They come in, right off the street

The problem it seems, is the feet

And then when the pain

Makes them complain

Orthotics just can’t be beat.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I have really bad ankles. I started with flat feet as a child, and things haven’t gotten better in the last 60 years.  Now I wear stiff hiking boots with orthotics you can, literally, drive nails with.  They keep me going.

A fair number of my patients, no matter where I go, come in with foot problems.

Most “ingrown” toenails result from people cutting a corner of the big toenail too short, temporarily relieving the pain but setting themselves up for worse problem when the nail grows out, cutting into the flesh. More than half the time the original problem stems from shoes functionally too small.  I tell people to keep their nails trimmed.  With a flair of showmanship I predict I’ll find a hole worn in their shoe lining from the big toenail, then I tell them to file a bevel into the end of the nail, making it both more flexible and easier to trim when it grows out.

Those with plantar fasciitis start the first step of the day OK, then the pain hits. But it gets better as the day wears on.  At the end of the day, they might sit and relax for 20 minutes but when they stand up they face excruciating pain.  I teach them stretching exercises, encourage them to lose weight, and advise new footwear.

Most WalMarts have a Dr. Scholl’s display; those orthotics (shoe inserts) can be the first step away from the pain. But if they don’t work, I recommend the podiatrist, or, sometimes, the orthotist, a person who does nothing but make orthotics.

The patient gave me permission to say that when I told her to take off her shoes and stand up, her arches sagged to the floor. They looked just like mine.

Then I talked about how I felt the first day I put my feet into the solid inserts. I walked away with a gait 30 years younger, my back straighter.



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2 Responses to “”

  1. ericjs Says:

    Treating weak ankles and arches that way is like treating weak arm muscles with a permanent arm brace (and over the years continually “upgrading” to stronger braces and casts as they continue to atrophy). They are fine to heal from an injury, but beyond that they perpetuate and exacerbate the source of the problem. Your feet may be the product a lifelong version of that process.

    I’d recommend looking into the ideas of the minimalist footwear or barefoot movement. There’s a bit of fantacism present in the movement, but the basic ideas are sound. And the one claim that is very well-documented is stronger ankles.

    It would take a really long, slow, gradual process to wean yourself off these orthotics and rehabilitate your feet.

  2. walkaboutdoc Says:

    ericjs, philosophically, I agree with your approach but practically I don’t. I give metformin or even insulin to diabetics when the real cause of disease is too much food and too little exercise. I give depressed people antidepressants when they really need to stop alcohol, tobacco, and marijuana, and to start exercising and socializing. I give asthmatics inhalers when, really, they need to make their lives smoke-free. As far as my own feet go, I have no left posterior tibial tendon, and no right tibialis anterior. These structural problems are not going to get better, not with all the king’s horses and all the king’s men.

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