Que sera, sera - The Future's (Almost) Ours to See

I recently recieved an email from another c/f adult where, among other questions, was asked, "What loss of mobility am I likely to face?" I thought I would share a part of my response, because I think it applies to pretty much all of us in Club Foot.

Unfortunately, loss of mobility is almost a given with our feet. There seem to be some contrary rationale for this, but both support my own theory that leads me to call our problem post-club feet. There is one school that believes the very act of encasing our young feet in castings and bracings is in fact the contributor to our later pain and loss of joint mobility. The other school does not agree with this theory, but fails to produce their own theory. So here we are. I tend to side more with the first theory. If you have ever heard of the Chinese practice (long abandoned now) of foot binding, you will see the logic of this theory. I had the opportunity to make a pair of shoes for a 97 y/o Chinese woman whose feet were bound as a child. Not only were the feet badly deformed, they also had almost no motion in them at all. We, to a lesser degree of course, had our feet bound, and during some of our most critical bone development phases. This is one of the
contributing factors in most of us c/f-ers having smaller feet than other people our same size. It also explains our "tiny calves."

There are a few other things you can do to "cheat" these oncoming issues, however. The addition of rocker soles to your shoes is one of the best. Rocker soles do several things at once: they reduce the amount of actual joint motion needed to walk or run, as the rocker itself provides more of the motion required. They also provide a more accurate moment of propulsion as that phase of the gait cycle requires. When we have reduced motion in the rear foot, it can produce a delay of the propulsive phase (AKA heel off) which puts greater stress on the rear and midfoot. Additionally, rocker soles reduce impact at heel strike, which can save substantial wear and tear on the ankles and knees.

It is very important to also keep your knees in good shape. Doing balanced muscle building of your upper and lower legs, anterior/posterior, and lateral/medial groups is critical. We c/f-ers are far more vulnerable than others to loss of knee cartilage and meniscus tears, not to mention ligament problems. By keeping these muscle groups strong and balanced, that is, working all groups equally, will make a substantial difference as you age.

To add to my original reply, I'll start with a few questions for you folks. At what age did you first start to experience chronic pain in your foot/feet? Were you then or are you now above your ideal body weight? And, what have doctors told you about your pain - how to deal with it, whether they recommend a surgery, and if so, what kind, and of course, whether this was going to be an on-going issue for you?

These questions deal with several issues we are facing: the age/weight factor may in fact tell you something about the pace of future breakdown, loss of mobility, sequelae ( a medical term for what else may go wrong as a result of the first thing or things that went wrong.) Then there is the issue of what the doctors actually know, or think they know, about what c/f-ers face in their future. Weight is, in fact, an issue, and we c/f-ers are in a damned if we do, damned if we don't situation, I am sorry to say. If we excersize right, we produce more wear and tear on the joints in our feet, which may lead to more chronic pain, which will, of course, be a really big de-motivator. And if we don't, if we take it easy, we also have to become very watchful of our caloric intake, or we gain weight. So, unlike those without post-club feet, we have to work harder, be more conscious of our actions, or we will merely add to the burden our feet already have to carry, which will only accelerate the eventual reduction in mobility, and chronic pain issues.

As to what the doctors tell you: if they are all saying "triple arthrodesis" or fusion, you need to push back. This is a poor solution. Yes, your foot pain will reduce, and may even stop - for a few years. But here's the kicker - a triple ensures that your ankles will begin to break down within five to ten years, and your knees will either keep the same schedule, or follow shortly after. So you will be trading one set of problems for another, or even several others. Fusions are irreversible. If we push back, if we begin to challenge this "conventional wisdom," the doctors will have to start thinking more creatively about alternate solutions. Yes, there are ankle and knee replacements, but those have a shorter life than you might imagine, especially for us c/f=ers - our biomechanics are quite different from everyone else's. Where someone who has a knee replacement due to their sports career, for example, they are told to expect ten to fifteen years of use. I would cut that, at best, in half for us.

So, I don't have any ideas about better surgical solutions for post-club feet. That, after all, is not my job - I'm not a surgeon. But I will shake the cages of the surgeons, because present solutions just aren't good enough, and in some situations, aren't good at all. My area is in applying mechanical solutions (or, it was, as I am no longer active, except as a consultant.) But it is also in trying, for the first time, to get the truth about talipes into the hands of all you other post-club foot folks out there.

And one more question: what has worked for you? What footwear, orthosis, pain alleviation techniques, etc., what has enabled you to proceed with as little pain and loss of mobility as you have? Please share it here. This isn't "my" blog - it belongs to all who spend their lives at Club Foot.