Using a Multifaceted Approach to Treat Aging Feet

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By Howard Hillman, CPed

[The aging population] remains underserved and ill-informed regarding solutions available for their painful feet. It is important to keep our older patients active and moving. That's where pedorthists come in.

One of Lord Byron's (1788-1824) poems makes a reference to "Time, the avenger." This is certainly appropriate when referring to the effect time and aging take on our feet. As the population ages, pedorthists see the price that their feet have paid, whether due to ill-fitting footwear, repetitive stress, work/sports injuries, diabetes, or just the ravages of time. Over the past five to ten years, well-designed footwear, braces, orthotics, and socks have become readily available to the general public. And while, for the most part, manufacturers have stepped up to serve the aging population, these patients remain underserved and ill-informed regarding solutions available for their painful feet. It is important to keep our older patients active and moving. That's where pedorthists come in.

Many of the baby boomers (those born between 1946 and 1964) are active and are eager to find ways to stay active. I once had a patient tell me, "Duct tape me back together and get me back in the game!" He was 72 years old and heading to Florida for a winter of dancing and golf. Our profession remains a frontline healthcare necessity for patients like him. With simple changes in footwear, the application of foot orthotics or braces, and some basic patient education, we can affect changes in a patient's life that lead to a reduction of injurious falls while increasing activity levels and quality of life.

Remember that you are not alone in this endeavor. It is important to expand your thinking beyond the shoes or orthotics you have dispensed. In that same vein, why put a patient into a finely crafted orthotic and a well-fit pair of activity-appropriate shoes, and not talk about gait, exercise, and fall prevention and avoidance? It is important to educate your patients beyond the pedorthist's scope of practice.

Over the years, you have developed a great database of referring practitioners who have come to depend on you for your professionalism and positive patient outcomes. Your referral sources might include podiatrists, orthopedic physicians, general practitioners, athletic trainers, and physical therapists- all of whom are also great resources to tap as part of your patient education program. If patients can be better served by introducing a colleague into the treatment process...introduce away! For instance, provide patients with contact information for a referring physical therapist for gait training or an athletic trainer for an exercise program. By working as a member of a team caring for your patient, you will often achieve greater patient compliance and more effective implementation of products you have dispensed, which leads to successful patient outcomes and the possibility of increased patient referrals.

Typically, a pedorthist would treat a patient with posterior tibial tendon dysfunction (PTTD) by controlling the foot and ankle orthotics that reduce the ground forces on the foot using solutions including AFOs or leather gauntlets and stabilizing footwear, which allow the tendon to heal and protect the tendon from further rupturing. That patient might return a year later with a prescription from his or her physician that reads something like, "orthotics/ shoes for PTTD." The patient has become a recurring source of income for your practice, but at what cost to the patient?

Consider if a more well-rounded approach had been taken. What if, during the patient's initial visit (last year), you had asked questions about the patient's lifestyle? You likely would have been able to discern that this patient had just retired and was planning on returning to the hobby of gardening. He or she had been ambulating on flat, hard surfaces for the past 30 years while working at the office or exercising on a treadmill. Now the patient is off to the world of uneven surfaces, varying terrain, slippery conditions, heavy lifting, and trip hazards. By providing the patient with basic education on gait, appropriate footwear, and exercise, he or she will have the tools for success. This approach may also head off additional injuries.

Given the proper information, coaching, and reasoning, the patient can avoid PTTD becoming a debilitating, lifechanging condition. With the appropriate application of therapeutic devices, such as shoes, braces, and orthotics, and implementation of a lifestyle-appropriate therapeutic plan of action, the patient can be set on a path for success. This multifaceted approach to patient care allows the patient to have the resources needed to live injury free. Then, if the patient does become symptomatic, he or she knows who to return to for answers.

Appropriate and reasonable levels of care can be turned into outstanding and long-lasting positive patient outcomes. Your patient care protocol should be consistent throughout your patient population. Without consistency in treatment, outcomes become difficult to quantify. Communication and follow-up are key to developing long-term treatment solutions. So encourage your patients to follow through with their treatment plans. Through education, explanation, training, and additional reinforcement of referring medical professionals, patient buy in is much greater, and the corresponding positive outcomes will be remarkable.

In the end, understanding the patient's health, lifestyle, and living conditions are keys to success. Ask questions, know his or her history, both recent and long-term, and work from a plan of action that will be successful. Working with medical professionals such as physical therapists, podiatrists, general practitioners, athletic trainers, and others reinforces your plan of action and increases the flow of referrals to your practice. Remember, if we can control and stabilize the foot and ankle, assisting the patient as well as his or her healthcare providers in maintaining healthy feet and ankles, the effects of time, "the Avenger," can be controlled, and life can be lived to its fullest. Whether it's PTTD, chronic ankle instability, diabetes, a neuropathic condition, foot drop, chronic heel pain, unstable gait, or many others, simply have a solution and plan of action. Let your referring physicians know what you do and what your successful treatment programs consist of, and then include them in your positive patient outcomes.

Howard Hillman, CPed, is currently the director of training and development at PAL Health Technologies, Pekin, Illinois.