What Podiatry ‘Life Hacks’ Do You Use To Make Your Life Easier?
- Patrick DeHeer DPM FACFAS
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Life hacking, according to Wikipedia, is “any trick, shortcut, skill, or novelty method that increases productivity and efficiency in all walks of life. In other words, anything that solves an everyday problem in an inspired, ingenious manner.” There are several websites that provide useful and interesting life hacks such as: http://1000lifehacks.com/ , http://www.lifehack.org/articles/lifestyle/100-life-hacks-that-make-life... , and http://twistedsifter.com/2013/01/50-life-hacks-to-simplify-your-world/ .
In seeing some of these suggestions on Facebook and Twitter, it got me thinking about “podiatry hacking.” Podiatry hacks are things that I have learned over the years to make my professional life easier. Listed below in reverse order are my top 10 podiatry hacks.
10. There is no best way to treat verrucae plantaris. Treating plantar warts multiple ways at the same time is better. I often use cryotherapy in the office while the patient uses topical acid therapy of at least 40% acid 24/7 unless the patient is getting the foot wet. The patient also debrides the area with a pumice stone after bathing daily to keep the callusing down over the wart.
9. Taping is a good way to evaluate orthotic correction. If you have patients whose condition does not fully resolve with orthotic therapy and you want to see if the orthotic needs more correction, strap the foot and have them wear the orthotic with the strapping. If they are better with additional external support in addition to what the orthotic is providing, then either increase the posting or raise the medial arch of the device.
8. When removing the screw for either a subtalar fusion or calcaneal osteotomy that inserts from the posterior plantar calcaneus, use the guide pin to locate the screw. The key is to use the same previous stab incision that you used for insertion and not make the incision any larger. Dissect bluntly down to the calcaneus and then use a pin to identify the cannulated portion of the screw for removal, which takes less than 10 minutes. There are no large incisions, no frustration of searching through the heel fat pad, and no excess postoperative scar tissue.
7. The Akin procedure is your friend. I almost always regret when I do not do an Akin with my Austin bunionectomies. I know the purists out there say it does nothing to correct for hallux abducto valgus and I agree. However, I often find that patients who fall into the moderate bunion deformity category have a degree of hallux interphalangeus deformity. By adding the Akin to the Austin you are correcting all levels of deformity. I never regret doing this, but I have regretted not doing it many times over the years.
6. Your hospital librarian can be one of your best friends. Every month, the librarian from one of the main hospitals I work out of sends me the table of contents for journals to which I do not subscribe. I tell her which articles I would like and she emails them to me. I save them in a parent folder on the computer with subcategories based on topics. This allows me to reference them easily when required. I often read the abstracts when she sends them to see if I want to read the whole article before I save it. She also obtains articles for me when I am writing an article for a journal.
5. Non-steroidal anti-inflammatory drugs (NSAIDs) are of little use in reducing inflammation. I use methylprednisolone (Medrol Dosepaks) like they are going out of style. They are cheap, effective and for short-term use. For inflammatory related pathology they are my drug of choice.
4. Doing less is more for hammer digit surgical correction. I need to be convinced by a clinical exam not to do a flexor digitorum longus tendon transfer for flexible, semi-rigid deformities. The less bone work you can do the better the result will be for the patient.
3. Heel pain treatment is a two-step process. You must first get the acute pain under control and then treat the condition in the long term. Initial acute therapy consists of inflammation management and treatment of all etiologies of the pathology. Long-term treatment consists of stretching the equinus when present (it is present most of the time and one should treat this in the initial therapy regimen as well) and orthoses for biomechanical control.
2. First metatarsophalangeal joint (MPJ) arthrodesis is the most reliable procedure for first MPJ pathologies. I use this for hallux limitus stage 2 and greater, severe hallux abducto valgus, hallux varus, revisional first MPJ surgery, and neurologically based deformity. Locking compression plates simplify surgery and allow for procedural reproducibility.
1. Equinus is the root of all foot evils. If the patient’s pathology has a biomechanical basis, often equinus is involved. Comprehensive treatment of the patient should include equinus treatment. This treatment may be either conservative with bracing, or surgical. For conservative therapy bracing is superior. I have patients use a splint for one hour a day until the deformity is fully corrected. Full correction consists of ankle joint dorsiflexion of more than 5 degrees with the knee extended. Typically this will take eight to 12 weeks of stretching. For surgical correction of equinus deformity, the Baumann procedure is my favorite hands down. This intramuscular lengthening does not cause weakness, calf indention or risk sural nerve injury like Strayer-type procedures.
There you have some of my top podiatry hacks. What are yours?