Wednesday, July 27, 2011

Rocker Soles, Part 2


OK, I promised some drawings, and I deliver now on that promise. Today, I want to start with two images, that will help to illustrate two things - the general shape of a rocker sole profile (side view), and some of the considerations that have to go into shaping the rockers for a specific person. Please be clear - I am not trying to describe a generic rocker design. I am illustrating some of the considerations that must go into the making of the proper design for a given individual only. This is because, as I have already stated, each person's biomechanics are different than that of another person. Yes, there are some general guidelines, but to apply some general design to rocker soles for every person would be to cause pathology in some significant percentage of those people. And we do not want to do that!

So, this first image is the profile of a general shape for a rocker sole (general here is used to mean average only):

OK, not the best drawing, but you try to do a graphic while a poodle is flicking your arm into the air every five minutes in a demand for attention - go on - try it!

The critical elements in this view are the rear rocker shape and angle, and the forward rocker shape and angle, both relative to the ground plane. The space between the two points needs to be flat - this is critical. Many commercially made so-called rocker soles fail on this point - they tend to have some element of a continuous roll heel to toe. The problem with that is it presupposes you never intend on standing still! Midfoot stability is important for both static stance, and the stance phase of gait. Note the "terminus" of both rocker angles. The rear rocker terminus should be across the center of the heel, and not forward of that center line. Some generic designs keep the rear rocker angle going much further forward of this point, and subsequently cause the knee to hyperextend - not a good thing.

The rear rocker provides several critical element to what makes the rocker sole effective:
1. It serves to aid the leg in deceleration on heel strike. In other words, it reduces heel strike shock by effectively increasing the percentage of the heel to initially contact the ground, which immediately begins to spread out the weight-bearing on heel strike.

2. It reduces, and in some people eliminates what can be called "slap" - slap occurs with most footwear, as the sharp corner of a heel, acting as a lever arm, propels the rest of the foot forward and down simultaneously. That is, there is no ability for the shoe to move gradually into full foot loading, or the stance phase of gait. The rocker angle works to slow the forward and downward momentum, essentially extending the moment between heel strike and stance phase in time. This slowing reduces shock, reduces the amount of motion in the joints of the foot during these phases of gait, and thereby permits the leg to move over the foot efficiently while the foot is required to do less work. In people who have joint fusions, there is little normal motion available due to those fusions. The rear rocker (and the forward rocker) provide motion to the gait cycle that is largely lost the the foot proper.

The forward rocker does some of these same things - reduces motion in the foot while restoring motion necessary for gait to the limb as a whole. Properly angled, and when the rocker sole is sufficiently high enough, nearly all motion the limb requires for effective gait can be provided through the rocker sole. The Hansen's Disease Center in Carville, Louisiana pioneered much of the design and understanding of how a rocker does what it does. Where any motion the foot performs - both vertical and horizontal forces (shear) will cause the Hansen's foot or the diabetic foot to very rapidly break down soft tissues and lead to potential ulceration, these forces and motions need to be minimized to a high a degree as possible. So the higher the overall sole, the more extreme the forward rocker angle can be, and the more of that motion it provides to gait without allowing damaging motions and forces to be applied to the foot itself.

The forward rocker angle (properly, in the side view, this should be called the pitch, or slope of the forward rocker,) can be designed either gradual or abrupt. A gradual pitch/shape will slow the stance-to-toe off phase of gait, whereas a more abrupt shape will speed the foot forward in this phase. In people where there may be a knee component to their gait issues, the more gradual slope should be used. People with a reasonable amount of joint motion in the knee and the forefoot can tolerate the more abrupt slope. Note that when I say it "slows" the phase of gait, this is a relative idea. Nothing prevents someone from running or walking fast in rocker soles - in fact, there is a tendency to feel better equipped to move at a more normal cadence than without the rocker soles. The slowing refers to a very brief moment of motion being extends for a small fraction more of time. Again, this slowing aids in significantly reducing motion in the foot itself while providing that motion required for gait.

It can help to think of it in this manner - imagine a stick with a one foot long piece of wood attached to one end. Picture using this object as a cane. Now, its clear that it would be very awkward - you would be forced to lift it fully from the ground and them swing it forward before planting it again flat on the ground.This would be a) loud, b) silly looking, and c) extremely inefficient and a high expenditure of energy.

Now, let's reshape that piece of wood by giving it a rocker shape. Now, you would be able to lift, swing, plant, roll, and easily lift for the next time the "cane" hits the ground. This requires much less energy, and won't result in your cane either breaking apart from the uneven distribution of forces, or getting thrown away as more a hindrance than a help. This is what a rocker sole can do for someone who either needs as much motion reduced as possible, or, in the case of us clubbies, provides motion necessary for gait where it is not available to the foot.

Remember, fusions are not the only thing that reduces available motion for the foot in various aspects of the gait cycle. Painful motion, such as with osteoarthritis-affected joints, benefit by this reduction of motion, as well.

Now, there is one problematic issue with rocker soles, and I would be remiss not to be clear about it. Because the shoe must be more elevated in order to permit the rocker angles to be properly incorporated (remember, this is a geometry problem - foot length, distance between the knee and the ankle, stride length - all of these and more have to be considered in order for the design for a given person to be effective). So this increased height (while simply loved by shorter folk!) also means that walking on uneven ground is more difficult, and takes some time to get used to. If a person is prone to falls, rocker soles are not recommended. But most people with severe post-club foot syndrome don't go "off-roading" very often, anyway.

OK, next time, we will look at the rocker sole from the bottom. It is not enough that the profile have the right slope front and back. We also have to take into consideration other issues, in order for the design to work properly. So more on that later.

Remember - if you have any questions about rocker soles, please post them in the Comments.

Monday, July 25, 2011

Remember That Idea For a Conference? Well.....

OK, sometimes things just emerge into the zeitgeist, as they say, and it appears that this notion I floated a while back for a conference on adults with post-club feet syndrome has some legs (sorry, couldn't help myself.) There is a summer intern over at the Ponsetti Institute that is working to help launch an international event, and, well, let the intern tell you directly:

"My name is Mayanthi Jayawardena and I am the summer intern at Ponseti
International Association and a new member of your forum. I wanted to
let you know about International Clubfoot Week (ICW) that will be
launching September 26-October 1 of this year. ICW will include a
variety of events around the world such as research forums,
community-based fundraisers, children's races, and the kickoff of
quarterly virtual parents' forums. Jenny Trevillian suggested that
I ask this group what you would find useful in a video web conference
for parents We intend these informational forums to be non medical,
instead focusing on everyday issues that parents of clubfoot patients
deal with, and parent-led, with each forum having a specific topic. An
example of a forum topic could be bracing : cost, keeping children in
braces, where to find them, how to make your child more comfortable
during bracing treatment, etc.

· Would you be interested in participating in such a forum?

· Would you be interested in leading the discussion in a
forum?

· Do you have any suggestions for topics that would be
relevant to you and other parents?

Thank you so much for your input!

Mayanthi Jayawardena

So, I made contact with Mayanthi, and asked about including something for us adult post-clubbies, and she/he (sorry, don't know for certain)  asked if I would like to take the lead on organizing that aspect, and I am now awaiting the response to my response to this excellent suggestion. Don't you just love these kinds of coinc-adinks?

So, I ask all of you readers again - is this something you would make a priority to attend? And what would you want to see happen at such an event? I would of course work to get as many doctors to come as possible, under the understanding they are there as much to learn from clubbies as we would be there to learn from them. But what else would serve to meet the needs of post-clubbies? And please do not suggest post-clubby sack races - I already have that on the agenda:-)

Here's a few of my ideas:

  • A forum on footwear, orthotics, and gait improvement.
  • a couple of massage therapists and physical therapists with experience working with post-club feet in hands-on demonstrations (good reason to include your partners!)
  • Alternatives to fusion, new directions in treatment options
  • Paliative self-help - foot massage machines, foot bath treatments, other equipment and tools, lotions, creams, etc., for temporary relief (a possible vendor fair?)
  • Discussions on pain relief methods
  • A collection of resources for all of the above as a take-away for participants.
Again, just a few of my own ideas. What are yours? And will you be interested in attending? I believe we will have some possible dates fairly soon. Then the question is, where? This first one may be best located in the US, as it would be in conjunction with the overall event, and probably in the vicinity of the Institute itself. But this would not preclude having an Internet video linkage for people unable to travel that far, so I see no reason this would not be an international event. Even the vendors could have a Facebook page for the event, with all of them on the same page.

What say you all? Please get back to me - I will take this seriously, and I hope you will, too. This is an excellent opportunity to finally get the recognition of the more active and well-organized CF community as it centers on newby clubbies - its really a continuum, with us adults on the other end. We should not have to be so isolated, and by being more a part of the over-all CF community, we are better positioned to influence things like research. And maybe, to not be so invisible.

Friday, July 22, 2011

Updates From a Gimp

Well, the Doppler was a dud. That is, I do not appear to have intermittent claudication - that's the good news. The bad news is - more doctors to spend my time and money on. Fortunately, a friend of mine is a GP doc who has done my prolotherapy, and he strongly suspects I am currently suffering from a nerve entrapment, which would be consistent with both the symptoms and the way they play out daily. So, onward through the fog.

Then there is the issue with the hand/arm/shoulder parasthesias and pain. My GP sent me to this shoulder specialist, who turned out to be a real jerk. Even if he is any good with a knife, there is no way in hell I'd let someone with the bedside manner of a moray eel open me up. Again - the fog.

I often have wondered how people with even  more severe issues than myself deal with the constant doctor merry-go-round. All I know is, there's a thousand other ways I'd prefer to spend my time. The pain, however, argues for the other course. That slimy weasel!



Those drawings of the rocker soles are nearing completion, should be up here very soon - please stay tuned.

Well, Happy Friday, drink 'em if you got 'em.

Toodles.

Wednesday, July 13, 2011

Where in the World is Carmen San di Clubby?

A little break from the serious stuff. Time once again to talk about you! Ain't that sweet?! So, it seems we are getting some nice visitors lately. Just in the last 24 hours, we revieved visits from:

Wednesday, July 13 @ 8:56 : Calgary, CA
Wednesday, July 13 @ 12:58 : Miami, Florida, US
Tuesday, July 12 @ 8:17 : Brighton, Michigan, US
Tuesday, July 12 @ 7:24 : Newark, Ohio, US
Tuesday, July 12 @ 6:24 : Tooele, Utah, US
Tuesday, July 12 @ 3:03 : Tucson, Arizona, US
Tuesday, July 12 @ 1:58 : Saint Helier, JE
Tuesday, July 12 @ 6:44 : Slough, GB
Tuesday, July 12 @ 6:37 : Waltham Cross, GB
Now, I couldn't be more pleased with the diverse cross-section of visitors - from Calgary to Waltham Cross - wow! Lovely. And you, out there in Brighton? Did you attend St. Patricks? And does Uber's Drugs still exist, and if it does, do they still have a fountain? I practically grew up on Uber's Specials, still the best ice cream sundays ever. Mmmmm, ice cream...... huh? Oh, sorry, got lost there for a moment.
A nice shout out to Saint Helier, stay in touch. And I know where Waltham Cross is, but I have to admit I'm stumped by Slough, GB. North, perhaps? Hmm. (I could Google it, but I'd rather hear from the visitor directly. It's OK, feel free to introduce yourself to all your fellow clubbies. We don't bite. (well, maybe our doctors, but never a fellow clubby.)

And same goes for Tooele, UT. Red Rock Country, or further East? You tell me:-)

Hi there, Tucson, and Newark and Miami. Hope things aren't too hot. I know the weather and the drought is kicking a lot of folks out South and East in a big way, so I am sending you cool, foggy, drizzly, San Francisco weather vibes, if that helps! We might be the liberal backwater some paint us out to be, (only a few neighborhoods, actually. We just like to make everyone else envious:-) but we sure are cooler than just about everyone right now!


The really fun thing is seeing the breakdown by country and state since we launched:

United States (US)1,436
California (CA)409
Texas (TX)171
New York (NY)168
Florida (FL)141
Utah (UT)93
Indiana (IN)54
Pennsylvania (PA)43
Maryland (MD)37
Illinois (IL)36
Michigan (MI)23
South Carolina (SC)20
Ohio (OH)19
Massachusetts (MA)18
Georgia (GA)17
Arizona (AZ)16
Virginia (VA)10
Washington (WA)9
Colorado (CO)9
North Carolina (NC)9
Missouri (MO)8
Oregon (OR)8
Iowa (IA)7
Tennessee (TN)7
Connecticut (CT)7
Wisconsin (WI)6
Minnesota (MN)6
Maine (ME)5
Kentucky (KY)5
Louisiana (LA)5
Hawaii (HI)5
Idaho (ID)4
Alabama (AL)4
New Hampshire (NH)4
Arkansas (AR)3
Vermont (VT)3
Kansas (KS)3
Oklahoma (OK)3
New Jersey (NJ)3
West Virginia (WV)2
Mississippi (MS)2
Alaska (AK)1
Montana (MT)1
District of Columbia (DC)1
New Mexico (NM)1
Nevada (NV)1
Wyoming (WY)1
Nebraska (NE)1
South Dakota (SD)1
N/A26
United Kingdom (GB)353
Canada (CA)138
Australia (AU)65
Germany (DE)50
Ireland (IE)32
New Zealand (NZ)27
South Africa (ZA)21
Taiwan (TW)16
India (IN)14
Philippines (PH)10
France (FR)8
Russian Federation (RU)8
Switzerland (CH)6
Norway (NO)6
Italy (IT)5
Netherlands (NL)5
Singapore (SG)5
Malaysia (MY)4
Denmark (DK)4
Belgium (BE)4
Turkey (TR)3
Korea, Republic of (KR)3
Pakistan (PK)3
Egypt (EG)2
Serbia (RS)2
Finland (FI)2
Hong Kong (HK)2
Argentina (AR)2
Sweden (SE)2
Israel (IL)2
Romania (RO)2
Hungary (HU)1
Slovenia (SI)1
Isle of Man (IM)1
Czech Republic (CZ)1
Poland (PL)1
Slovakia (SK)1
Iceland (IS)1
Spain (ES)1
Colombia (CO)1
Thailand (TH)1
Lao People's Democratic Republic (LA)1
Vietnam (VN)1
Sri Lanka (LK)1
Chile (CL)1
Brazil (BR)1
Indonesia (ID)1
Puerto Rico (PR)1
Mexico (MX)1
Macedonia (MK)1
Bosnia and Herzegovina (BA)1
Bulgaria (BG)1
Portugal (PT)1
Greece (GR)1
Saudi Arabia (SA)1
Iraq (IQ)1
Morocco (MA)1
Croatia (HR)1
Now, how cool is that? Clubbies Unite! But Croatia? You need to get those numbers up!! We are cheering for you.
And in case you are one of our lucky visitors from a non-English speaking country (like you American's for example:-) please just use the Translate figure on the top of the page. You can even comment in your own language, and I can translate it for the other visitors. Don't you just love the future, now that it's here?

:-)