COST EFFECTIVENESS/YIELD/MEDICAL ECONOMICS
LEG PAINS - STOP PHYSIOTHERAPY, CHANGE THE SHOES
Patients complaining of pain in the legs occasionally become a source of headache for me. In the beginning, I used to send them for physiotherapy. Then, I noticed that after spending thousands of rupees on physiotherapy, they were shown some common exercises, to be done at home, but the pains still continued. Therefore, since the last few years, I have stopped advising physiotherapy for non-specific pains in the legs. I have also never prescribed NSAID group of drugs or pain killers for such patients.
First of all, I would like to make it clear that there are plenty of “known” causes of pains in the legs. I will give you a few examples:-
The pain in the knees, due to common osteo-arthritis can start in overweight patients, around the age of 40. The first symptom which bothers them is pain, while sitting down or getting up from an Indian toilet, or pain while climbing or going down the steps. Then, after a few years, the pain occurs while walking. Even at this stage, the X-rays are usually normal. This is a specific entity.
2. Patients, (specially females), who have vague aches in both legs and calves, more while walking and working, and more in the evenings. Such patients also complain of puffiness and swelling around the ankles, towards the evening. Deep vein insufficiency, is the cause of these symptoms. 3. Patients having plantar fasciitis, mainly complain of pain in the calcaneum and sole of the foot. 4. Patients having general bone diseases like osteo-malacia, also have generalised bone pains. Such patients also complain of pain in the back, besides leg pains. 5. Sciatica : These patients complain of sharp pain along the nerve root, which often starts in the lower back, is usually unilateral and can be confirmed by doing straight leg raising sign. 6. Flat feet can be diagnosed if the patients are seen properly, when they are standing up.
There are many other causes, but the ones mentioned above are most common. Here, I am discussing patients, who have already consulted orthopaedic surgeons; have taken physiotherapy treatment, and still complain of pain in both the lower limbs.
Such pains are more commonly seen in females, but nowadays, it is being increasingly observed in males as well.
Always look at the shoes of these patients. Do not feel shy to pick them up and look at the soles and observe other details. The only advice, which you can give them is ‘to change the shoes’. Try it, in a few patients. You will notice that at least 50% of them, will definitely respond and come back to thank you. Comparatively, in cases of chronic active hepatitis, if only 50% of the patients respond to Inj. Interferon, costing 2-3 lakh rupees, the results are considered very good.
Remember that there are four requirements for a pair of good shoes:- 1. Thick soft sole; 2. No heels; 3. Broad forefoot; 4. Soft uppers.