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One of my biggest reasons for writing The Whole Foot Book was to share the experiences and answer the questions that my patients have had over the years during the course of treatment. It may surprise some readers, but many of the conditions I have discussed, I have personal experience with. There are many conditions that I have identified that cause me to have a high chance of getting these problems. I have had lifelong problems with controlling my weight; I am not overly flexible; People have remarked on the bouncy step that I had as a child/adolescent as a result of my tight Achilles tendon. My activity has varied widely during my life from extremely athletic to “couch potato”-ish. And now, at age 48, my ligaments, muscles, tendons, skin, and bones do not have the resiliency that they once had. All of these problems lead to overloading the front of my foot.
As a result, I have had Achilles tendon problems repeatedly. I have developed and recovered from plantar fasciitis/heel spurs in each of my feet and I have developed a hammertoe after irritation of the second toe joint in the ball of my right foot.
While some conditions may require surgery for the best result, in most, especially non-traumatic, problems, surgery is neither the fastest nor the best method of recuperation. And while the scars that remain after many conditions (such as a hammertoe), may be objectionable and make me prone to re-injury, in my opinion, it is preferable to the problems (stiffness, numbness, and scars) that follow surgery. In some instances, the deformities and occasional persistent pain may make surgical reconstruction the practical option, but you must understand that there are alternatives to surgery. My foot problems have never come to this point, but those of a minority of my patients have and surgery was the logical choice for them.
These alternatives include exercise therapy (either by yourself or with the assistance of a therapist), temporary or permanent limitations to activity, weight-loss, and therapeutic shoe wear, braces and orthotics/inserts. There are also pain-relieving methods that include massage, anti-inflammatory and other pain medications, and heat and cold application.
Which is right for you? Most of the time it is a matter of trial and error. Usually you should try several methods that will fit in with your life and then modify, and adapt your regimen until you figure out what works for you. Find a doctor that understands your preferred approach to treatment and has the patience to work with this. Communicate your goals to him and often the best course of treatment becomes clear.
For me and my feet, I have a lot of better things to do than recover from surgery or to take the chance of becoming my doctor’s next surgical disaster (and all doctor’s have them). All surgeries have a chance of failure and it may surprise you that for most foot surgeries that chance is somewhere between 5% and 30%. In a few, it may be as much as 50%. But my case of plantar fasciitis, Achilles tendinitis, or hammertoe may not be your case and surgery is sometimes necessary. My advice is to give non-operative treatment a chance and this involves patience, persistence, and thought on the part of both you and your doctor.
-Brett Fink, M.D., co-author of The Whole Foot Book, a comprehensive guide for anyone with foot pain.
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