Miller W E
Clin Orthop Relat Res. 1977 Mar-Apr(123):55-9.
A conservative approach to foot problems is especially useful in patients with diabetes, rheumatoid arthritis, diminished circulatory changes, and those who are too debilitated for surgical treatment. If one will start with either the medial heel wedge or the anterior heel correction, some response should be evident within 4 to 6 weeks. If the response after a trial period of approximately two to three months for a heel wedge or another two to three months for the anterior heel doesn't relieve pain, then perhaps some other problem might now become easier to localize, i.e. Morton's toe syndrome, hallux valgus, soft or hard corns, or hammertoe deformities. When the anterior heel is prescribed many foot problems other than metatarsalgia will stop being symptomatic and surgery treatment can be bypassed. A physician must know about the supply of shoes in the community and, if necessary, instigate a better inventory of available shoes. In addition, it is necessary to establish good rapport with the shoe repair man so that he will not intrude in your patient rapport or alter your directions. Patients also need advice about losing weight. Frequently a loss of 15 or 20 pounds will change a patient's complaint from one of extremely discomforting daily weight-bearing to a tolerance of a fair amount of walking and at least a reduction of the complaints to a more endurable and functional level. One can't expect the shoe correction to do everything for everyone. The anterior heel isn't the whole solution to the complicated problem but it helps to have patients begin to see results in more comfort in their shoe wear.
对于足部问题采取保守治疗方法，对患有糖尿病、类风湿性关节炎、循环系统变化减弱的患者，以及那些身体过于虚弱而无法接受手术治疗的患者尤其有用。如果从内侧足跟楔形矫正或足跟前部矫正开始治疗，在4至6周内应该会有明显的反应。如果在使用足跟楔形矫正进行大约两到三个月的试验期后，或者在足跟前部矫正另外两到三个月后，疼痛仍未缓解，那么也许现在更容易确定一些其他问题，即莫顿趾综合征、拇外翻、软鸡眼或硬鸡眼，或槌状趾畸形。当开了足跟前部矫正的处方后，除了跖痛症之外的许多足部问题将不再有症状，从而可以避免手术治疗。医生必须了解社区内鞋子的供应情况，如有必要，促使对现有鞋子有更好的库存。此外，有必要与鞋匠建立良好的关系，这样他就不会干扰你与患者的关系或改变你的指示。患者还需要关于减肥的建议。通常，体重减轻15或20磅会使患者的抱怨从每天负重时极度不适，转变为能够耐受相当量的行走，并且至少将抱怨减少到更可忍受和更具功能性的水平。不能期望鞋类矫正对每个人都能解决所有问题。足跟前部矫正并不是复杂问题的全部解决方案，但它有助于让患者开始在穿鞋时感受到更多舒适，从而看到效果。
