We spend much of our time in residency performing surgery and perhaps an equal amount of time thinking about how to do surgery. What's the best procedure for a bunion with a hypermobile first ray and large IM angle? What's the most effective fixation method for a triple arthrodesis? Is external fixation best for calcaneal fractures? Much of our literature revolves around surgery. It's not McGlamry's Textbook of Foot and Ankle Conservative Care is it? As a new practitioner, though, I'm coming to realize the vast majority of medical practice is conservative in nature, which we're often not educated well to perform.

As a resident, conservative care is often something mentioned in passing, such as "when such-and-such conservative therapy fails, surgery is the next step." We don't spend as much time on conservative care as we do on the surgical side. Obviously, any surgical procedure compared head to head with any conservative modality is more complicated with more potentially harmful effects and requires more thought and training. However, I advocate to you that conservative care is what you'll perform the vast majority of the time in the office, there's little science behind it, and almost every elective surgery you will perform will have some form of conservative care preceding it. As much as you might wish it, not every patient is going to walk into your office demanding surgery. Image that!

Just as in surgery, I've spent a good bit of time watching my trainers in their offices, absorbing their styles. I've carefully observed my attendings deal with patient care, specific conservative therapies, and complications. The best practitioners seem to have a system established for conservative care. Here's an example. When a patient comes in complaining of heel pain diagnosed as plantar fasciitis, one of my attendings would provide a 10 point treatment plan consisting of: education, nonimpact exercise, running shoes, OTC insoles, calf stretches, icing, and sometimes injections. If they're not improved at least 50%, he prescribes a night splint, NSAIDs, custom orthotics, and physical therapy at subsequent visits.

Regardless of your opinion about this treatment regimen, the effective part is that the treatment plan was comprehensive and treated the etiology of the problem. He also communicated clearly and without hesitation. You have to be convincing when you're telling a patient how you're going to treat them. A lack of clarity or confidence on your part may be confused with incompetence. This is the art of conservative care.

I'd love to see a textbook on conservative foot and ankle care. How long should a cam walker be left on for an Achilles paratendonitis? What therapies are available for PTTD other than Arizona and Ritchie braces, etc? What about those diffuse, hard to diagnose conditions like "metatarsalgia." What are the best ways to accommodate that hallux valgus in the nonsurgical candidate? What role does padding and taping have? What about shoes? Would it not be a fabulous resource to us new physicians to have a conservative McGlamry? I'd appreciate an up-to-date text that discusses this facet of podiatric care from national experts. I'd buy that book!

Talk to me,

Jarrod Shapiro, DPM
PRESENT Resident Editor
[email protected]

Ask, and ye shall receive....

PRINCIPLES AND PRACTICE OF PODIATRIC MEDICINE
* 2 volumes / 1,516 pages / 1,400 figures and tables

A Comprehensive Guide to All Essential Principles of Podiatric Medical Practice

About the Editors

Data Trace Publishing brings you this long awaited, one-stop resource on current podiatric medical practice. Inside, you'll find the most up-to-date information on podiatric issues from experts in the field. The text's wide reaching scope encompasses major topics like foot and ankle disorders and injuries, surgical procedures, and rehabilitation, but also offers insights into behavioral medicine, alternative therapies, and the role podiatry plays in the fight against epidemics and disease.

The combination of theory and practice make it a must-have reference for students, residents, and practicing physicians.

To learn more or order PRINCIPLES AND PRACTICE OF PODIATRIC MEDICINE, 2nd ed., call Data Trace at 800-342-0454 or order online at:

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To order learn more or order PRINCIPLES AND PRACTICE OF PODIATRIC MEDICINE, 2nd ed., call Data Trace at 800-342-0454 or order online at:

https://datatrace.com/medical/principle_present_body.htm

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