Thursday, December 23, 2010

Feets, Do Yer Stuff!!

Last day of work till next year - yee-haw!!! I've been thinking about this blog for some time now, and wondering what I can do to get more of you to share your own experiences. I thought, "Self, how about monetary incentives?" And I responded, "Well, Self, you got squat, so how do you plan on doing that?" And I was all, "Why you gotta rain on my parade?" And I was all back, "Cuz rains all we got right now, fool!" I do that sort of thing to myself now and then, especially when I'm off my meds, er, chocolate. So if I can't pay you to jump in and share, its back to the drawing board.

I know from other discussion groups and blogs out there that there's lots of sharing among parents of tykes with club feet, and that's as it should be - they get so little real information that sharing is their best option. But us adult clubbies, well, we're another story. I saw a photo of myself at about three, with my Mom looking at my feet, encased in another set of casts. I saw her worry, and her confusion, and wondered how she did it with so little support. She wasn't just worried about my feet and comfort in the present moment, but saw and felt the road I would have to walk through my life and wondered how I would fare, and hoped every day she was making the right choices. That all of those choices were framed and pressed on her by a small handful of medical folks, whose knowledge and skills she had no way of verifying, or putting into a comparative context, meant shear trust was her only real option.

I am of course grateful for all her efforts on my behalf. But I can't help but wonder how different parents facing these same questions today will cope, given the much broader scope of support and information available, especially on the Internet. But one way they are no different at all is they, too, must trust how the choices they make now will affect their child as they become adults and walk the road of their lives. That is one part of why I continue this site - not to say each child will face the same trials many of us older clubbies have, and continue to do, because each case turns out different, and there are many successful outcomes - but I do this for those that are less successful, because even with Ponsetti, and other advances, there are still failures of the process, and each one still has to walk through their own life. I just don't want these clubbies to feel as alone and in as much pain as I and many others have. I hope to provide that information and support that wasn't available to me.

But I can't do it alone, first because I don't have all, oh, hell, I don't have very much at all, of the answers, and second, because support takes many people sharing their triumphs and ongoing problems with others walking a similar road. What worked for you might make a real difference in someone else's life, and vice-versa. And what remains a difficulty for you may help other clubbies know their own pain and experience isn't only theirs to bear. I have to think that the best incentive is in fact your own life experience, and hope in this next year many of you folks around the world with post-club feet find the courage and time to open up more, share resources and ideas, commiserate and cajole where appropriate, and make 2011 a better year for clubbies everywhere.

Happy New Year to you all.

Monday, December 20, 2010

Holiday Cheer, or, How to Kiss Under Holly When Your Feet Are Screaming

My sweet Patootie likes to dress up the place for the Holidays, so as you probably can guess, I am the one who gets to do the work - lights, tree, etc., etc. I get to take it down and repack it all, too. It's gotten to the point where I'd like to design a house with built-in lights that can be exposed and turned on by the push of a button, so I don't have to keep up the seasonal discomfort associated with all that cheer. As you might imagine, I get to wear two hats this time of year - Sandy Claws, and Grinch. I think I'd trade them both in for one of Druid in Cave, at least for one year, a vacation from the day before Turkey till the day after the New Kid on the Block drops down the chute. But I regress...

My office held its annual Holiday blow-out, this year as a moving feast, er, drunken revel, going from one place to another. Despite the generous libations, it did not suffice to anesthetize my screamin' doggies, so I never made it to the last venue. Fortunately, I had an appointment with my massage dude the next afternoon, and after an hour of twisting and shouting, I was nearly normal. Which in and of itself barely attests to my over-all state, but nonetheless, it will have to do for now.

I know there are many others out there who have similar limitations, who must plan each step. Over the years, the actual "standing/walking/dancing" time allowed has shrunk, and today is far more limited than I'd like, but there it is, isn't it? And no matter how many times I ask Sandy Claws for a new bike (euphemism alert) for Christmas, I'd be more likely to get a case of matzo for Hanukkah (I am very ecumenical, for a staunch Implementarian (we worship hardware stores and garden centers - don't worry - we don't proselytize - we don't even extemporize. We just get the job done.) But the good thing about the Holiday section of the year - I can up the meds in the name of good cheer. Can't you see how much bigger my smile has gotten? :-)

Well, I may or may not update again before the tree dries out, but in case I don't, have a Very Merry Whathaveyou, and a Happy Blue Cheer, in the flavor of your choice. Make mine Cherry Garcia.

Monday, December 13, 2010

Prolo el Mano-e-Mano, Dont Count Yer Chickens, Izhak!

Another prolo session this past Saturday. Things seem still on track. But last Wednesday, went to the regular doc, who ordered some blood tests, due to my overall fatigue and aching joints. Been going on about a month or so, maybe a bit longer. So today got a call from Doc - everything came back negative......except - positive for rheumatoid arthritis.

Lovely.

And the various meds all have some really fun side effects.

I hope scotch isn't contraindicated.

Wednesday, December 8, 2010

Ouch! It's Like That

People who suffer from chronic pain have a difficult time understanding why people who don't, just don't get it. It's not like we like to be in pain, nor as though we all secretly desire to be addicts, or that we love to complain. No, no, and no to all of the above. But the truth is, chronic pain is the perpetually unwelcome guest. We didn't invite it, we're tired of feeding it, and we can't get it to leave. And people who do not suffer from chronic pain may from time to time experience pain, well, for them, it soon goes away. Their reality is that pain is an inconvenience. For those with chronic pain, its a never-ending intrusion, an endless interruption into the lives they would rather be leading.

Imagine never having a day when you don't have to be interrupted by some part of your body. You can never just focus on your play, your work, your enjoyment of the moment, because there is always this other thing, this monster under the bed. Go ahead, try to imagine it, I'll wait..... So, if you have never suffered from chronic pain, you probably couldn't achieve the requisite level of dark outlook, and all that attends thereof. It's OK, we know you couldn't do it. The fact is, we wish we couldn't do it, as well. But those of us who do suffer in this manner need to be patient with those who are free from such a constant encounter with pain. They really don't get it. It is what it is.

But the impact of chronic pain can affect those who live with us, work with us, and often have grown tired of playing with us, because our limitations are upsetting and a drag. I mean, lets be honest about this - handicapped people are not as much fun as people who are up for a marathon, or sky diving, or a serious set of tennis. Its not that they can't do these things, its just that they do them, well, slower, or more differently than we, the able-bodied, pain free folks would prefer. I get it, really, I do. We cramp your style.

But here's the irony, if you will. When the unfortunate happens to the presently able-bodied, its far more likely to derail them than it does with those of us who've been a long way down Hurting Road for a long time. We are better able, most of the time, to dealing with our situation, because we've had the practice. Hey, its the one advantage we have, so buck up. What makes you so upset - you didn't think you would be immune from the vagaries of the human condition, did you? Oh, I see. Well, that must be tough for you.

We who understand are left to wonder - why are you complaining so much? Get over it. Isn't that what you always say to us?


Friday, December 3, 2010

Prolo Update, Pain in the Neck, Herding Them Calves

Well, been away a bit, so not much to say about that, but waaaaay too much to say about everything else. The prolo seems to be holding on the right knee, thankfully. But my puppies have been going through a particularly rough patch of late. Think its time for new orthotics - been wearing these for a long time, and even thought they are made from old WWII tank iron, they could use a freshener. Maybe switch to titanium, eh?

The neck fusion may need a wee bit of revision - the bottom screw appears to have loosened (but they warned me of that possibility,) and they will have to go in from the back and wrap a wire around my neck. Sweet. Always thought of a garrote as something to be avoided, but what can ya do? Then again, so many people have commented about my loose screw that I wonder if I risk becoming a bobble-head.

The real issue for me currently (you really love hearing about my issues, right?) is my calves. They seem to be causing me more pain than I've ever noticed before. It makes for a feeling of weakness as I walk, and I am tending to take shorter steps as a result. It may unfortunately become a vicious circle: shorter steps mean less exercise, which leads to more atrophy, which leads to shorter steps - whew. I get tired just trying to explain it. Anyway, I keep doing research in hopes I can find even one clinician out there who has something to offer other than fusions, but little to report thus far. But stay tuned - miracles sometimes happen - the Giants, for example:-)

Well, here comes the holiday (weight-gain) season. Maybe it would help if I just kept my mouth closed? Nah - I just love pie.

Tuesday, November 23, 2010

Have a Clubby Thanksgiving, One and All!

Its a tradition in the Bumbus household to give thanks to all who impacted our lives in the previous year (except regarding politicians.) It is with that spirit that I am launching the First Annual Thanks for All The Clubby Stuff that may or may not have touched my life. I urge you, dear Readers, to offer your own where appropriate.

1. I am thankful to have pretty much recovered from a very bad knee injury and a spinal surgery. But not for the hospital food. I am especially grateful to Doc Smith, Prolotherapy Wunderkind, for needling me back to health. Way to stick it to me, Doc!

2. I am thankful for my dearest of dearness, oh She of the High Level of Tolerance (except as regards all the condiments crammed into the refer - that peeves her Mightiness mightily.)

3. I am thankful for all of the Readers of this here blog-o-mine, even those who have yet to write, comment, or throw gummy worms my way. Oh, you out there in Finland? Sorry about the weather.

4. I am thankful I can still ambulate, even if I come to resemble a fat duck more every day. At least the webbed feet add some advantage in the rainy season.

5. I am thankful that more people every day are being treated for club feet via the Ponsetti method, and that their long-term outcomes look markedly better than those of us not so fortunate. And thankful, as well, that some percentage of us not so treated had better outcomes, as well.

But mostly, I am thankful for the feedback I have received from many of you about this blog, even the several that smacked me upside the head. I don't pretend to have all the answers, mostly more questions, and having others to challenge my own assumptions is critical to helping other clubbies increase their knowledge, and hopefully, walk with a little less pain, for as long as possible.

Happy Thanksgiving to you all!



Wednesday, November 17, 2010

Another Lesson in Biomechanics, or, The Foot Bone is Not Connected to the Eye Bone

Thought I'd offer a little more insight into the inner-workings of our feet. We clubbies can't know too much, is my view, as the more you know, the better your understanding and communications will be with the docs you deal with.

Today, lets look at this whole idea of "range of motion." Simply put, this just means how many degrees of motion is available to a particular joint versus how many such a joint should have within a so-called normal range. For example - your elbow joint has a normal range of roughly 150 degrees. It would not be possible to have much more than that, as your biceps sort of get in the way. But injury can cause that amount to diminish, or someone with a very loose ligament structure might be able to hyper-extend their arms such that the amount might be greater. This is just to help it be understood that your range may be different than the "normal" range for any given joint.

This is especially true for post-club feet. And not only in our subtalar joints. The mid-tarsals, the calcaneal-cuboid, and the ankle joints will almost certainly display reduced and constricted ranges of motion. By constricted I mean that the joint might be capable of being stretched to a normal range, but in functional terms it is either too painful, or the arthritic changes make it increasingly stiffer, and thus have a lesser range available.

Now, remember - no joint operates in a vacuum - they are all working in a chain, as it were. Each joint has some level of influence on other joints, and not merely the ones on either side. The subtalar joint, as the most pertinent example, has an effect on nearly every joint proximal (further up the body) and also distally (toward the end of the foot, in this instance.) This is due to the function this particular joint plays for all phases of gait, or ambulation. Other joints, such as the calcaneal-cuboid, can influence the subtalar joint, both in its range of motion, and in its biomechanical alignments during each moment of that motion.

Here's an example: take a small box, like a box of tissues, and place it on a table. Take a small plastic cup, and place it on top of the tissue box, then place a small plate on top of the cup. Right now, everything is stable. You can shake the table, and the stack might jiggle or vibrate, but if you centered everything, the stack will probably remain upright.

Now, take a spoon, and insert the handle of the spoon beneath the tissue box, any side will do. The curvature of the spoon handle will cause the stack to tip a small amount. Now, shake the table again. The stack might remain intact, but the small plate will almost certainly shift, because you have altered the relationships between each object. Take another spoon, and insert it beneath the small cup, but on the opposite side as the first spoon beneath the tissue box. Again, shake the table. Now, you can see the instability of the stack has increased.

The place where two bones meet at a joint is called the articular space, or the articular surfaces. This is where one bone articulates - moves - against the other. The shape of each of those bone's articular surfaces is what determines certain aspects of range of motion, as well as direction and quality of motion. If, for example, there is a bone spur on or at the edge of an articular surface, it will alter the normal motion available to that joint. Likewise, alterations in tendon or ligament strength, placement, or tension (laxity, for example) will change the range and quality of motion.

Clubbies have, by definition, altered joint articulation, or patho-mechanics. Patho-mechanics is just a ten-dollar word for things not working normally. That is, they vary from "normal" biomechanic functioning. We have had our feet stretched, casted, surgerized, braced, twisted, tightly encased, and abused in myriad ways. All in service of "fixing" our feet. Unfortunately, there has never been a way to be certain, from one clubby to the next, if the articular surfaces were optimally aligned. Getting a foot to "plantigrade," that is, the sole of the foot on the ground, has been the primary measure us success with club foot treatments, and that can be accomplished without ever acquiring excellent, or even good, alignment. Add to this the action of stretching, casting, bracing, and encasing the small, growing foot. The relative strength of the tendons, ligaments, and muscles on opposing sides of the joints will nearly always be less than ideal, and sometimes downright wrong.

This is why those of us clubbies who did not have the best of all possible outcomes face an increased propensity for arthritis in the joints of our feet, not to mention ankle and knee problems. There is even cause to believe, (though no real evidence, as no studies into the question have ever occurred) that we face a higher-than-average probability for hip replacements down the line. Again, these are all a function of reduced and restricted ranges and quality of motion in some or all the joints of our feet.

I realize my posts are often depressing as all get out, and I apologize for that. But for too long, folks lie us have had to grope in the dark for answers and for better understanding of what we face, and why things just didn't work as well for us as for some other clubbies. So that is why I do this blog.

On a somewhat different note, I think I better understand why so few of you dear readers have wanted to tell your own stories. For me, its been the focus of a significant part of my work life, as well as my daily experience. Plus, I do a lot of writing, so I have few inner prohibitions about being open on this issue of being a clubby. But I suspect many of you have had what I also had - lots of negative input - teasing, maybe bullying, and the constant reminder of your feet making you "different" than your peers. So I'll try not to pester you anymore for your story. If you wish to share, it is certainly welcome, but if not, that's fine, as well. The last thing I want to be, to other clubbies, is a pressure from yet another direction.

So, Happy Thanksgiving. Enjoy the meal, and your friends and family. And thank your feet for carrying you this far, so far. It wasn't their fault, and it isn't yours. It's just what we were given, and we can't be blamed for that.

And as far as I've been able to determine, there is no such thing as an eye bone. There is, however, the occasional sharp stick in the eye, of which I have a wee bit of familiarity.

Monday, November 8, 2010

Prolo, Slobbo, Wacko - or - How I Stopped Worrying, and Learned to Love the Bum

Well, just had my next prolotherapy session, and I have something interesting to report to you, faithful reader! Its starting to work! My knees are doing better than they have in nearly a year, and my recovery time from the latest treatment was about two days. It helped, of course, that my doc used some acupuncture this time to significantly reduce the pain (helped along of course by some major pain meds prior to the treatment.) I face one to two more sessions for the knees, but the feet are just at the start of the process.

They are taking longer to recover, but then, the nerves in y feet are so hyper-enervated from decades of chronic pain and swelling that its no surprise. We are taking a slow approach, and doing a combination of regular prolotherapy, and neuro-prolo, which employs a larger number of injections, but not as deep, and with less dextrose per injection. The regular ones go pretty deep -they have to get to the inter-articular spaces to have the best chance of getting results. But if it gets similar results as I'm getting with my knees, then it will be worth the discomfort of the therapy. This stuff seems like the first real chance to see significant reductions in my chronic pain levels. I'll keep you all informed.

Tuesday, October 26, 2010

More About Muscles - No, This is Not a Tribute Column for Jack Lalane!

You may recall my post about issues related to deterioration of the muscle tissues in the gastrocnemius and soleus muscles, the muscles that comprise the calf. That there seems to be a correlation between the muscle atrophy associated with club feet, and subsequent changes later in life. Well, it appears such tissue atrophy also occurs naturally, as this abstract reveals. But it still doesn't fully explain the differences found between (otherwise) healthy individuals, and us post-clubbies. And since the only current studies related to this tissue issue appear to be done vis-a-vis cadaver studies, I suspect none of us really wants to wait for our own chance to contribute to such studies, if we have to wait that long, and be in that bad of a condition just to make it in the study. I know I don't.

It seems to me an excellent study could be accomplished through simple MRI comparisons. Recruit as many post-clubbies as you can to first have an MRI done bi-lateral lower legs, centrally focused on the calf region. Add to this circumference measurements at one-inch increments from the center of the knee to the medial malleolus (that knob on the inside of your ankle,) every one inch, bi-lateral. Finish it off with a surgical history re: club-foot Sx, and type/number of castings used for your "correction." Oh, yes - age - gotta have that, and maybe sex - we all like sex, don't we? You don't? Oh, sorry.

Now, this study would show prevalence, degree, and age/sex relationships against degree of tissue deterioration. This could then be cross-compared to the results in the above-cited study by Fujiwara K, Asai H, Toyama H, Kunita K, Yaguchi C, Kiyota N, Tomita H, Jacobs JV. in:

Changes in muscle thickness of gastrocnemius and soleus associated with age and sex.

So, any grad students out there looking for a dissertation topic? You come forward with your interest, and I'll help you recruit subjects. The nice thing is, this can be done as a collaborative effort with local orthopedists and podiatrists who already see such people who would qualify as subjects.

Well? What do you say? Any takers?

Monday, October 25, 2010

Ouch - Oh, You Know What I Mean!

Rough week. That last prolo session took a bit longer to recover from, mainly because we covered more ground, er, body surface area, I mean, that we did in prior sessions. So mostly I've been feeling totally arthritic - stiff back, knees, feet, shoulders, blah, blah, blah. If I'm sitting for as little as ten minutes, I creak when I stand up. Not too promising, ya dig? But I shouldn't really complain (well, maybe just a little) because I'm still working, still thinking, still doing my best to avoid all the hoo-haa in the nasty-political-shenanigans arena. Wake me when its over, please?

I met a young woman recently, who asked I not use her name, whose club foot has caused her great anxiety over both her mobility/activity levels, and her fashion-quotient. Athletic shoes do not make it at the clubs these days, apparently. (How did it come to this, where I hear words like "the young folk," and "what the kids like these days" coming out of my own mouth?  Sheesh. Completely over the hill, I am.) The gals like them shoes, 'cuz they know the boyz gonna dig 'em. And honestly? I have no answer for this particular dilemma. When I was still making shoes, I lost count of the number of women who would say something along the lines of, "I simply cannot wear anything with less than a three-inch heel."!!! And when I'd point out it was those three-inch heels (not to mention the 4, 5, and 6 inch variety) was more than likely the cause of their current uglified feet - all gnarly and arthritic, and pre-shaped for the pointy toes, well, they'd spit their snake venom in my eye and shout, "Just make the damn shoes and stop telling me what I want."!!

Now, they did have a point - it wasn't my place to tell them what they wanted. But, it was my place to tell them what they were likely to get, being that it was in fact their spiky pumps that made comfort highly unlikely. Women most often buy shoes for the imagined sexy punch it will give them over the competition. So much so, in fact, they seem willing to bear almost any pain or discomfort in service of that imaginary happiness. There's even a name for this "condition," - Algolagnia: sexual pleasure from pain. Note that this is different (albeit perhaps only in degree) from masochism, which is defined as the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer. So we can note the "bound," and the "made to suffer" as being the primary parts of algolagnia, with the added notion of sexual pleasure. Now, it might seem silly to make such a point of this - after all, how could something that brings pain (high heels, pinched toes) also bring pleasure? Well, if you are in fact a masochist, its a no-brainer. But for most women, the pleasure is not direct sexual pleasure, per se, but indirect, as the sight of those delicious little black pumps bring the requisite associations to mind, and thus, to the cash register.

So, let me explain the physics involved. Essentially, its plain old Archimidean plane physics - the incline plane, to be exact. If you stand on a hill, you will eventually slide downhill. Placing the foot in this kind of relationship to the ground requires the means to hold the foot in the most stable position on that "hill," which means narrow, pointed toes, to hold the foot back, and keep the heel of the foot within the shoe. The higher the heel, the tighter the toes - you really can't have it any other way, at least for the pump. Now, add laces, and you can make the toes wider, but laces are, well, let's be frank about it (unless you name is Joe) - laces are patently NOT sexy.

But for us clubbies, we either come to terms with not being sexy, or redefine what that actually means, and how we want to express that part of our very human nature. Because, like I told this young woman, you want to run the marathon of your life - that is, keep active for the course of your natural years allotted - you better stay away from steep hills. Lots of "sensible shoes" out there now look pretty damn hot, ya ask me! She just needs to quit worrying about emulating the Brittany crowd, and shoot for the Burning Man milieu.

Better tattoos, anyway.


Wednesday, October 20, 2010

Where You At, Eugene? Waaaaayyyyyy Over There

So, took a look at the visitor standings for this bitty blog, and was mildly surprised by what I found:

United States (US)642
United Kingdom (GB)125
Germany (DE)20
New Zealand (NZ)19
Ireland (IE)16
Canada (CA)14
South Africa (ZA)13
Australia (AU)8
Norway (NO)5
India (IN)4
Singapore (SG)3
Philippines (PH)3
France (FR)3
Korea, Republic of (KR)2
Russian Federation (RU)2
Denmark (DK)1
Finland (FI)1
Netherlands (NL)1
Greece (GR)1
Lao People's Democratic Republic (LA)1
Vietnam (VN)1
Israel (IL)1
Pakistan (PK)1
Italy (IT)1
Switzerland (CH)1





So first, let me thank Hillary in Switzerland - good effort, but maybe tell a couple of friends about us. In lieu of that, you can send chocolate (I am always running out of chocolate.)

And I must admit to some surprise at finding the Lao Republic chiming in, though not in any real numbers, of course, but remember, you CAN click the Translate link at the top right and get all this juicy clubbie stuff in the language of your choice. We are strictly multi-cultural here - club feet do not recognize artificial boundaries.

And Greece? Just one? Come on, you supplied us with our own club-foot god, Hephaestus. Surely we can get a bigger showing from you folks, can't we?


Nice to see the Russian federation going neck and neck with Korea. We're pulling for you, folks!

And finally, a special shout out to Finland. Love the vodka, people! Nice bottle, too!

So to all you worldly clubbies out there, spread the word. Especially you, Switzerland. You don't want to stay in that bottom slot too long now, do you? Think Matterhorn, think Alps. Just don't expect me to climb it - I'm lucky to make it up a few flights of stairs, these days.

Sunday, October 17, 2010

Gimp On Down Today! Heck, We're Givin' 'Em Away!!

OK. been a mite quiet lately from this side-o-the-fence, many good excuses, but why bore you? You aren't a tunnel, after all, are you?

So yesterday I do the 4th installment of my prolotherapy. Most painful one yet, because I took less pain meds that I should have, so my fault. But now I know with great certainty I am NOT a masochist. No way in hell do I get any jollys out of that. No siree. But now, my doc and me? We're on first scream basis. No more of those icky formalities - we just jump right in there and stick those needles where they most want to go - straight through your lowest pain setting.

Seriously, we are continuing to go deeper into the sinus tarsi region, and also along all the original surgical scar areas. Did I say tender? Oh, my. But hopefully, when the initial inflammation subsides, (two-three days or so) I'll begin to see some distinct benefits, I'll keep ya'll informed!

Heads Up

Once again, I implore each of you to pass this blog on to others with post-club feet. I know there are lots more clubbies out there, but I also know how many clubbies want it kept secret, like thats gonna make things any easier. I mean, come onnnn! Hasn't ever worked before, and I doubt very much it will ever work at all. So send 'em on in - we don't bite!

Wednesday, October 6, 2010

Take an Aspirin, and Call Sally in the Morning

In our last encounter, faithful reader, we spoke glowingly about the Subtalar Joint. So today, we will talk about what isn't really there. I mean, of course, the empty space inside the subtalar joint, better known as - wait for it - the sinus tarsi. Sounds like some high priest of the Mongolian steppes, doesn't it? You can almost hear the thundering echo off the distant mountains when you say it, right? No? Oh, well, let's talk about it, anyway, OK?

The sinus tarsi is defined by the space created between the calcaneus and talus.



When the subtalar joint loses cartilage, and compensates toward a maximally pronated position, which is fairly common in post-club feet, it is the sinus tarsi that becomes one of the primary locations for chronic pain. Usually, though not always, properly casted and constructed foot orthoses can provide a few degrees of relief by preventing the subtalar joint from reaching its end of range of motion with every step. Essentially, end of range of motion is where a given joint cannot move further in a particular direction, or cardinal body plane. An example is when you try to over-extend your elbow joint - eventually, you cannot make it go any further, unless you are trying to break it. In which case, it's probably going to hurt. Very badly.

Sometimes, the sinus tarsi can become so inflamed it is essentially "hot" all the time. The pain can be very debilitating. There are options, though each has only a limited amount of effectiveness. Orthotics, as mentioned. Sometimes, an injection of cortisone can break the inflammatory cycle long enough that the joint has time to settle down, but its somewhat hit-or-miss - sometimes it works, sometimes for only a short period, and sometimes it doesn't work at all. It seems somewhat dependent on the degree of inflammation, and the actual amount of range of motion available for the specific joint. The more motion available, the better the results.

I tend to go for the chain-reaction approach: soaks and massage, plenty of stretching of the joint in an inversion direction. Then the cortisone, and then newly casted orthotics. This last is because if you can capture the foot by casting it when it is at its most relaxed, it can be positioned better for the resultant orthotics made on that cast.

Cuboid Syndrome

The cuboid is the bone that abuts the lateral aspect of the calcaneus, and is so named because, well, its essentially a cube. It has the least amount of contouring of any other joint surface in the body, and this makes it very easy to become "subluxed." This is simply a fancy word for dislocated. In fact, the cuboid can be subluxed for a long time before anyone even knows it is the source of any pain. There are a few podiatrists, and maybe even fewer chiropractors, who have the skill to do proper adjustments to move the cuboid back into congruency. The interesting thing about these kinds of adjustments are that, when done properly, the relief is nearly instantaneous. You need to look around to find anyone whose properly trained, as foot adjustments are not in the standard curriculum of either disciplines - they are acquired through specialized training and certification.

The thing that causes the cuboid to sublux, of course, is chronic over-pronation, as this, in effect, torques the calcaneal facet of the calcaneal-cuboid joint away from the facet of the cuboid. This causes the ligaments, over time, to stretch sufficiently that the cuboid is no longer held in the proper configuration against the calcaneus. And when this subluxation occurs, it places even greater pressure on the sinus tarsi. The result? Big ouch.

An excellent description of Cuboid Syndrome can be found here.
So, next time you are hangin' with the clubbies at the Subtalar Joint, give a shout out to that old shaman, Sinus Tarsi. Just don't be downwind when he has to blow his nose.

Thursday, September 30, 2010

The Subtalar Joint, or, Everything You Never Wanted To Know About Where It Hurts

Ah, yes, the Subtalar Joint. Used to hang out there all the time, toss back a few pints, kick it with the hommies, play a little snooker. But then, it got too weird, ended up having to pay through the nose for a cheap laugh. Er, I mean, its that part of the foot of every clubbie that is usually the site of the worse pain. Looky here:


See this link!






So, the subtalar joint is the interface between your heel bone - the calcaneus, and the bone that sits on top of the calcaneus, called the talus. The talus is the bone that serves as the mortise of your ankle joint. The subtalar joint is the only joint in the body that moves through all three cardinal body planes, and thus imparts "tri-plane motion." This triplane motion is what permits the leg, and thus the entire body above, to rotate internally and externally against the foot while the foot is "pinned" to the ground. Without this ability, your other joints above the subtalar joint have to try and provide this same rotational component to your gait, which, most sadly, they cannot do. Its not that they don't want to - I'm sure even if you asked them nicely, they would have to hand their heads and tell you how sorry they are that they cannot aid you in your request. Its just that they are not "designed" to provide this kind of motion. Tsk.

So why do clubbies often have so much pain in this area? Two reasons, really. One is that due to our various surgeries and castings, we have a much narrower range of motion in our subtalar than does a normal subtalar joint. As we get older, this inadequate amount of motion begins to wear away at the cartilage of the joint, causing osteoarthritic changes, which increases inter-joint inflammation. And Voila! Pain.

Second reason - Due to those same surgeries, the various ligaments holding the subtalar together are compromised. Remember - they had to stretch one side (medial) and sometimes release (cut) some of those ligaments to get your foot/feet back into the so-called normal position. If you think about it, it means there was already damage done, even if for good reasons. Trauma cares nothing for motives - trauma is what it is.

This is why many doctors think a fusion is called for, because by stopping all joint motion, well, that joint stops hurting. Which of course is true, but... Remember what I said up there near the top? That this joint is the ONLY joint that provides this critical motion? And if you take away or limit that motion, then other joints will have to "take up the slack?" Except - there ain't no slack. What this means is that sooner or later (and mostly sooner) you have to look at a probable ankle fusion, then a knee fusion, and then, well, by then, your doctor is dreaming of giving you a voice fusion, ya dig? Essentially, you are trading one locus of pain for another. Just so you know.

This is why properly made foot orthosis and rocker soles can often slow the overall deterioration of the subtalar joint, by limiting the NEED for the joint to some degree, while permitting the gait to function closer to normal, while maintaining the subtalar joint as close to its "neutral" position as possible. This simply means to have the joint not at the end of its range of motion all the time. This can often allow you many more years of relative comfort. I say relative, because it is not a perfect solution. Its merely the lesser of two evils, in many instances.

I have had some short-term success having steroid injections in the subtalar joint, but I wouldn't recommend it for the faint of heart, or for the timid. It hurts. Like the blue freakin' blazes, let me tell you. They have to stick the needle quite a ways in there, and then the fluid has to push everything out of the way, and oh, criminy. Just one word of advise if you are planning on doing this - leave the gun at home. It's not considered polite to shoot the doctor.

I have noticed, over the years, that I get temporary relief by stretching and holding the foot back in the clubbed direction. Ironic, right? But this is one of the few ways to open the subtalar joint. Remember - the subtalar is at the end of its range of motion when the foot is maximally pronated, which is the case for most of us clubbies. By stretching the foot in a supinatory direction, you take the foot away from the end range, thereby temporarily relieving the constant pressure that causes the pain.

Of course, hot soaks, paraffin baths, hydrotherapy, hot tub jets, even ultrasound all can offer some temporary relief. But the goal should be to do whatever you can to get those puppies off their fully pronated thrones. So to speak.

We will be talking about this issue more in the coming months, hopefully with a couple of guest columns. Till then, try to stay out of the Fusion Bar and the Subtalar Joints. ya gotta cut back on the night life sooner or later. It is sure to catch up with you - ya ain't no spring chicken any more, right?

Saturday, September 18, 2010

An Offer You Can't Refuse - Well, You CAN Refuse It, But Why Would You?

Inevitably us clubbies end up at the doctor for something pertaining to our feet. And it is not all that unusual the doctor will tell you something that sounds like "well, your hornswoggle upsits is banging paltries with your shimaperatus, and doesn't look too good. You can either have three sessions of hotfreakinwhatsits therapy, or we can go in to do a series of tenopteratoron extensions, which may or may not result in partial or even permanent periastalsitic hemipleasia. Or, you could just wait and see how bad it can really get."

And you can either take this lying down, which trying to make sense of it is guaranteed to do to you, or you can demand a layperson's explanation, which may cause the doc to lay down and fall into a deep slumber, occasionally waking to ask for an ideal T-time. Or, you can take me up on my offer.

I am quite willing to act as an interpreter. Now, I don't speak Chechen, so if you're doctor is speaking to you in Chechen, can't help ya! But, in most other languages, I may be of assistance, with the aid of Google Translations, and my network of local orthopods and podiatrists, who I have trained lo these many years to speak in plain, simple, people-talk. And I will either post the translation here to share with all, if that is OK with you, or make it entirely between just you and me, totally private. Your choice.

Because I don't know about you, but when my doctor told me I was facing either partial or permanent periscoptic suprasemitic hairistalsis, it took me nearly a year before I could even leave the house.

Monday, September 13, 2010

Strange Goings-On Out On the Back 40

So it has finally happened. My shoemaker, Salvadore, has been forced into retirement due to poor health. He's had to lay down his hammer at the mere age of 80. Now, you might think I am being a little sarcastic here, and truly, I wish I could be, but this is actually Sal's attitude about the whole retirement deal - he wants nothing to do with it! This has always been my experience with the older generation of shoe makers - they usually drop dead at their "last." Its not because they wouldn't appreciate some well-deserved rest, no, not that at all. Its due more to two things - they never made so much money they could put much aside, and they are extremely dedicated to the happiness of their clients. You don't really see that sort of dedication to one's craft anymore. I don't really know if that's a good or a bad thing, though I tend to think its more bad than good. And that's not just because I am selfish about losing my particular shoemaker, though I am, of course.

Its also because, and really, folks, I never thought I'd reach the point in my own life where I'd say something like this, but here I go - its because those are the kinds of people who were my teachers, my mentors, and I think despite the reluctance of the modern world to have to actually get its hands dirty, there remains a noble and affirmative need for people with skill, craft, integrity to the product of their own effort. There is precious little remaining in our cultures that fits that definition. If I sound here like a fuddy-duddy, I will not apologize for it - I am only now old enough to understand the value we are losing, not in a trickle, but in a flood.

And for all the hateful talk about immigrants going around these days, I am proud to admit that each and every one of my teachers were themselves immigrants, who learned their craft in places like Italy, the Philippines, Guatemala, and Russia. They came here to build a better life for their families, they worked harder than anyone I have ever known in my life, and sadly, not a single one of each of these great craftsmen's children followed in their father's footsteps. Because there are easier, more lucrative trades and professions. Because their peers were headed in other directions. But, and this is where I think the difference is greatest between that generation and the last several generations, it was never just about money. It was about doing good by your fellow people, about creating something that would make a lasting difference in the lives around you. Nowadays, these just seem quaint, or naive ideas. Besides, they do that in China, right? Or Mexico? So we can all be wealthy entrepreneurs, or something, I suppose.

Anyway, I plan on buying Sal a case of his favorite drink, no matter what it is he likes, because he has done more than anyone I know to keep me upright and still able to walk. Even if it is with pain, its with far less than it would otherwise be. And its important, in my book, to thank a man like that.

Of course, I still have to find another shoemaker. But that's for another day. Right now, I'm hot on the trail of a special Philippino whiskey. I'm pretty sure he'll be willing to share.

Thursday, September 9, 2010

The First Talipes Beauty Contest!

OK, time for all those pretty Talipes Feet to come out of the closet - you know who you are!!! I'll warm up the runway with our first entry, lil' ol' me! Yep, I gonna bare it all, right here on the stage, so cover those kid's eyes, and get a gander! I urge as many entrants as possible to help us create a true gallery of Talented Talipes Peds. Come on, you know you want to bare it all - from the ankles down!

Left (or Liberal) foot, medial view

Right foot, medial view

Right foot, dorsal view

Left foot, dorsal view (note the dorsal fin, very useful for its natural habitat)
Close up, left foot, medial/dorsal view of surgical scar related to anterior tibialis transfer.

Well, our first contestant likes short walks any time of day, curling up with a good heating pad, and swimming in a sea of Tiger Balm. Ankle braces optional. He loves to dance, but is resigned to remain a mere butt-rocker for the rest of his days. He is anxiously searching for a swivel seat cushion to achieve his goal of breaking the Guinness record for number of hours butt-rocking to Motown tunes. Let's give a big hand to our first contestant, eh, folks?

Thursday, September 2, 2010

Swingin' the Club on the Back Nine

I had a conversation yesterday with a friend who had never asked me why I use a cane, and limp, and all the good stuff that must at some level make it obvious I am never going to be an Olympic contender (except perhaps in the consumption of a certain brand of dark chocolate......mmmmmm). And I, being the discrete individual I am known to be (yeah, by squirrels, maybe,) never got around to telling her about it. Sorta slipped my mind, I guess. So, I launched into a two hour diatribe about duck feet or something, and she was pretty polite about it and all. But eventually, she had to slap me and remind me I was caught in a overly-long digression, and even worse, I had repeated myself several times about the Magna Carta, or something. Mmmm, chocolate.

And I realized, its actually not that easy to explain post-club feet to the, well, uninitiated. You can either go the purely medical route, which always makes their eyes glaze over or, the over-done, boo-hoo, you mean you've never heard of club feet route, (which, if they are anyone of a certain age in the Bay Area, are quick to tell you of course they know about Club Foot, that totally hot orchestra that used to play wild music at the silent film festival, right? Yeach. You see my problem?

And to top all that off, how do you explain the whole deal, and then add, "oh, and each clubbie has a slightly different experience, depending on...things." And now ya gotta try and explain the "things," and man, by the time you're done, you swear the next time, you'll just tell them is an old war wound. Just to keep the conversation somewhere under fifteen minutes, so there's time to move on to, "Hey, did you see the new release of Avatar?" What, you think I want to talk about this all the time? Sometimes I like to talk about the first quantum moments after the Big Bang and how string theory makes it so much easier to understand, or maybe, how a hawser from the Titanic is different from a slipknot on the Andrea Doria. (Sorry, goin' sideways here.)

Actually, the best explanation I've come up with so far is to ask the person to imagine the ancient game of golf, back in prehistoric Scotland, when they still used those briarwood clubs that, well, actually looked like clubs! And then imagine those on the ends of your legs, and that buying Ferragamos was never going to be on your bucket list. And now, imagine a bunch of doctors basically thinking of your feet as Play Dough, and how they pull, and stretch, and slice and dice and stitch, and cast and brace, and do it some more. And finally, they tell you, "OK, Sally, out you go! You are pronounced normal. Buck up, and have a grand life. See ya!"

Of course, if they still don't get it. I just take off my shoes. The record so far is five point five seconds before the screams erupt. The doctors who see them never make it past two.

Man, I do need a scotch. And some chocolate. Mmmmmmmm.

Wednesday, September 1, 2010

Rockin' All Over The World, or at Least, Your Feet

A recent off-line communication with a visitor here gave me the opportunity to write up a little help file, as it were, for directing your pedorthist or shoe person on how to build rocker soles specifically for you, as opposed to some generic design, so here goes:


If you also need a lift:


If you are going to a custom shoe maker, ask them to put most of the lift inside the shoe - it makes for a more stable lift. You should also ask them if they understand rocker soles. They may understand them generically, but that is not the same as their being willing to work directly with you on the proper shape for you. This is an important distinction, I cannot stress it enough. You will have to be willing to spend a few hours during the final fitting stage. They need to create the midsole rocker, and leave the final sole off, until you test the shape, and allow them to make modifications until you both get the right shape. Here is what you want to achieve:

A real heel - rocker, that is

Your heel should be able to strike the ground as softly as possible, so the rear rocker angle cannot be too steep, nor too shallow, and should become level no sooner than, nor later than, the center of your heel. The shoemaker/pedorthist needs to see your stride length - this is important. The shorter your stride length, the shorter the length of the rear rocker, and the shallower the angle. By the same token, the longer the stride length, the reverse is mostly true. I say mostly because there are exceptions, especially where the foot has more limited range of motion. If you have had a fusion, the rear rocker shape and length is very critical, because it will actually have to substitute for the motion your fused foot can no longer provide. So - test, test, test, before they put on the final sole. Its shape should allow your foot to essentially "roll" onto the midfoot, with no sensation that your foot is "slapping" The idea is to reduce both shock and foot slap, that sudden motion right after the heel touches the ground, and then pitches the rest of the foot forward. The correct shape will also reduce stress on the knee.In the case of a fusion, it should also reduce that motion from point of contact all the way to full foot loading. That is, when the foot is fully flat on the ground, with neither the heel nor the toes moving.

Moving forward, and kick!


The forward rocker should be gradual, but steep enough in height that it allows your knee to naturally bend as you move toward toe-off. There should be no sense of your foot stopping just before it leaves the ground - there should be a smooth, fluid motion. The angle of the initiating point of the rocker, across the ball of the foot, needs to be no more than 15 degrees off the straight line of motion of travel (pointing straight ahead). If your feet naturally splay outward, that is, they are in an externally rotated position compared to the direction of travel, the rocker angle needs to not interfere with your leg and foot's actual angle of travel, or you will start having knee issues. And the actual point of initiation of the forward rocker should be just behind the line drawn between the center of your first and fifth metatarsal heads. The more outwardly rotated your leg and foot are, the more the shoemaker or pedorthist needs to move the medial point of the forward rocker further behind (proximal to) the first metatarsal head. The idea of the forward rocker point is to initiate heel-off just before the foot would do it naturally - not a lot before, but just before. This will eliminate the tendency to hyper-extend, or lock, your knees.

Your experience with a rocker sole should make walking seem far less effort than before. They can help reduce shock, and joint motion, and will help you get longer life from the shoes, as well, because they help distribute the weight more evenly as you walk.

And remember, you should have a rocker on both shoes, because otherwise, you will start having issues with the longer limb, or the non-post-club side, for you uni-lats out there, as well. So the lift must be in addition to the height of the rocker sole. Plus, it makes you taller!

If the shoemaker is reluctant to work with you on this, you may need to find another. Or, take the finished shoes to a qualified pedorthist to have them appropriately modified. The correct design of the rocker makes all the difference. If anyone tries to tell you that a "rocker sole is always the same shape for everyone," slap 'em with a cold fish, and keep on truckin'!

Finally, I will be getting some photos and drawings out of deep storage in the next week or so, and will post them below this article, so check back often. And consider making a copy of this post to take with you to your shoe folks. Don't worry if they get offended - its better for you to be certain they do it right!

Sunday, August 29, 2010

Musculature of Club Feet - What is Known, and What is Not

I recently undertook to chew on a rather amazing graduate dissertation about genetic research  into the eitioligy of talipes equino varus. It's called "Analysis of Variation in Clubfoot Candidate Genes, by Audrey R. Ester, of the University of Texas Graduate School of Biomedical Sciences at Houston. Most of it is quite above my head, but I tend to rather relish tackling things well above my head from time to time. (And sometime end up well below my feet.)  Usually, I do manage to, at minimum, "get the drift," and many times, actually grok the item at a decent enough lay level that I can afterward follow the conversation, as it were. And sometimes, just once in a while, mind you, I am able to take that limited comprehension and use it in service of deepening my understanding of some associated topic or field of study. I'm kinda kinky that way, I'm told.

But the most interesting part of Dr. Ester's paper is at the beginning. She starts with a brief recap of what constitutes a club foot, and then follows with a section on the current research on the muscular issues related to talipes, especially the nature and possible causes of the lower leg muscular atrophy most clubbies tend to have. And there is some very interesting stuff in this section, so I am going to quote liberally from the paper, and I am providing a link to the paper so you can attempt to tackle it yourself, should you be as kinkily inclined as myself.

Where it seems appropriate, I have inserted word definitions, to aid the reader with deeper understanding of the material. These are bracketed by [ ]. I have also removed the references from the quoted portions, but these can be examined by reading the full paper.

"Musculature and tendons of clubfeet"

"Clubfeet are also characterized by hypoplasia [Underdevelopment or incomplete development of a tissue or organ] of the calf muscles, which often persists throughout life; however there are conflicting studies about muscle placement, fiber density, and even muscle size...... In general, Irani and Sherman concluded that muscles of clubfeet are underdeveloped and smaller when compared to unaffected limbs. Because the
calf muscles have found to be hypoplastic,  they have been the focus of several histological [The study of the form of structures seen under the microscope. Also called microscopic anatomy] studies in clubfeet."



"In 1977, Isaacs et al. investigated the types, number, size, and direction of muscle fibers in individuals with clubfeet. This study concluded that clubfoot calf muscles are “grossly abnormal”, with higher numbers of Type I fibers, and both types of muscle fibers were larger than controls. Type I muscle fibers are also known as slow twitch muscle fibers and are redder in color because they have a higher myoglobin and oxygen content. These fibers are used in long-term activity because they resist fatigue, as opposed to fast twitch (Type II)
muscle fibers, which are used during short bursts of activities, are more fatigable and can only receive energy from glycolysis [is the metabolic pathway that converts glucose, C6H12O6, into pyruvate ]. In addition to higher numbers of Type I muscle fibers, Isaacs et al. found evidence of denervation [ interruption of the nerve connection to an organ or part] in calf muscles of clubfoot. The larger muscle fibers imply that atrophy [is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle] is not the reason for smaller muscles, but might be caused by a neuropathy. ...

Fukuhara et al. performed histomorphometric [the quantitative study of the microscopic organization and structure of a tissue (as bone) especially by computer-assisted analysis of images formed by a microscope] and immunohistochemical [or IHC refers to the process of localizing antigens (e.g. proteins) in cells of a tissue section] studies on 16 ...clubfeet and 27 normal feet (seven normal feet from unilateral patients and 20 feet ...of the same age range as those affected). This study found that the bone malformations were secondary to ligament and collagen changes. The tibialis posterior ligament was found to be enlarged, and the orientation of the collagen fibers was disrupted. .... This supports data from previous studies that suggest that calf muscles in nonsyndromic [not part of a syndrome] clubfeet are abnormally small.

In 1998, a prospective study was performed by Loren et al. in which muscles of children with clubfoot were examined histologically, and further investigated if surgical intervention impacted these histopathological findings. About half of the patients with clubfeet showed abnormal muscle morphology. Twenty percent had fiber type disproportion [Congenital fiber-type disproportion is a disorder that primarily affects skeletal muscles, which are muscles the body uses for movement. People with this disorder typically experience muscle weakness...] , and 30% had fiber size variation (>3:1 ratio). The clubfeet with abnormal muscle morphologies had an increased risk for clubfoot recurrence and a second operation (5.6 fold increase). "
 .
"A histological study of clubfoot in 2006 reported on 431 muscle specimens obtained from 68 patient surgeries. This study gave very different results with 86.3% having “no discernible pathology”. Atrophy and an over-abundance of type I muscle fibers was found in 12.8% of the specimens. This study was much larger than the Omeroglu study and was a better representation of the average clubfoot compared to normal musculature. Other case studies have reported an additional muscle coming out of the soleus [one of the calf muscles] muscle. There have also been reports of a flexor digitorum accessorius [an accessory, that is, extra]  longus muscle that is aberrant in children with clubfoot. These case studies involve small numbers of clubfeet and from individual collection sites. In addition, many of these evaluated the “clubfoot deformity” but do not
discriminate between idiopathic clubfoot and syndromic clubfoot, and so these clubfeet might have different musculature due to syndromes (such as a neuropathy). A large-scale comprehensive study in idiopathic clubfoot patients is needed to validate these findings."

So, what does this all mean? First, it shows that there is more behind the musculature atrophy of club feet than merely the aftereffects of serial casting, bracing, and long period of non-weight bearing may produce alone (or rather, in combination.) [Quick aside - non-weight bearing during various growth stages in childhood means less pressure on the growth plates (epiphyseal plates) at the ends of the long bones of the leg, which alone can cause variable degrees of atrophy. When this occurs under unilateral conditions - that is, on one side - it can also induce some level of leg length difference, as the non-weigh bearing limb has limited growth during such periods.] The section also illustrates that, "the jury is still out," that is, there are some contradictory studies, and therefor, there needs to be more, and probably different kinds, of studies to further understand what is going on with club foot related atrophy.

At both a developmental level and a genetic level, there are factors that affect the muscle fibers themselves, causing these fibers to be less developed (hypoplastic.) There is also some intimation these changes may or may not be amenable to improvement by exercise, but this seems to be more difficult to determine who might be impacted by such efforts - it seems the percentages aren't all that high. To refer back to " Type I muscle fibers are also known as slow twitch muscle fibers and are redder in color because they have a higher myoglobin and oxygen content. These fibers are used in long-term activity because they resist fatigue, as opposed to fast twitch (Type II) muscle fibers, which are used during short bursts of activities, are more fatigable..." Don't be too confused by the apparent contradiction of " higher numbers of Type I fibers,..." A higher number of such fibers does not translate to "stronger', or more durable. Any change from a "norm" is seldom a good thing. Atrophy is sometimes reversible, but if the cause is a disease or genetic factor, there will be minimal improvement, and in the long term, a higher potential for increased weakness.


As I have mentioned in several prior posts, there is a unique parallel to post-polio syndrome, though the causes are different - both seem to show increased muscle degradation with age. It could be a more rapid, age-related break-down, or long-term overuse, but what is most important for us clubbies is how this may potentially affect our quality of life, and what additional costs may be associated with the aspect of post-club feet.

Finally, the last line in the above-quoted text -  "A large-scale comprehensive study in idiopathic clubfoot patients is needed to validate these findings." Amen, I say. But when, and by whom? And I would add, in post-club foot patients, as well. Because if the findings are validated in histological studies and later confirmed through other types of studies with infants and children still in treatment, the one certain way to validate such a theory it to study post-club feet muscular degeneration. This would have the effect of determining what, if anything, might be done differently during initial treatments - surgeries, casting, bracing, etc., to reduce such degradation in future generations of people who live with post-club feet.

I urge you to go and read this paper, at least as much as you are able to. I will confess that once I got to the actual genetics analysis part of the paper, my eyes took on the look of a crazed cop who'd run out of glazed donuts. You can see the paper here.

Thursday, August 26, 2010

Prolo Check-in, and Other Distractions

It is now 5 days after my last prolotherapy session. The pain has almost completely subsided, about as long as it took after the second session. The knee is feeling much stronger, but its far too early to say anything about the effects on my feet, as we only just started that part of the process. I'll keep you all updated on the progress. You can also go here to learn more about prolo.

My shoe guy, Salvadore, is now into his mid-seventies. He just had to go in to have a portion of a lung removed (life-long smoker, unfortunately.) He's back home, and says he will start working again next week, but I don't know - I tried to tell him its time to retire, take it easy, but he's too dedicated to his customers, and not one of his five sons wanted to go into the business.

Anyway, I am coming to terms with the fact I need to locate another shoemaker, who is willing to work with me around my specific needs. And my preliminary search was a real bomb. You know, at one time, there were thousands of shoemakers in this country. Today, I think the number is in the low hundreds, if not less. Me, I'm gittin' old and creaky, so I'll probably squeak by. But all you youngsters out there? When the feet really hit the fan? I do feel for you - its gonna be tough getting the right footwear. As you can see over on the right hand bar, I am trying to constantly update and expand the Resources/Links section, to help respond to this impending crisis, but I need all your help in doing so. Please send me links to shoemakers, pedorthists, etc., who have helped you out. Maybe together we can keep them busy enough to hire and train more shoemakers. Do your part for the clubbies of the future!!

OK - back to work.

Sunday, August 22, 2010

Ouch. Get Centered, My Tuckus!

OK, so, yesterday, I did my third prolotherapy session, for my right knee. Only this time, we upped the ante - we also got started on my feet. Just the sinus tarsi on the left, but allover this on the right foot. Meaning, (hand swirling in large circles) ALL THIS. And I really thought I'd prepared properly, see? Fully loaded MP3 player and 4, count 'em, 4 dilaudids, whacky stoned, my spousal at the wheel. The doc LAID ON the lidocaine (ten million bees stinging all at once - fun. No, really.) But I tolerated it, yes I did. Looking at the lovely photo of some South Seas island on the ceiling, doin' that breathin' thing, blasting seriously cool tunes.

And then he started. Oh Holy Shinola. The worst session yet, 'cuz do boy was goin' DEEP. Especially in that old sinus tarsi. I have to be honest here - I screamed like an eight-year-old girl getting her first Barbie. And folks? No, over here, look this way - yep, that's right, over here! I did that about thirty times. Now, this was the most pain meds I've taken yet for these sessions, but maybe it was the humidity, or maybe my nerves are so seriously smacked that it's gonna take full-blown general anesthetics to go through another session like that.

Thing is, I know I'm totally over-enervated in those areas, so it should really come as no surprise. Maybe I can stop off at the dentist first, and get hit across the back of the head with a tank of nitrous. Wake me up when its over, eh?

OK, enough b-in and m-in - I can tell the therapy is having an over-all positive effect, so I am going to stick with it. But seriously, if I'd had a gun, there'd a been a bang, kids. I mean, I gave Jamie Lee Curtis a real run for her money, as scream queen. Poor doc. Musta thought I was gonna smack him.

Sure did WANT to.

Thursday, August 19, 2010

Aw, Quit Yer Complainin', Victim!

We definitely live in weird times. It is suddenly the habit of people who are somehow frightened of the "other", be it because of color, culture, religion, class, or, need I even say it, disability, to attack the particular group they are frightened of, and make that group the "problem," rather than being capable of seeing how their own biases are in fact the problem. Case in point: I came across this little gem on another disability web site, and thought it was a perfect example, so wanted to share it with you all:

"
  1. Louis Michael Mount Says:
    Maybe if you all started dealing with your disabilities instead of whining about them all the time there would be some progress. No one wants to put up with some self-entitled complainer who thinks everything should be done for them just because of they are different than everyone else."
     
So. "whining", "self-entitled complainer", "think everything should be done for them (us)". Oh, and "started dealing with your disabilities." Where, oh, where to start? Mr. Mount here thinks trying to change laws, public attitudes, medical community attitudes, etc., is "whining." Apparently this fella thinks that exercising our Constitutional rights is "whining." And that "thinking everything should be done for them" isn't just another way to spin our demanding having access to the same options as non-disabled people already take for granted. Self-entitled? Apparently Mr. Mount feels that he would be "self-entitled" if he demanded adequate care from the medical community? Or is it that using phrases like self-entitled is a way to show his own superiority, or to deflect by casting aspersions the fear he has of what - possible contagion? Or, just sayin' here, is Mr. Mount merely being a self-entitled complainer, himself?

And don't get me started on "dealing with our own disabilities." Just exactly does he think the disabled community should do - wait for folks like him to "grant" us equality? That we aren't dealing when we are working to change the system to make it more responsive to us, after eons of being swept aside, marginalized by the so-called abled community?

We are hearing ad hominem arguments and attacks like this in many corners of our world these days, whether its in response to charges of racism,   or in calling people who are struggling for their share of the democracy we supposedly ALL should benefit from victims. Hey, I don't see myself as a victim - if I did, I wouldn't be taking steps to make sure that isn't what I am in the eyes of the society at large. And I strongly suspect this is true of nearly every "disabled" person out there. These kinds of attacks and ignorant rants don't tell us anything about ourselves. Rather, they tell us volumes about the writer/speaker. Mainly they tell us that, but for the fact they have not as yet encountered similar obstacles, they have no ability to empathize with anyone who isn't exactly like themselves.  Of course, it is always possible Mr. Mount is a self-hating disabled fella, has been known to happen.

That's his problem, his "victim-hood" if you will. It is NOT ours.

Oh, by the way: "different than anyone else?" Is Mr. Mount simply saying anyone who isn't "like him" is "different?" And the last time I looked, EVERYONE is different than EVERYONE else. So Mr. Mount, unless you know something about clones, and especially can prove that's what we are, or, you are, well, different works for me. Just as its worked for the entire world since the very beginning of life on this planet. And, if everyone were "the same," then either you, Mr. Mount, would also have a disability, or no one else would. Either way, what difference would that really make?


Wednesday, August 18, 2010

Calling Clubbies All Over The World!

Now, I know you folks outside the US are looking at this blog (I have my spies!) but I'm apparently not speaking your language. You should note, however, the Translation feature over there on the right panel of the blog. The All Powerful Oz, er, Google supplies this little gem, so you one single visitor from Laos (yes, I thought it was you! How's it going over there?) might be encouraged to take another look, and in your own language! How's that for service?!

And on a similar note - I would really like to hear from folks with post-club feet in other countries, or even uncorrected club feet. This is a forum for all of us who are dealing with the effects of our syndrome on our daily lives, and to gain insight, support, and ideas for dealing with that impact. So please, do weigh in here. What resources do you have, what resources do you lack? What have you done to get relief? What would you like to know about resources in other countries, whether you are going to travel, or just to see what else may be available?

Come on in - we don't bite. That's over on the dental blogs. :-)

Monday, August 16, 2010

The Perils Of Gumbo-Meds, or, How I Stopped Worrying and Learned To Love The Hot Sauce

So yesterday, woke around five, and did my once-a-year Major Seafood Gumbo Par-tay - ten to fifteen different kinds of seafood, okra, file - the whole twelve yards. Oh, and Trappey's. It gots to be Trappeys Hot Sauce for it to be really gumbo-licious, ya dig? So, as I said, on my feet for hours and hours cooking, schlepping, hosting, serving, and wow, who woulda thought? Right about seven in the eve? Total foot crap-out, down like a pound-o-sox, hadda take mucho meds, still didn't do the trick. So, had more gumbo today, more Trappey's (oh, yeah) and I realize its maybe like folk wisdom (or malarkey?) but right now? Feelin' groovy, baby. 'Course, coulda been the Red Stripe. Just sayin'!

Well, it may not work for you, but either it did work for me, or all that seafood has me hallucinatin'.

Oh, no! I guess I've become a cheap drunk!

Discalimer: I ain't gittin' no cases of Trappey's for consideration of mentioning this total maximum flavor ride and back-o-the-head-blowin' goody, but if they suddenly discover this totally groovy review of their excellent stash, and have an unshakeable urge to ship me a lifetim supply o' this devlishly good stuff, who am I to tell them whhat to do? No, really! Who am I? Three bottles down, and I can't even remember what I'm doing right now. And what are YOU lookin' at? Darn pooch thinks I'm gonna share this wicked stuff with him! Ha! I say, Ha!

(Did I just say that out loud? Really? oops. Oh, no, is it all gone? Oh, the agony!!!)

Friday, August 13, 2010

Hammer Time

A fairly common accessory to most post-club feet is the hammer toe, and the claw toe. As both cause the top of the second phalangeal joint to press against the inside of the top of the shoe, the eventual results are callouses, corns, and blisters, oh, my! There are, as you might imagine, numerous approaches to relieving the pain these little beasties can cause, from chemical, to surgical, to mechanical. Let's take a look, shall we?

Corns are those especially resilient little meanies that have a "core" to them. That is, they grow outward from near the bone, well below the epidermal layers. This makes them especially difficult to get any long-term relief from without resorting to unconventional warfare. There are many so-called corn removal systems, some of which work better on some people, but not so well on others. It's pretty much a try 'em out for yourself situation. One of the problems with the chemical solutions is the need for constant repeat applications, much of which just gets rubbed off the surface of the corn as soon as you put your sox on.

There are of course surgeries to straighten toes out, but here again, these surgeries work in some cases, and not so much in others. Despite what doctors like to tell their patients, the fact is that each of us has our own unique way of responding to such surgeries. I don't advocate against them, but just know the outcome may not be what it's sold as. Certainly where the hammering is very extreme, surgery will offer at least some percentage of relief. But where there is less rigidity of the deformity, there are other approaches to consider first.

Whether corns, callouses, or blisters (which are usually merely a precursor to a callous,) the other factor at work in promoting the growth of either is pressure - shoe pressure, of course. When the deformed digit raises the toe/toes, they have a greater propensity to encounter shoe pressure merely because they are raised higher than adjacent toes. But there is another factor at work here - the pathomechanical action of the toes during the various phases of gait. This is especially the case where there has been an anterior tibialis transfer, as the toes are used to assist the front of the foot with dorsiflexion, that is, picking up the front of the foot as the toes leave the ground during the toe-off phase of gait. This action is necessary to prevent the toes from dragging, and to position the rest of the foot to prepare for the heel to strike the ground on it's next heel strike.

The result is what is known as extensor substitution - using a different set of extensor-group muscles to provide the motion either impaired or lost to the group normally assigned this particular task. We can observe this directly with people with multiple sclerosis - they have difficulty with their entire lower extremity anterior muscle group, and the one way they can get their feet off the ground is by using muscles all the way up in the hip and pelvis to do the job. So when the toes are made to do the job of dorsiflexion of the foot on the ankle, their superior, or top group of muscles and tendons get a real workout, far more so than their inferior, or bottom group does. This overpowers the inferior group, and hammering or clawing are an inevitable result.

There are two distinct mechanical responses that can offer near-immediate relief from shoe pressure, however. The first, and certainly most obvious, is to stretch the area directly over the offending digit. Here is a youtube video that offers some help on how to do this yourself:






Now, this video only shows you stretchers that are used to stretch the width of the shoes. There are other devived that stretch the height, and these open at the sides instead of at the top, as the video shows. So it's important you get the right kind. And those little bump attachments? Very important to getting targeted stretching in the right place.

The best and easiest tool to use for stretching the top of the shoe without affecting any other part of the shoe is to use a ball and ring stretcher: See this web page as an example (not affiliated with this site, nor receive any considerations from same.) The trick to stretching a shoe is quite easy - you need three things - the stretching tool, stretching fluid, and a shoe material that is in fact stretchable. Many man-made materials offer little or no stretching potential, whereas leather uppers are always a good bet. As for the stretching fluid - you can buy some, or, you can easily and cheaply make your own. Merely mix 50% water with 50% rubbing alcohol. Apply liberally over the top of the shoe. I suggest applying it over the entire area, so as to prevent a stain, that is, the edges of the fluid applied to the shoe may remain visible, so by applying it over-all, this seldom will occur. Rub the fluid into the material, then apply the stretcher you've chosen. If using the ball and ring stretcher, you can either set the clamping mechanism and walk away, or "walk" the stretcher over the broader area to prevent the appearance of a "bubble" raising the top of your shoe. It may take several applications of stretching to make the change permanent - many materials, even leather, has some level of elasticity, and wants to return to it's original shape. So be persistent. Because one other thing to consider with stretching - this reduces or removes the pressure over the offending area, and thus reduces the need or at least the frequency for future chemical assaults.

The second mechanical approach is to both stretch, and add rocker soles to your shoes. The rocker sole reduces the need for extensor substitution by helping supply that motion to the foot during gate. No, it doesn't change the muscular dynamics at play, but it makes the need for those dynamics reduce, sometimes by a significant amount. If the foot is achieving what it needs to during toe-off, then the compensatory actions of the toes are less needed.

Finally, if you intend on using chemical means to pair down the callous or corn, consider first soaking your foot/feet in warm water with epsom salts, to get the skin as soft as possible, then using a callous blade to remove as much of the hardened tissue as possible, before applying your chemical warfare. You'll get better long-term results, as the chosen chemical agent will be better able to get down closer to the root of the "problem."

For more info on this, visit here. The most important thing is, be consistent with whatever approach you use - you'll have much better results. For even better results, consider seeing your local podiatrist to get the whole process started. They have the knowledge for both diagnosing and treating, which is especially important with differentiating between a corn and a callous - critical to taking the right approach with direct treatment protocols.

And don't forget the bottom of the toe/s! The toe lifts at the second joint, but also drives the first (end of the toe) into the sole of the shoe, so you will also have to consider adding a depression in the shoe insert or the forefoot extension of the orthotics you have. In very extreme cases, I have had to use a dremel tool to carve into the shoes insole to provide this relief. 

Oh, and whatever you do, don't take that old Three Stooges approach. Don't try using another hammer on the problem:-)