Wednesday, June 30, 2010

What I'd Rather Be Thinking About Right Now

Let me start by saying I don't assume to speak for everyone with post-club feet - that's why I keep encouraging comments and such, because we all have somewhat different experiences, while at the same time having very much in common. And let me further clarify that the way I have or am experiencing my feet and their effects on my life is, in fact, strictly mine. Though I am finding there is remarkable shared experiences on this issue by many. This is all by way of setting up what follows, so no one reading this thinks I am describing their experiences. However, if you should see similarities, please do let us all know. I sincerely believe that we, as a unique group of people with a unique set of issues, are the ultimate authority on our condition, and in the final analysis, those who most deserve the benefit of open and interactive communication. So, on with the show.

Some of you may have seen a post recently by someone wondering if amputation was a solution to the chronic and often agonizing pain we clubbies tend to live with. While this might seem a really radical solution (and I agree that it is), I also immediately understood where that thought came from - I've had it many times myself. But behind that urge, and in fact for me behind nearly everything and every time I feel my feet ruining my day, lies one overarching, yet seldom consciously thought, desire.

I want to go one day without ever thinking about my feet, from when I wake in the morning, to when I lay down to sleep at night. Scientists, especially those who study the brain, and those who study human consciousness, use a term - mindshare. This basically means the amount of time we allocate to think about any one specific thing over the course of our day. For example, in the news quite frequently these days is the impact cell phones and texting are having on driving safety. Scientists have studied this idea of "multitasking" quite extensively, and have come to believe that multitasking is a myth, in the sense that no one, and let me use their emphasis - no one - does multitasking well, and most people actually do the individual things they do while multitasking more poorly than they do when doing those same tasks individually. Something about walking and chewing gum at the same time, I believe.


I am one of those people who doesn't multitask very well, and I also know why - my painful feet are constantly grabbing mindshare. So adding one, two, three more things is a lost cause - I am already doing two things, constantly - whatever I am doing, plus my feet/pain. This colors nearly everything I do in ways I often come to resent. I don't really LIKE having to remember my "half-way point" when out walking with my wife. Nor do I like saying, "another time, maybe," to friends who want me to go on an outing. Its like being attached at the face with a mirror-image whose sole job it is to nag and rain on my parade.

This awareness, this confession, if you will, does not bring respite. What it does is to keep me always seeking solutions. Which at least has kept me from becoming a drug addict, I suppose. I have had people tell me, after they understand why I am reluctant to go on a romp, they are amazed I am not so addicted - they often say, "well, if anyone does, you sure have the right to be." So sweet, my friends.

But that desire to not have to think about my feet, even for just one day, never really leaves me. To be free at last is, I acknowledge, pretty far-fetched. But a man can dream, can't he? I think about what such a thing, were it to ever occur, would open up for me to better spend my time on. Learn the accordion? Study Italian so I can order with greater authority in my favorite restaurant? Increase my earning potential? Actually get a full night's sleep for once? Who knows?

But at least I'd be able to find out, wouldn't I?


How about you? Do you have mindshare problems, as well?

Monday, June 28, 2010

About That Torn Calf Muscle...

As those of you who've been following this blog already know, I did a bad thing to my right knee a few months back - torn meniscus, torn medial collateral ligament, and, to the surprise of even the docs, torn muscle fibers in my medial gastrocnemius, or calf muscle. This last item is perplexing on several aspects - it is not consistent with the other injuries, it appears to be older than the other injuries, and the docs said it would have been the result of something like a football tackle. Not something I am known for.

And, as some of you also know, I am doing on-going post-club feet research, via an examination of any and all papers and books on the topic. The current paper I am reading and dissecting, "Long-Term Follow-Up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release", by Dobbs, Nunley, and Schoenecker, from JBJS, 2006. This study looks at 45 patients at an average of 30 years post-treatment, which makes it perhaps the best such study available. While there are flaws, in my opinion, there are a number of very revealing items, which I will go in to in greater depth soon.

For now, however, there is one finding that lept out at me, and I thought it worth sharing here, especially for those of us well beyond 30 years post-treatments. In the Discussion section, this item caught my attention:

The few studies in which patients were followed to skeletal maturity showed that the early results obtained with extensive soft-tissue release deteriorate with time, indicating that longer follow-up is necessary to evaluate the lifelong function of a surgically treated club foot. Ippolito, et. al. found that patients in whom clubfoot was treated with a more extensive soft-tissue release surgery functioned less well at skeletal maturity than did those treated with the Ponsetti method of manipulation and casts. Unsatisfactory results were attributed to increased osteoarthritis in the foot and ankle, increased ankle stiffness, and increased gastrocnemius weakness in the patients treated with the more extensive surgery.

So first, "few studies." This is apparent throughout the literature, and I've editorialized on this before, and will undoubtedly do so again. But of more importance now are the other two bolded items: that soft-tissue surgery, while effective in changing the appearance and general function of the club foot, may actually contribute to later degenerative changes; and it may also result in increased gastrocnemius weakness. So there's the answer to my torn calf muscle. And to so much more related to my chronic pain. Essentially it boils down to this - it should come as no surprise. The very surgeries played a role in subsequent deterioration, as the papers reference to radiographic studies show. All that arthritis was, in this study's conclusion, inevitable.

And do note the comparison to the people treated via the Ponsetti method. Elsewhere in the same paper a comparison made between the two approaches show a nearly 90% better outcome with Ponsetti than with soft-tissue releases and the older Kite casting technique. It is this one specific item that further validates my demand for additional long-term follow-up studies. Here, with a relatively small sample group, is seen how such a study can validate or invalidate previously held assumptions that were/are the basis for treatment that will have a life-long impact on the persons so treated. To fail to carry out such studies, especially on a broader sample group, is in my view, a failure of the Hippocratic oath itself.

Now the question is, what can I do, with even hope for moderate success, to heal my gastrocnemius? I'll keep you all informed on my progress with the prolotherapy. In the meantime, besides the size of your calf muscles, have you or do you experience weakness in the calf? And what, if anything, has worked to help improve that condition?



Sunday, June 27, 2010

Feet in Motion: 36 Years of Footloose Joy

Last night, we went with several friends to our 20th time at the 36th Anniversary of the San Francisco Ethnic Dance Festival, the largest and longest ethnic dance festival in the country. And, as has been the case for the previous 19 times we've gone, this was the most thrilling and happiness-causing evening ever. Before I wax superlative, go take a virtual look for yourself at the incredible breadth of talent this festival produces, at World Arts West. The last weekend is the one we attended this year, specifically because of the troupe who had a specially commisioned performance:


WORLD PREMIERE
This piece is a celebration of the beautiful culture of Afghanistan showing the positive face of its rich heritage through dance and live music.



 And here is their Facebook page.




After all the horrible news over the past twenty years coming out of that ravaged nation, this astonishing performance give more than hope for the people of Afghanistan, it show all the joy and potential currently hidden away among those beleaguered people. The color, the music, and the incredible motion and beauty displayed at this performance literally took my breath away. I don't think I have ever had a dance performance cause me uncontrollable smiling ! If you ever get the chance to come to San Francisco in June, make sure you get tickets to at least one of the amazing shows at this festival.

Now, Why Would a Clubby Enjoy Dance So Much? 

Hmm, good question. OK, I'll take dance for $500, Alex! Back in the day (when I was young, and more impervious to pain) it was the 60's, 70's, and 80-ishes, I was a dancin' fool, as we used to say. Yes, I would pay for it, sometimes for days afterward, but when I was out there boppin' and rockin' and even a little pogo-ing, I felt free as a bird, and temporarily disconnected from the pain. I used to arrive at the start and not quit till the last song. Then I'd hobble home, like I do most days, now. So, if I can't do anymore floor sailing, then baby, I ain't gonna stop butt-rockin'! And as much as it reminds me of what I can no longer do, I can still enjoy the motion vicariously.


And while I was watching these amazing Afghani women dance with such joy, I had this thought pop into my head - look at all the energy some people use to bring beauty into the world.

Just amazing.

Saturday, June 26, 2010

The Tabs, Boss, The Tabs!

You may notice the tabs now appearing at the top of the page. I will be adding additional material to each of these pages as time goes on, including links to previous posts that are relevant to those tabbed pages. It will make it easier to navigate the blog. Also, the tab, My Story, Your Story, allows all of you to tell your own story of life with post-club feet. I will also be adding my own story, in on-going installments, and welcome your comments. I figure we all have something interesting to say about our joys and struggles, so stop by and tell yours!

Friday, June 25, 2010

New Features

I've put in some new features, as you may have noticed. The best one, in my opinion, of course, is the Language widget over there on the right side. This lets you instantly translate the entire blog into the language of your choice. Pretty cool, yes? Not the perfect translations, but good enough to make it understandable. And, if you choose to comment in your own language, other participants can translate it to the language of THEIR choice. Very cool. Yes.

Tuesday, June 22, 2010

Literary References to Club Feet

From the Club Feet wiki, the following is a list of known literary references with club-footed characters. I am quite certain there are more, just waiting to be dug up:


  • The main character, Philip Carey, in W. Somerset Maugham's novel Of Human Bondage, has a club foot, a central theme in the work.
  • Hippolyte Tautain, the stable man at the Lion D'Or public house in Gustave Flaubert's novel Madame Bovary is unsuccessfully treated for clubfoot by Charles Bovary, leading to the eventual amputation of his leg.
  • Charlie Wilcox, the main character in Sharon McKay's novel Charlie Wilcox had a club foot.
  • In Yukio Mishima's seminal novel The Temple of the Golden Pavilion the character Kashiwagi has club feet which parallels the stutter of the main character, Mizoguchi.
  • In David Eddings' Malloreon series, Senji the sorcerer has a club foot.
  • In Caroline Lawrence's Roman Mysteries series, a character called Vulcan the blacksmith appears in the book "The Secrets of Vesuvius". He reveals that he gained the nickname because of his club foot.
  • In Bernard Cornwell's "Warlord Chronicles," Mordred, King of Dumnonia, has a club foot that is often used as a symbol for his ugliness and weakness as a ruler.
  • In Daniel Keyes' Flowers for Algernon Gimpy, one of Charlie's co-workers at the bakery, has a club foot.
  • In Heinrich von Kleist's play The Broken Jug, the main character Judge Adam has a club foot, betraying him as the culprit who broke the jug.
(The entire wiki contains some good material, but there are still, in my view, errors and misconceptions about adult post-club feet therein. I'll expand on that in a later post.)

If you've had a chance to read any of these books, it should come as no surprise how people with club feet are presented - most often s characters who are untrustworthy, somewhat slippery and dark, or pathetic.

It is only with the gods that we have a chance, as it were - Hephaestus and Vulcan - one and the same, actually (Greek and Roman). Here, we are the creators, the makers. This god was the only god in either pantheon to actually work. They made the armor and the weapons of the gods, including Zeus' thunderbolts. Heck, Hephaestus even won the love of Aphrodite. Not bad for a clubby, eh?

This negative depiction seems like an origin story for all the nastiness some of us experienced from other kids growing up - because we were "different," we had to be less than they were.

Wouldn't you just love to go back and throw that Aphrodite thing in their faces? :-)

Sunday, June 20, 2010

Chronic and Acute Pain - There's Nothing Cute About It

"Sorry, not today, Joe. I really over did it yesterday. You guys go on and enjoy the game. I'll amuse myself at home today."

Sound familiar? We all say things that are variations on this particular theme when we live with chronic pain. We tend to respond to the world the same way someone suffering with rheumatoid arthritis does - it's called "avoidance behavior." And it makes perfect sense - when our feet are screaming at us, who in their right mind would just jump up and join the fun? We need to recuperate. Some can recuperate quickly, some of us take quite a while longer to get the same relief. Some of us use medication, some refuse to. Some resort to additional surgeries, often with dubious results, while others will no longer even trust a doctor to trim our toenails. So while we have many different approaches to dealing with our pain, we all have one thing in common - pain.

Chronic pain differs from acute pain only in duration. Chronic pain does not have to be present every minute in order to be chronic - it just has to display some type of regularity. Acute pain (stub your toe - that's the ideal demonstration) arises quickly, and eventually resolves. Chronic pain usually resists resolution through the normal approaches to pain resolution, or at least, requires ongoing, and often debilitating, regular application. This often leads to addiction issues, just one more thing you just love to deal with. (Irony alert.) The medical establishment has struggled for decades on the issue of chronic pain, and because they have still not found real solutions that work in most cases, there is sometimes a tendency to "blame the patient." It's "in our heads," we need psychological counseling, etc. Gee, that's the answer I was looking for! (Sorry.) Well, there is some truth to this assertion: pain is, literally, in our heads. All those nerve endings getting crushed between bones and compressed by chronic inflammation is being sent to, and processed within, our brains. But as for psychological issues? Look, Doc! You walk every day in pain, subject yourself to multiple surgeries, get told you are now "normal" when you know its a lie, try to fit into your community without being seen as a freak, and then tell me its in MY head. Hell, sure it is, but its also in my feet, and my ankles, and my knees, and my back! I mean, stop treating us clubbies like were ignorant fools, and that you have all the answers. because so far? Your answers haven't done much good.  (Sorry, again. Just went off, there, didn't I?)

Let me give you an illustration, something that just happened to me yesterday, that might illuminate what will follow. I am currently undergoing prolotherapy to attempt healing my torn meniscus and other parts of my knee without resorting to surgery (getting tired of people cutting me open.) Now, prolotherapy consist of many small injections of lidocaine and dextrose - -sugar, really - into the area in question. These injections are done over many months, in a series. They can be very painful, even with the lidocaine injections first, because they can be fairly deep, and because the fluid instantly puts pressure on the local nerves. (I know this sounds like a real sales job, doesn't it? But given all I've learned about prolotherapy, I feel it will be worth it. I'll keep you informed on my progress.) So, who wants instant screaming-I'm-gonna-tear-the-roof-off-this-building-with-my-bare-teeth kind of pain? Not me, nosiree. So, I opted for the meds.

Now, I took 3 2-mg hydromorhonne - dilaudid - which did in fact reduce the screaming. But (you knew there was a but in there, didn't you?) some of the deeper injections still hit their marks, and I was not too happy. Finally, my good Doctor Mike pulled off his ear protectors and made a little, well, suggestion. You could call it a guided image for me to focus on. He suggested I let the drugs "do their job." He said, don't focus on the pain, just watch it when it happens, like its somewhere in the distance, and just watch it while it does what it does. "Ride on the drugs like they are a cloud," he suggested. So, I did. And I was soon able to feel the needle while simply observing what it was doing. I seemed to see the pain like it was on it's own little island, and I was simply a distant observer. And it worked. I still felt a couple at a deeper level than I wanted to, but overall, it made a real difference, and we got through the session fairly quickly. When we were done, I simply got up, with only a little dizziness, which passed quickly, and off I went. Its a bit sore today, but that was expected, and is mostly tolerable.

So, how does this apply to chronic pain? After all, it was acute pain I was dealing with, right? Yes, this represented acute pain, no question. But think about this: if I was able to use that type of mental imaging with acute pain, how might I be able to use that same concept with chronic pain, where I have even more time to excersize those mental muscles?

When I feel pain, I am not merely experiencing the pain where the hurt arises. I am also extending that pain by my systemic reactions to that pain. I "splint" against the localized sensation, by tightening muscles around the area in an effort to stabilize the region. This tensioning of the surrounding musculature tends to spread - first its my foot and ankle, then I may limp, which is simply another type of compensatory function in the face of painful feet. While this limping may take some immediate pressure off the affected foot (or feet - yes, there is bi-lateral limping,) it has the longer-term effect of tensioning other sets of muscles and ligaments further up the body. The pain is no longer truly localized. The ultimate effect of this is to make me focus on how the pain makes ME feel, not on simply observing the pain where it arises, and allow it to occur in only that locality. I have now made the pain, ME. And the more, and the longer, the pain is ME, the harder it is to relate to anything else other than as a response to the pain I am feeling. This is why using meds to "stop" chronic pain seldom works -first, they wear off, and therefore the pain is still, ME. Then, the meds don't merely affect the pain itself - they also affect the way I feel in general - foggy, sleepy, forgetful, on and on. I either become addicted, or I eschew meds altogether, and become, well, surly, cranky, depressed, you get the picture.

So, how to get to that place where the pain is no longer YOU, but is merely pain occurring in one locale, and capable of being observed, rather than being obsessive? There are many relaxation and centering techniques out there. You may have to try a few before finding the one that works right for you. For example, biofeedback has a long and proven history with helping people control pain, as does meditation, visualizations, yoga, even certain martial arts, like tai chi. The main thing is to find a way to isolate the pain in your mind - surround it with a certain color, or an enclosure. Allow it to be there, but not be IT. yeah, sounds all New Age-y, but there is a growing body of research to support this approach to dealing with chronic pain. And until some pharmaceutical company develops the perfect drug, with zero side effects, and non-addictive, well, we may be on our own. And medical marijuana is not legal in all states, so what can we do?

We can take control of our own bodies, and the pain that arises in them, instead of surrendering that control to things that either don't work, or that turn us into something we no longer want to hang around with.

How do YOU handle your pain?

Friday, June 18, 2010

Steppin' Out Shoes

Let's face it - we've got some ugly feet. Skinny calves, short and wide feet, oh, and don't forget the scars. Gals - those 6-inch spikes? Uh-uh. Guys? Those Ferragamo slippers? Ehhh, nope. But, like nearly every other human on this small, blue orb, we have those ego issues. Who doesn't want to look good, even if they feel not-so-good?

Here's a prime example. Many years back, when I first got into making footwear, I was presented with a 14 year-old girl (NO, now stop that nasty-minded thinking! She wasn't "presented" to me - she became a client, OK?) Anyway, this young girl had been born in Vietnam. When she was three, a bomb struck so close to her house that a wall collapsed on her, crushing one of her legs. There was no choice at the time but to take out nearly eleven inches of bone. The doctor who referred this girl told us she had an 11 inch leg length discrepancy. So, we thought we were prepared. Oh, no we weren't!

She came into the clinic, and as she walked toward me, I observed her gait. I was instantly confused - she showed no signs at all of a discrepancy. None. Zero. Zilch. She wore a long skirt that just showed the tops of her shoes, so I could see that her heel was hitting the ground, and she had clearly not adapted as a toe-walker. It wasn't until we had her raise her skirt to mid-thigh that we saw the truth of the matter, and to this day, I've never seen another person present like this girl did.

Because she was a young girl, appearance was everything (sorry, not trying to be sexist, just a realist.) She had accomplished a form of compensation that defied all logic - she had learned to walk with the knee of her long, good leg, bent. To the degree that she had no pelvic tilt, no limp, no discrepancy in any other aspect of her gait. If this still doesn't make sense, let me explain one more thing.

The goal of biomechanical compensation is to do three things: maintain, for the visual processing we need to do, a level horizon line; maintain a balanced inner ear (or vertigo will result); and minimize energy expenditure. If walking on your toes answers these three criteria, that will do the trick. But to walk in the manner she did, with the knee on her good side bent at nearly 40 degrees, to address these same three criteria? She addressed the first two remarkably well. But the last one? This girl was using more than any reasonable amount of energy, all in the name of her all-too-human vanity. After we designed a pair of very fashionable boots (that placed most of the lift inside the boot,) she took nearly a year to straighten out the good leg.

By the way, she absolutely loved the boots - they had flowers stitched all over them.

The point of this story is to show just how far even the most handicapped person will go to feel normal. So, its no surprise, nor should there be any need to have to explain, why we all wish to be a little more fashionable, simply to "fit in." But with feet like most of us have, this mostly seems like a futile dream. We have fit problems, balance problems, different-sized shoe problems, orthotic needs, etc., etc. Plus, some of us like purple - no, not talking about me here, just saying!

For many of us, merely finding a good shoemaker who can make us even moderately comfortable is a feat in and of itself (sorry, can't help myself.) To get the extra option of having those shoes look like the latest at Macy's, well, not so easy. There are a few out there who can do both - looks, and comfort, but they are few and far between. With that in mind, what has been your experience in this? Have you found that ideal shoe person? What did it take for you to make yourself understood, regarding your shoe needs? Share your story here, and maybe we can get a few more folks less afraid to get out there on the dance floor.

Or at least, happier when they look in the mirror.

Thursday, June 17, 2010

Some Musings on Isolation

"It wasn't until I began to encounter other clubbies on the Web that I even knew there were others out there like me." This isn't my quote - I've been the lucky one, I think - I've met quite a few. No, this quote came from another clubby who asks to remain anonymous, and I will respect that, and I understand why he asks this of me. In fact, I have now seen quite a number of clubbies make similar pronouncements - how alone they've felt, how isolated, how "I must be the only one who has these problems."

First off, let me assure you, all of you, that this is not true - there are literally hundreds of thousand of fellow clubbies out there across the world, and far more than you might imagine have very similar issues - chronic pain, shoe and orthotic problems, the "skinny calf" issue, but more than anything else, the sense of isolation. I have given this particular issue many years of thought. In fact, I've spent more than thirty years working with a psychologist on the various issues related to my experience growing up and living with club feet. Believe me, I had no idea how much material I had to work with until, well, I started to work with it. And I believe I can offer at least a couple of insights.

If any of you have spent any time at all on the discussion groups, you will see posts from parents of new cubbies. All parents worry about their children's health, of course. But people who learn their child will have a disability are more worried than most - dealing with raising a child is hard enough without also having to cope with special needs, and even more, a daily concern for their child's present comfort and future happiness. They seek the doctor's assurances their child can be cured, fixed, made "normal." With some disabilities, such comfort is not possible, due to the either extreme nature of the disability, or the shortage of actual interventions available for their child's condition.

But with club feet, it's a different situation: doctors are able to make the feet look "normal," that is, sole of the foot flat on the ground, and looking like a foot, not like an ancient Scottish golf club. So the doctors, wanting to make the parents feel better, tell them that of course, their child will be normal. And they keep telling them that until the child is grown, and released from their care. And as the child grows, their doctors and their parents offer on-going reassurances, that, despite all the hell they may experience at school or with their peers for being the "different one," this too shall pass. Then, the child is an adult, and many soon learn, some later than others, that there is nothing about their feet that is normal. Shoes? Not normal. Sports activities? Maybe for a few, or for a while, but eventually, well, forget it. Want to dance with your spouse on that twentieth anniversary? What are you willing to give up for the next week to pay the price for that wonderful evening?

Too harsh? I wish it was an exaggeration, but unfortunately, I have heard all this and more from fellow clubbies, and it reflects my own experiences, as well. But what about that isolation issue we were talking about? When we grow up being told we will be normal, and then have to admit it just isn't the case, we have to deal with a number of realizations that are not very pleasant to come to terms with. One is (and while I don't believe this is a conscious flash of insight, I do believe it shows itself in some very distinct ways,) we feel we've been lied to. We may feel we are to blame for having failed at achieving this long-promised "normal" state. We may think we did something wrong to make our feet "revert," or collapse, or whatever words we formulate to try and explain the disparity between what we were led to believe and expect for our futures, and the actuality of our experiences.

But there is another factor at play here, one that is very hard to see, but that I believe has the greatest influence on our thinking about our post-club feet. Because our feet have been made to look "normal," unless we are consigned to shoes with braces attached, our condition is, in essence, invisible. Unlike someone with, say, cerebral palsy, there may be no outwardly discernible signs of our disability. This has a dual effect - on ourselves, and on those we encounter through the course of our lives. For us, we want to be normal, we want to be able to do the things we see others doing, have the same kinds of fun, and consequently push ourselves to do things we maybe should not.

My example? Well, at least one (there were far too many to bother you with.) I once walked the entire Lost Coast of California, 45 miles along the beach between the mouth of the Matole River, and the tiny burg of Shelter Cove. This is the longest uninhabited coastal stretch of the State, and is for most hikers a three to five day journey. And usually, no one does it alone. Most of those people are admittedly smarter than me. I took nearly ten days. I only had food for six. On the second day out, I slipped on a rock while crossing a very swollen creek (springtime is not the smartest time to do this) and sprained the holy hell out of my ankle. Needless to say, I didn't prove anything to anyone except how foolish I am capable of being.

But I did that, and all those other things, because I wanted to prove (to who? hell if I can remember now - it was nearly forty years ago.) I was normal. Notice I did it alone? Not much proof in that, eh? But, that was part of the isolation I kept myself in. You see, if I had asked someone to go with me, I would have been forced to reveal my terrible secret - that my feet weren't "normal."  But how does this affect others in our lives? In many ways, I've come to understand, but mostly through their unconscious sensing there is something we clubbies are holding back. We, many of us, that is, seem to feel it is, if not impossible, at least very difficult, to talk about our feet and their pains and limitations, so we don't. Despite the fact we continue to experience our feet hurting, and despite keeping mum about them. It is hard to see this at work, but we may feel it by sensing it is difficult for us to build new connections, especially as we get older. Which merely deepens that sense of isolation. Which can in fact lead to depression.

Now, I am certain this does not apply to all of us. But the input I've gotten, both on the Web and in person, with other clubbies, is that this isolation is fairly common. Because lets admit it - if we grow up thinking we are the only one feeling these things, because how do you meet other clubbies in public, if their disability is as "invisible" as yours, well, why talk about it with people who can't understand your experience?

Let me ask you all a simple question. This is my own experience, and I wonder if it may be at least in part, yours. Most people have fantasies - sexual, financial, super hero, whatever. Mine? To have one day, just one, where I get up in the morning, put my feet down on the floor, get up, and go about my day. I come home in the evening, make dinner, maybe see a movie, snuggle with my honey, and hit the hay. Here's the fantasy part - I do all this, just for one day, and I do not once, and I mean once, ever even think about my feet. Oh, I occasionally think about winning the lottery, because I have better odds on that one. But that's about as far out as my fantasies go. Pretty dull, eh? What's yours?

By the way, earlier I alluded to "hundreds of thousands of clubbies," and you probably wonder how I came up with that? The number is actually quite a bit larger than even that. Here is how the calculation works: club feet occurs in 1 in 750 to 1000 births (the lower number applies to a few Third World countries, sadly). There are approximately 285 million people in the US alone. That means there are roughly 28500 people just in the US with post-club feet. This is not counting recent births, immigrants, etc. Do the same calculation for other countries, and the numbers get pretty high. Since the current estimated world population is over 7.4 billion, the number is roughly 7,400,000.

See, you are far less alone than you imagined:-)

Tuesday, June 15, 2010

Things Are Too Quiet Out There!

Well, its probably because I've been a bit busy these last few days, and haven't kept up with the demands of blogging AND my day job. There does appear to be a problem with the blog, however - it won't appear on a Google search! This despite doing all the things Google recommends to make the site more visible to search engines. Except for one thing, that is.

I need other sites linking to this one, so the blog comes up in other site searches as a link. So, I ask you, dear readers, to mention this blog on other sites you pay attention to, in hopes it will generate more traffic. Then maybe we can get more clubby's taking the survey!

Remember - it's over there, on the right!

On another note, I have been reading through other books and papers re: club feet, and hope to be able to synthesize some more interesting tidbits. Especially on a study that looked at the efficacy of the Ponsetti method. Won't do us post-club-footers much good, but it does represent a hopeful sign that there's an increasingly rosier future for the newly arrived clubbys. Give me a few days to complete some more reading, and then to compose myself. Dog knows, I clearly lack composure!

Sunday, June 13, 2010

Knee Issues, Not Tissues

Let's get specific for a change - let's talk about knees. Or rather, let's ask you to talk about YOUR knees. For example, do you currently have knee problems, and if so, what specific problems? When did you begin to experience knee problems, at what age? Have you had any surgical work or joint replacement on your knees? Consider this a mini survey!

Most knees experience some type of problems as we age, but people with other pathomechanical problems - post-club feet, severe over pronation, and the like, tend toward earlier and often more severe knee issues, especially as the ability of the subtalar joint to function normally is lost or greatly reduced. The knee not only has to work against normal gravity in the planes of motion it is designed for, but with added weight, and/or additional pathomechanic involvement, our knees are highly susceptible to long-term deterioration and sudden injury - torn meniscus, ACL tears, loss of cartilage, etc.

So lets get an idea of the prevalence of knee issues in the adult post-club foot community. Operators are standing by to take your comments!

Thursday, June 10, 2010

Pre-Historic Dig Uncovers Ancient Manuscript!

Sometimes I think its helpful to explore the past of a particular field, if only (usually) to see how far things have come. But, as the famous adage goes, be careful what you ask for. Sometimes, you get a glimpse of how far things, have NOT gone.

Take this little gem. I found it in a book called Club Feet: Its Causes, Pathology, and Treatment, by William Adams, FRCS, London, 2nd Edition, 1873. If you get past the florid writing style, and some of the archaic terminologies, its a real window onto medical thinking regarding club feet, some of which persists to this day. I'll see you on the other side of the snippet below, wherein our hero talks on the psychological impact of club feet. Remember, this was before Freud.





So, we need to examine our habits of mind, is it? Byron aside, elsewhere in the chapter, Adams refers to those without having any corrective interventions (unchanged club feet) as having to go back to the farms, or remain in areas of "manufactury." And throughout the text, there are many references to the challenges faced by people with club feet back in the late 1800s. So at least by that token, there's been a wee bit of forward momentum.

But, and you knew there was going to be a "but" now, didn't you, when you examine some of the surgical practices, there is surprisingly little that has changed. He talks of tenotomies (achilles lengthening) and anterior tibialis transfer, as well as osseous (bone) realignment, much as is still done today. The thing that is not so surprising, to me at least, is they did no long-term follow-up back then, either.

I will be paying occasional visits to this book, with the aim of showing other aspects, most especially some of the shoe and brace approaches taken back then. For example, did you know that they used metal as part of their casting? It was used to hold the foot into a specific position while the plaster dried, because plaster in those days took quite some time to set. So the metal remained a part of the cast. Sounds downright comfy, don't it?

How about you out there? I'd love to hear your comments on this lovely little excerpt, and to hear as well about other sources of historic information on club feet, if you have any.

And remember, work to develop those highest qualities of your mind. You'll make philosopher yet!

Tuesday, June 8, 2010

The Survey Has Arrived

Well, here it is. Over there on the top right side of the blog. It's a bit long, but only as long as it needs to be. It will run for at least three years, which is how long I suspect it will take to get a substantial number of responses (unless I am being overly naive, which may be the case.)

I urge you all to complete the survey. This data will be presented to various medical journals for consideration of publication after it is completed, so that medical professionals can start (finally!) to see what post-club foot does to us, and how it might be better addressed.

If you have any problems submitting the survey, let me know - I'm still learning, as you might suspect.

But do let others with post-club feet/foot know about this survey, and urge them to complete it, as well.

Thanks for your participation!

Yep - Lab Rats, One and All, That's What We Are

This is a response to Denise's latest comment. I thought it was worth exploring in more detail than a reply comment would suffice.

Denise,

First, I want to say how awful it is you had so many failed surgeries. It often seems we clubby's are guinea pigs for surgeons. Here is an unfortunate fact: there is no single body of evidence that addresses post-club feet issues as to what surgeries will be more successful than another surgery for the same issue - its all up to an individual surgeon to hopefully understand, and have the real skills, to both apply and succeed at that particular surgery. And we get to be their test subjects. As I keep saying, its all about the biomechanics - if there is an insufficient knowledge of both "normal" biomechanics and abnormal, then any approach to musculo-skeletal surgery stands a better-than-average chance to fail. And I would be more than happy to debate any surgeon on that statement, anytime they wish.

As for the orthotic question: Yes, by all means you should wear one on the non-club foot. This is because that foot is doing at least 1 1/2 times its normal job - it bears more weight (not 2 to 1, but still more - we tend to compensate, especially in the presence of pain,) it is firing its muscles with greater frequency (it needs to not only bear additional weight, it also needs to work harder to maintain balance, so it will have to fire those muscles more.) A properly made orthotic will aid in those increased functions.

However, you will still need something on the clubbed foot. Placing an orthotic beneath only one foot adds material, and therefor height, to that side. If you don't have the same material thickness beneath the opposite side, you induce a leg length difference. Now, that said, I have found most (not all) folks with a uni-lateral club foot already have a leg length difference, with the clubbed foot side being shorter. So, if you only add the same thickness, you may still be too short on that side. I urge you to seek out someone who has done a lot of work on limb length discrepency, which may not be so easy. Many doctors - orthopods, podiatrist, chiropractors - may say they "treat" limb length difference, but there's a small (not really) problem: few of those doctors really understand the proper ways to determine the true amount of the discrepancy, and even fewer understand how a specific uni-lateral pathomechanic anomaly may require adjusting what that amount means to any resulting treatment plan. Just because (assuming their measurements are accurate) you are measured with, say, a 1/2 inch discrepancy, failure to understand 1. the duration of the compensation your body has undergone (how many years have you been compensating,) 2. the specific biomechanics of the post-club foot; and 3. the manner in which you, specifically, have compensated for both the one post-club foot and the actual discrepancy, will nearly always result in some level of failure.

At minimum, you need to try for balance. I have found it almost always a more effective approach to be your own best investigator - its your body, you have to walk in it for the rest of your life, and you've already walked in it this long. So here is one thing you should try:

Get a stack of flat, hard objects, like magazines, but all of the same thickness. In your bare feet, and on hard flooring, place one of the magazines beneath your one clubbed foot, none under the other, for now. Stand straight, but relaxed. Allow your knees and hips to assume their most relaxed positions. Close your eyes, and get a sense of the position of your hips and knees, right to left. Pay attention to the position of your head, your arms, your spine. Are your arms at the same position right to left? Is your head tilted to one side, or is it level? You can try this in front of a mirror, but it is important that you not try to "correct" what you see - this requires being completely honest with yourself (we always unconsciously "adjust" ourselves when we notice something "off kilter.)

Once you have gotten that sense of your own body's position in space, step off the magazine and do the same thing with nothing under either foot. Note the difference. Now, replace the magazine with two of them, and do it again - check your body to notice the difference - does one hip feel higher, or one knee feel more "locked"? This will start to get you aware of how your body is balanced or unbalanced. The criteria are: both knees should be at the same, somewhat un-locked position. Your hips should feel level, and so should your shoulders. If you are standing in front of a mirror, do you notice any change in the tilt of your head, right to left?

There are more ways to assess leg length discrepancy, but these will start to help you understand how your body is either balanced or unbalanced. If you feel that one side is shorter than the other, the next test is to acquire a small piece of firm foam, like is found in shoe soling. Your local shoe repair shop is the best resource. Ask the cobbler to make you two shoe lifts for inside your shoes. One should be 1/8 inch thick, and the other 1/4 inch thick. Start with the thinner one - place it inside the heel of the shoe on the side you feel is shorter. Walk around with it in your shoe for no more than 1 hour (on your feet - sitting doesn't count:-) Use this for a few days, to evaluate how your knees, hips, back, and shoulders/arms feel. If you find there isn't much difference, exchange the lift for the thicker one, and do the whole process again. If you now feel a difference, slowly, no more than an additional hour each day, increase the time you wear the lift while standing and walking. If at any point in this process you start to feel pain in any part of your body, back off an hour or so, and make a slower break-in, until you are able to wear the lift without pain.

It may be that this is still not enough, that you in fact need more lift. But stick with this for now. Any additional amount really requires you get professionally evaluated, because what you don't want, is to create more trauma. So go slow - it took you this long to get where you are, don't expect to rush everything in the other direction without causing trauma to yourself.

Our bodies are masters of compensation, for many insults to our "bus." But not to all of them. If the bus gets a flat, it can be fixed. but if the bus drives into a ditch, its going to take much more time and effort (and money) to get it back on the road. But don't give up - just be patient, and always remember - you are the one driving this bus - only you can decide if the fix worked.

Saturday, June 5, 2010

A Caution About Orthotics

We live in the New Jazz Age, as it were - everything is shiny and new and digital. This includes the various methods of making foot orthoses. Today, you can have your feet laser digitized. Totally WOW! And for most people, this is a really fast and effective approach. But - there's always a "but" - if your post-club feet have a very limited range of motion, or you've had fusions, this is not, in my view, the best approach. Allow me to explain.

There are currently two primary types of digitizers - static position scanners, and expert-positioned scanners. Static scanners are precisely that - you place your foot on a platform or within an enclosure while in a seated or standing position, and click! your feet are scanned. Unfortunately, this means your feet are most likely in their most problematic position, and the resultant orthotics are most likely to maintain your feet in or near that position.

The expert-positioned scanner requires a trained technician or biomechanist to position and hold your foot in what is called its neutral position while the scanner captures your feet in that position. Orthotics made on such digital parameters are far more likely to allow your feet to operate from this neutral position, and thus allow your joints their optimum ranges of motion. This leads, in most instances, to reduced pathomechanics during the entire gait cycle.

But with post-club feet, most trained technicians and biomechanists, in my view, don't see in their careers enough people with post-club feet. This means they are less likely to 1. successfully capture the true neutral position of our feet, whose neutral position is quite different, in many cases, from less "altered" feet. I know this from many years of working with both plaster molds and digital data of all types of feet, including post-club feet. And 2. Making the required modifications to the resultant images based on that same limited experience with feet like ours.

Before the advent of digital laser image capture, all orthotics were made from a plaster mold derived from either a plaster casting technique, or the step in the foam box technique. The foam box technique is fine if the orthotics are to be made from soft materials, because such materials will compress and collapse fairly rapidly, and can't have too much negative impact if they aren't well positioned and properly modified. But devices made of firmer, longer lasting, and more controlling materials offer less room for error. If a device made from polypropylene, for example, is made incorrectly, you are going to know about it fairly quickly. There is some, but not much, room for error. More rigid materials offer many advantages - more positional and functional control, longer life, greater resistance to compression and collapse, and more resistance to the acids in our sweat. But if made improperly - through casting or digital capture, and subsequent modifications of the resulting image or mold, then such materials can cause reactions ranging from aches to outright new and painful, and the odds are high such a device will be rejected.

I realize this doesn't seem very hopeful or upbeat, but again, I am trying to move the bar as high as possible for us clubbys. The precision required to both capture the proper position, and the skills necessary for proper mold or image modifications as applied to post-club feet require much experience. Unfortunately, and while I am willing to be corrected on this, I believe that I am the only post-club footer to have ever done this kind of work, and to have done it with more than twenty people with post-club feet (believe me, that's actually a lot.) This made me pay very close attention to how post-club feet vary from other types of foot deformities. The one foot type that most resembles post-club feet are those on people with Charcot-Marie Tooth's Disease. And I made shoes and orthotics for many such folks, as well.

So, to not be a total downer here, let me offer a few suggestions:

1. Find someone who understands and is well-practiced at neutral position casting technique. Podiatric biomechanists, especially ones trained at the California school, are better trained at this than most, but there are a few certified Pedorthists out there that really understand this technique. Question your practitioner on this, whether they use plaster casting, or laser digitizing.

2. Question as well who will be doing the actual modifications and manufacture of the devices. If you can't get that information from your practitioner directly, insist they put you in touch with the people who will be doing this. Speak to them directly about your feet - you are the best teacher on the subject of your own feet. Some of us, for example, have "fatter" soft tissue, especially around our heels. Some have some part of that soft tissue (also known as fat pad) that is laterally displaced - it doesn't stay under our heel when we put our foot on the ground - it "squeezes" out to the side. This soft tissue needs to be accounted for in the modifications to image or mold, or the devices will pinch or press that soft tissue in a painful manner. The height of the heel cup may also require increasing to account for this issue, as well. (If you are having problems explaining these issues to the practitioner or technicians, contact me with their contact information, and I'll be happy to "translate" for you.)

3. Break-in. Properly. Or risk failure of the devices.

4. Beware those who tell you "this" is the best/better/newest/coolest way. There are many gimmicks aimed at foot comfort. They only really work for a narrow slice of the foot-wearing public. An example: you might remember Earth Shoes? These shoes tried to sell buyers on the concept of the "negative-heel shoe." That is, the heel of the shoe was lower than the ball, causing the foot to fall harder at heel strike. The sales pitch used pictures of a bare foot in wet sand, citing this as a "natural way to walk." Unfortunately, both the pitch, and the shoes, were way off base: how often do YOU walk barefoot on the beach, compared to how often you walk on concrete, wood, tiles, etc? And, when you do walk on wet sand, how long does it take before your feet, legs, back get tired? As for the shoes? They ended up causing a large number of knee injuries, because (and I really shouldn't have to even say this, but what the heck) this position causes the knee to hyper-extend, which can lead to meniscus tears, torn HCLs, etc. Oh, lots of lawsuits ensued. So question all such claims - it may save you another trip to the doctor. And quite a bit of money, to boot (shoe pun:-)

Of course, I DO have a bridge to sell.

Friday, June 4, 2010

Coming to a Blog Near You!

I wanted to alert you folks about some things I am working on for the blog. Besides the survey (about 1/2 way done, BTW) I am developing a list of the following resources:

1. Qualified biomechanics specialists around the country
2. A list of orthotic labs
3. A list of shoemakers who are focused on custom therapeutic foot wear. (Sorry - no cowboy boots or 6 inch spikes.)

These will take me a month or so to complete (I DO have a day job, eh?) But you, yes, you, can help me with this project. All you have to do is to send me the resources you already use or know of, and I can include them on these lists. If you act before midnight tonight, you won't just get one, not just two, but three thanks for the price of one!

When the Bad Doggies Howl

Last night was one of "those" nights. You know - when the bad doggies howl? After a particularly long day on the feet, my puppies are screamin'! So, regardless of whatever else I had in mind for my evening, well, that gets scrapped. Instead, I settle in for a long evening of soaks, massage, and grumbling about missing a night at the jazz festival. Or something like that.

And let's face it - the soaks, unless you are one of those lucky so-and-so's with their own jacuzzi, are only a marginal improvement over having the family dog lick peanut butter off your feet. Which at least has the added value of making everyone laugh. But soak 'em is always the first step. Because if I try for the massage without it, well, sometimes the screaming is mercifully brief. Other times, my wife has to hit me with several containers of Cherry Garcia before I can settle down.

The funny thing about massaging post-club feet? The best direction for stretching my feet to temporarily reduce the pain, is to move them back in the direction they were in before I had surgeries. That is, into their initial club-foot position. This seems to be the only way to relieve the lateral sinus tarsi pain, but I must admit - I've always been a sucker for irony, so I guess it all evens out.

Then, after yanking and stretching, and pummeling the doggies into relative submission, I head for the bliss of the iSqueeze. Oh, my! Let me tell you, since I can't seem to find anyone to do the exact kind of foot massage I really need, this thing comes in a close second. Not cheap, certainly, but a real investment in future aahhs! and oooohs!, and maybe a good night's sleep without screaming arch cramps. So, no matter how you look at it, its money well spent. (By the way, here is a link to see what I'm talking about - http://www.amazon.com/s/?ie=UTF8&keywords=isqueeze&tag=googhydr-20&index=aps&hvadid=3587741415&ref=pd_sl_ifngfc4yv_e - cut and paste it into your browser bar.) There are a number of different makes out there - I suggest you try a few - Brookstone stores carry the iSqueeze, for example. I highly recommend you get one that goes as far up your calves as possible - makes a real difference.

Another thing about foot massages: most massage therapists seem to think shiatsu or extreme deep tissue massage is the answer to everything (even getting the waxy build-up off the car.) Oh, the arguments I've had while prone on the table. Let's face it - they just don't "get" feet like ours, do they? What really works for me, is slow, steady stretching of all the joints, especially in the directions opposite to where the doggies sit while they stand (or something like that - that's the problem with metaphors - what are they really for, if not to confuse?) I am also a fan of slow, large-hand kneading, (not dissimilar to the act of kneading bread, by the way) where the therapist does not concentrate in minute areas of my feet, but works them over with a light-weight steam roller. AAhhhhhhh!

And then, there's my anti-gravity chair. Lay down, tip that beast alllll the way back, and Goodnight Irene!

No, really - goodnight!

Thursday, June 3, 2010

The Issue of Biomechanics, Orthotics, and "Qualified Practitioners"

The recent comment from Denise is the impetus for this post, so thanks to you, Denise!

The art and science of foot and gait biomechanics is a still-developing field, in many respects. And there are many practitioners, both orthopedic and podiatric, who have had some training in biomechanics. But this is no different than saying most have had some training in surgical techniques - of course they have - it was one of their medical training requirements. But at some point in their training, every doctor, regardless of their license, decided to focus on one or maybe two areas of practice. While a surgeon needs to understand biomechanics to guide his or her surgical interventions, does not make that surgeon a specialist in biomechanics as it applies to assessment for and casting for foot orthotics.

Likewise with an understanding and expertise in the casting for, and the manufacturing of, orthotic devices. Again, there are varying levels of expertise. This is an important distinction, because many people go see a podiatrist or orthopedist who suggest orthotics, and while they are qualified to make such a suggestion, and even understand how such devices should function, they themselves may not be the best person to do the proper gait analysis, do the correct casting techniques, and use a laboratory that is well- versed in all the nuances of particular pathomechanics to inform their making your orthotic devices. Or, you wouldn't hire a plumber to put in a new light switch. Both the plumber and the electrician are contractors, but they have specialized skills.

Biomechanics is still a somewhat "fuzzy" science, in that there are some competing theories by podiatrist vs. orthopedists. These competing theories are somewhat driven by turf wars - orthopedists tend to look down at podiatrists, and podiatrists may justifiably resent having aspersions cast their way. But as the client, you need to do your own investigation, not as to the operating theory, but as to the level of training your chosen practitioner has received, how long they have been practicing, and their success with other patients having the same issue as yourself. Do not hesitate to ask the doctor to put you in touch with such patients, to ask their experience with outcomes.

Not all casting techniques are created equal, as well. Weight-bearing casting takes a substantially different "picture" of the foot than non-weight-bearing, neutrally positioned casting. The proper technique will determine whether your devices actually work, or just maintain your feet in their worst possible position. Think of when you, as an infant, had your feet casted for your talipes. If the foot was positioned incorrectly, the results would be less than desirable. The same holds true for casting for orthotic devices.

Further, the method of manufacture, the choice of materials, and the skills of the lab technicians all have an impact on the efficacy of the resulting orthotics. This may not be evident when the devices are first put into your shoes, but will make itself evident in short order. Always, and I mean always, be your own best advocate. If the devices either cause more pain, or fail to alleviate the pain that was the impetus for the orthotics in the first place, take them back to the doctor. work with them to get the devices either adjusted, or remade. Its your money, and it goes without saying (so why am I saying it:-) your feet.

Finally, the topic of proper break-in. If I took your feet and put them into a new position, and told you that was it, keep in that position from now on, well, I guarantee you will, within a short amount of time, come looking to sue me! Because making an abrupt change to joint positions is as much a trauma as the slow trauma that got you to this point in the first place. the difference is, its MUCH faster trauma.

Our bodies are really quite remarkable in their ability to compensate for slow trauma, some body types more than others, however. People with a loose ligament tone in their bodies, who often refer to themselves as "double-jointed," tend to compensate quite rapidly, and at more levels of the body. However, they also tend to show more problems in other joints that have compensated, over the long haul. People with very tight ligament tone, on the other hand, are not as good at compensating, especially in the short term. And of course, there are many gradations of ligament tone, and this is the main reason, besides the amount of time a particular condition has been present, that the proper break-in approach is critical to the success of foot orthotics. Let's say you are a 45 year old with bi-lateral post-club feet, and are just getting your first orthotics. And your ligament tone is on the tighter side. You may need as much as two to three months of gradual use of the devices before you are able to wear them full time.

The normal break-in recommendation works something like this - day 1, no more than 1 hour on your feet with the devices. Sitting does not count - only the amount of time standing, walking, running, count. day 2 - 2 hours. Day 3 - 3 hours, and so on. The "usual" break-in time is two weeks. But we who have post-club feet nearly always take more time to successfully break in our orthotics.

Finally, there is one other element that is absolutely critical to the success of orthotics - the shoes you put them into. If you put your new orthotics into those old, run-down shoes you have so painfully broken in, I guarantee the orthotics will fail, at least to some degree. I have always recommended clients either buy new shoes, or get their old ones repaired and re-balanced. The orthotics need to be in as neutral an environment as possible especially at the start of the orthotic usage. By the same token, the kinds of shoes you place the devices into also makes a difference to their success. Higher heels (sorry, ladies!) are not going to give as good a result, because higher heels make the foot slide forward. No surprise there - the foot was not designed to be always walking down hill!

Our feet start off with many disadvantages. The entire purpose of foot orthotics is to attempt to regain for our feet some of those lost advantages. It is important that we give as many possibilities for success as we can, for the ultimate success of this form of therapy.

Tuesday, June 1, 2010

The Pains of Club Feet

Pain is a funny thing - everyone hates it, but it serves a critical purpose. Without pain, we would not know when to stop, avoid, refrain, etc., from doing the very thing that causes the pain. This is especially the case in a diabetic, for example. As many people with diabetes are vulnerable to peripheral neuropathy, essentially, the loss of their sensory nerves in their feet and legs, they lack this critical feedback mechanism. This makes them susceptible to the formation of ulcers, that, if left untreated, can lead to amputations, and even worse complications.

For those of us with club feet, pain is both a motivator and a de-motivator. We want to do all the things our family and friends do, all the things our jobs demand of us, but as time goes on, we find it more difficult to ignore our pain. We may seek out other surgical solutions, start to use pain medications with greater frequency, stop doing all the things we love to do, try other mechanical responses to the pain. We risk addiction with the pain meds, less-than-hoped-for results from the surgical procedures, or disappointing results from the mechanical modalities. We may fall victim to some of the myriad quack solutions as we become willing to try almost anything to alleviate this chronic pain. We also risk depression, and loss of faith in solutions of any kind.

There is, however, a mind-set that can help get through this dark night we often find ourselves in. This mind-set is constructed of several elements. First, don't give up. This is critical, because without it, we can in fact succumb to addiction and depression, and quite honestly, neither are solutions, merely additional problems, and potentially more destructive than the pain itself.

Second, be willing to try some things again, but from different approaches. That pair of orthotics didn't work? Try a different podiatrist or orthopedist for the evaluation and/or casting, and try a different orthotic lab for the devices. Not all professionals have the same skills or sensitivity to the particularities of club feet - in fact, few truly do. Or pain meds - if the type or combination's you've been using aren't doing the job, or are screwing up your ability to function, ask your doctor to recommend a different approach. Be willing to try alternative approaches - acupuncture, which has a long history of success at pain reduction; massage (don't be afraid to tell your massage therapist how to do the job right on your feet - you know better than they do what works, and what hurts;) Self-massage - I use a device called the iSqueeze, a really remarkable foot massager - not cheap, but see it as an investment in your long-term comfort. Some medical plans may cover such purchases, if you can satisfy their demands for proof of need (and I suspect you can.)

As for surgeries - this should always be your last resort. Foot surgeries for post-club feet are usually a speculation on the part of the clinician. The truth is, many soft-tissue surgeries on adults have long recovery periods, especially tendon surgeries. They require extensive and religiously attended to physical therapy for the best possible outcomes. This means at least doubling the amount of recovery time most surgeons say will be necessary - they want you to feel confident, so they tend to understate the time require for complete recovery. Don't take my word for it - go talk to a couple of physical therapists. They are the professionals that get to see the failed surgeries as much as the successful ones. And talk to others who have had the same procedures for the same issues. You will find as many successes as failures, which should be an indication that your odds for success are about the same, regardless of what the surgeon would want you to believe.

There are many kinds of pain associated with club feet. Some of us have pain in the sinus tarsi region, deep inside the subtalar joints. We may describe it as "bone pain." Some have recurring cramps - in the arch, the calf, even the toes. I have one kind of pain I haven't been able to ever get a satisfactory answer to. It occurs occasionally, thankfully. It feels like my lower legs become "heavy," almost as if the circulation is being blocked, which may well be the case. Given that most club footers have some amount of muscle atrophy in the calf and feet, due largely to all that casting and bracing, it seems reasonable to assume our blood vessels are also somewhat proportionally smaller, and thus prone to "sluggishness." I am also certain there are other types of pain, other degrees, locations, triggers , and more.

With that in mind, what is your pain like? Where, under what conditions, how acute or how chronic is that pain? What do you do to alleviate the pain, and what works best for you? Do you employ massage, and how does that work for you? Foot adjustments? Foot soaks? Ultrasound? Share your solutions with the rest of the club foot community. You have nothing to lose, and many things to gain!