Placing a Digital Block

One of the most important aspects of performing any surgical procedure is the ability to achieve appropriate anesthesia. During my first few years in practice, I tried a variety of techniques attempting to discover the most efficient, painless way to perform a complete digital block.

If you will follow these steps, I am confident that you to will get great results.

1. Apply a topical preparation to the site of the digit that you will be placing the injection. I use this compounded topical (Benzocaine 20%, Lidocaine 6%, Tetracaine 4%) Allow the topical to stay in place for at least 15 minutes prior to the injection, although optimal time would be 30 minutes.

2. Mix 2.5cc of 1% Lidocaine Plain with 2.5cc of 0.5% Marcaine Plain and add 0.2cc-0.4cc of 8.4% Sodium Bicarbonate (helps decrease the stinging sensation with the injection). Don't use to much Sodium Bicarbonate, as this will decrease the effectiveness of the anesthetic.

3. Clean the application site with alcohol.

4. Spray the injection site with a 'cold freeze' topical spray (see my blog post on 'Placing a Plantar Fascial Injection for a link to the product that I use)

5. Inject approximately 1 1/4cc of the mixture into all 4 areas around the digit. You will essentially be making a ring of anesthesia around the digit of choice.

Check out my Demonstration Video

  

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The "Orthotic" Sandal

"My feet are killing me..." "The heel pain is back..." Such common complaints of my patient's as they inevitably transitioned from wearing orthotics throughout the winter months into flip-flops for spring and summer.  For years I struggled with this scenerio.  I tried (unsuccessfully) to use the basic logic of "cause and effect" but to no avail.  Patient's were frustrated and so was I.

Is there a sandal that's affordable, functional & attractive enough to help with this problem?  I searched for several months to find a product that met my criteria.  I ordered a variety of samples, from different manufacturers, that claimed to be the "most supportive and comfortable."

Finally, I found the Spenco Total Support Sandal.  These "Orthotic" Sandals retail for $40.00 and are worth every penny!

Spenco Total Support Review for "Nature Lover's"

Spenco Total Support Review for "Athlete's"

Spenco Total Support Review for "Everyone Else"

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How to Treat Plantar Fasciitis

Tips for a Successful Cortisone Injection

For this injection I recommend a 27 gauge needle that is 1 1/4" in length.  I use 1cc of Lidocaine Plain, 5mg of Kenalog, 2mg of Dexamethasone Phosphate, 0.3cc Sodium Bicarbonate (for your patient's comfort).

I also highly recommend using a topical "cold freeze" prior to the injection.  This decreases the pain of the initial injection and also minimizes your patient moving their foot in the beginning of the procedure.

I would suggest this inexpensive but very effective product manufactured by
medique pharmaceuticals.

Lastly, It is worth having a medical assistant help hold your patient's leg (right at their knee and above the ankle)

  

It is also important to have your patient stretch, ice and massage the plantar fascia.  Here is a link to a printable patient education handout that you can utilize in your practice.  Patient Education Instructions

Finally, many of your patient's will require the use of a supportive shoe insert.  Some individual's will need a custom orthotic but many will do great with a high quality pre-fabricated device.  Please do not send your patient to the local discount store to purchase "gel pads" or heel cups.  I highly recommend the Pro Powerstep orthotic.  This pre-fabricated insert is supportive & easily transitioned into.  Your patient's will be very pleased with this product.  The wholesale pricing is under $18.00 and the inserts retail at $40.00.

ProTech Powerstep Orthotics

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Making my way to the AANP National Conference

I am excited to return to the AANP National Conference in Las Vegas to present a session on "Diagnosing and Treating Common Foot and Ankle Conditions".  The opportunity to speak at such a well respected conference is one that I highly value.

My journey as an APRN began in 2000 when I graduated from the University of Kentucky.  I achieved my certification as a FNP with the ANCC (I was young and did not know any better...)  Upon graduation the career opportunities in the Central Kentucky area were limited.  But I only needed one opportunity to open and a few weeks after graduation I was offered a full time position in a growing podiatry practice.  In talking with several NP's and fellow students I was advised that I may inevitably be hurting my career opportunities by taking the position.  After all...  Who had ever heard of a NP working with a podiatrist.  Was it even legal in Kentucky?  Did I know enough about the foot and ankle to effectively care for patients?

After doing the research, I found that it was legal to work in collaboration with a DPM and since I have never been one to follow the path of least resistance, I accepted the position.  As far as having a knowledge base that would allow me to be an excellent foot and ankle clinician, that would come years later as I have spent several hundred hours of self study to gain the experience and confidence that I have today in treating many common and complicated foot and ankle pathology.

In speaking with many Nurse Practitioners, Physician Assistants, Physical Therapist and MD's/DO's, I have come to the conclusion that adequate training and education in foot and ankle care is missing in our educational experience.  With this blog, I hope to introduce you to some interesting case studies, offer effective and research based practice guideline suggestions and provide video education on performing common foot and ankle procedures.