What do you call a nurse with a sore foot? A nurse.

Who works harder than nurses? OK, no need to start a fight here, but do I have a point?! Walking around a LOT, standing for hours, hard concrete floors, lifting and manual handling. And not always in the best shoes... because they're usually the ugly shoes! One thing is for sure, at Pioneer Podiatry, we see a LOT of nurses.

Not surprisingly, there have been quite a few studies into the kind of injuries that nurses get. And guess what? Nurses have some of the highest rates of musculoskeletal injuries amongst all the medical and health professions. In some studies, up to 85% of nurses reported a musculoskeletal injury, with foot and ankle pain coming in close second behind lower back pain, and just in front of shoulder pain.

Another review of over 35 studies into lower limb injuries in nurses showed that foot and leg pain is a major cause of sick leave amongst nurses.

So how do we help nurses?

Firstly, footwear prescription is so important to get right. Just like writing the right script for the right antibiotic for the right bacterial infection is critical to getting a good clinical result, so is getting the right footwear script with the right design and technology elements to prevent or help to cure a musculoskeletal injury. Too much, or not enough, support or cushioning can make a small problem worse. Other things such as midsole density and heel pitch make a huge difference. And, perhaps the most important factor of all... style! If you need a more dressier footwear style, you don't want to have to be stuck with the ugly shoes. The honest truth is... you might buy them, but you're very unlikely to wear them.

We take all these factors into account when prescribing shoes; support, design function, and fashion. If you get one element wrong, it's not going to help. We are certified shoe nerds, and we pretty much know every shoes out there. If we can't direct you to where to get the shoe you need, we can source and fit it directly for you.

The second way we help nurses is by using one of the super skills of our profession... custom orthotics. An orthotic is something you put in a shoe to change the way the foot works, usually to reduce the tissue stress on an injured area, or to improve biomechanical function. A custom orthotic is an orthotic that is made from a 3 dimensional impression, mould, or optical scan of your foot. Custom orthotics are very effective at treating many injuries, and they are many nurses walking around Mackay with our orthotics in their shoes. It has enabled them to walk and work without the end of day pain they previously experienced. And that is good news, not just for those nurses, but also for the patients they treat! I mean, is it easier or harder to do your job with a sore foot? You know what I'm saying?

If you know a nurse with a sore foot, you should share this blog post. They will thank you for it!

Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: a cross sectional study
Suzan Mansour Attar
BMC Research Notes 2014, 7:61 doi:10.1186/1756-0500-7-61

Lower extremity musculoskeletal disorders in nurses: A narrative literature review.
Stolt M, Suhonen R, Virolainen P, Leino-Kilpi H.
Scand J Public Health. 2015 Sep 9. pii: 1403494815602989

Is the hippocratic oath still relevant today?

Ever since the dawn of medicine, we have been drawn towards a sense of presumed ideals and ethics necessary in the healing arts. When we seek the help of a doctor, most people are in a state of physical, mental, or emotional vulnerability, and we need to assume the best intentions of the person into whose hand we are putting our health, or perhaps even our life. For this reason, there is a long tradition of oaths used by physicians upon completing their training to explicitly outline these ideals, so no one is guessing what is expected of these venerable citizens.

And when I say long, I mean really long. The Hippocratic oath is perhaps the oldest, and most well known, and is attributed to the ancient Greek Physician Hippocrates of Kos from the 5th century BC. While it is a fascinating read, it is hardly something most modern physicians would honestly abide by, particularly considering the opening promise to "swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea". However, even in these dark distant past times, there are thoroughly modern medical concepts such as to use treatments and procedures only "for the good of my patients according to my ability and my judgment and never do harm to anyone". There is even a promise to not undertake procedures that you are not experienced in, but to "leave this operation to be performed by specialists in this art".

Many medical oaths also make explicit the most powerful skill which a treating physician can possess. Surprisingly, this is not an elusive technical clinical skill, but rather the rare art of careful listening. It is the ability to truly probe into the root motivations and desires of our patients and to empathise with what they want to achieve. In teaching our new graduates, I tell them to look beyond to presenting complaint, and find out what this pain is preventing your patient from doing. Their real problem isn't heel pain or an ingrowing toenail, it's the fact that they can't play soccer with their teammates, or that they can't stand at work, and are afraid of losing their job. Or that they can't go walking each afternoon for exercise with their wife, they are gaining weight, and facing mounting criticism for this from their doctors. Once you find this deepest level of "why", you have to key to connecting your medical interventions in a relevant and engaging way.

In "A Modern Hippocratic Oath by Dr. Louis Lasagna" we have the wise assertion to "... remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick." Unless we truly understand the surrounding life context of our patients, we are never able to work alongside them in a partnership towards their goals.

And finally, though the modern oaths have removed the references to Apollo the Physician, there is still space to recognise these oaths as more than just a code of ethics for professional behaviour. Dr Lasagna states in his modern oath "...Above all, I must not play at God", indicating that there may be ethics and decisions above our pay grade as mere mortals. In recognising some of these self-evident truths, many ways choose to define this oath as a pledge to God himself. Whatever the personal persuasion may be in the end, to recognise the gravity and weight of such a responsibility as we have, and by articulating this and declaring it in front of those we seek to serve, is surely one of the most powerful ways to keep ourselves accountable to our highest ideals and ambitions.

Healing Heel Pain

Firstly, the longer you or your patient has had the symptoms, the longer it will take to heal.

Plantar heel pain is the culprit in most mechanical heel pain cases. It has a fairly predictable patient description- severe pain localised to the plantar heel, particularly when first weight bearing after a period of non-weight bearing (i.e. getting out of bed in the morning, after driving 30 minutes in the car etc). This pain will typically decrease after a number of minutes, and then returns gradually through the day, and worsens with more time spent on feet, or with higher intensity activities (e.g. running, exercise, jumping etc).

You are more likely to develop the condition if you're female, overweight or have a job that requires a lot of walking or standing on hard surfaces.

You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.

When to see or refer to us:

• Heel pain that continues when NOT walking or standing
• Heel pain that lasts MORE than a few weeks, even trying rest, ice and other home treatments

Reach out -- we can help!