Care: Ankle and Foot Problems
Guest: Dr. Bill McKibbin – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Bill McKibbin, who is
Assistant Professor of Orthopedics here at the Medical University of South
Carolina. Dr. McKibbin, I understand
that your area of specialty is the orthopedic care of ankle and foot problems,
which must be incredibly common. It
seems like everybody has had pain in their feet at one time or another. At what point though should a person make a
decision to come in and see a specialist like you? When should they begin to really worry about
Bill McKibbin: Well, in particular, when
things have just lasted too long and your gut feeling is that things have gone
on for too long or, for instance, things might just be too painful for what you
might otherwise think that you have. As
an example, an ankle sprain is really one of the most common injuries one can
have in being active or just working a normal day. And the pain seems out of proportion to what
it should be and, over time, if it seems to linger too much, that would be a
great example of a reason to come see me.
Linda Austin: So, I would guess, then,
that it might be a mild pain that lasts for a long time or a severe pain, even
if it’s very acute, that a person might come into see you.
Bill McKibbin: Yeah.
Linda Austin: Now, let’s imagine I come
in. I’m your garden variety patient and
I say, you know, doctor, I’ve just had
trouble, my feet hurt when I walk, where would you start with the
diagnostic evaluation? What would happen
Bill McKibbin: Well, what’s very
important in this case is to get a complete history on how this is all
happening for you. And, once we get that
then it’s a whole lot easier to direct the physical examination and, for
instance, then take x-rays, which is very common in the workup for almost any
Linda Austin: What sorts of problems
will show up on an x-ray?
Bill McKibbin: Well, things that show up
on an x-ray would be, for instance, arthritis or arthritic changes that one can
see in the bones and joints, or around the bones and in the joints. Sometimes a spurring can be seen as a for
instance. And other things that can show
up would be fractures or, a lot of times, a lack of hard radiographic findings
can also direct us to diagnoses that are more specific to the soft
Linda Austin: And, what might some of
Bill McKibbin: Well, for instance, the
garden variety sprain or strain. That
would be a great example of that, a ligament strain or tear, or even a tendon
Linda Austin: I would imagine that one
of the lines of thinking that keeps people from coming in to have their foot
examined is the concern that maybe there’s nothing you can do anyway. What are some of the common causes of foot
pain for which there really are not good treatments?
Bill McKibbin: An example of that might
be certain types of nerve pain. There
are though some nerve operations that we do that are fairly uncommon. But nerve pain, as opposed to bone and joint
pain, is a lot tougher to deal with on an ordinary basis.
Linda Austin: But it was interesting,
when I asked you that question, you really had to think for awhile.
Bill McKibbin: Yes.
Linda Austin: So, really, I guess what
that means is that most causes of foot pain, there really is some sort of
treatment that can be offered. Is that
Bill McKibbin: Yes. I would really agree with that. And I think it’s a mistake to make the
assumption that nothing can be done, because even if one doesn’t have surgery,
a lot of times you can get treatment which certainly will make it better or
even make it go away.
Linda Austin: What are some non-surgical
causes of foot pain that you commonly treat?
Bill McKibbin: The most common cause of
foot pain that we almost never have to do surgery on is plantar fasciitis or
just old fashioned foot pain which occurs on the bottom of the heel.
Linda Austin: How do you treat that?
Bill McKibbin: Well, there are very many
ways of treating it. But we start off
with stretching, primarily. And there
are other things that can be done, like good orthotics. Over-the-counter-type orthotics or even
custom orthotics can help.
Linda Austin: Orthotics are, what,
inserts that you put into shoes?
Bill McKibbin: Inserts that will go
directly into the shoe. That’s correct.
Linda Austin: And, the foot stretching,
can you describe what that consists of?
Bill McKibbin: Well, specifically, it’s
a stretch designed to lengthen the calf muscle and the Achilles tendon, more
than the ligaments in the foot itself.
So, it’s a set of stretching exercises which helps over time. And sometimes we even augment that idea of
stretching with night splinting.
Linda Austin: Can you describe a little
bit more about plantar fasciitis? What
are the typical symptoms of that?
Bill McKibbin: The typical plantar
fasciitis patient will be somebody that comes in with pain on the bottom of the
heel that seems particularly bad when you get up in the morning or have been in
a sitting position and then rise to a standing position. That’s the typical type of pain that one
would experience there.
Linda Austin: Interesting though that
it’s not after you’ve been walking for a long time.
Bill McKibbin: That’s correct. In other words, a lot of patients can easily
walk whatever their routine is and only hurt afterwards.
Linda Austin: So, that would be the tip
Bill McKibbin: Yes.
Linda Austin: And, is it usually in both
Bill McKibbin: No. A lot of times, it’s just one foot, inexplicably.
Linda Austin: And yet the stretching
exercises really help.
Bill McKibbin: Absolutely. It’s an unusual case that stretching won’t
help at all. But, again, I feel that
it’s really important to establish the diagnosis first because sometimes there
are some overlay diagnoses that can influence how that works.
Linda Austin: Such as what? What might be confused with plantar
Bill McKibbin: Well, sometimes
tendonitis, and, specifically, there are some different tendons near the heel,
that go by the heel, that can hurt in a different way, and that can add a
little confusion to the diagnostic differential.
Linda Austin: Dr. McKibbin, thanks so
much for talking with us today.
Bill McKibbin: Thank you.
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