Wednesday, October 08, 2008

Aching feet in Denver, Colorado

As a primary care doc, I'm the 'first responder' to that which ails my patients. When any particular problem steps out of my areas of expertise, I refer. I present to you the difference between a helpful consultation and one that makes you wonder why we bothered.

Both patients presented to me with foot pain. Patient #1 had pain along her arch, worse first thing in the a.m. or after rising from a chair. I figured she had a falling arch and/or a chronic sprain in her midfoot, but she did not improve with arch supports. Podiatrist #1 sent me a letter that reiterated the history, diagnosed it as 'left foot pain,' but she did not have further recommendations for this patient's care.

Patient #2 had right heel pain that began after she increased her physical activity. I felt she had plantar fasciitis. She had tried stretching and OTC arch supports, so I sent her to Podiatrist #2 as this pain was seriously interfering with her daily activity as well as her ability to stay active. He diagnosed:

1. Fractured calcaneal exostosis
2. Chronic proximal resistant plantar fasciitis
3. Hyperpronation of the right foot
4. 2-3 mm. limb length discrepancy left longer than right

He recommended custom prescription orthotics, and spent some time with her discussing the deformity of her foot based on her fractured heel spur. He told her the pros and cons of extracorporeal shockwave therapy, and gave her literature on the procedure.

Now granted these two problems are different but which podiatrist do you think I will use in the future? His name is Joseph Mechanik, DPM of the Colorado Foot Institute, and I recommend his services to you. His evaluations are consistently thoughtful and careful.


Ann of the Incredible Gift said...

Podiatrist #2 is definitely the one to whom I would wish to be referred.

I've been very fortunate over the years in my choice of primary doctors. And in their choices of specialists for referrals.

I'm thinking of the foot doctors to whom our PCP sent Margret. I think their card says: foot, ankle and sports medicine.

Margret had seen an orthopedic doctor for her knees, and he was also quite good, too, in my opinion.

She had a fall coming home from her program, and her ankle hurt. Saw the PCP first, and he suggested she go directly to the orthopedic doc. Orthopedic doc was full up for the whole week, so remembering the 'sports medicine' on the foot practice card, I called them and asked if they'd be willing to see her and evaluate her foot. Yes, bring her right over, we'll squeeze her in as the last appointment. This would be her first time seeing the newest (third) doctor in the practice.

She explained the fall, the doctor looked at the x-ray and then examined her foot.

The doctor showed us on the x-ray where bone and tendons were attached, and which way the stress of the fall would pull the bone, and the place where most such falls would have broken it.

The verdict: her flexible tendons and ligaments had saved her from a broken bone.

Treatment: keep applying ice packs half hour on, half hour off for the rest of the day; keep the foot elevated as much as possible, and call him in the morning to tell him if she was still having pain, because he suggested she stay home and stay off it, and she wanted to go to her program the next day. (Group therapy, indoors, not much walking, and some of her best friends would be there.)

On the way home, Margret said, "Mom, that doctor is CUTE!" and giggled.

Morning came, and she felt fine. I called and told him so. He cleared her to go, IF she promised to take it easy, and IF she promised to have a staff member call Mom if the ankle started to pain her again.

JeanMac said...

Def. a case of "Coulda told you that" - what's up with that? Maybe just not interested in the patient.We had one oral surgeon who wrote such kind personal comments about the pts we referred - the other was just pure clinical, short and not at all sweet.