Golden Rules of Foot: Sacred Parts of any Practice of Medicine

                                     Golden Rules of Foot

There are rules that govern everything, and medicine is no exception. There are very special rules, which I call the “Golden Rules of Foot” that apply to all aspects of my practice of podiatry. I live by these rules. They are sacred to me. Where some rules are made to be broken, these rules are close to unbreakable. When I make a logical decision, based on much thought and consideration, to break one of these rules, I get mud on my face. These are rules with little or no exceptions whereas most general rules have many exceptions. When I practice the science of podiatry, the rules I was taught, or read in books, or hear at seminars, have many exceptions. This is the art of medicine. The Golden Rules of Foot are part-science and part-art. When they are learned and practiced, healing occurs. When they are broken, in my rush through the day, I typically regret it.

     Every health care provider will actually have their own Golden Rules, formed by years of their unique personalities, observations, and patient experiences. But, Golden Rules can be learned instantly, when we are open to learning (our life long task!). Golden Rules typically do not take a long time to become embedded because they speak to our souls as true from the start.

Golden Rule of Foot: Whereas the human spirit is very sacred, the golden rules of foot are also sacred.

                                         The Balance between Art and Science in Medicine

     It is not the purpose of this posting to go over every rule, but I want to expose the reader to them

in some way. I challenge the health care provider to come up with 50 or so of their own Golden 

Rules of Foot. Again, there are rules and there are Golden Rules, and it is important to make the 

distinction of what is unbreakable. Golden Rules should be unbreakable. Here are 56 examples of 

my Golden Rules.

Some of the Golden Rules for Rehabilitation:

Golden Rule of Foot: Begin strengthening the area the moment you are injured.
Golden Rule of Foot: In overuse injuries, we injure the weakest link in the chain. It is our job
                                   to find out why it is the weak link.
Golden Rule of Foot: Most overuse injuries have 3 causes to look for (at least).
Golden Rule of Foot: The foot is the foundation of the body, and if off by a little, can cause injuries to occur. Always look in treatment to make the body more stable starting at the foot.

Golden Rule of Foot: Listen to your body. It will not lie to you.

Golden Rule of Foot: Never push through pain that begins in a workout, progressively gets worse, and produces limping.

Golden Rule of Foot: Never mask pain with pre-activity drugs, including ibuprofen, aspirin, etc.

Golden Rule of Foot: About 80% of healing occurs in 20% of the overall time, with the remaining 20% taking 80% of the total time.

Golden Rule of Foot: Good pain normally dwells in the 0 to 2 pain level (scale 0 to 10).
Golden Rule of Foot: Obtain 0-2 pain levels when treating injuries as soon as possible with whatever means possible and maintain that level through the rehabilitation of the injury. 

Golden Rule of Foot: When 80% of the symptoms are reduced, and normal walking occurs without limping, a return to an activity regimen can be initiated.

Golden Rule of Foot: Treat neuroma/nerve pain aggressively, or it will decide to stay around.
                                    Nerves can cause their own pain, making the original problem worse.

Golden Rule of Foot: Place yourself back into the immobilization phase when you have consistent flare-ups or are getting worse.

Golden Rule of Foot: Allow time for rehabilitation to succeed or to fail, so you can possibly avoid unnecessary surgery or you will know you need surgery.

Golden Rule of Foot: If you are advised on elective surgery, get a second independent opinion, and do not tell the second doctor what the first doctor wanted to do. You want an independent consultation.

Golden Rule of Foot: When rehabilitating an injury, always have a Plan B.

Golden Rule of Foot: If there is swelling or internal joint stiffness, you must work on it daily.

Golden Rule of Foot: Our feet deserve our utmost concern, respect, and care.

Golden Rule of Foot: Do not make treatments more complex than they need to be.

Golden Rule of Foot: If you can find a stretch that makes the painful area feel better, and you are halfway home to full rehabilitation.

Golden Rule of Foot: Keep It Simple Stupid in your treatments whenever possible.

Golden Rule of Foot: In restoring full function, there are many effective treatments available, so experiment or get other opinions.

Golden Rule of Foot: For every day in a cast or boot, it takes two days to get back to normal.
Golden Rule of Foot: We lose 1% of muscle strength daily with an injury, and only gain back 1/4% daily as we rehabilitate.

Golden Rule of Foot: Never get a cortisone shot when you are not sure it is needed, and if other good treatments are available.
Golden Rule of Foot: Never get a long acting cortisone shot into or near a tendon.
Golden Rule of Foot: Submersion is the best way to apply ice or heat.

Some of the Golden Rules for Diagnosis:

Golden Rule of Foot: Treat the patient, not the test.

Golden Rule of Foot: When taking X-rays of the feet, take them standing whenever possible to show alignment issues.
Golden Rule of Foot: An x-ray may not show a stress fracture in the first 2 weeks of an injury, or ever for that matter.
Golden Rule of Foot: Always think that pain can have 3 sources: Mechanical, Inflammatory, and/or Neurological.

Golden Rule of Foot: When the pain is superficial and not responding, look for a deeper problem.

Golden Rule of Foot: Watching a patient walk or run can be crucial in finding the cause of their problem(s).

Golden Rule of Foot: If an injury comes on acutely, and there is noticeable swelling in the area, the diagnosis is stress fracture until proven otherwise.

  

Golden Rules for Running

Golden Rule of Foot: If you cannot run 5 miles, see if you can run 1 mile, or even 1 minute.

Golden Rule of Foot: It is better to run one second than not at all during the rehabilitation process so you can tell your providers your  activity level accurately.

Golden Rule of Foot: When you can walk 30 minutes at a good pace without pain and without limping after an injury for three straight days, then you are ready to start a walk/run program.
Golden Rule of Foot: Training should allow of periods of recovery (typically 36 hours)

Golden Rule of Foot: Do not change shoes within six weeks of the start of a marathon.

Golden Rule of Foot: Do not change shoe type, running style, or orthotic design when you are increasing your activity levels weekly.
Golden Rule of Foot: Alternation is Important in Training with various distances, surfaces, shoes, and speeds.

Golden Rules for Ballet

Golden Rule of Foot: In treating a ballet dancer, it is important to review their technique.
Golden Rule of Foot: In treating ballet dancers, you must investigate the activities that they 
                                   do when not dancing also. 

Golden Rule of Foot: En pointe should begin when the dancer is skeletally mature, 12-13 years old, has good technique, and a minimum of three years of ballet experience.

Golden Rules for Home Treatments

Golden Rule of Foot: When in doubt to heat or ice, use ice.

Golden Rule of Foot: After an injury, try to attain a pain-free environment as soon as possible (0-2 pain levels).
Golden Rule of Foot: Athletes must understand Good and Bad pain.
Golden Rule of Foot: Strengthening Programs should be done in the evening within two 
                                   hours of bed to allow the area to rest after fatigued. 
Golden Rule of Foot: Stretching should never hurt, and if needed, should be done 3 times a day. 

Golden Rules for Short Leg Treatment

Golden Rule of Foot: With lift therapy, start low and go slow.

Golden Rule of Foot: Keep lifts and orthotic devices separate.
Golden Rule of Foot: Low Back and Hip Pain produces by walking is Short Leg Syndrome 
                                   until proven otherwise.

Golden Rules for Orthotic Therapy

Golden Rule of Foot: When designing or wearing orthotic devices for plantar fasciitis, the patient must feel the weight is being transferred from the painful heel area into the arch, and the patient must feel that the heel area is being suspended or cushioned. Without these two factors occurring, the orthotic devices will not be as helpful as possible.

Golden Rule of Foot: When dispensing orthotic devices (or receiving them), there should never be any pain.

Golden Rule of Foot: When getting used to new orthotic devices, always blame any new

pains on the new devices.

            Golden Rule of Foot: Never introduce new orthotics into an athlete increasing their mileage (like in marathon training). This should be during maintenance running periods.  

Golden Rule for Running Shoes

Golden Rule of Foot: If pain is produced by one pair of shoes but not the other, stay in the pain-free pair.

Golden Rule of Foot: Look for Asymmetrical Wear Patterns as a sign of something wrong.

This above was an excerpt from my book: Secrets to Keep Moving.