Outside of post-surgical scenarios and fractures, it’s rare an orthopedic boot is necessary. I’ve seen them prescribed inappropriately many times. Severely restricting or eliminating movement to that extent with an immobilization boot is the last option for orthopedic disorders. For example, you don’t want to boot a tendinopathy! As I always say, it comes down to competent diagnosing.
Not only are patients often getting incorrect treatment for their ankle/foot complaints, but walking around on an uneven surface can disrupt other parts of the body. A boot can jack you up both literally (by an inch or more) and figuratively. It’s common for people to complain of knee, hip, or back symptoms because of walking around in a boot. For those who do need to wear a walking boot, I usually recommend buying something to attach to the other foot (such as an “Evenup Shoe Leveler”) to level the feet or simply wearing a higher shoe on the unaffected foot. -- Laura
Ever wonder why, with all the technological medical advances in orthopedics, our population doesn’t seem better? In conservative care, there’s been electric stimulation, ultrasound, laser, and less techy modalities such as tape and soft tissue tools. Outside conservative care, we’ve gone so far as to make injecting steroids, fusing spines, electrifying nerves, and removing and replacing whole joints commonplace!
Perhaps the worst offender is the MRI. Imaging is certainly warranted in a few situations (as is surgery), but it’s current widespread use isn’t. Not only is this expensive for society, but overreliance is bad medicine: MRIs cannot reliably demonstrate cause and effect regarding symptoms and they often create needless fear in patients’ minds that they’re degenerating.
The human body has an amazing capacity to heal itself; orthopedic issues such as fractures, tears, disc herniations, sprains, etc. are regularly alleviated with time, not medical intervention. However, when a body’s independent healing falters, learning the right movement (and learning which to temporarily avoid) is key. Immobilization is rarely necessary. A clinician who uses her ears and brain to thoughtfully understand a patient’s problem should realize that a self-management protocol based on movement – nature’s best remedy – is almost always the best medicine. -- Laura
A muscle strain (aka a pulled muscle) is a minor tearing of muscle fibers. It can also occur in the tendon portion of the muscle. A more significant tearing is simply referred to a muscle tear or a torn muscle. A strain is usually caused by a quick or unexpected motion, and often the patient can recall the moment of injury. Local pain and inflammation occur and the muscle may feel weak. The area may also appear bruised. A strain is treated for a few days with RICE as needed [rest (eg reduced weightbearing), ice, compression, and elevation]. Over this time, it should gradually get better. (If it is not getting better, it's likely that the diagnosis is not a muscle strain!!) Next, full muscle strength as well as motion in the nearby joints needs to be restored so that the muscle is able to handle all that is thrown at it - that's where I come in. -- Laura
If your foot/ankle needs to be immobilized and/or you can't walk on it, you have a few options. There are wheelchairs and crutches, but what fewer people know about are knee walkers (aka knee scooters or knee rollers). If you have the balance to manage them, they're a great way to get around quickly. Also, they don't take up too much space and don't require a lot of arm use like crutches do. Here is an example. -- Laura
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