What If?

Comment by Laura: I have been to several orthopaedic surgeons and they only recommend surgery. They never mention stretches, physical therapy, pain medication, lifestyle changes, etc. It’s very frustrating. Surgery is scary and the recovery is long. This is why people are searching for alternatives.

Hi Laura,

Your question/comment is outstanding. Unfortunately your story is all too true and common. To be honest, most of my colleagues do want to help you in the best way they know how. However, the non-surgical methods that they are aware of, the same ones they have been taught and tried in the past, fail too often.

Why do these non-operative treatments fail, you ask? To be blunt, they treat the wrong thing—the obvious "problem" in the foot (plantar fasciitis, midfoot arthritis, second MTP synovitis, etc.). After all, you just showed them where the problem is that needs to be fixed and they can touch it and reproduce it. The source of your complaint is so obvious, it is right there in your foot. Any fool can diagnose and treat your problem. Certainly, it would be nice if you went in and said, "My foot hurts, but the pain in my foot is really coming from my asymptomatic calf that is too tight. So doc, what treatments do you have to fix my calf so that my foot or ankle pain will go away?”

Do my colleagues ascribe to a thing as simple as calf stretching? For the majority, the answer is NO! Sure, they tell you to stretch, but their advice in this regard is anemic and unenthused. The words and body language to tantamount to, "Go ahead and try some stretching, but it won't work." Even if they believed or knew the calf was the problem stretching the calves would be too simple and would take too long to treat, and both you and the surgeon want this resolved now. Almost everyone, and I mean everyone, thinks that calf stretching does not work even though the evidence says otherwise. So here you have a SURGEON who finds that these non-operative treatments fail (how convenient)…well the next step is obvious. We pull the old scorpion on the frog in the river thing and do what is in our nature, we cut.

Stick with me here because I am coming to a point.

Orthopaedic surgeons and podiatrists are generally good diagnosticians. Then they get an MRI, don't get me started. Here is the problem, and here is the treatment. Simple, right? Any deeper thought is not usually necessary because the problem is so obvious, especially if they get an MRI. That's where you pointed for gods sake. So, the thought that the calf is what is boogering up your foot and ankle is just not on the radar or comprehensible to most of us. But we should be better than that.

The idea that your symptoms might not be coming from where you are pointing and originating from a remote location is generally speaking above our pay grade. Having stated that, it is most definitely our duty to connect the dots between cause and effect. We call it clinical correlation and unfortunately it is becoming a lost art. Then and only then can we have any chance of effectively treating the problem effectively.

To further make my point I was going to use a medical illustration here like constipation, but I opted for golf. Both can stink BTW. A reasonably decent intermediate golfer with a pretty good swing has started to slice the ball and of course, tries to fix it themselves along with all their golfing buddies handing out their unsolicited help. They finally go to a pro for real help presenting their own theories as to the cause. The pro smiles and says, "Hit a few 7 irons for me,” knowing there are only so many causes of a slice. The golfer thinks it is very complicated and there are infinite reasons because a slice can be so hard to eradicate. The pro suggests some seemingly minor, totally unrelated change, like the stance and voilà, problem fixed. No changes in the swing what so ever. The cause of a problem is not always what it appears. Think outside the box!

This is where I get angry. Here is the problem Laura, my colleagues are mostly closed minded to this concept so I have to reach out here to everyday people like you, to the AO-nation. Using plantar fasciitis as an example, just look at the number of treatments for this problem. There is an old line in medicine, "When there are many treatments for the same problem, none are really working well". Most often presented with a clinical dilemma we know the underlying cause of the problem, but in some cases it is just difficult to treat or we have not found the right answer yet. Here it comes, wait for it……..

What if the treatments are not working because they are not directed at the cause, but at the end result, the effect, the location where you are pointing? What if the cause is unknown or not accepted? What if most everyone is missing the point completely? In this case we are doomed to endless searching and making the same mistake over and over. What if the simple concept of equinus or calves that are too tight causing the majority of foot and ankle problems was actually correct? What a revelation that would be for so many of us!

Too many of my colleagues fail to make this connection, but some do get it. Here’s a video that makes me think: maybe I’m not all alone.

Original link: Plantar Fasciitis: looking in all the wrong places.

Keep moving, my friends,

AO

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