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. 

Podiatry Question #1

I created this blog to teach. I wanted to teach my patients first of all to be smarter in the rehab course, and perhaps to prevent injuries in the future. But, I also created this blog for podiatrists, podiatry students, and all in health care with an interest in feet and biomechanics and overall health. I am in my 6th year of teaching the podiatry students at Samuel Merritt University’s California School of Podiatric Medicine. They are wonderful, and I am blessed. I am starting this series of questions with the hope they will all know the answers by the time they graduate, or even as they begin their practices. Many of these questions will be for lay folks, sports store personnel, coaches, or just students of good health. I will ask the question, followed by a photo to gap the answer by some space, and then the answer. Shall we begin?

#1   When treating tendinitis in any form, what mnemonic is commonly used to think through the possible treatments?

Answer: The mnemonic B.R.I.S.S.  Biomechanics  Rest.  Ice.  Stretching.  Strengthening. These are the 5 key components to treating all types of tendinitis. Of course, there are so many other treatments of tendinitis out there that have helped, but BRISS gets the process started. The Biomechanics are concerned with the forces that caused the injury, and the forces that can be changed to help the injury. Rest is a four lettered word for everyone, especially top level athletes in competition, so we tend to shift the attention to Activity Modification. We need to rest the area, but we need to cross train. Ice is universal for Anti-inflammatory measures, but we are getting better at knowing when to ice, and when to heat, when to use contrast bathing. This also applies to anything that decreases the inflammation including oral medicines, injectables, topical, prescription or OTC, physical therapy, or acupuncture. Stretching is key to relaxing the tissue, and many tendinitis cases do not get better until you can find the way to stretch that makes the area feel better. And finally, Strengthening, is so crucial. We must assume that any tendinitis is caused by weakness of the tissue, or surrounding tissue. Start strengthening to some degree the day you hurt yourself.