The purpose of this article is to introduce the basic considerations for patients suffering from foot and ankle diseases, and I hope it can help you, especially the foreign patients who intend to come to the clinic. I. Choice of specialty Foot and ankle surgery is a subspecialty under orthopedics, but its treatment concept is quite different from that of general orthopedics. Domestic foot and ankle surgery started very late, and there are only ten or so years of history of real foot and ankle surgeons, and there are less than three medical institutions that are really specialized in foot and ankle surgery. The current situation is that the majority of hospitals are orthopedic surgeons who also do foot and ankle, the doctor or well-known experts in the foot at the same time, he is also doing hand surgery, microscopic sewing the vascular nerve, replace the hip, nail the fracture of various parts of the body, repair the knee, deal with the intervertebral disc. Not that there’s anything wrong with that, but the subtext of being comprehensive also means not being specialized enough. Fortunately, more and more orthopedic surgeons are realizing the difference between major orthopedics and foot and ankle surgery, and appreciate that working in this field without a specialized training background in foot and ankle surgery can be very overwhelming. As a result, more and more orthopedic surgeons are choosing to go to specialized foot and ankle centers for further studies and then to set up foot and ankle specialty clinics. Specialization is the inevitable development of medicine, and understanding and choosing a specialty is necessary for patients to seek medical treatment. This topic is similar to the above, in fact, when choosing a specialist, the patient is choosing a doctor. The reason is that we often encounter such a patient in our clinic: the foot and ankle disease has caused him to transfer to all the major hospitals in the capital, and when he comes to the clinic, he has four or five medical records in his hand, and he will turn them over to you one by one like a treasure “I have been to XXX academician of XX famous orthopedic hospital, he said 。。。。 I went to XXX famous orthopedic specialist, he said. Later, I asked someone to register with XXX famous sports medicine specialist, he said my deformity 。。。。 ; I also saw a XXX minimally invasive specialist, who advised.” , finally this patient concluded, “So many famous doctors have seen, but there is not a common statement, my head is big.” Yes, encounter such a situation, not only the patient his head big, the doctor after listening to the head even bigger! Here I just want to say one thing, yes, XXX academician is very famous, he is our teacher’s teacher, the predecessor of the predecessor, but he does not do foot and ankle; XXX expert is also very famous, but the problem of your foot is completely beyond the scope of minimally invasive treatment. What tests are needed for foot and ankle diseases, X-rays, CT, MRI? More than half of our patients come from overseas, and about 90% of them have a history of treatment in foreign hospitals. We often encounter patients who bring CT and MRI, but not X-rays, because they think CT/MRI is more advanced than X-rays. The point here is that X-ray is the most basic, visual and general examination, and its role is irreplaceable. Especially for patients with a history of previous trauma or surgery, previous X-rays are a valuable reference for current treatment and must be brought along! There is also a situation where the patient has finished the X-ray, CT, and MRI in the field or outside the hospital for the convenience of this visit, thinking that this will save the time of the visit. In fact, this is not true. When we come to the clinic, we will find that firstly, the examination site is wrong, secondly, the angle of projection is wrong, and thirdly, the scan quality or the technologist selects the wrong range of films (CT/MRI), so although there are a bunch of examination results in hand, there is very little valid information that can be extracted from them. Therefore we have to reissue the checklist. For foot and ankle diseases routine X-rays must be taken in weight-bearing position, that is, standing up, rather than sitting or lying down. This is because weight-bearing radiographs can reveal more problems such as joint space narrowing, bony impingement, and joint instability. For example, there is a group of bunion patients who do not actually show bunion under non-weight bearing because of lateral instability of the metatarsocuneiform joint, but have very severe bunion under weight bearing. In another group of patients with reversible flatfoot, the arch is good when non-weight bearing, but once weight bearing, the arch collapse is obvious. This is why foot and ankle surgery requires a weight-bearing x-ray. In addition, depending on the specific disease, additional films of the oblique position of the foot, heel axis, seed bone axis, stress position and other positions are optional. Therefore, it is recommended that if the patient does not have previous imaging data, then he or she should come to the clinic first and then have an examination. I seldom prescribe medication to patients in the clinic, and if I do, the most common medication I use is anti-inflammatory painkillers. Because many foot and ankle musculoskeletal system diseases in the acute stage of the application of non-steroidal anti-inflammatory drugs or very good effect, not only pain relief and anti-inflammatory effect. And for those who ask to prescribe blood activation medicine, foot soaking medicine request, I always smile and refuse. More often than not, an ice pack or a tub of hot water can bring the same physical therapy effect. Fractures or soft tissue injuries have a natural repair process that cannot be significantly shortened by medication. Of course, for cartilage damage I would recommend the application of glucosamine sulfate or hyaluronic acid to protect the joint cartilage, which is still more effective. V. About physical therapy Physical therapy is a discipline that has a surprisingly useful role in the conservative treatment and perioperative intervention of many bone and joint diseases. It improves circulation, promotes growth, and controls inflammation. But only if the physician is clear about the principles and indications of the various physical therapy modalities. Sadly, the current situation in China is that many doctors and most patients see physical therapy as a “panacea”, and after various interventions have been done with poor results, they will say “let’s do physical therapy” when they really have no choice. In fact, at this time, the person does not actually understand physical therapy and does not have much hope. Not all patients are suitable for ultrasound, and not physiotherapy is the same as Zhou Lin spectrum or medium frequency. This is the eternal principle of dialectical treatment. Sixth, about minimally invasive minimally invasive, in fact, is a good thing, but in the current Chinese it is used badly. The status quo is that very few people understand the real minimally invasive, and very few people can really do it well. The minimally invasive that is currently flubbed in the market is either inactive or superficially minimally invasive but actually massively invasive. Minimally invasive, on the other hand, is not a panacea. Many complex foot conditions, especially complex bunions, do not lend themselves to minimally invasive treatment. It is the expanded application in unsuitable cases that creates so many unmanageable complications. Again, minimally invasive is not a problem, but the abuse of minimally invasive becomes a problem. Seven, about closed injection Closed is for the pain of osteoarthritic system diseases in the local injection of anesthetic drugs, steroid hormones, or a mixture of the two. Its pain relief and anti-inflammatory effect is very good. As always, closure is a good thing, but it should not be abused. In terms of treatment, it can be applied to chronic inflammatory diseases of soft tissues, but care must be taken not to hit the tendons when injecting, especially multiple injections can easily cause tendon damage and rupture. For osteoarthritis, the short-term effect of injection into the joint cavity is also very good, but it cannot be repeatedly applied for many times. Another important application of closure injection in foot and ankle surgery is the role of differential diagnosis, which can play a very good role in aiding diagnosis by observing the effect of injection at the suspected lesion site with a high accuracy rate. Closure is not terrible, and when applied appropriately, it can receive very good treatment effect.