Stephen A Margolis
Feet! Not really a glamorous endeavour when I went to medical school. At best, it seemed to almost be an afterthought, something to fill in those dreaded end-of-week lectures, when everyone had their eye on the clock and was looking forward to relaxing. Yes, we had traditional lectures, as this was long before problem-based learning arrived. Friday afternoon was hardly the spot for high attendance, in part as university hours were rather long and crammed full of activities when compared with more recent times. Anyway, our education was chock full of important issues such as ischaemic heart disease, chronic airway disease and the like, and limbs, especially the bits at the end, were seemingly unimportant. Even in traditional orthopaedics, there was little emphasis on anything outside of fractures that required surgery, although the odd bunion seemed to sneak in occasionally. Hospital residency was not really much different; feet were considered for pulses or swelling but not really much else.
So it was no surprise that I was in for a rude shock (or is that an awakening?) when I arrived in general practice. Many of my patients had problems with their feet: teenage girls struggling through their ballet classes with mid-foot pain, young and not-so-young athletes challenged by sore feet halfway through their marathon, through to X-ray-negative foot trauma that fails to heal, recalcitrant infected ingrown toenails and even the odd inflamed bunion.
How much has changed in the intervening years? De Berardis et al2 found little enthusiasm among physicians when examining the feet of diabetics, while Williams and Graham3 noted that patients with rheumatoid arthritis felt their foot problems were often ignored. Pinney and Reagan4 noted ‘a marked discrepancy between the musculoskeletal knowledge and skill requirements of a primary care physician and the time devoted to musculoskeletal education in Canadian medical schools’. Day et al5 found that Harvard ‘medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field’.
Perhaps then, it is timely for AFP to review common problems in the feet in some detail. This month, we revisit the mid-foot and heel/hind-foot, and explore the key processes that GPs consider in managing problems in this area. Beran6 provides a detailed accounting of peripheral neuropathy from a GP perspective. For those more procedurally minded Bryant and Knox7 revisit the standard surgical techniques for ingrown toenails. And yes, a potential answer for footsore novice ballerinas is there as well.
Speaking of feet and the travels they facilitate, AFP turns 44 this year and is continuing its personal journey of evolvement with the release of our latest revamped layout. Our commitment to our readers, evidence-based processes and style is unwavering as we celebrate redressing our package.
- Rinzler CA. Leonardo’s foot: how 10 toes, 52 bones, and 66 muscles shaped the human world. 1st edn. New York: Bellevue Literary Press; 2013. pp xii, 193
- De Berardis G, Pellegrini F, Franciosi M, et al. Physician attitudes toward foot care education and foot examination and their correlation with patient practice. Diabetes Care 2004;27:286–87.
- Williams AE, Graham AS. ‘My feet: visible, but ignored . . .’ A qualitative study of foot care for people with rheumatoid arthritis. Clin Rehab 2012;26:952–59.
- Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am 2001;83-A:1317–20.
- Day CS, Yeh AC, Franko O, Ramirez M, Krupat E. Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School. Acad Med 2007;82:452–57.
- Beran R. Paraesthesia and peripheral neuropathy. Aust Fam Physician 2015;44:92–95.
- Bryant A, Knox A. Ingrown toenails: the role of the GP. Aust Fam Physician 2015;44:102–05.