A Long Response to Lacey

Lacey,

Wow. I'm not sure where to start, so I'll start by saying how sorry I am you've been so poorly used by the very profession you seek entry to. However, I am certain if you prevail, you will be the kind of orthopedist I would want to work with. You have, through the fates, gotten lessons no medical school would ever be able to offer you, and which will make you both the more compassionate, and hopefully the serious detective all doctors should aspire to. The Hippocratic oath deserves a very close re-reading by most of the practitioners I've encountered so far in my own life and career.

But let me attempt to at least begin to dig a bit deeper, if I may? Surely you should be able to use the HIPPA Act to demand copies of all your surgical and treatment records, including copies of X-rays and MRI's - those records do actually belong to you. And unlike myself, whose records turned to dust on inferior quality microfiche decades ago, your records should be well preserved. So I urge you to go after them. In fact, I urge every clubby to do whatever they can to get copies of their own records. Not the least because, should any future surgeries be contemplated, such records will help the new surgical team better understand what they are dealing with. And while you might suppose every subsequent doctor automatically requests all such records, let me assure you, many do not, especially records twenty years old. So you have to be the one to keep a copy, so that you can be your own best advocate.

As for fusions: I have said this many times, and suspect I'll be saying it for the rest of my life - fusions are a good thing in music, and a bad thing in feet. Yes, they will stop pain in the immediate moment. However, they ultimately transfer the pathomechanics distal to (above) the fused joints. If the subtalar is fused, the ankle begins to deteriorate, and depending on your specific biomechanics, the knee may tag along for the ride. Fuse the ankle, and its a guarantee for the knee, then the hip, lower and upper back, etc. Dare this orthopod who suggests the fusion to deny this fact. And make him back it up with real data. I'm not normally someone who likes Vegas, but I'll put money on that.

To stay with the gambling metaphor: in poker, there's this thing called the "tell." This is what each of us has, in different ways, that gives away our bluff. Any doctor who cannot "complete the chain," for a recommended course of treatment, and merely expects you to trust "their knowledge," is going to lose at poker with me. tell them you are really from Missouri, and insist they "show you."

What I mean by "complete the chain" is simple, really. To address an issue, especially one of pathomechanics, as an isolated phenomenon, (the feet all by themselves) is an utter failure of medical knowledge. We stand at the bottom of a gravity well, and it is our feet that are the foundation of the rest of our body. They are also the beginning of the chain - the chain of joints, muscles, tendons, etc., that must work in concert to both resist that gravity, and provide efficient and stable locomotion and movement through space. To deny this is a chain is foolishness, pure and simple. Your feet do not have a separate existence from the rest of your body.

To that idea, add this: any change in one part of this chain causes changes in other parts of that chain. Change the function and the position of the foot, and the leg/pelvis/spine/shoulder/arm/head portions of the chain are directly impacted, sometimes subtly, and sometimes grossly. There is some evidence that our particular ligamentous "tonality" has a strong influence on the speed, degree, and impact of any pathomechanic compensatory response. This seems to mean that people with looser ligaments tend to compensate faster, more severely, and at more levels of the body than those with tighter ligamentous tonality.

So, lets have a surgeon make a change in isolation, and then let many years pass, sometimes fewer, sometimes more. New pathomechanics, those arising out of the compensatory action of the chain, now cause new problems. The next surgeon looks primarily at the "existing identifiable problem," and so treats the symptom, but seldom the cause. (Treating the symptoms does not refer to the initial club-foot treatments in the infant, but to subsequent responses to the outcomes of those earlier treatments. Its what happens when you say, "it hurts here," or "when I do this..." and the doctor responds to only that one part of the body. This is fine for an immediate trauma, or a diseased organ, but in the area of biomechanics, a failure.) And so on, unfortunately.

In my view, a good doctor must think through the whole chain, both in space (the whole body, in motion,) and time - what will the effects of THIS surgery be upon THIS person for the rest of their life. Yes, sometimes that is very difficult to say with precision. But. And I want to say this very carefully, so it is not misunderstood - taking the full picture of the body's specific biomechanics into the initial equation of any planned response to a deformity as complex as club feet cannot help but lead to better outcomes for the entire life of the person being cut open and reconfigured. (Yes, I know, run-on sentence. Used to get flak for that in school. Sorry.)

I hope I haven't bored you too much. I sincerely would love to be able to help you find better answers, and I believe the first step must be to get those records. You need to understand, in detail, what was done to you. Without a foundation of real knowledge, any further decisions have a great possibility of being flawed. Please feel free to tell me more about when, how, etc., you got where you are today. You can contact me off the blog, if that is easier. email me directly at pisnoopy2003@yahoo.com.

One last thing for now:You may very well be the only, or one of the only orthopedists with club feet. So in fact, you will know more about club feet than any other surgeon alive. You may not believe that just yet, but think about this - they know club feet from the outside - you know them from the inside. And insider knowledge trumps everything else.