Select Page

Comment: 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. 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 understand, the same ones they have been taught and tried in the past, fail too often.

Why do these non-operative treatments fail, you ask? I heard you ask that just now BTW. 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?”

surgeon_angry-orthopod-blog

Do my colleagues ascribe to a thing as simple as calf stretching? NO! Even if they believed or knew it was at 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.

stick-with-me-here

Orthopaedic surgeons and podiatrists generally are not diagnosticians. Here is the problem, and here is the treatment. Any deeper thought is not usually necessary because the problem is soon obvious. After all we do have the MRI. We FIX things! So, the thought that the calf is what is boogering up your foot and ankle is just not on the radar or comprehensible to us.

The idea that your symptoms might not be coming from where you are pointing and originating from a remote location is frankly above our pay grade in general. 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.

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 suggest 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 you think it is. Think outside the box!

golflessonthatguy-1021x580

This is where I get angry. Here is the problem Laura, my colleagues are totally 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!

I say how 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.

Stay healthy my friends,

AO