Is Manual Examination Of The Foot A Dying Art?

Things change with time. My favorite television show in grade school was The Man from U.N.C.L.E. The first car stereo I installed in high school had an eight-track tape player. My first computer purchase was an Apple IIe with dual floppy drives and no hard drive.

   If you have been around for a few decades or more within the podiatric profession, I bet you have all noticed changes within the clinical skills of podiatric physicians. Some of these changes are good and some are bad. New technology has greatly enhanced our ability to diagnose and treat certain conditions. However, along with these positive changes brought on by advances in technology, certain changes have also occurred within our profession that I believe are negative.

   A good example of the potential negative effects of increased technology came to light in my office just two weeks ago when I was seeing a patient for a follow-up consultation. I had first seen this patient over a year ago for a consultation when I provided a diagnosis and treatment plan for a work-related injury to her foot and ankle. When I walked into the examination room, the patient was full of smiles and said she was very happy to see me since I had helped her so much when I last saw her.

   With my curiosity aroused, I asked how I had been so helpful to her during our first visit over a year ago. She said, “You were the first doctor, including the one physician and one podiatrist that had examined my foot prior to you, that actually touched my foot. You were the first to properly examine me and give me a proper diagnosis.”

   I was somewhat shocked by my patient’s comments about her doctors not touching her foot to examine it. However, upon further thought, I had been hearing these types of complaints from patients with increasing frequency over the past few years. Many doctors, including many younger podiatrists, are relying less on manual examination skills and more on diagnostic tests to diagnose and assess their patients’ injuries.

   It is not uncommon for me to hear comments like, “The doctor never touched my foot and seemed more interested in staring into the screen of the laptop computer to fill in the chart notes than in examining my foot.” Another comment I frequently hear is, “The doctor looked at my X-ray and MRI scans, and read a few chart notes, but never really examined my foot.”

   It was not like this when I was a young podiatrist. My professors emphasized manual examination of the foot throughout my podiatry school, residency and fellowship years. We learned how to examine the foot manually for pulses and skin temperature. We learned to perform tests for proper neurological function. We got instruction on palpation of joints to determine swelling and/or tenderness, and how to examine joints for movement quality and range of motion. We learned how to determine the strength of the foot and lower extremity muscles manually. Most importantly, the anatomy of the feet and lower extremities received constant emphasis. I am very grateful for this knowledge that my professors passed on to me since it has made me a much better clinician for my patients.

   However, in today’s technologically advanced medical world, is the younger generation of podiatrists still learning manual examination skills and getting a sense of the importance of those skills? I do not see it. Is the increasing emphasis on performing and interpreting the latest diagnostic tests reducing the time spent teaching our younger generations of podiatrists important manual examination skills that can quickly determine a patient’s diagnosis, help assess the etiology of his or her pathology, and help monitor treatment progress? I believe so.

   Do you find yourself spending more time looking at a computer screen than manually examining your patients’ feet and looking into your patients’ eyes as you explain their pathology and proposed treatment plan to them? Has increased technology effectively disconnected the bond between you and your patient, a person who needs to trust you and be confident in your knowledge and skills? Is manual examination of the feet becoming a “lost art”? I hope not.

   Things do change with time. However, not all change is good for our profession or our patients.

   Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.

   Dr. McCord retired in December 2008 from practice at the Centralia Medical Center in Centralia, Wash.