3 out of four for Swift. Next patient I just see I do three out of four just so you guys know how many I tend to do so how many they have set up. The next patient was a 63 year old man for nail fungus. He decided not to do the the

nail sample. He just wanted to get right into it. And so we did a three month follow up and prescribed that your benefit. I looked at his LFTS. He showed it to me on his phone. He had a little app that would that I could look at his LFTS from his from his doctor. Next patient was a patient that had X-rays. She had some nails, she had some

nails and calluses and she had a hammer toe on the left 4th digit. And that was kind of bothering her. So we looked at that for her. And this is one that kind of a challenge when you get these, they probably all get these. But this is a patient that said, hey, you know this other doctor, he moved his office and he, his nail care is always covered by him. So I want to make sure it's covered by you and I and I never

guarantee that for patients. I say I'm too young in my career to, to make things up. So I said, you know, if it's not covered, we charge 75. I think we're low. I think I'm going up to 100. I'd like to know what other people do, but for if it's not covered, but it's 75 currently. We evaluated the digit. I did the, the, the nail care. And then we'll, we'll see if it's covered by insurance.

I doubt it. I don't think she has class findings. Next was a 21 year old female. She's here for a follow up for Cellulitis after nail puncture wound. The Cellulitis is getting much better. She still has some guarding I think due to the puncture end of the tissue and things are still painful in there. She's still guarded but but feeling quite a bit better. Next patient was a 58 year old

female. She has really a neuropathic foot with Charco and I had her go to hang her to get a crow boot and we did an X-ray afterwards. So she's doing better in the crow for three months. I'm going to keep her in for another three months and then transition her into a diabetic shoe. Next patient was a follow up after 6 epat a 69 year old female. She is doing great has no

issues. She had a little issue with her orthotic being like a rubbing a little bit on the lateral side of the heel so I heated them up and dropped down the lateral side a little bit and she's feeling much better.

This is when I did a video on so I'm starting to do YouTube shorts or I use submagic and I record them right in the treatment room for like success, successful patients or like certain videos that I want specifically for our website. So a couple things we've been doing lately. I, I do have a virtual assistant that helps in the website and she's doing some like focused web pages on things that I want,

like orthotics. And so when I get a, a good orthotic or shockwave success story, then I will make a short and then I can put that on the, on the, the website. So the way I do that is I when I record it, it automatically

uploads it to submagic. And then I'll, I'll rename it to say like, hey, this is a good one for the page on orthotics or the page on Shockwave. And then when the virtual assistant goes in there and they add the subtitles and the title and they upload it, they'll know to upload it as well on the YouTube and also on the website in that area.

So it kind of has a workflow pattern and it allows me to make the videos without 2 problems. 1 is it doesn't occupy space on my phone because it uploads it directly to their platform called Sub Magic. I do it right from my phone. And the second thing is it it allows me to do it in the treatment room with the patient versus having to wait or record it at another time. I find getting it done right when I'm with the patient works better. Next patient was a 58 year old female.

She had first metatarsal kind of the plantar medial aspects like a, a neuritis. So we did X-ray, recommended some things for that recommended like a cortisone. She didn't want that but just said I would give it time. I think it was a bad shoe that kind of aggravated it. Next was a swift 3 out of four getting better. Next was a fifth met base fracture, got an X-ray doing much better. No follow up there within the

global period. Next was a 82 year old that came in for an office visit and he had a a portal keratoma on the OR IPK on the right fifth met head. So I removed that. Next was a 41 year old female that E pat status post A6 sessions six weeks out. She feel like her, her orthotics set her back. They're kind of a high arched orthotic. And I, I tried to lower them down in the office by heating them up, but they may have been a little bit too high.

So what I did is I said, you know, if it if it continues to bother you, I'm going to drop down the arch for you. I don't charge if I do that. And I also I did a just a another shockwave for her just because I was I wanted her to get better and she's already paid for six. It didn't really take much extra time for me. So I did another shockwave on her, just the soft wave, only for her. She was doing better.

I did another ultrasound as well for her that did still show thickening and effusion within the plantar FASA. So might just need more time or a few more treatments. Next was a 82 year old man. He had a right ankle sprain, he had a little fall, and he had a follow up on his nail fungus. He's been taken to benefit as well. He's doing well. Next was a 65 year old female that had pain and foot swelling. I recommended an AFO because she

had some posterior tibial tendonitis. She wanted to try her orthotic first. She has an older orthotic she hasn't been wearing so I gave mostly shoe recommendations for that. Next was a 43 year old that had She's here at 4 weeks out for a medial kidneyiform fracture which is quite odd. And I I want to order an MRI because she's not feeling much better and I just want to make sure I'm not missing anything. So I ordered an MRI for her. Next was a a a patient with an

IPJ hallux ulcer getting better. We we struggle with him with his insurance in terms of covering collagen. So for him he actually went to Amazon and found like collagen powder for $30.00. I don't know if it's the same stuff as what I do with the Amerigel, but it certainly is a lot less expensive. That's what he got and he felt like it worked last time for him to get it healed. But I think a lot of it has to do with his hallux limitis and

his his his bio mechanics. Next was a 61 year old male got a orthotics bilateral. Oh, this was this guy's a butcher. So he's butcher, he's on his feet a lot came in many years ago for plantar fasciitis. And what I found is certainly even though I have a new treatment with the shockwave, patients tend to want what worked last time and I tend to try that first. So I learned this at a lecture about like surgeries, right?

If you do an Austin on one patient and it worked really well, they're going to want an Austin on the other side, even though a Lapidus might be preferred. A lot of times they just know what to expect and they kind of want the same thing. So same thing with orthotics.

He had Northwest, so I scanned him for Northwest even though I don't use that as much anymore. I scanned him for Northwest and he had bilateral cortisone last time. That works, so I did bilateral cortisone. He also had orthotics, so I made new orthotics because his current ones are cracked and then I also added on their bilateral night splints for him. So we got bilateral ultrasound, bilateral X-ray, night splints, orthotics and the cortisone.

So this is an idea of kind of like stacking up treatments that can be beneficial for our our patients. Next was a patient six out of six out of shockwave and did an office visit and they'll be back in three months, actually six weeks for the follow up. Next was a 76 year old that an Ind for ingrown toenail and nail care. Next was a patient 59 year old female that had bilateral subtalar joint pain. So I did bilateral sinus tarsi injections, no ultrasound guidance for that because it's

kind of a bigger, bigger joint. And then finally there was a patient that had some kind of weird kind of foot numbness and pain and I did gabapentin for this patient and I'm going to see them back in three months and see how they're doing. So that was the day I did do a couple of videos. I try to do a couple of videos every day. So the thought is there's going to be so. And then what my virtual assistant does is they batch

those videos. Another benefit I like to do in Shorts is I don't have to do thumbnails. So it saves a little bit of time on thumbnails and the idea is the best producing videos, then you can turn those into like ads by putting a little call to action at the end of them. This is some I learned from Alex, Alex Harmozzi for marketing. OK. OK, guys, until next time, have a good one.