GIVE UP THE SHOES??

It was almost 1500 and I was getting tired doing my “time” in the family practice office. I only had a few weeks left to go and more than ready to end the preceptorship. I looked at the sheet to see who the next patient that needed to be seen was and their chief complaint. It read, “Painful right knee and foot.” I looked at the age of the patient and saw it saw a 52-year-old woman who had no significant medical history. It was time to go into the exam room to meet the patient.

I lightly knocked on the exam room door. When I walked into the room I saw a somewhat attractive woman sitting on the fake leather bench flipping through a magazine. She had long black hair which was curled, had too much make-up on her face, long polished finger nails, a very short skirt, and a tight blouse. What caught my eye were her shoes. She had three and a half inch thin high heels which looked too small for her feet. Her toes looked like she had to grease them to get in the shoes because I thought I heard them screaming for mercy. It was more than apparent this patient did not like the aging process and still dressed like she did some twenty years ago. Even before taking her history I knew what her problem was with her knee and foot. The shoes!!

“Hi Mrs. M. I am the nurse practitioner student who will be seeing you today. Can you tell me what brought you into the office today,” I said as I sat on the roller stool.

“Well, my right knee and foot have been hurting. They really have been bothering me lately,” said Mrs. M.

“How long have they been bothering you?” I asked writing down her history.

“For the last several months. They just haven’t gotten any better,” she said.

“Is their any particular time of day they hurt more than others? Or do they hurt all of the time?” I asked.

“They seem to hurt more during the day than at night. But I don’t know why they still hurt. It is really starting to interfere with my day,” said Mrs. M. I looked at her poor toes stuffed into the too small shoes. I wondered if they would need to be resuscitated.

“Have you taken any medication or done anything that has made the pain better?” I asked. I thought I heard another toe scream in pain.

“I tried Motrin and it seems to help somewhat. But why do they hurt all of the time now? At some point they should stop. Shouldn’t they?” she said.

“What kind of work do you do?” I asked.

“I am a secretary,” she said.

“It says here you do not take any prescription medication or have a history of knee problems?” I asked.

“No. But the pain in my knee and foot have not gotten any better so I thought I would get an x-ray or something. There has to be something wrong,” she said. I thought I heard a toe scream its last breath.

“Okay. Please sit on the exam table so I can look at your knee and foot,” I said. Mrs. M. got up and sat on the exam table. I palpated her right knee and asked her to take off her right shoe. As she took off the shoe I thought I heard a sigh of relief. The toes got a chance to breath. As she took her foot out of the shoe I stood there and tried to figure out how they got in there in the first place.

I palpated her right knee, right foot, and listened to her heart and lungs. I could not reproduce the pain in either her knee or foot. There was no deformity, swelling, or bruising. I concluded Mrs. M. needed to get different shoes. Once I finished my exam Mrs. M. sat back down on the fake leather bench. I sat on the roller stool.

“To be perfectly honest I think the problem with your knee and feet are the shoes you are wearing. The heels are too high which can stress your body and put it out of alignment. Plus they look kind of snug and that might also be contributing to your pain,” I said. I knew that advice would not go over well and me, the nurse practitioner student, would be thought of as an idiot who should be working at the local McDonalds.

“No my problem is not with my shoes. I have been wearing shoes like this for over twenty years and have had no problems. It has to be something else,” said Mrs. M. as she crammed her right foot back into the shoe tomb.

“If you could wear flatter shoes for a while you may find your pain may decrease,” I said. I wanted to tell her to get rid of the heels because eventually other things would begin to hurt. But that would sacrifice fashion image over body mechanics. What was I thinking?

“No. I have worn high heels for over twenty years. There has to be something else,” she said getting agitated with the nurse practitioner student. (Yes, once again my work was done. I have ruined another life by telling them they should wear flatter shoes. Maybe the fashion police will come and get me one night. I will go to hell!)

“But you are getting older and our bodies tend to act differently than it did when we were twenty,” I said. (How many times do I need to give this aging speech?)  She sat on the bench obviously wanting anybody but me in the room.

I knew this conversation was getting nowhere and Mrs. M. was not very happy with me attacking her shoes. I excused myself and went out to talk with my preceptor.

After discussing Mrs. M.’s history she agreed with my analysis of the situation. She had not seen the high heels but I knew once she saw the poor toes shoved into the black tomb she would see my point.

We walked back into the room and my preceptor had her first vision of the shoes I had talked about. I wondered if she heard the toes screaming. My preceptor once again reiterated what I had already told Mrs. M. Mrs. M. wanted nothing to do with giving up her one size too small high heels. Even after repeating herself, the patient wanted nothing to do with giving up the heels. She walked out of the office not very happy and I was sure she would make another appointment in another provider’s office who would tell her…”Yes, the heels are good. They could not cause pain. Damn those other providers who shunned your wonderful high heels.”

Once 1700 arrived I thought about Mrs. M. I knew she wanted to look good which included wearing high heels. But what she needed to understand was as we get older it may cause problems that may not have happened when we were twenty. Aging is inevitable. In reality the thought of aging was sometimes painful and fought with every step. Never give up the shoes and live with the pain!