The Upshot, The Downlow, and The Whole Shebang

I was thinking today (not yesterday, though. It was a holiday for me,) that we clubbies, like most folks with handicaps, have a requirement the non-handicapped don't ever need to face. It's hard to imagine living without the constant reminder of our handicaps. For some, its the chronic pain. For others, it might be the social stigma. Or employment discrimination (it might be illegal, but who really pays attention to that, I ask you?) But whatever the primary focus, it just doesn't often happen we can go a day or so without being reminded of our limiting factors.

It was only when I was trying to explain to my sig-other about how the pain factors in to just about everything I hope to do in life that I could see the true distance across this divide. She, for example, thinks absolutely nothing (well, not exactly true - sometimes she thinks only) about going into a shoe store and freely obsessing over the latest John Fluevogs (I couldn't begin to describe them - look them up,) and then coming home to help her drool over them. Which is where I fail as a husband, I suppose. My shoes, after all, cost waaaaaaayyyyyy more than hers, and they don't come from a store. They come from my long-time colleague and fellow shoemaker, Sal. And I usually have to save up for six months to afford them.

You are probably wondering about now why I am going on about shoes, using it as an example of the divide between us handicapped and those nons. Its like this. Sal, bless his hard-working heart, has the Big C. Just couldn't stop smoking. And then there is the adhesives and dust inherent to the trade. And even though he has insisted on continuing to work, he has finally set a date-certain for retirement. I just gave him a deposit on what will be the last pair of shoes he will make for me. In six months, I need to find a new shoemaker. One that "gets it." One within a five-hundred mile radius, hopefully.

My wife just goes to the local malls and such. So she doesn't get how this is not merely a story of Googling for an answer. It's much, much harder than that. It takes an awful lot of mind-time, and really stokes the old anxiety boiler, ya dig?

I'd rather be shopping for a brain surgeon.

I think my wife hopes I find one.

Home on the Range of Motion

Range of motion is the term used to describe how many degrees of motion are available to any given joint. As there are many types of joints, each has an "average" range. However, many of us fall outside these averages, either with excessive motion, or severely limited motion. Joint motion is usually described by the degrees of motion available in each of the various cardinal body planes - frontal, transverse, and sagital - frontal (or coronal) slices the body front to back; transverse (or horizontal) slices top to bottom, or cross-sectional' sagittal (or antero-posterior) slices side to side.

Joints move both in a plane, or planes, and through a plane or planes. For example, your leg swing moves through the sagittal plane, but in the frontal plane, and to a lesser degree, the transverse plane. Most joints move in one plane and through two planes, but several move through all planes, and in multiple planes, as well. Shoulders, hands, and more to the point, feet, and several of its joints, occupy this other category. Most notable of all is the subtalar joint, which moves in three planes, and through three planes as a result. And of equal importance is the quality of motion available to each joint. Whenever a joint is inflamed, or in pain, its quality of motion is impaired.

But why is this important for clubbies to understand? Stay with me over the next few days as I go deep inside the subtalar joint, and what it means to you and me.

To Share is to Dare

This is a general post sharing a prior comment I responded to, because I think it is useful for all clubbies to keep in mind:

Ah, the tight Achilles - that kid always did drink too much (Trojan pun.)

We 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. Helps to use a little skin lotion, to help the ice pack "glide" across the skin.

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; equino - 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. (Named so because a horse's foot appears as if the heel is up in the air and the horse is walking on it's toes.) 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. (Although, weirdly enough, it was considered sexually alluring - go figure. Plus, women whose feet were bound could not walk on their own - they were either carried in a chair, or were held up on both sides by servants, creating what was called a "willow walk" due to the fluttery gait so produced. I actually made a pair of shoes for a very elderly Chinese woman whose feet had been bound as a child. Sad. It was usually only done with women from wealthy families, which makes sense - somebody would have to pay to carry them around everywhere. Like all those limos in Hollywood, eh?)

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 designed 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.

But we gotta be sexy somehow, don't we? :-)

Gait Analysis Primer, or, The Way She Wiggle and the Way She Walk

The word gait refers to the act and action of walking, running, and other forms of upright ambulation, particularly how each body segment interacts and affects the other parts of the body, giving each individual their own unique "walk." From issues such as alignment, speed, and hip/pelvic travel (side-to-side), we can begin to understand where pathology may be hindering effective ambulation, from mere performance-related concerns, to significant pain and impairment.

When we put one foot in front of the other, a whole complex of muscles, nerves, ligaments, tendons, and bones and joints must work in some kind of harmony in order to move that foot ahead of the other foot, then repeat, over and over, thousands of times a day. The fact that we do ambulate in an upright manner makes it far more complex - bi-pedal stance is far more impacted by gravity than quadripedal is. Some have described human gait as the act of constantly falling forward, but always (mostly) catching ourselves in time, then repeating the process. There is some truth to this, but its actually quite a bit more complex than that. Gait analysis is the art and science of studying and refining this complex process with the aim of improving the outcome for the given individual.

In order to get a taste for how this works, try this the next time you are in a public place where many people are walking around. Select any other person at random, and position yourself to walk behind them for a block or so. And no, I am not promoting stalking! Stay back a minimum of twenty feet. Now, watch the way the person walks. Start at the level of their feet - what kind of shoes are they wearing? Shoes always influence our gait. High heels have the most significant impact, so you need to realize from the start that any gait analysis is usually done with the subject in their bare feet. Watch to see whether one foot appears to strike the ground or leave the ground in a manner different from the opposite side. This takes practice, but that's what we're doing, isn't it?

Watch to see if the heels of each foot "bounce" a little after the heel strikes the ground - this is often, though not always, a sign of a tight Achilles tendon. Observe how the feet are pointed in stance - are the toes pointed in, or out, or fairly straight ahead? Each of these possibilities impacts the over-all gait in different ways.

Now, go up to the hips. Does one side appear to move further to the side than the other during the same phase of gait? Does it rise more? Again, each of these may be indicative of some type of pathomechanical issue.

Move your gaze up to the shoulders - does one appear higher than the other? Do the arms swing the same amount, or even the same angles? Then the head. Does the upward movement that occurs as the heel of each side leaves the ground appear even, that is, the same for each side? Or does there appear to be a difference, and even a head tilt to one side?

OK. Now, try the same thing for people walking towards you. Make the same observations. Are you beginning to see the scope of this art, even a little? It takes a lot of training, and a lot of practice. The high tech tools that are often used for gait analysis offer deeper insight, but the core knowledge of gait analysis remains the training and skill of the clinician.

Next time, I'll expand this topic by looking at some of the specifics as they may apply to us post-clubbies. Until then, just explain to your significant other that when you are watching someone's hip motion, it's in the cause of science. Bet they've never gotten that excuse before!

Welcome, 2011! Care to Dance? Mind if I Limp Along?

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!

Feets, Do Yer Stuff!!

Last day of work till next year - yee-haw!!! I've been thinking about this blog for some time now, and wondering what I can do to get more of you to share your own experiences. I thought, "Self, how about monetary incentives?" And I responded, "Well, Self, you got squat, so how do you plan on doing that?" And I was all, "Why you gotta rain on my parade?" And I was all back, "Cuz rains all we got right now, fool!" I do that sort of thing to myself now and then, especially when I'm off my meds, er, chocolate. So if I can't pay you to jump in and share, its back to the drawing board.

I know from other discussion groups and blogs out there that there's lots of sharing among parents of tykes with club feet, and that's as it should be - they get so little real information that sharing is their best option. But us adult clubbies, well, we're another story. I saw a photo of myself at about three, with my Mom looking at my feet, encased in another set of casts. I saw her worry, and her confusion, and wondered how she did it with so little support. She wasn't just worried about my feet and comfort in the present moment, but saw and felt the road I would have to walk through my life and wondered how I would fare, and hoped every day she was making the right choices. That all of those choices were framed and pressed on her by a small handful of medical folks, whose knowledge and skills she had no way of verifying, or putting into a comparative context, meant shear trust was her only real option.

I am of course grateful for all her efforts on my behalf. But I can't help but wonder how different parents facing these same questions today will cope, given the much broader scope of support and information available, especially on the Internet. But one way they are no different at all is they, too, must trust how the choices they make now will affect their child as they become adults and walk the road of their lives. That is one part of why I continue this site - not to say each child will face the same trials many of us older clubbies have, and continue to do, because each case turns out different, and there are many successful outcomes - but I do this for those that are less successful, because even with Ponsetti, and other advances, there are still failures of the process, and each one still has to walk through their own life. I just don't want these clubbies to feel as alone and in as much pain as I and many others have. I hope to provide that information and support that wasn't available to me.

But I can't do it alone, first because I don't have all, oh, hell, I don't have very much at all, of the answers, and second, because support takes many people sharing their triumphs and ongoing problems with others walking a similar road. What worked for you might make a real difference in someone else's life, and vice-versa. And what remains a difficulty for you may help other clubbies know their own pain and experience isn't only theirs to bear. I have to think that the best incentive is in fact your own life experience, and hope in this next year many of you folks around the world with post-club feet find the courage and time to open up more, share resources and ideas, commiserate and cajole where appropriate, and make 2011 a better year for clubbies everywhere.

Happy New Year to you all.

Holiday Cheer, or, How to Kiss Under Holly When Your Feet Are Screaming

My sweet Patootie likes to dress up the place for the Holidays, so as you probably can guess, I am the one who gets to do the work - lights, tree, etc., etc. I get to take it down and repack it all, too. It's gotten to the point where I'd like to design a house with built-in lights that can be exposed and turned on by the push of a button, so I don't have to keep up the seasonal discomfort associated with all that cheer. As you might imagine, I get to wear two hats this time of year - Sandy Claws, and Grinch. I think I'd trade them both in for one of Druid in Cave, at least for one year, a vacation from the day before Turkey till the day after the New Kid on the Block drops down the chute. But I regress...

My office held its annual Holiday blow-out, this year as a moving feast, er, drunken revel, going from one place to another. Despite the generous libations, it did not suffice to anesthetize my screamin' doggies, so I never made it to the last venue. Fortunately, I had an appointment with my massage dude the next afternoon, and after an hour of twisting and shouting, I was nearly normal. Which in and of itself barely attests to my over-all state, but nonetheless, it will have to do for now.

I know there are many others out there who have similar limitations, who must plan each step. Over the years, the actual "standing/walking/dancing" time allowed has shrunk, and today is far more limited than I'd like, but there it is, isn't it? And no matter how many times I ask Sandy Claws for a new bike (euphemism alert) for Christmas, I'd be more likely to get a case of matzo for Hanukkah (I am very ecumenical, for a staunch Implementarian (we worship hardware stores and garden centers - don't worry - we don't proselytize - we don't even extemporize. We just get the job done.) But the good thing about the Holiday section of the year - I can up the meds in the name of good cheer. Can't you see how much bigger my smile has gotten? :-)

Well, I may or may not update again before the tree dries out, but in case I don't, have a Very Merry Whathaveyou, and a Happy Blue Cheer, in the flavor of your choice. Make mine Cherry Garcia.

Prolo el Mano-e-Mano, Dont Count Yer Chickens, Izhak!

Another prolo session this past Saturday. Things seem still on track. But last Wednesday, went to the regular doc, who ordered some blood tests, due to my overall fatigue and aching joints. Been going on about a month or so, maybe a bit longer. So today got a call from Doc - everything came back negative......except - positive for rheumatoid arthritis.

Lovely.

And the various meds all have some really fun side effects.

I hope scotch isn't contraindicated.

Ouch! It's Like That

People who suffer from chronic pain have a difficult time understanding why people who don't, just don't get it. It's not like we like to be in pain, nor as though we all secretly desire to be addicts, or that we love to complain. No, no, and no to all of the above. But the truth is, chronic pain is the perpetually unwelcome guest. We didn't invite it, we're tired of feeding it, and we can't get it to leave. And people who do not suffer from chronic pain may from time to time experience pain, well, for them, it soon goes away. Their reality is that pain is an inconvenience. For those with chronic pain, its a never-ending intrusion, an endless interruption into the lives they would rather be leading.

Imagine never having a day when you don't have to be interrupted by some part of your body. You can never just focus on your play, your work, your enjoyment of the moment, because there is always this other thing, this monster under the bed. Go ahead, try to imagine it, I'll wait..... So, if you have never suffered from chronic pain, you probably couldn't achieve the requisite level of dark outlook, and all that attends thereof. It's OK, we know you couldn't do it. The fact is, we wish we couldn't do it, as well. But those of us who do suffer in this manner need to be patient with those who are free from such a constant encounter with pain. They really don't get it. It is what it is.

But the impact of chronic pain can affect those who live with us, work with us, and often have grown tired of playing with us, because our limitations are upsetting and a drag. I mean, lets be honest about this - handicapped people are not as much fun as people who are up for a marathon, or sky diving, or a serious set of tennis. Its not that they can't do these things, its just that they do them, well, slower, or more differently than we, the able-bodied, pain free folks would prefer. I get it, really, I do. We cramp your style.

But here's the irony, if you will. When the unfortunate happens to the presently able-bodied, its far more likely to derail them than it does with those of us who've been a long way down Hurting Road for a long time. We are better able, most of the time, to dealing with our situation, because we've had the practice. Hey, its the one advantage we have, so buck up. What makes you so upset - you didn't think you would be immune from the vagaries of the human condition, did you? Oh, I see. Well, that must be tough for you.

We who understand are left to wonder - why are you complaining so much? Get over it. Isn't that what you always say to us?

Prolo Update, Pain in the Neck, Herding Them Calves

Well, been away a bit, so not much to say about that, but waaaaay too much to say about everything else. The prolo seems to be holding on the right knee, thankfully. But my puppies have been going through a particularly rough patch of late. Think its time for new orthotics - been wearing these for a long time, and even thought they are made from old WWII tank iron, they could use a freshener. Maybe switch to titanium, eh?

The neck fusion may need a wee bit of revision - the bottom screw appears to have loosened (but they warned me of that possibility,) and they will have to go in from the back and wrap a wire around my neck. Sweet. Always thought of a garrote as something to be avoided, but what can ya do? Then again, so many people have commented about my loose screw that I wonder if I risk becoming a bobble-head.

The real issue for me currently (you really love hearing about my issues, right?) is my calves. They seem to be causing me more pain than I've ever noticed before. It makes for a feeling of weakness as I walk, and I am tending to take shorter steps as a result. It may unfortunately become a vicious circle: shorter steps mean less exercise, which leads to more atrophy, which leads to shorter steps - whew. I get tired just trying to explain it. Anyway, I keep doing research in hopes I can find even one clinician out there who has something to offer other than fusions, but little to report thus far. But stay tuned - miracles sometimes happen - the Giants, for example:-)

Well, here comes the holiday (weight-gain) season. Maybe it would help if I just kept my mouth closed? Nah - I just love pie.