The more I look at feet, the more I realise it is less important to get an accurate diagnosis than to appreciate the cause of why pain happens.
Modern medicine has made leaps and bounds in making diagnosis. Ultrasound, MRi, CT scan, bone scan just to name a few.
The detail one gets from these assessments are useful in the hands of an experienced practitioner but can also be misinterpreted. This can lead to a diagnosis that does not fit the picture of what the patient is concerned about.
It often focuses the attention of the medical personnel as to what they find as being the source of the problem, and hence dictates the treatment direction. With the “proof” at hand, it makes a convincing argument to take the next step in treatment, which is often not necessarily conservative.
The consequences of this approach still leaves many questions unanswered as the causation of the original condition may still be at large.
Let’s take an example of a bunion formation, or hallux valgus deformity. The patient seeks help from the GP complaining of pain in the first metatarsal or of the deformity making footwear difficult to wear.
They would be referred for an x-ray, then a referral to orthopaedic or, in some cases, podiatric surgery. This approach almost inevitably ends up in surgical correction of the deformity.
The problem comes in when there has been no appreciation of the original cause of the condition outside of ‘inherited’ or footwear related damage. So the patient after healing, thinks that the case is closed.
This is often not what happens. The functional reason behind the condition is still there and will often lead to new foot problems or a resumption of the original condition.
Looking at the bigger picture rather than just locally at an x-ray is just as important.
Another example is Forefoot Neuroma. Diagnostic Ultrasound is good at seeing this condition but again fails to appreciate the cause. There are many levels of severity in this condition and many times conservative care is sufficient to ease and cure it if the original cause can be appreciated.
This can be done adequately with a functional Biomechanical Assessment looking at all the features of foot function to pelvic mechanics to determine causation.
Hence the risk of diagnosis with scans which focus the mind leading to unnecessary procedures that do not always solve the problem as the ‘cause’ still prevails.
The message to take home is, look for the cause, worry less about the symptom as, once the cause is dealt with, the symptom will take care of itself.