Feet Don’t Lie / Heather, Pediatrician and Storyteller 

So when I was in medical school, it was really common on different rotations to have the attendings tell you totally different things, and so one of those totally different directions I got was about feet, actually, where one supervising doctor said, “Always look at the feet.” Then, on the next rotation, I was told to never look at the feet. I think the real reason behind both is that feet don’t lie. You can tell a lot about somebody from looking at just their feet.

So the first rotation that I did in medical school was in psychiatry, and it was in inpatient psychiatry evals, so people that got admitted to the hospital for a medical reason, but the team thought maybe they had a psychiatric disorder or that somehow psychiatry could help take care of the person. One really common thing that we ended up getting called for was somebody found down. So the mailman or somebody else just finds somebody laying on the floor in their house, and no one knows anything about how they got there or what happened to them. It’s really a huge mystery.

And so they would often call psychiatry, because a lot of the people would be just talking nonsense, not making any sense. You don’t know whether it’s neurological or psychiatric. Were they poisoned? Do they have brain cancer? Big mystery, and so when we would do these visits, we would always look at the feet. The attending said the feet always gave a clue unto the duration of how long people’s minds were really confused and deranged, to the point where if they had their own waste in their toenails, and their toenails were really long, then they were really unhinged for a really long time in their house, like weeks and weeks, and that probably, their problem was not going to be fixed in a one-week hospital stay. They would need long-term placement or something more longstanding.

So it was really the only part of the body that we looked at on the psychiatric rotation, was taking off the socks and looking at the feet. And so you can tell a lot. You can tell if someone’s mobile. If someone can’t walk at all and hasn’t walked in a long time, you can tell by looking at the feet. You can tell hygiene. You can tell if someone’s really depressed. You can tell their living situation. Are they unhoused? Do they have access to a shower? You can tell a lot about the feet, and feet don’t lie.

And so the next rotation I did was at the VA, and I went to school in Cincinnati, which borders Kentucky. Kentucky’s on the other side of the river. There’s a lot of poverty in Kentucky, and so a lot of the people that would come into the emergency room hadn’t really had great medical care, not great access to care. Some people didn’t have hot water in their house, actually, which is unusual up here in the Northeast where I live now, but it was not super unusual in Kentucky. And so I was kind of doing, admitting a man for, I think he had chest pain, and he was going to stay in the hospital overnight for a day or two, just to monitor him and things like that.

They always teach you as a med student, and I was bright, eager-eyed, this was one of my first patients ever, do a head-to-toe exam. So I went to take off the shoes and the socks, and the attending in the ED was just like, “Whoa, whoa, whoa, whoa, whoa. Do not look at the feet. Never look at the feet.” I actually knew this attending really well. He was a fellow who would moonlight as an attending at nights. This was the middle of the night. I think it was a weekend, and he was just a fierce advocate for his patients. He really was. He really cared. He was also, had this really irreverent sense of humor. He wasn’t saying that the feet weren’t important.

It was more that if you take the shoes and socks off, there’s always a problem to add that you kind of need to deal with during the hospital admission, but it wasn’t a problem for the emergency room. It was more, once they were admitted and on the floor, then you take the shoes off, and then you see if their diabetes is out of control, is there X, Y, Z, so … But the way he just kind of was like, “Whoa. No feet. Put the socks on,” so yeah. So you can kind of almost get whiplash doing all your different rotations in med school, because you’ll be told a totally different thing the day you switch to a whole new rotation.

So it can be really hard to suss out the rules and what you’re supposed to do and all of that. But it just kind of highlighted two sides of the same coin, that you can tell a lot from feet, and feet don’t lie. They, in particular, tell a lot about the social situation of the patient, and sometimes those things you can’t find out, really, from any other way, unless the patient tells you.