I’m a firm believer in the old adage “communication is a two-way street.” When I started working as a Pedorthist in 1997, I learned very quickly the importance of clearly communicating to my patients when a patient, who came into my clinic with a prescription for custom-made orthotics, asked if orthotics were special shoes.
Although Pedorthists are trained to clearly explain their assessment and treatment plan, as a patient, it is equally important you tell your Pedorthist if you don’t fully understand something. Before you leave their clinic, make sure you completely understand the reasons behind your pain or mobility problems, how pedorthic treatment will help and what you have to do to make it successful.
If you don’t understand pedorthic terms such as “realign”, “uppers”, “fascia” etc. say so. Similarly if you don’t fully understand why you have been asked to change your footwear (i.e. stop purchasing running shoes from a discount store) ask. If you need your Pedorthist to speak slower or use different words say so. There is often a lot of information to digest and confusing terms to understand so it is completely normal to have difficulty taking it all in. It is not unusual for patients to need to be told things three times before they understand.
From a Pedorthist’s perspective, we also need our patients to clearly communicate with us details about their own situation and preferences. Five or six years ago, a lady came to our clinic for help with her heel pain. She was very well-versed and explained exactly what was going on. When I assessed her, she presented all the symptoms of plantar fasciitis. Her arches were fallen and she had a typical flat foot. As is the case with flat feet, her heels were turned outward and her forefoot was turned inward. However, at the end of her appointment the patient told me she only felt comfortable wearing very soft, flexible shoes. This footwear was counter-intuitive to me for the condition I was seeing so I decided to go with the treatment I thought was best.
I fit the patient with a pair of semi-rigid orthotics with deep heel cups and the appropriate inner posting and asked her to start wearing running shoes with added heel and arch support. At her check-up appointment, the patient complained that her knee was starting to hurt and that both the orthotics and shoes were uncomfortable. Based on this, I adjusted the angle of the orthotics and softened both arches, which she said felt better. However, at her next follow-up visit, her symptoms had not subsided and she still said her shoes and orthotics were uncomfortable.
I decided to re-make her orthotics. This time, I used a very soft accommodative material to build her orthotics and there was no heel cup or heel support. I also changed her footwear to a pair of extremely soft walking sneakers. When I followed up with her four weeks later, she had no more pain and she felt very comfortable. It was an important lesson for me to listen closely even when I hear things that are counter intuitive. I really should have listened to this particular patient as she was my mother.
By Deny Dallaire, B.Sc., C. Ped (C), Moncton, N.B.