I don't know about you, but I need a vacation from my vacation! Waaaayyyy too many things to do during the holidays, and insufficient will to do them with glee. But I regress...
Been limping a lot more than usual, lately, and it brought back fond memories of when I did a lot of gait analysis. Limping is much more than a sign of pain, you see. How we limp is one of several indicators of our overall pathomechanics, and can act as a signpost for the central cause of the limping itself. Of course, when we limp because we just stubbed our toe, there is little left to discover! But the case with us clubbies is seldom so simple. We may have a limb length difference (more common than you may imagine,) or the biomechanics on the left differs from the right, and the limp is a response to that difference, which may be the cause of the pain that brings on the limp. This is why it is so important to have your gait analyzed by a good biomechanist, because the real cause may be harder to pinpoint than you may suspect. Limps can arise from knee and hip/pelvis issues as much as from foot issues, and some limps are the result of neurological deficits, or, insults as they are described, such as stroke, or some other disease or accident-induced trauma.
I will be doing several posts in the coming months on this topic, focusing on specific kinds of limping and other clear pathomechanical signals that may arise from post-club feet. Stay tuned.
And Happy 2011!
Friday, January 7, 2011
5 comments:
Welcome to The Truth About Talipes! Your comments are welcome, and strongly encouraged. We with post-club feet are the best sources of information about the issues we face. Join in! (If your comment fails to appear, make a second attempt - Blogger is known to have "issues" with Comment upload from time to time.) And right now, it seems it does not want to display comments on the main page, but it will show them for individual posts, so don't give up yet!!!
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Thank you. I have been wondering if I should have a gait analysis done. - Lora
ReplyDeleteWhere does one have a gait analysis done? Is that something that requires an Rx from a doctor?
ReplyDeleteYou want to locate a sports medicine center near you. I have found the best gait analysis done by biomechanically-trained podiatrists, so be sure to ask about their training and focus before making the appointment. No, you don't need an Rx to have such an analysis done, unless you are one of those poor unfortunate souls trapped in an HMO, and then you will have to convince your gatekeeper doctor to cooperate.
ReplyDeleteThere are several different kinds/levels of gait analysis, from simple observations and measurements, watching you walk and perhaps run, to video and motion sensor technology and pressure-plate studies (now there are in-shoe sensors that do an even better job, so look for those,) (which runs a tad more expensive, wouldn't you know?)If you find the right clinician, you don't really need the high tech stuff to get the information that will make a difference, but if your insurance will cover it, I say go for it! The bells and whistles are always fun to know.
But getting the gait analysis done is really the first step. Then you need to know what to do with it! Usually, a really well-done gait analysis helps inform the design of orthotics, and can suggest the proper approach to footwear and footwear modifications (rocker soles, lifts, etc.) But again, there is no uniformity of skills and knowledge around this issue, so you really need to do your homework. I will start a project to try and identify the clinicians that best adhere to the standards I know are possible, especially here in the Bay Area, where a lot of the science and art of gait analysis was, and is still being, developed. Updates as I get them!
Thanks Natumbo. I have a sudden achilles inflammation on my club foot that I am not quite sure how to explain. After 35 years (or more) of no treatment on this foot after having 2 major surgeries on it as a small child, I have to assume it is caused by neglect and daily wear and tear. I am wondering if I should have a gait analysis done or just seek out a really good orthopedic surgeon?
ReplyDeleteAh, the tight Achilles - that kid always did drink too much (Trojan pun.)
ReplyDeleteWe clubbies have tight one's to begin with (why couldn't we just have tight buns, instead?) The lengthening is actually a response to just that. But, and this is a critical "but", the fact they were lengthened does NOT mean they are no longer tight - quite the opposite, in fact. So, we need to be doing several things more regularly than non-clubbies need to. 1. Achilles stretches. There are many ways, but regardless of which style you use, there is one thing you MUST NOT DO! Bouncing stretches - these can cause micro tearing at the tendon insertion (where it attaches to the calcaneus.) Do your stretches slow and hold. Try to do them at least two different ways: the "push the wall" approach, and the "grab the toes" approach. Both have the added benefit of helping stretch your hamstrings, helping the Achilles by aiding the hamstrings in doing more of the work on extension (when the foot is maximally on the ground, just prior to the heel coming off the ground, is the point of maximum extension of the leg.)
2. If the Achilles is particularly painful, do ice massage before stretching, and after. Just use an ice pack and rub it along the lower length of the Achilles and especially around the insertion into the calcaneus.
Take it slow - don't rush to achieve maximum stretch at the beginning - work your way up as the weeks progress. And it is very helpful to incorporate these stretches as a life-long part of your workout, because tendons are somewhat elastic, and have a tendency (no, not a pun,) to shrink back if you stop working at keeping them supple.
As for surgery? I'd try the massage and stretching for a while before thinking in that direction. You might even want to see a physical therapist for more focused exercises.
One more thing - in the worse case scenario, consider wearing slightly higher-heeled shoes for a while - this prevents the Achilles from stretching all the way to the end of its range, so you aren't hitting the pain point with every step. BUT! Don't use that as a substitute for the stretching - do both, and eventually you can go back to lower heels. And if you are wearing high heels all the time? Well, that's how they tend to get tighter. Let me explain:
Our shared condition is called "talipes equino-varus." Let me break that down - talipes - feet; eqino - horse-like; varus - the direction the soles of the feet are pointing, or bent in. So, "equino" (not like wino, by the way,) means that the heel cannot reach the ground, because the deformity prevents it doing so. There is another condition called "acquired equinus" meaning the foot, having been in high heels for many years, has shortened the Achilles to such a degree that the foot can no longer place the heel on the ground, and the person so affected walks on the balls of their feet. This same deformity occurred in the past among women in China whose feet were bound, resulting in what was known then as "lotus feet." Very painful, I can assure you.
So, what does this mean for clubbies? Regular wearing of high heels can actually shorten the Achilles over time, thereby potentially reversing all that surgery done to you as a child to lengthen them. So even if you go and have another surgery to lengthen them again, you won't be doing yourself much good if you put them right back into the high-heeled shoes.
Keep on writing, by the way. Love your blog.