The cost of prevention vs. the cost of doing nothing.

Daniel Graham

Daniel Graham

Podiatrist at Podiatry First

“I never thought it was bad enough to do something about it.”

Usually when a patient books in to see me for the first time, it is because an issue has developed and more common than not, it has been occurring for some time.

“I just thought it would go away”

So many issues can be avoided if we simply have issues addressed as they arise.

For this article I would like to use Lisfranc injuries as an example. The warning signs for a potential Lisfranc injury can be as subtle as slight aching in the midfoot after running. Whereas, the end result is a trauma that requires surgery, followed by lifelong pain.

Interestingly, the Lisfranc (tarsometatarsal) joint was coined after Jacques Lisfranc de Saint-Martin (1790-1847), a surgeon of the French Napoleonic era. He was a field surgeon during the French Revolution and often had to remove gangrenous limbs. Saving effort and time he would utilize the tarsometatarsal joint to amputate the forefoot following injuries often sustained from falling from the saddle with a foot stuck in the stirrup. These days an injury to this area (the apex of the arch) is referred to as a Lisfranc injury.

How to recognise there may be an issue.

The Lisfranc joint is basically where the smaller (tarsal) bones in the foot articulate with the longer (metatarsal) bones. One of their roles is to provide support and stability to the foot throughout midstance and propulsion. As we move over the foot and push off these bones create an arch that proves as a rigid lever for propulsion.

When the foot is not functioning appropriately this area often “collapses” and results in malalignment and increased forces through the arch. Subsequently, increased tensile stress is placed through surrounding tissues and load patterns are changed. Unsupported, this can lead to pain and increases the risk of serious injury resulting from direct or indirect trauma.

In this instance we can see that pain through the midfoot or arch may be an early warning sign that something is wrong.

But how can this become costly?

The abnormal function and stress in this area leads to instability, placing the foot at risk of trauma. Throw in a direct or even indirect trauma and the increased loads can result in dislocation, fracture, compartment syndrome, osteoarthritis and severe deformity.

Now although a severe Lisfranc injury does not require amputation, it does require surgery for stabilization.

This is where the cost starts to come in. To fully investigate a Lisfranc injury we need to assess the area in question via CT scan and/or MRI. Once confirmed, surgical stabilization is required. This can not only add monetary costs but there may also be additional costs in the future such as chronic pain.

The studies are pretty unanimous that following Lisfranc injuries the onset of osteoarthritis begins as early as 2-3 years and subjects may require multiple arthrodesis throughout their lifetime and they never go back to normal.

We could continue to discuss subsequent emotional costs and reductions in quality of life, however I think this is sufficient to demonstrate my point.

“It will be alright”

Even if it is just a niggling feeling and “nothing major”, a simple assessment could save you a whole lifetime of physical, emotional and financial strain.

Now obviously I have used this example as it goes from one extreme to the other but there are so many issues that can develop from something that may seem of no real importance; knee arthritis/replacements, hip arthritis/replacements, herniated/bulging discs can all start with that “little niggling”.

“If only I had of found out earlier”

If you have that little something that you have just been leaving idle, come in and have it checked out before it becomes an issue. I am definitely not the first person to ever say PREVENTION IS BETTER THAN TREATMENT!

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