9 replies to this topic

[Pasc]

In October 2006, I went to a physio as my left calf was in pain. She referred me to a podiatrist, and by December 2006 and $550 later, I was in orthotics. The pain had subsided by then (which I put to being on holidays). The pain didn’t completely go away, and by the May 2007, it was much worse. I dropped the k’s and went on a 2 month holiday, at which point the pain decreased but did not subside altogether.
August 2007, I went to another physio who diagnosed a second degree tear in the left calf. A few months of intense physio later, the calf is back to normal. However, the left leg still suffers from a ‘dormant’ pain. It seems to have a permanent feeling of discomfort. Physio B assesses everything else, including nerves and other cross training which may be the cause of the pain. He takes a good look at my gait and orthotics. My left foot is neutral and my right is mildly overpronating. The left orthotic, as it turns out, results in me supinating and the right is neutral. I am now running without orthotics. So far, no major issues and the left leg seems to be coping.
My questions are : How much change could have occurred in the last 18 months? Should I go to another pod for a second opinion?
Ultimately, I am a bit miffed about the situation, if it is indeed correct that the orthotics weren’t right for me, then why was I given them in the first place?

[Louise]

my experience:

Physio: has me on the treadmill and watches me run; shows me how to strap my knee and prescribes exercises
Pod #1: has me walk up and down the corridor and sells me $400 orthotics (which I no longer use)
Pod #2: has me walk and run down the corridor (and has no idea why my foot hurts)

I have yet to find a Pod that uses a treadmill to diagnose running pains. Why is this? You cannot judge someone's running style down a 10m length of carpet.

I'd be interested to hear the views of the Pods on this forum...

[brizza]

i am a physio and am a bit annoyed at the randomness and inconsistancy which seems to surround the whole management of sports injuries by physios,pods,chiros,i can't help here except to say that i fully sympathise,i do my best to never badmouth other peoples work even when it comes my way BUT....

[Chopper the Hands man]

I recently went to a Pod after the inside of my right foot hurt and he had me run on a treadmill. A week later I had my own orthotics. I ran with them for 4 weeks, then came back and told him now that my knee is starting to hurt so he shaved off a little on the orthotics and since then nothing has hurt and I am able to run without pain and do as many k's as I have ever done before. He was a young guy, probably only been in the industry for a few years (noticed his graduation certificate on the wall) but even he realised that you need to run on a treadmill and video it, to properly analyse ones problem.

I did not bother visiting the pysio

[Steve 'The Footman']

Louise Treadmill running also has its problems as the hip action and general coordination is affected for most people to the extent that it may not expose problems that occur while running normally. The best type of gait analysis is when you are warmed up and doing your normal sort of running.

Brizza has got it spot on when it comes to inconsistency with injury management. It does not matter whether you see a physio or a pod there is always the chance they will not really understand your problem or create the best treatment plan. As a podiatrist myself I would like to think that Pods would do a better job with orthotics however this is not always the case.

Pasc with your own situation it may be that things have changed since you had the orthotics or you may have never needed them. Different practitioners have different perspectives and different bias and no one can always get it right. Hopefully the Pod you saw thought they were doing the best thing for you.

Best Practice or Gold Standard Injury protocols do change and all practitioners need to be aware of these changes and continue their medical education and training. Once you have practiced for a while it is tempting to fall back on your own anecdotal experience. This can be dangerous and lead to the problems that Brizza raised.

[milesy]

I find this a very interesting topic as I am a physio and my husband is a podiatrist. I personally feel that his knowledge on the foot and appropriate interventions is far superior to what we are taught in the physiotherapy course. However, I do feel that an integrated approach of health professionals is often required and there is a huge overlap in knowledge especially when it comes to the lower limb.

On the original post by pasc, the physio referred the patient on to the podiatrist who prescribed orthotics. Maybe orthotics were not required, but considering it sounds like the initial problem was a calf tear, was it not the physio who missed this diagnosis? I know the podiatrist also missed it, but in their defence the referral letter may have been poorly written (eg. Overpronates, needs orthotics). I think it was poor judgement on both of their behalf's.

I am going to play safe and say it depends on the practitioner themselves- I think a good podiatrist and a good physio would BOTH have picked up the calf tear. When it comes to orthotics I would say see a GOOD podiatrist that understands runners (preferably one themselves- there are plenty that post on this forum). For other complaints see a GOOD Physio (again there are some that post on this forum- Brizza stands out in my mind for Sydney runners).

Just my opinion!

[Bellthorpe]

Keep in mind that there are good and bad podiatrists, and good and bad physiotherapists. It might take some time to find the person that will suit you best.

CoolRunners are fortunate, in that an excellent podiatrist and an excellent phsyiotherapist have already posted in this thread, and their (distant, unseen) advice is freely given here.

I haven't seen a podiatrist, but my first port of call for any injury is my physiotherapist. Sometimes he refers me to a doctor, sometimes he initiates treatment, sometimes he tells me to piss off and stop wasting his time. But I trust him and value his wisdom. If he were ever to tell me to visit a podiatrist, I would then do so.

[brizza]

i had an excellent education and training as a physio,we studied everything from paeds neuro to icu and adult trauma,the anatomy and physiology was great,psychology,social sciences and the rest,but i finished knowing nothing about biomechanics and sports medicine so the first thing i did was research and teaching to get up to speed and will still research something or other on a daily basis,i think this is too hard for most practicioners even if they wanted to and it is very easy to get out of the habit and the special interest groups are often networking and socialising groups.i have to admit i have learned nothing from the last several few conferences and courses i have been on-just my beef-i'm over it now-thanks for listening-briz

[B+]

As a patient, my experience has always been with all things keep visiting and asking people for referals until you find a practioner that you are comfortable with.
From what I have seen and this is stereotyping a bit I know.
Pod's tend to want to put you in orthodics and don't normally offer rehab or prehab type exercises to improve the function of the foot and lower limbs.
Physio's tend to work with rehab exercises and try to improve the function aspect.
A lot of times one won't acknowledge or offer a referal to the other.

Always try to find a practioner that works with sports people if your injury is sports related. This way there is a better chance that your explanation of the issue is understood.

As for costs and diagnosis, well in my view it is luck of the draw. I have had several pods examine me and tell me that I need orthodics and others tell me I don't. Running with and without has resulted in different injuries at different times. So who knows.
In the end I am always guided by my Physio as he has treated me forthe last 18 years and probably understands my body better than most.
Is there a recourse if you feel you were misdiagnosed and therefore mistreated an possibly prescribed the wrong thing and had unneccessary expenses incurred? I don't know but would think that it would be hard to prove.

Train safe

[Pasc]

Thanks for all your words of wisdom and insight on this matter.
Next time, I think I will get a few opinions before I take any further action.... onwards and upwards from here!