Finished 1st day of IM rotation and my legs are killing me.

[Taxonomy]

I'm overweight 230lbs. Gained about 60lbs during MS1-2 years. My preceptor likes to walk a lot and when we go in to rooms he likes to have a nice long chat with patients (which is very good), but he stands all day and I can't sit down while he is standing, because that will be a bit wrong (sitting MS3 while attending is standing lol). So I probably wasn't used to this kind of change - after mainly sedentary 2 years.

My knees hurt and my feet are just dying lol. I'm thinking to use an elastic band for knees like power-lifters use - something compression like. My shoes are comfy, but it didn't help - considering shifts are 12 hours. Lots of guys even heavier than me - just wondering how they are surviving? Do you guys rub some secret gel and do a hot feet bath at home at the end of the day to revive poor feet lol?

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[Tigerhawk77]

Get firm inserts and wear tennis shoes. Also mind your mood and sleep. I always magically got back and neck and foot pain in Medical School when my mental health was poor.

 

[wholeheartedly]

I've heard people recommend compression socks for the OR, so that might be an option. Even if your shoes are comfortable, they still might not be right for standing all day. I have different shoes that have worked well for standing vs walking all over vs jogging. I've also heard and found it can help to switch off your shoes, as in don't wear the same pair at home as work and switch off shoes different days at work.

 

[Crayola227]

you can look through my post history for:

self care
feet
foot
pain
sneakers
compression stockings / socks

I know students that were able to get accommodations for certain types of pain.

ACT NOW. If your hands or feet go out, your career could be over before it starts.

 

[chizledfrmstone]

you can look through my post history for:

self care
feet
foot
pain
sneakers
compression stockings / socks

I know students that were able to get accommodations for certain types of pain.

ACT NOW. If your hands or feet go out, your career could be over before it starts.

What...

 

[Crayola227]

What...

I know someone who, starting their first med school clinical rotation on surgery, developed a commom repetitive strain injury they thought would just settle down, but it ended up that it never went away, to this day. Somewhere down the line they were unable to continue working as a direct result. They're basically just screwed.

People think of other careers more for on-the-job injury being career-ending -- professional figure skating, carpentry, etc. But desk jobs or on your feet jobs have it too.

Repetitive strain injury is a real risk in our careers. I know many physicians who grapple with carpal tunnel. As attendings that is much more manageable with work load (scribes, dictation, part time, consulting, etc) than for residents who may not do so.

It's really important whenever these things raise their ugly head to act swiftly to address them. Or, even better, prevent them.

That's why I say, take care of your hands and feet. Same with backs, necks, etc. Because I've seen people lose careers over their dysfunction.

I don't think that's crazy advice.

If your feet are hurting this bad a few weeks in, I wouldn't hope for it to just resolve with time, although it may. I would take it career deadly serious and go to lengths over it.

 

[Esotsm7]

+1 for getting better shoes/inserts, this helped me to get through my surgery rotation. Oh and also daily stretches.

Maybe get an appointment to see PT? You definitely want to get this under control sooner rather than later...

your career could be over before it starts

Depends on your career choice. Plenty specialties don't require you to be standing or walking the whole time. If your legs bothers you after 1 day then maybe you shouldn't pick a career that requires you to stand for prolonged period of time e.g. surgery. But then again ophthos sits most of the time so it really depends.

Just do what you can to get through your current rotation, but you should take care of yourself as well!

There is a saying in Japanese that literally translates to "Doctor's body", which in the correct context it means that physicians are overworked and they neglect to take care of themselves. You should take care of yourself!

 

[Angus Avagadro]

I recommend high protein low carb diet. Losing even 10 lbs in my experience can make a big difference. Sorry, dont mean to be rude, but OP indicated they were overweight. First things first

 

[Crayola227]

first things first is to address the OP's foot health at the weight they are at NOW

yeah, weight loss would help

to be fair, being overweight was one reason I was so concerned and felt they needed to be aggressive, if weight is the root cause then they need all the help they can get in the interim as it will take some time to address that, meanwhile....

fwiw, the physicians I have seen struggle most with this have been normal weight

 

[frosted2]

I recommend high protein low carb diet. Losing even 10 lbs in my experience can make a big difference. Sorry, dont mean to be rude, but OP indicated they were overweight. First things first

Low carb has saved my life. I feel so much better not hooked on that sugar s**t.
Occasionally I will add some Aleve when I am feeling extra crunchy after a long shift/lots of walking (I've had a few knee surgeries). Soaking in water as hot as you can stand it helps as well. Prop your knees up with a pillow if you are a back sleeper.

The importance of hydration can't be overstated when working and walking a lot.

Hope something helps

 

[Thelonious Chunk]

.

 

[nlax30]

Agree with the recommendations for self care and to find potential solutions (right shoes, inserts, orthotics,etc..) as well as improving on the weight issue as soon as you can to prevent more long term issues.

I’m in a field where a LOT of docs develop significant ortho issues so I’m very cognizant of trying to develop habits now to mitigate that. I wear lead and stand for hours a day and already developing some foot issues.

 

[676188]

Long time runner with plantar fascitis, here’s my advice for foot/leg care. You’ve already gotten lots of good advice here, but I’ll add what I’ve done over the years:

Go to a running store that does gait analysis and get shoe recommendations. Buy two pairs of good shoes and swap them out daily. The insoles get compressed and need 24 hours to bounce back. Replace every 6-12 months depending on how much abuse you put them though.

Compression socks are really helpful for tired legs and feet. Epsom salts soaks help after a long day on your feet.

If you have flat feet or any structural foot condition, see an orthopedic doctor and get orthotics.

For every pound you lose its 4lbs/sq ft of pressure off your knees, hips, ankles and feet. Try to get to a healthy weight as soon as you can.

 

[Angus Avagadro]

Also agree with orthotics. Jus a shout out to DPMs, this is what they live for. Saw my DPM friend, had neuroma on both feet. A couple of injections, and proper orthotics, I'm now pain free. This was after seeing a local ortho hand and foot specialist whose orthotics didnt help.

 

[xffan624]

I have chronic knee pain due to old injuries. 3rd and some of 4th year were total crap due to all the needless standing. It gets better in residency. I'm even in a specialty that rounds, and the rounds are more tolerable as a resident and when you're not on an inpatient, then you decide when you sit or stand mostly. Sometimes on bad days when we were rounding I'll just tell the attending that I need to sit due to my knee and I bring a rolling chair along.

 

[Crayola227]

I agree DPMs are better for orthotics than orthopods, many don't even do orthotics and will just refer to podiatry. Podiatry can refer you to ortho as needed. However, insurance may not cover DPM but they always seem to cover ortho. Orthotics often aren't covered by insurance, but I find worth the investment.

Regarding swapping shoes, make sure it's the same shoe. Changing the structure of your shoes can be bothersome to feet because they "get used to" the shoes you're wearing, in a good way typically.

Don't lock your knees. Shift on your feet a little from time to time, as well as bending and straightening your legs alternately a little for blood flow.

Ditto compression socks. I use Jeffries in the highest OTC compression I can find. They are TOUGH to get on, and you will notice them, but the way your feet feel at the end of the day when they are released.... sooooo good. I had 4 pairs and washed them by hand in my sink with a little dish soap or laundry soap in cool water, hung to dry. So they last longer. Doing that I was on a good cycle for not taking long at the end of the day to wash but having enough dry pairs for surg, which is good as you have little evening time.

This is a good thing for all rotations where you are static, be it standing or sitting (so good on IM too).

In med school we had a lecture from vascular on venous stasis, and basically their mission in life was to spread the word that only prevention is really good for basically all lower leg vein issues (look up some pictures and then decide if you'll put up with the socks....) and that basically as a rule all humans should be wearing the socks, especially standers/sitters/health care workers (contraindications notwithstanding).

Humans are literally not designed to be static and immobile for hours on end, we are designed for walking upright. So keep that in mind and do what you can to counteract the musculoskeletal issues that arise from modern day life.

 

[Crayola227]

If plantar fasciitis is an issue, I can write more on that as well.

 

[TypeADissection]

Have no fear OP. It gets much easier when you’re on surgery.

 

[OrthoTraumaMD]

Your knees take 4 times your body weight with each step. Lose 20 lbs—> 80 lbs of force off each leg.


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[TypeADissection]

Your knees take 4 times your body weight with each step. Lose 20 lbs—> 80 lbs of force off each leg.


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I think we’re thinking this all wrong. If you add 20 pounds then you’re gaining 80 pounds of force. Gotta think of the gainz.

 

[Stagg737]

I think we’re thinking this all wrong. If you add 20 pounds then you’re gaining 80 pounds of force. Gotta think of the gainz.

I can power walk 700 pounds. Come at me bro.

In all seriousness to OP, lots of good advice here. I get through long days by leaning on stuff. Walls, chairs, counters, etc. It shifts your weight from a direct perpendicular force through the joints to a less direct, angled force at times. Not going to cure you, but definitely helps me out a bit.

 

[psych_pa]

I'm actually 15 lbs underweight. I run and weightlift.
Even when I stand for the entire day following a doctor I cannot hardly do it standing the whole time. It is not my feet per se, but rather my back. I do need a bit of a break every now and again. The rooms we go into usually only have two chairs, one for the doc and one for the patient while I am the one stuck standing. I know you say it's wrong to sit while he is standing, and I have felt the same way, but once I explained my situation to the doctor I was following he understood completely and allowed me to take small breaks in between. Self-care. Sometimes they're so used to it, it is not something they even consider and/or think about.

I suggest telling the doctor, but that's just me. I let people know when I'm suffering.

 

[Crayola227]

I'm actually 15 lbs underweight. I run and weightlift.
Even when I stand for the entire day following a doctor I cannot hardly do it standing the whole time. It is not my feet per se, but rather my back. I do need a bit of a break every now and again. The rooms we go into usually only have two chairs, one for the doc and one for the patient while I am the one stuck standing. I know you say it's wrong to sit while he is standing, and I have felt the same way, but once I explained my situation to the doctor I was following he understood completely and allowed me to take small breaks in between. Self-care. Sometimes they're so used to it, it is not something they even consider and/or think about.

I suggest telling the doctor, but that's just me. I let people know when I'm suffering.

Yeah, that's great, but it's definitely something to avoid as much as humanly possible in medical school and training, especially on surgery.

I went through this exact thing the first rotation of the year, and the Dean and Chief Resident in surgery flat out told me this, and how it would hurt my career.

So no, I don't suggest telling who you're working with. It might be worth talking to one's personal physician whose medical record system is totally separate from where you train/work, and an ombudsmen if they guarantee confidentiality, and possibly the Diversity Office to see about accommodations if needed.

As I said, overlook any aspect of your health that related to doing your job, at your peril. Mention any weakness or suffering to anyone that can affect your career, at your peril. Tough to strike that balance.

 

[psych_pa]

You make a good point.

 

[Hass_Love_Fitness]

If plantar fasciitis is an issue, I can write more on that as well.

I’d like to hear more on plantar fasciitis. I’ve been suffering for almost a year now.

 

[Crayola227]

I can't give medical advice. I can suggest using the SDN search function to read about other users' experiences and how that impacted their career in a health profession.

I suggest to anyone to search my post history on any topic that interests them. I'm self involved like that.

 

[Crayola227]

Shoe Recommendations

note I, nor anyone else, is recommending shoes to anyone else to treat any sort of condition. We're talking in educational generalities about feet.

 

[Crayola227]

Blog about your life here: thread 1

I wrote a post on the topic of plantar fasciitis.