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Hi All

Can anyone explain the reason why some or many patients cannot or will not
relax their feet and legs when on the podiatry couch.

"I am relaxed" or "ooh! I'm not one for relaxing" they say as their feet are six inches off the couch. It is very difficult to manouver their feet to the position required and mobilisation is impossible.

Are there a physiological or psychological reasons for this you could explain so that I may better understand my patient.

They need a valium or maybe some Entonox would do the trick (joke)

Cheers Dave Smith

Dave

I have no idea what causes this but have a feeling it is psychological.
In addition, whenever I get a patient like this I will choose softer materials for my FFO's to help with compliance. These patients seem to have more issues with orthotic wearing in times and compliance with the actual orthoses is diminished.
I also do the same with people with ticklish feet - its a bit of hocus pocus but anything to help with compliance is always useful.

Phil

with mine, it's unadulterated fear, yours truly, mr "dressings"

If I have a pt who 'can't relax' or stays stiff while I'm trying to move their feet or mould silicone/formies etc, I ask them if they are breathing normally-you'd be surprised how often that works!
Ticklish pts I just enjoy torturing-gotta get some lurks and perks from your job!
Mahtay

__________________
Cheers

Mahtay

"Time Wounds all Heels."

I have noted that many older individuals, over the age of 60, have more difficulty relaxing than younger patients. If you can get them to lie down flat on their backs, this often helps them relax.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hello all

Thanks for your replies. Is it just me or do others get a bit cranky with these patients (only in my head not to their face). This both an amusing subject and a serious one (well not too serious) Sometimes I can get so hacked off with a patient that has rigid feet and legs. When doing Chiropody (remember that) especially when using a scalpel it is really neseccary to stretch the skin by manipulating the joints of the foot. If the patient has their feet curled like a spineless hedgehog (its like a small stubby spined porcupine) you need the grip of hercules to straighten it out. After 2 mins my thumb joints are aching and and I just want to swear at the twat in the seat. I smile and make soothing noises instead, he relaxes, but as soon as my hand is within a millimeter of his foot its hedgehog time again. Or there is the other type who fully pronate/evert their foot like its trying to escape from its connection to the ankle, there's others who full supinate/invert as if their feet would like face each other to have a cup of tea and a chat. Then there are the levitators who's feet gradually progress towards the ceilling. "Relax Mrs Brown". "Oh I am relaxed" "but your feet are in the air" "well I feel like I'm relaxed". "well do you go to bed with you legs in the air" (I meant go to bed to sleep, not the other thing, you dirty boys and girls). So while I could just get quite frustrated with these patients I would rather understand why it is not possible for them to relax and perhaps find a solution. Kevins idea about laying flat makes sense as I've not noticed anyone has been stiff when laid flat for biomechanical exam pruposes. But I don't know if Chiropody patients would go for a supine position, it's not what they expect. Perhaps just a large tilt on the back rest would do it. I'll let you know.


All the best Dave

you might want to consider slipping yourself a cheeky valium there my friend

__________________
malpractice makes perfect

Andy

Yeah you might be right, I've just taken sixz
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well relaxed - sweet dude:zzzzz: