Why Treating Symptoms Of Foot Pain Is Not Always The Right Thing To Do
By Dr. Robert Kornfeld
Every day in every city, people visit doctors for a variety of ailments. In many cases, the patient is aware of the problem before the doctor. They are experiencing symptoms that alert them to the problem and then the next step is to visit the doctor. Once at the doctor, the symptoms and history are used to create a differential diagnosis (meaning the most likely conditions causing the symptoms). Tests may need to be done to confirm the doctor’s suspected diagnosis. Once confirmed, treatment begins to relieve or suppress the symptoms. This is the basic model that most doctors in America follow. What is missing from this paradigm is, in my opinion, the most important thing to consider. And that is, what mechanism(s) has caused this condition? It is critically important to find the reasons why a patient has a diagnosable condition. More important than actually treating the symptoms.
Finding the actual mechanism of pathology is the only way to not only stop the symptom complex from worsening over time, but to actually prevent other health challenges. Identifying the mechanism and correcting it will also leave our patient healthier than when they arrived with their chief complaint(s). So how exactly does this work?
As a doctor who specializes in treating chronic foot and ankle pain for well over 35 years, it has been my experience that there are many reasons why patients develop pain syndromes that seem to not respond to conventional therapy. For example, when we treat a chronic inflammation, we must understand how and why this happens. Plantar fasciitis (inflammation of the arch supporting ligament) is a common condition that I treat. Many of these patients wind up in my office after seeing several doctors. Many of them have been given cortisone injections or prescription anti-inflammatory medication. While this approach can help some patients, it definitely does not help every patient. It is important to understand that inflammation is a directed response by the immune system. There are 2 main types of inflammation – primary inflammation (the pathway that fosters detoxification and repair of injured cells) and chronic inflammation (the pathway that protects cells that the immune system is struggling to heal). Cortisone and anti-inflammatory drugs are designed to suppress inflammation, thereby relieving that pain. Unfortunately, these medications are not pathway specific. They will not only suppress the chronic inflammation (which is the pathway causing pain), but will also suppress primary inflammation. What does this mean? Simply that the medication is suppressing the body’s ability to detoxify and repair AND protect the injured cells. This can actually foster a chronic problem by blocking the repair of the tissues that are injured.
But wait a minute. I did say earlier that some patients are helped by these medications, didn’t I? Why isn’t everyone? That is the stuff of understanding mechanisms. Since the immune system is in charge of the healing capacity of the body, what can affect the immune system in a way that makes it so hard for some people to heal? That answer is not simple, but I will break it down into its simplest form. We look at many possibilities because so many things can affect the immune system.
In my specialty, we first must look at the biomechanical influence on the symptom complex. This means identifying any contributory factors in the patient’s lower extremity structure and function. Once identified, a plan of exercise, stretching, and corrective orthotics is prescribed. Once this is accomplished, if the condition persists, we look for burdens on the immune system that make the body’s ability to heal impaired. This may have to do with poor diet, lack of hydration, stress, insomnia, toxic chemicals in our air, food and water and impaired pathways designed to foster homeostasis (efficient functioning of the human body). Things that affect these pathways are hormone and neurotransmitter imbalances, vitamin and mineral deficiencies, food sensitivities, lack of adequate sleep, relationship and financial stresses, lack of exercise, obesity, parasitic infestation, infectious diseases like Lyme and Babesiosis, mercury and other heavy metal toxicity and the list goes on. Evaluations for each one of these possible underlying mechanisms may need to be done to get the patient healed. Of course, we test for what is most likely first. I personally do not believe in “kitchen sink” lab testing.
We basically need to improve the patient’s epigenetics (diet, lifestyle and environmental factors influencing their genes). This requires educating the patient so that healthy choices and lifestyle habits are fostered over time. When we manage a patient this way, we can then utilize safe, natural medicines that support a healthy immune response so the body can heal. When we work to support natural physiology, we do not see side effects. When we work to suppress pathways with medications, we will see side effects as the body works to circumnavigate the blockade. Drugs do not foster improved health. But treating mechanisms and supporting the body does. In addition, some therapeutic modalities may be employed to improve microscopic circulation to the involved tissues. The amount of blood being delivered to an area of injury is the primary determinant of healing.
This goes against the instant gratification model. There is no “magic pill” for chronic conditions. It must be a methodical, well thought out approach. Patience and time will ultimately give us the best long- term resolution to chronic suffering. In the process, we not only relieve that condition we are treating, but we change lives for the better.