Manual lower extremity manipulation and podiatry?

[GymMan]

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Is this used much? I know DC's tend to elongate or traction out the legs during adjustments. I wondered if a DPM would ever use this type of treatment, or help manipulate the bones of the foot or ankle to allow better movement via tractioning or the like. Just wondering if hands on medicine is used in podiatry, as it is in Phys.Therapy or other forms of manipulative medicine.

 

[birdieDPM]

There has been lots on this over at Podiatry Arena:
http://www.podiatry-arena.com/podiatry-forum/tags/index.php?tag=/manipulation/

 

[densmore22]

DMU DPMers learn about certain OMM techniques on the foot, ankle, knee and hip. It's taught in our clinical pod med and diagnostics course. I personally don't remember too much from it, but at the time I thought it was cool. As for actually using it in practice, I don't think there are many that do, but I'm sure there are some out there.

 

[Feli]

Keep in mind that physical therapy, much like chiro, has no real proven medical value in the mind of many allopathic docs. The culture of allo medicine is now evidence based treatment decisions (surgery X vs surgery Y measured success rate, medication A vs B proven results, etc). For manipulations, it's all subjective: the patient "feels better," "seems to be getting more motion," "feels a tad bit less pain," etc. The stretching, range of motion, etc is really nothing all too different from what rehab or long term care nursing assistants, personal trainers, etc will do for clients. Sure, there are physical therapy modalities that theoretically improve local bloodflow temporarily (baths, massage, ultrasound) or increase flexibility (stretching and ROM), but the results are all relatively subjective. The only stuff that PT can really do that has proven medical value is iontophoresis (sending dermatologic creams down into the tissues with ultrasound or electric current), and they need the referring doc to write the Rx for those creams.

Some pods I've seen have their patients do a lot of PT during surgical rehab, and others don't use PT for much aside from gait training their hospital inpatients (walker, crutches, scooter, etc). PT isn't very well covered by most insurances unless it's rehab for a major injury (auto accident, workers comp, stroke, etc). Weeks and months of sessions will burn a lot of cash very fast, and the pod or ortho patients can often get more bang for their healthcare buck using that money differently (imaging, surgery, medications, braces, orthotics, etc).

A lot of ortho and pod docs that I've seen will send the patient to PT for a just few sessions after removing a case/brace. The patients need to get some flexibility back, and the idea of sending them there is that they will learn some stretches and motions that they can do. Some docs will send them there for months and months... but usually only if the patient has great insurance and/or they don't think the patient will commit to the stretching and strengthing on their own. PT becomes basically a high priced personal trainer, stretching coach, or massage artist for those patients.

I'm not bashing PT here, but you just have to realize what it is and its limitations. Podiatry is an evidence based specialty, and we have objective data for most of the stuff we do. Sure, there is anecdotal evidence and personal experience will always have a role, but I don't think very many pods twist knees, pull on heels, or crack toe joints to cure ailments if that's what you are asking. You can't fix a bunion, fracture, or flatfoot with your bare hands... unless maybe your nickname is "JC"? Any "alignments" or "adjustments" that DPMs do are generally achieved with surgical manipulation of bones and tendons, braces/shoes/orthoics to limit motion, or both.

 

[iceman69]

PT visits burn up a lot of money with just the co-pay for a relatively minor, yet very painful injury, like a rotator cuff tear...Another reason PT/Rehab visits are not typically prescribed greatly amongst orthos from what I have been told by a couple of them is that you don't make much money for the time you spend haggling/fighting with insurance companies to get adequate rehab time for a lot of complicated pts...

 

[SportPOD]

Physical therapy is generally dispensed to help with a lot of soft tissue injuries. One of the things I see in my practice that is the main cause of injuries is a lack of flexibility. This leads to tendon injuries with weekend warrior types. In my practice, I have visited therapy centers, especially ones that are more hands on. When you have a "hands on" therapy center, more attention is placed on the patient and less on moving them around from machine to machine. At hands on therapy centers, the therapist will spend most of the initial visit going over the gait and stability of the patient and getting an idea of where the patient is weakest. The subsequent visits are structured on strengthening and flexibility. Overall, when my patients are able to visit those type of therapy centers, they are 85% successful. Most of the failures that you might see or hear about on various rotations are usually from the so called "mill machine" therapy centers. I hate sending patients to those type of centers, because yes, they don't get any better, but sometimes I'm at the mercy of insurance.

If there is a "one on one" approach to therapy, most of the time, patients get better with therapy. This is especially useful for your sports med patients, who want to get better NOW.

As far as the copays go, yes, the patients have to pay anywhere from $30 - $50/visit, but that patient also spends an hour at the therapy center and the therapy center will get a total max payment of $70 bucks (including the copay). So it ends up being a pretty good deal for the patient to get skilled physical therapy which in my patients will help speed up the healing process.

I highly recommend visiting a therapy center (not a mill machine) but one that maybe is known amongst the active crowd. If you're in AZ, PM me and I can give you the name of several in Phoenix.