Tuesday, November 28, 2017
Podiatry Question #2
I hope you enjoyed the first question several days ago. These are meant to educate, but also to test your knowledge. Sometimes there is more than one way to answer, but I need to give you my personal best answer from a podiatrist viewpoint. Hope you all survived Thanksgiving. It is the start of an energetic and blessed, but exhausting, month towards Christmas. I love the Holidays.
Podiatry Question #2: When we help patients through a rehab process, what pain level do we try to keep them at?
When rehabbing athletes and non-athletes, working them through the various landmarks of recovery from injury, you must keep them between the 0-2 pain levels which are considered a healing environment. Initially, that may mean needing crutches and a boot, then various forms of taping or braces or orthotics, then some limits on what shoes they can wear, etc. But, in the pursuit of keeping the pain within 0-2, the patient learns what is needed to help them fully recover. I see so many patients spend too much time waiting for a test to be done, with no attention being made to the amount of pain that they have. Every day with high pain levels causes more muscle compensations and weakness to develop, more possible nerve hypersensitivity, and more gait changes to avoid pain. It may be impractical for some reason to reduce the pain this much, but when you do not, you are always delaying the process of complete recovery. I just had a patient that needs her dislocated 2nd toe fixed surgically. This will be the only way to completely eliminate her pain, but I am trying various shoes, taping, Budin splints, icing, and activity modification while the long process of finding a surgeon and the right timing in her life comes along. We must have that as our mantra: Keep the pain down between 0-2. Compromise is needed at times, but we should look for ways to lessen the compromises when we can.