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Tuesday, October 26, 2010

Top 100 Biomechanical Guidelines: #4 Understanding that the Levels of Treatment Range from Simple to Complex

There is a whole range of treatment options available for any injury or pain syndrome. It is important to match the seriousness of the injury with the complexity of the treatment, but that is where the art of medicine plays a vital role. Protocol based medicine, or I call it check list medicine, can be too black and white. The bunion on this patient's right foot may not be given all the options available. The art of medicine is in the nuances and subtleties. In general, I believe most injuries should be treated from simple to complicated based on how the patient does. If simple is working, why change it? Are you doing the patient any harm by not doing something else? Yet this requires followup and decision making at multiple points during the treatment. Following protocols, whether appropriate or not for that individual patient, is easy and efficient and less brain power needed to implement.  Let us all, doctors/therapists/patients, think more. Our bodies are too important. This blog is all about empowering the patient to understand the treatments available to them and how to think through the process from sickness to health.

The two photos presented here actually present a common scenario I see in a podiatry practice. Two patients present to my office with the same problem---a painful bunion on their right foot that they do not like. Then, 6 months of treatment occurred leading to 2 results--first patient relatively happy with a conservative bunion program (see post below), and the second patient relatively happy with a new reconstructed foot by my partner Dr Remy Ardizzone (a subtle advertisement for her). There were no protocols other than I move from simple to complex based on the patient feedback and preferences. I find some patients are only presented more simple approaches to a problem and some patients are only presented with surgical solutions to their problems (definitely more complex).

The second part of this is that each aspect of a treatment has many complexities normally ranging from simple approaches to more complex approaches. Surgery on this bunion could have been done many ways, but in this instance my partner close a more complicated approach since this is what she felt was necessary. If you look at any treatment modality, there is an extremely wide range of options covering the spectrum of simple to complex. Orthotic devices range from very simple to very complex, treatment of short legs varies from heel lifts to shoe lifts, strengthening exercises range from simple range of motion exercises to complicated functional multi-directional tasks supervised by a trainor or therapist, and so on and so on. Along the course of treatment each aspect of treatment must be evaluated and decide if the treatment level is appropriate for the injury at that point. Is it the right orthotic device? Are the strengthening exercises the right ones, or do they need to need tougher or easier, or work on a different part of strengthening (more power, more endurance, more eccentric firing, etc.)? Are the anti-inflammatory measures appropriate for right now, or do they need to be changed? And on and on.

This series of blog posts dealing with 100 principles of careful treatment hopefully will help you and your family and friends to be part of the team dedicated to your health by active participation in all aspects of the treatment.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.