When There Is A Disconnect Between Different Specialties

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Author(s): 
David Levine, DPM, CPed

Finding Common Sense Solutions To Simplify Patient Treatment

Sometimes it takes true attention to detail in order to obtain optimal function. Medicine has become so specialized that we sometimes readily hand off what we don’t know or understand. In this particular situation, it would have made more sense to work from the ground up instead of starting at the leg and moving down to the ankle and foot and down to the ground. After clinicians determined that his situation was not acute and that he was not going to have surgery, comprehensive conservative care should have been the focus. Instead of trying to stabilize the foot internally with surgery, the focus should be on external stability with shoes, shoe modifications, orthotic devices and bracing.

   The first step is a simple one: fitting him for a pair of shoes. The shoes should meet certain criteria that will help all conservative modalities succeed. Adequate length, width and depth, along with proper midfoot stability, are important considerations. If feet are dramatically different in size, then mismatched shoes are an option. If the deformity is significant enough, then one should fabricate custom shoes.

   After obtaining appropriate footwear, then consider either an orthotic or a brace. This should be based upon his function.

   X-rays indicated a Lisfranc dislocation in this patient. This has resulted in significant abduction of the forefoot and a large medial prominence in the midfoot. In other words, he had a transverse plane deformity. Fabricating a brace to control a transverse plane issue will only create shoe and friction-related problems. The brace needed to fit the shoe, which is straight lasted. The foot is abducted and the apex of the transverse deformity is where the blister occurred. The solution for this patient was shoes to fit both feet and accommodative orthotic devices that will alleviate pressure and friction from the prominent region of his midfoot.

In Conclusion

The practice of medicine is divided into many specialties. However, the care of our patients is not always easily categorized. Many of our patients need several modalities that rely upon each other. To have many providers each only doing their own thing without the knowledge and expertise of other areas does not necessarily help the patient. The key to optimizing function is communication among specialties and trust in our colleagues to help the patient obtain the best outcome. That starts with common sense and sometimes something as simple as a properly fitted pair of shoes.

   Dr. Levine practices at the Frederick, MD Division of The Foot & Ankle Specialists of the Mid-Atlantic. He is the Director of Physician’s Footwear, an accredited pedorthic facility in Frederick, Md. He is also the owner of the Walkright retail comfort shoe store in Frederick, Md.

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