People who are overweight or obese tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in their body. Reducing weight can generally help improve the healing process

Any amount of physical activity - no matter how small - is good for your patient. Acute pain can lead to chronic pain however most patients return to normal life but some will suffer persistent pain and long lasting disability.

Strategies to improve foot pain.

Pacing and spacing

Often people in pain get into a cycle of doing too much on good days and very little on bad days which results in less good days and more bad days with no improvement in pain. Most end up sitting for long periods of time, do all jobs in one go and complete all housework in one go.

POLICE is an acronym (protection, optimal loading, ice, compression and elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours. Protection and relative rest are advised immediately after injury for the first 24 to 72 hours. Optimal loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How they progress will vary from person to person depending on the injury. It is about finding the injured area's happy place and increasing slowly and gradually with their activities.

Following the pain activity ladder can identify activities patients consider severely painful, moderately painful and mildly irritating and to act to change their habits. The pain scale, most often used in healthcare, measures pain from 0 10 (zero being no pain and 10 representing the worst pain they can imagine). 

If they can identify the level of pain they are experiencing, they will find out if they are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing their activity. When completing rehabilitation exercises it is best to work within the green (and sometimes amber zones depending on what they deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If they find themselves in the red zone they are likely pushing themselves too hard and may flare up the pain.

Why do shoes matter?

Shoes that your patient uses can either help maintain a health pain-free foot or could cause increased stress and pressure which can aggravate foot pain. Poorly fitting shoes can also significantly increase the risk of falls or injury. Feet differ in size, type and shape just like footwear, one size and style will not fit all.

A shoe with a good fit will determine how comfortable it is. you can help ensure the shoe is the correct length, width and depth for their foot by:

• Maintaining a thumbs width between the end of the shoe and the longest toe

• Wearing a shoe that is rounded at the front and deep enough to allow the toes room to move

• Wearing a shoe that fits comfortably and snugly around the heel. this helps to stabilize the heel as the shoe strikes the ground. they should also be able to insert their finger between the back of the shoe and heel

• Wearing a shoe with an adjustable fastening like laces, straps with buckles or velcro. this will help hold the foot firmly in place and reduce friction.

• The ideal shoe should a thick, shock- absorbing, non-slip rubber sole with a heel gradient of no more than 1 ½” (4cm)

• A shoe with a curve at the forefoot region is known as a rocker or toe spring and can be beneficial in reducing strain in the tissues in foot during the propulsive phase of walking

• Wearing shoes that are made from natural fibres or breathable synthetic materials that allows moisture to evaporate, the upper should be soft with no hard seams or ridges

Based on NHS Scotland board’s realistic medicine strategy it’s important to listen and try and understand our patient’s problems and preferences.

Sharing decision making between healthcare professionals and your patients can be key to successful outcomes.

NHS scotland boards are encouraging people to ask about their care. questions to consider:

• Is this test, treatment or procedure really needed?

• What are the potential benefits and risks?

• What are the possible side effects?

• Are there simpler, safer or alternative treatment options?

• What would happen if i did nothing?

There are six main pillars of realistic medicine, this is to help fully understand what matters to our patients:

• Change our style to shared decision making

• Build a personalised approach to care

• Reduce harm and waste

• Reduce unwarranted variations in practice and outcomes

• Manage risk better

• Become improvers and innovators

This pillar is about ensuring we fully understand what matters to our service user and we are doing the right procedure to the right service user and reasons that to them and involved in the decision making process.

This area is to try to maximise the benefit and maximise the value that treatment for the individual.

This about ensuring our treatments are not causing any unnecessary harm to the service user and reduce wasted appointments where service users have to see another clinician.

This pillar is about reducing unwarranted variations and individual service users will need their treatment tailored to their individual needs but to produce standardised best practice.

This pillar is about minimising risk to our service users.

This pillar is about understanding staff and allowing you influence practice from new research evidence and also having new ideas to facilitate research.