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.