Management of Bilateral Feet Degenerative Changes
The recommended first-line management for bilateral feet degenerative changes includes podiatry assessment, custom orthoses or insoles, and appropriate footwear to reduce pain and improve mobility. 1
Initial Assessment and Conservative Management
- Refer for podiatry assessment, treatment, and monitoring to minimize pain while walking and to evaluate the specific degenerative changes observed in both feet 1
- Consider patient-specific insoles and appropriate footwear as the primary intervention to reduce pressure on affected areas and improve foot function 1, 2
- Implement a multidisciplinary approach including podiatrist, occupational therapist, and physiotherapist to address pain and maintain mobility 1
Orthotic and Footwear Recommendations
- Use custom foot orthoses to redistribute pressure away from painful areas, particularly for the forefoot degenerative changes and calcaneal spurs identified in the imaging 3
- Select footwear that is firm and comfortably fitting, with appropriate length and width, a rounded toe, and a flexible flat sole with heel support 1
- Avoid tight-fitting or high-heeled shoes which can exacerbate foot pain and deformities 2
Specific Interventions for Identified Conditions
For Calcaneal Spurs and Enthesopathy
- Apply shock-absorbing insoles to reduce pressure on the calcaneal spurs 1
- Consider a heel cup or cushion to alleviate pain from the plantar calcaneal spur 2
- Use gait analysis systems when available to assess walking pattern and evaluate therapy effectiveness 1
For Forefoot Degenerative Changes
- Implement metatarsal pads or bars to alleviate metatarsal pain and redistribute pressure 2
- For bony spur at the base of the distal phalanx of the big toe, consider toe spacers or padding to reduce pressure and friction 2
Pain Management
- Apply ice therapy for 10-minute periods through a wet towel to reduce acute pain and inflammation 1
- Consider topical or oral NSAIDs for pain relief, particularly for acute inflammatory episodes 1
- For persistent pain despite conservative measures, consider referral for further evaluation of injection therapies 1
Monitoring and Follow-up
- Schedule regular follow-up appointments based on symptom severity, typically every 3-6 months 1
- Monitor for changes in pain levels, mobility, and development of new deformities or complications 1
- Assess the effectiveness of prescribed orthoses and modify as needed based on patient response 3
Long-term Management
- Implement exercises to strengthen intrinsic foot muscles to help maintain foot function and prevent worsening of deformities 4
- For patients with significant disability despite conservative management, consider surgical evaluation, though conservative approaches should be exhausted first 5
Common Pitfalls and Caveats
- Failure to address footwear issues can undermine the effectiveness of orthotic therapy 1
- Inconsistent use of prescribed orthoses may lead to poor outcomes; encourage regular use for optimal benefit 5
- Neglecting to monitor for diabetic complications in patients with decreased bone mineralization can lead to missed opportunities for early intervention 1
- Overlooking the need for regular debridement of hyperkeratosis (callus) can result in increased pressure and pain 1