Wednesday, April 27, 2011

This Little Piggy Went to Market, This Little Piggy Went Home...

Post-clubbies have one thing in common when it comes to footwear - they have little in common with non-clubbies. Fit, function, and fashion? Well, we are lucky to get two out of three. There is of course a spectrum - some, such as myself, have decided to go custom only, as this option affords the best degree of all three. However, it has the downside of being expensive. Some have figured out they can use some combination of athletic shoes and street shoes, within limits, of course. A few continue to try for the fashion option despite the disadvantages in the realms of fit and function. You could argue that these are exactly the same variables non-clubbies face/choose, but the degree of compromise clubbies have to face is significantly greater. I know this because my sig other can walk into any shoe store in the land and come out broke, whereas I go into any shoe store and turn around and come right out again, usually depressed I can't buy a set of loafers.

To make it even more interesting, those clubbies who wear AFOs or bulky foot orthotics are even more limited, especially when it comes to fashion. Nobody is happy to be considered a fashion dweeb, but we either learn to get over it, or it drags us down further. Personally, I've pretty much accepted the fashion write-off, as it is far more critical I get reductions in pain. This is why I will never have a future as a masochist.

The custom option, besides being expensive, is increasingly difficult to find. Most folks have to travel a significant distance to find a custom shoemaker these days, and unless that shoemaker is younger, they will eventually find themselves where I now find myself - looking for a new shoemaker. Salvadore, who was both my fellow shoemaker, and my personal shoemaker after I stopped doing the work myself, has finally raised his hammer for the last time (that's a shoemaker's pun.) I am amazed he held on so long - he's eighty, and unfortunately, he's got the Big C. And despite having five sons, none wanted to follow in their father's footsteps, so he leaves no heir to take over the business. As he was also doing substantial work for the VA, and returning, wounded vets, there are going to be a lot of hurting folks just over one person's retirement. But, as they say, se la vie.

On another note, I'd like to share something I've been thinking about for a long time. Most clubbies know that when they go see a foot doc for their ever-increasing pain, they are more likely than not to be told they need a fusion. Now, I've made no bones about my feelings on this issue, but I understand why this seems the only option - it will indeed, hwoever temporarily, stop the pain. But eventually, the ankles go, and then the knees, so in essence, a fusion merely trades pain in one place for pain in another. So, as the only tool in the tool box, it's a devil's bargain.

And, I even understand why most surgeons are reluctant to try other approaches - no real research and nobody wants to be the first through that door. But somewhere out there is a orthopedist or podiatrist who can think outside the box, and be willing to work with clubbies toward more realistic and longer-lasting solutions. To that end, I am calling on all clubbies to start talking to their doctors about the possibility of participating in a conference where both doctors and clubbies will attend, the aim being to 1) offer the clinicians a larger population of clubbies to examine and listen to so as to broaden their understanding of the variations in both function and lack thereof in post-club feet, and 2) brainstorm with us clubbies on other potential approaches.

So, here is my offer: if you find this a compelling idea, and are willing to work to make contact with your doctor/s and with other doctors who might find this an interesting idea, I will host such a conference in the San Francisco Bay Area. I will be responsible for bringing clinicians from this area into the mix, and to securing a venue and all the planning needed for this to happen. I will propose a tentative date of June, 2013, which should be more than enough time to spread the word, and to get initial responses that will justify going forward with this idea.

And I will also extend this idea to those out there who have children currently being treated. I think that despite what their pediatric surgeons may tell them, their kids are as likely to have future issues as not, and they may find it reasonable to learn about what might be possible for their children as adults.

So, my question to all you clubbies out there is simple - would you find this a good enough idea that you would make the effort to come to such a conference? Let me know.

I mean, there doesn't seem to be much reason to keep accepting the status quo, from my way of thinking.


Saturday, April 16, 2011

Night Splints, Redux, and Some Meandering Mental Spelunking

So I've been wearing the dorsiflexion night splints for this heel spur/plantar fasciitis problem, and it is having some positive effect. The "first step" pain so often indicative of both conditions has lessened considerably. But when I've been sitting a while, well, here it comes again! Onward I plod.

The negative on the night splints is how they have caused me to regurgitate old memories. As a child, I had to wear similar night splints, as I've mentioned in a prior post. But now, I have dreams of that period, and they ain't pretty, ya dig? Though these present day splints are made of plastic and velcro, and are significantly more comfortable by comparison, getting up to hit the head in the middle of the night is nearly as bad as the first time. Hence the dreams, I suppose.

I recently read an article on folks who suffer from Charcot-Marie-Tooth's Disease. I remember making shoes for a number of such folks back in the day. I am struck by the similarities, not of the conditions themselves, per se, but how post-club feet, CMT Disease, and even MS, of how the conditions are experienced by those who have to contend daily with them. Chronic pain, the every day knowledge that you will only get worse (though without any firm timeline, degree of change, or speed of deterioration knowable by you or by the medical community,) the constant awareness of needing to plan your day so as to avoid any unnecessary efforts, a background buzz of staying at least moderately aware of the surfaces you walk on, the shoes you wear and their balance or lack thereof, and more.

I know for myself, and for many others I have made shoes and orthotics for over the years, it might only be a difference of one degree of wear on my shoes, or having to negotiate ten blocks of city streets with slanted sidewalks, to set off a long bout of both foot and, by extension, lower back pain (compensation at work,) though the effect of the slanted sidewalks can sometimes be offset by walking back in the opposite direction, but on the same side of the street (this just unbalances you in the opposite direction, and while no less problematic for my feet, can at least stave off the painful back a while.)

I have long been aware of how I notice the way in which other people walk - that's partly a hazard of those years of doing gait analysis - especially when I see their badly-worn shoes, or the women who wear those six-inch spikes and walk with a distinct wobble. I know from long experience working with such people when they get older, and the toll of that need for attention finally grabs their attention in unpleasant ways, that it could all be avoided. But when you do not suffer from chronic pain, there just isn't a problem, is there? There is a factor known as angolaglia, which means the willingness to bear pain whose cause appears to contribute to one's beauty. (See William Rossi's Sex Life of the Foot and Shoe, an excellent primer on all things shoe and foot fetish and the attendant psychology. Look it up on Amazon.) So after spending many years trying to "talk some sense" into (particularly) the women who do this slow, steady damage to themselves, I finally had my eyes opened by an elderly woman who responded to my suggestions by saying (quite bluntly, as I recall,) "young man," (I was, once,) "men do not pursue women whose body has no form, and whose walk has no motion." Well, she sure shut my mouth. Trying to talk sensibly to a woman about healthy shoes is like trying to convince an alligator to adopt a vegetarian diet. A complete waste of time.

In my case, there is no willingness to bear the pain, there is only its inevitability. And as for beauty? Ask my beautiful wife. I'm the furthest from objectivity when it comes to my glorious mug.

Tuesday, April 12, 2011

MRI's Don't Lie, Do They?

To begin, it is clearly no secret I've been dealing with these post-club-feet blues for a long time, so when I developed the heel spurs on top of everything else, it didn't really surprise me. And when the doc sent me for the MRI's, I thought I knew what to expect - a real mess. Well, that doesn't even begin to describe what they showed. In the report by the radiologist, I found it both amusing and upsetting to see a perfect example of how a medical professional can employ clinical language to say, basically, "those are the most fu**ed up feet I have ever seen, and I demand you keep them far away from me." Following is the Impressions section of the report, which is sort of like a synopsis:

1. SUBTALAR JOINT AND MIDFOOT DEGENERATIVE CHANGE WITH NAVICULAR CYCSTIC CHANGE/EDEMA AND FEATURES OF POSTERIOR IMPINGEMENT NOTED.
2. PLANTAR FASCIAL CALCANEAL SPUR WITH MODERATE THICKENING, PLANTAR FASCIA, AND WITH MINIMAL SURROUNDING SOFT TISSUE EDEMA.
3. DEGENERATIVE CHANGE, METATARSALPHALANGEAL JOINT, WITH VARUS ANGULATION OF METATARSALPHALANGEAL JOINT, FIRST DIGIT..

He also notes the appearance of an Achilles tendon tear, but feels it is less-than-remarkable in  light of all the other scary stuff.

(I suppose I should feel a bit insulted being characterized as a degenerate, but that's exactly what my seventh grade teacher said about me, too, so what the heck.)

So, I have two choices vis-a-vis the heel spurs/plantar fasciitis - keep going with the prolotherapy, or try a cortisone shot to settle it down, and maybe later have to do it again, or worse, surgery. I think I'll stick with the prolo (though my wife is beginning to think I may be a closet masochist, given the degree of pain the procedure causes one to endure. But I just keep telling her it builds character. ((of course, she simply reminds me I'm enough of a character already, so please don't do her any favors)))

But all this has made me curious (well, actually, I think it was heat stroke at eight years old that did that, but I digress.) Have you had heel spurs/plantar fasciitis? How did you deal with it? Let us all know. After all, we're mostly in the same sort of boat, ya think?


Monday, April 4, 2011

Heel Spurs, Redux

OK, so, today I go in for an MRI on both feet. I can't wait to see the film! Finally, a starring roll. In cross-sections, no less. Actually, it should be quite interesting. Given the number of surgeries I've had, there has to be a mess-o-scar tissue in there, which might make my doc a bit dizzy as he tries to make sxzense of it. That's right, sxzense, that is exactly what I meant. Or not.

So, I thought this would be a good time to try and enumerate all the surgeries, therapies, and hardware that have been applied to me footsies over the years, simply by way of something fun to do. That OK?

1. Manual stretching and serial casting, starting at two weeks of age. This continued until I was two or so.
2. Tendo-Achilles Z-plasty, to lengthen the Achilles, B/L.
3. Medial soft tissue releases, B/L.
4. Anterior Tibialis lateral transfers, B/L.
5. Dennis Brown night splints.
6. Surgery to remove a bone cycst on the dorsum of my left foot, that resulted in the rupture of my tensor retinaculum, a fascial band that holds the anterior tibial tendon against the foot. The result is that my left anterior tib bow-strings away from my foot, and makes it a perfect site for shoe irritation.
7. Dorsi-flex assit night splints. These had metal uprights and a steel plate along the bottom, with wide elastic bands that attached to both sides near the toes, and extended to the calf band. They were supposed to hold my feet in a dorsiflexed position all night. The fun part was sounding like Frankenstein's monster when I got up at night to go to the bathroom. I woke everybody, because there was no way to walk in stealth mode, ya dig? Plus, I tore through sheets at an amazing rate!
8. Twister straps. These were the ultimate form of torture. I wore them when I was in the third, fourth, and fifth grade, where they presented an especially delightful experience in gym class. You see, I had to wear a girdle. Yep, a girdle. The wide elastic bands attached directly to my brown, round-toed, orthopedic shoes (the height of fashion, dontcha know) on the outside near the front of each shoe. The elastic bands were then wrapped around my legs three times, spiral fashion, and then attached to a girdle under my clothes. That is, unless I was changing for gym class, where I got to put on a show for the class, whose expertise at humiliation and bullying was significantly better than my expertise in being a duck. (As in water off a ....) Plus, they left rather painful welts in a spiral around my legs - when I removed them at night, I remember the pain being enough to make me cry.
9. Those Damn Shoes - I hated them - nobody anywhere ever wore brown, round-toed laced high-top shoes - except me. Took a lot of crap for that, in case you were interested.
10. The last surgery (to date) involved the removal of two bone spurs on my left foot - one was posterior calcaneus, and the other posterior talus, and they clapped hands every step. The docs who did the cutting managed to sever the distal third of my sural nerve, making the outside, or lateral, border of my foot permanently numb. Marvelous!

Another memory - when I was little, and having casted feet, I remember vividly the process for removing the casts. After a few weeks, as you might suspect, my feet and ankles would be itching like the blazes. The technicians would use a cast-cutter to remove them - the cast cutter has a sharp, circular blade, but it vibrates instead of rotating. Let me tell you, once you got past the fear caused by the noise those things make, you quickly came to realize how much the crazy thing made you tickle. And I mean like crazy tickle. Then, after the casts were taken off, there was all that dry skin, and residue around the surgical site that was crusted on. They had to soak my legs, then use a stiff brush to get all that stuff off, and that, my friends, did NOT tickle - it hurt like the fires of heck!

Funny thing is - these days? All I wear are high-top, round-toed, lace-up boots. At least now, they're black.


Friday, April 1, 2011

I've Had It - They're Coming Off!!!

I really can't take it anymore - the pain, the frustration, the humiliation. I've tried to work through this for years, but I've finally reached the end of my rope. Hell, I've even thought of using a rope! Or worse. What could be worse than rope, you ask? Fire. Fire would be bad. It would really hurt. So, no fire. Or can you imagine, water? Deep, cold water? Me either. Bbbrrrrr.

No. I am going to do it with surgical precision. A scalpel, maybe some local anesthetic. Or not. Depends on how bad I want to remember the experience, what's it to you? Sorry. I'm just a little nervous around needles and stuff. Forgive me.

But I try to stay focused on the upside. Soon, it will all be over, and then, bliss! I won't ever again need to explain it to strangers, or excuse it with friends. I'll be able to regain more social activities, instead of always avoiding crowds. I may even be able to smile for the cameras once again. I understand I used to do that, when I was young. But I am not young. Not anymore. I have a sister who's young, and good for her. Or maybe I am already too damaged psychologically by all these years of dealing with this horribly deforming facet of my life. If that's the case, well, I already have a well-stocked wine cellar, so I can tell the whole world to just bug off. And I'll do it, too, believe me. But only if it comes to that, I promise.

Mostly, besides getting rid of the pain, I look forward to mounting the buggers on a wall plaque after the surgery. The doctor already promised me, and even suggested I have them bronzed. I thought that might be a little over the top, but I'll be happy to keep them on my desk in a specimen jar. Like a butterfly, or a frog. My wife is a little sickened by the whole idea, but she is glad I'm finally having them cut off. They were really starting to bother her. Or rather, all the grief they were causing me, that's what was bugging her. She just got tired of my years of complaining.

So, I go in next Wednesday. It's well past time - all the other so-called solutions didn't do anything to alleviate the problem. I tried soaking them, taping them, even using every over-the-counter remedy known to drug stores. Nada. Zip. So, enough.

Those damn nose warts are coming off!! Yeah!







You do know what day this is, don't you?







April 1


What, you thought I was talking about my feet? How would I ever be able to dance again?