You Body is a Four-Story Wonder!

You probably, like most people, see your body as a single item - your body, and nothing else. But modern science (ain't it a grand thing?) will tell you that in fact, your body isn't even all yours. We are home to, and most likely fully dependent for survival on, hundreds of species of other beings that perform very critical tasks on our daily behalf. Bacteria. That's what I'm talking about! No, actually, I won't be talking about bacteria - that's just a ploy to get you to read further.

 

What I AM talking about are the four levels of your body that we use to describe how you compensate when your table, er, supports, well, that is, your legs are not of equal length. Like the table I spoke of in the last post, your two legs have to perform in a similar fashion as that table - they need to provide equivalent stability in as bi-lateral a fashion as possible. When they fail to do so, the body becomes imbalanced, and force the body to begin compensating for that imbalance.

 

To describe that compensation, and to aid in determining how to respond to effectively change that compensation back to a more normal bi-lateral state, we need effective language and ideas in order to communicate what is wrong, where it is wrong, and what to do to respond to the problem. This is no different than any other scientific or technical issue - without good, descriptive, and accurate language, we cannot effectively resolve the problems that crop up.

 

We begin by dividing the body into four segments - primary - from the floor to the knees; secondary - floor to hips; tertiary - floor to shoulders; and quaternary - floor to the top of the head. As the body is essentially a structural chain, changes made at lower levels of that chain promulgate proximally - that is, from the initial location of the imbalance upward toward the center of gravity. Because we humans - as well as every other being and object on Earth - reside at the bottom of a gravity well, anything that alters our balance alters how we react and operate in relationship to the direction of gravity. This is a very important concept for the purposes of our understanding of bi-lateral biomechanics, just as it is for that table.

 

So when we talk about how a given body compensates for an imbalance in their bi-lateral functioning, we describe where those compensations occur, and to what degree they are occurring, by indicating to and at what levels we see compensatory changes. If, for example, we see a simple change where the foot on the apparent short-limb side of the body begin to walk more on the ball of the foot, raising the heel more rapidly on the affected side, but no change in the levels of the hips or shoulders, we would describe this as a primary compensation. And for most primary compensations, the body often maintains only that level of compensatory involvement for many years, sometimes for life, without eventually moving to another level of compensation.

 

But there is no guarantee of this. Our bodies are being acted upon by forces both external and internal. Gravity we cannot resist, but that is also true for many of the internal forces at work. One example is the state of any one individual's ligaments. Not everyone has the same tone to their ligaments - some of us have very tight ligaments, some fairly middle-of-the-road ligaments, and still others have a very loose ligamentous tonality. The term "ligamentous laxity" properly describes what is more commonly known as "double-jointedness." It merely means that such an individual's ligaments are so loose as to permit their joints a far larger range of motion. Such people are sometimes more prone to injury, but they are also prone to developing more and far more problematic compensatory mechanics. We will touch on this more in future installments here.

 

For now, just remember that your body works to manage compensatory demands by adjusting itself across these four levels. Note that each level incorporates all the levels distal, or below that level, so Secondary also encompasses Primary, and so on. This, too, will be important to recall in our other installments.

 

Next time: why you can't resist my compensatory charms!

More on the Unbalanced Life

Picture a table - flat top, four legs. Simple as it gets. Now, if the floor the table sits on is perfectly level, and the table's legs are all exactly the same length, and the table's top was planed to a level surface, you should be able to place a marble on the center top of that table, and the marble should just sit there. A very boring marble on a very boring table, on a very boring, level floor.

But isn't that what you want out of a table? Nice, and boring, and level. If it wasn't level, well, the marble would roll off the table, and you would be walking past that table, step on that marble, slip and fall and break something, end up at hospital, pay a lot of time and money trying to recover, and get no time at all to spend enjoying that table! Pretty raw deal, right?

Now, let's say that one of the legs of that table is somehow shortened, just a little bit. That would make the table unsteady, but if the other three legs remain the same length, the table will more likely than not keep that marble perfectly safe away from the floor, and save you from another trip to the ICU. Unless you lean on the table, of course. But with four legs available, you merely have an unsteady table rather than an unlevel table - again, unless you lean on the table. So keep your elbows off the table, OK!?

But what if you suddenly have two legs that are a little shorter? Well, first off, somebody is really out to mess with you. Are you sure you've been keeping the house locked up tight? Because this really should NOT be happening, wouldn't you agree? But there it is - two legs one length, and the other two another length. Now, that table is pretty much not level - but it may be steady again! Unless the shorter legs are kitty-corner (or catywhompous, if you prefer) and now the table is both unlevel and unsteady. This table has some real problems, doesn't it?

But lets say we stop talking about that table, and instead talk about you. If both your legs (you DO only have two, right? You are NOT a table, yourself, are you? Let's hope not!) are the same length, you are probably level (though there are things that can make you unlevel when both legs are the same length, but we started with tables and legs, and I don't want to get too far off the central premise here, OK?) But while you might be level, you may be unsteady - hopefully not due to excessive drink - but because you are only symmetrical side-to-side, not front to back. At least I hope so. It would be creepy if you were - symmetrical front-to-back, that is. I don't want to talk about this if you are going to get creepy, OK?

So, again, let's pretend that one of your legs is a little bit shorter than the other - though I suppose we could say that the other one is longer than the shorter one, and that might make everyone happy. Does that work for you? Good. Now, with each leg having a different length, you are unsteady and unlevel. Yes, I know, our world makes us all feel that way sometimes, but stay on topic here, OK?

If your legs are different lengths, then your pelvis will also be unleveled, as will your spine, shoulders, head, etc. Even your hat will look funny. But all is not lost! Because your body has a unique ability to compensate - make up for the difference - when faced with unleveling. And this compensatory function, as it is known, works in some rather remarkable ways, and usually works according to some basic, yet variable, rules.

The first two rules are the only ones that never vary - they apply to all bipedal creatures, uh, people, for the purposes of this lecture. Yes, I am lecturing here. You didn't think this was a poetry reading, did you? You did? Boy, you came to the wrong classroom today, didn't you?

Rule one: Your inner ear must remain balanced, no matter what the body has to do to maintain that. Rule number two: Your eyes must remain parallel to the horizon. If you think about these two rules, they become rather obvious: an inner ear imbalance leads to vertigo, and an un-level visual horizon leads to an arrest for drunkenness in public - or at least a great deal of discomfort trying to walk down the street!

So, all other ways the body compensates for leg length differences are tied in to maintaining these two factors, sometimes even if it causes pain in other areas. But for now, just remember this one thing: Your body only has two legs. 

Sometimes we all need a little reminder.

Nest time: If you only have two legs, how can you have four levels?

Are You Living an Unbalanced Life?

No - not unhinged - though you may be, I couldn't say - but unbalanced. That is, does one side of your body appear lower than the other? Does your head tilt to one side, does one shoulder appear lower than the other, does on hip drop lower than the other? If you stand in front of a mirror with both arms hanging loose to your sides, does one appear to hang a little lower than the other, or does one appear to hang closer or farther away from your sides than the other? When you walk, has anyone ever commented that you look a little crooked, tipped to one side?

If you can answer yes to any of these questions, you may have a leg length discrepancy. If you are a Uni-CF, then odds are even higher that you have such a discrepancy. Yet you may be curious as to why one leg being shorter than the other can cause things like a hip or shoulder appearing lower than it's counterpart, or for your head to tilt a little to one side. This is because when your foundation (just like in a building) is uneven (your legs) then the entire structure will also be uneven. A difference as little as 1/8 inch can cause long-term issues with other parts of your body. But strangely, not everyone reacts - or, compensates - the same as another person might.

This is because we each have somewhat different physical characteristics that make compensation a very personal experience. Some of us have very tight ligament structures, some very loose, and some are somewhere in the middle. This difference can have a lot to do with how a given individual compensates, and to how many different levels of the boy they actually compensate.

This is an introduction to what will be an occasional series looking at how the body compensates for asymmetry. I will be looking at how compensation can present, and how to reverse that compensation when and where it is warranted. Patience - all will be revealed!

Just don't become unhinged, that's all I ask!

To Monetize, or Not to Monetize?

So, I am considering adding a store and some affiliate marketing to this blog, in order to raise money for the research fund I am trying to launch for clubby research. This is not an easy decision, as I have preferred remaining non-commercial. But I am finding it hard to locate enough money to pay for all the legal and administrative costs associated with launching a not-for-profit organization, so this seems like one potential avenue to explore.

The focus would be only on products and services of value to the clubby community - canes, wheelchairs, elastic wraps, orthotic makers, shoemakers, etc., all focused on real clubby needs. The affiliate marketing aspect of that would be tricky, as most such programs make you take ads that may have no relationship to what the blog or site is even about. But I suspect there are ways around that.

What I need from you out there are ideas of the kinds of products and services that would help you out, day to day, and for relief of pain, etc. No pharmaceutical ads, though - they make enough already off everyone else. 

Please add your comments to this post, pro or con, and any ideas for products and services you want/like. I am especially interested in companies you have already had a good experience with. So, jump right in - what would you like to see here?

Navigating the Mental Marshlands

All disabilities - or, difabilities, as I prefer to call them - have certain elements in common, regardless of the physical or mental or behavioral manifestations each possesses. Some have more chronic pain than others, some are more visible than others, some are even more "money-worthy" than others. There are "orphan diseases" which should be updated to include syndromes and conditions, as not all "orphaned" disabilities are diseases, per se. There are some that present multiple ways - that is, they manifest on multiple parts of body and/or mind. Some are in fact fatal, some short-term, and some lead to steady deterioration over many years. But these are merely some of the ways difabilities may differ.

But the commonalities are often overlooked. For one, everyone with a difability knows they have one. If the physical and/or mental manifestations of that difability don't make it clear, then the reactions of the non-difabled world will make it clear sooner or later, and often in trauma-inducing fashion. For another, except in those difabilities that resolve, whether from a disease running its course, or because the difability was due to an injury that finally heals, the difabled understand they are going to be dealing with their condition and all it may imply for their entire life. This may mean having to deal with issues such as trying to make a living, having to pay for products and services others will never be faced with, even having daily concerns for one's personal safety, especially in some less enlightened cultures around the world.

These commonalities can also have deep psychological components, deep wounding starting quite young, sometimes from family members, schoolmates, teachers, even medical professionals who have poor training and even poorer capacities for compassion and understanding. The courts and law enforcement often display extreme ignorance when dealing with handicapped individuals, especially those who have developmental difability. There have been many instances, even in the US, where individuals with cerebral palsy have been mistaken for drunken or drug-compromised individuals and treated abhorrently. Such experiences leave significant mental health issues that people with difabilities cannot always afford to get the proper help with. To make matters worse, there are not that many mental health professionals who are skilled in meeting the psychological needs of the difabled. And if such an individual is also trying to deal with chronic pain, they are often mischaracterized as merely seeking drugs to feed some mythical addiction. The deeply flawed nexus between our medical profession and our legal system serve to make this a nightmare for such people.

One of the things which make seeking resolutions for these misunderstandings, injustices, and shear ignorance on the part of those who should know better is the social fragmentation of the difabled community. Too many have seen it more in their self-interest to place the focus on their own specific difability - MS, MD, CP, HIV-AIDS, arthritis - and in the short term, this fragmentation has worked - for those who have managed to gain the attention of the rich and famous. But for those who fall more into the "orphaned" zone, this fragmentation has made life even more difficult, and has made it less likely that we will see any improvement in broad-based psychological care, improvements in the reactions and responses of the legal and law enforcement community, and a deeper appreciation of how all those with difabilites are treated by the medical profession and the insurance companies.

I do not expect to see this fragmented behavior of the difabled community to change, certainly not in the near term. It works too well for those whose difabilites show up in larger numbers, and where funding levels have permitted there to be some advances in treatment, prevention, and palliative care. But there is a cost to this, which is borne mostly by those with "orphaned" syndromes, conditions, and diseases, and because so little funding and even less public awareness often attends the affected individuals of these "orphaned" classes, the situation can seem dire, unfair, and without hope. Maybe it is time to start a conversation among all the difabled community, to seek more equitable ways to deal with both the specifics of each form of difability, and with the commonalities we all deal with every day.

I am ready for that conversation. Are you?

How do I Feel About World Clubfoot Day? Meh.....

Today, according to the Ponsetti Institute, is World Clubfoot Day - actually, it is Ponsetti's birthday, so there's the first clue. Not that I don't think there shouldn't be a celebration for us clubbies, but the problem is, it isn't - for all clubbies. It's for all the new clubbies, yes, all the young ones, those, specifically, still in the care of the pediatric medical community. And I think that's OK - as far as it goes.

The trouble is, it doesn't go far enough. Because for everyone past the age of pediatric care, well, you are pretty much on your own. Unless you think having one solution - fusions - is really a sign the medical community cares about you. I mean, go ahead, celebrate, but what, exactly, do adult and late-teen clubbies have to celebrate? We see the use of words like "corrected", and "cure" and "prevent." None of which are true, and all of which are designed to lull parents into complacency. The doctors want compliance, belief, trust. That's why they just can't bring themselves to tell parents the whole truth.

Even the Ponsetti community isn't hearing the truth. Just because you reconfigure the feet with little or no surgery still fails to address the other aspects of TEV - the distorted muscle cells of the lower leg, the fact that repositioning/reconfiguring does not guarantee fully optimal biomechanic alignment of the joint facets. And even by their own studies, at least 20% of those treated through the Ponsetti method fail to find long-term relief. If we also look seriously at the actual studies done by Ponsetti practitioners, they still haven't had anyone, at least not in any significant numbers, reach middle age and still report a pain-free life. So thanks, but I would rather wait for the real long-term studies before I start patting Ponsetti on the back.

Now, I am glad that the Ponsetti Institute is really trying to make a difference for the kids with CF. I am happy those kids have someone at least trying something different. But until they start dealing with the truth of the matter in a forthright way, I won't be sharing their party just yet.

And until the medical profession starts to take all of the rest of us clubbies seriously - do the real research, develop substantive solutions for those of us not so lucky to be born in the Ponsetti Era, seek good palliative treatments that don't start and stop with fusions - I will only be celebrating the day each clubby I know finds some small amount of relief from the daily grief of their damaged feet.

That's the only party I see worth celebrating right now.

My Wife Went to Carnivale, and All I Got Was This Lousy Chair

Staying home again...you know how it is. The spouse wants to go to Carnivale, where you have to walk 20 blocks just to get near the parade, then stand and cha-cha for hours, watching your kid or your neighbor's kids in the middle-school samba party selected for the twentieth space of the parade, then shuffle back through the hoards to find your car, or wait for the trolly, whichever. And you used to go with your spouse, until that last time when the pain was so bad you walked home on your hands (and you had never walked on your hands once in your life,) but that was better than scootching home on your butt. So now, you stay home, and spend six hours in front of the computer in your on-going search for the best scooter at the best price, and wonder when you will finally give in and get the damned thing.

I find it puzzling that I even need to justify such a purchase, not unlike the mental gymnastics I went through on that whole handicap placard question. You know: There are many people already in wheelchairs who need them, and I can still (sort of) walk. Man, was I stupid - or perhaps just overly stubborn, who really knows. But here I am, realizing that staying home all the time is just plain warped, as though it were some virtue. Oh, for crying out loud, man - get a clue! Just call me slow on the uptake, I suppose.

But the reality is, you aren't merely getting a scooter - wait! There's more! Yes, much more. First, if you have steps, you need to build a ramp, unless you live somewhere they actually have garages, which we don't. So - a ramp means altering the front yard -  all 8 x 18 feet of it, which in my case means no more plants in the front of the house, which is pretty sucky, ya dig? Which means a serious negotiation with the esposa, that I promise you is going to be epic. Then, you need a lift for your vehicle, as you need some way to carry the scooter when you are going more than several miles from home. There's another $400-1000. Ain't this grand?

And as for the scooter itself, well, that is where the fun truly begins! You want a three-wheeler, or a four-wheeler? One is better for outdoors, and the other for indoors, so if it looks like you just can't do much walking at all, then three wheels is for you, because the turning radius is shorter, meaning you can maneuver it around the old abode easier. But if you can still walk around the house OK, then go for the four-wheeler because it is better for the outdoors, and some models will handle off-roading better than a Willy's in four-wheel drive. And Sugar Magnolia, to you, too!

Then there is miles-per-charge - the greater the range, the higher the price, it seems. And carrying capacity - that is you, your groceries, and Spot all together, so keep in mind what you plan to do while you are out and about. If you like going to big street parties or Disneyland, plan for the higher capacity, because you know the grandhoppers will be tuckered and think of you as the bus. Just sayin'. And don't forget the accessories - most come with a nice old-fashioned wire basket to hang on the front for shopping. But then there are the rain covers, the locking back trunks, the three-toned horns, and those plastic streamers you add to hang from the handlebars, just like when you were a kid. I kid you not!

Anyway, the spouse came home with glitter painted on her face and looking blissed out. I, on the other hand, merely had a glazed expression, not unlike a doughnut. And no churros for me.

Another Window on the Issue of Pain

Pain, especially chronic pain, and even more especially bone-deep chronic pain, is not just one thing. It has many variables, solicits many reactions, has multiple dimensions. This is why it is so difficult to manage, and everyone who experiences it knows that the best you can hope for, most of the time, is to manage the pain. This kind of pain, as most clubbies come to learn, is never really just going away.

Perhaps the most difficult thing is to successfully explain such pain to others, especially to doctors. They are quite fixated on their vaunted 1-10 scale, with all the happy-to-miserable faces, as though all pain can fit such a system. They seek objective measures for a subjective reality, and while this might suit sudden-onset, short-term types of pain, it hasn't a clue when it comes to life-long chronic pain, bone-deep or otherwise. This also, I believe, explains why pharmaceuticals fail at dealing with such pain, because they are designed to target how the brain processes pain with little regard for where the pain is being generated,  which for us is in our feet and lower legs. And it also explains why some clubbies are now exploring and seriously considering amputation as a real long-term solution, for which they have ample justification.

Of course, amputation has its own issues, but bone-deep pain isn't one of them. But besides the bone-deep chronic pain, there are other types that occur with post-CF feet. There is compensatory pain - when our ankles, knees, hips and back begin to ache and scream because our biomechanics are completely screwy, and nothing is acting the way it should, our symmetry is shot, and our bodies are trying to find ways to ambulate without making our inner balance complete garbage.

There is the pain we get when our arches cramp, our calves seize up, our toes get corns from being hammered and press against our shoes. There is the feeling of our feet being in traps all the time, because we need all that tight support to get through the day, and when we take those tight shoes or boots off at the end of the day, or remove our AFOs, we scream from the effort our muscles and joints have to make merely to relax. It's almost as if we are better off inside those traps.

Essentially, clubby pains are all about trade-offs. We trade one pain for another, just to shift the pressure, just to take the edge off. An ice-water soak one day, heat the next, pay for a day at the museum by calling in sick because we can't even think about getting out of bed. We get tired of the tight boots and wear slippers all day Saturday, and then pay for this small cheat on Sunday. Trade-offs, but never substantial solutions.

Yet despite this, despite the pain, the half-measures, the frustrations with the medical community and their near-absolute ignorance when it comes to our particular feet, most clubbies I know are driven to enjoy their lives in spite of these awful realities. Some are driven with their love of sports, some are driven by their careers, some merely by the stubborn refusal to be beaten down by the dubious burden they were born to bear. We deal with pain because we must, but we deal with life because we insist on it. Nearly every clubby, at some point in their life, usually after bearing the burden of pain for many years, feels like it will inevitably bring them to their knees. Yet even then, they fight, they demand more of the world, of themselves, because they know something about dealing with life that people who are not carrying such burdens don't know, may in fact never know.

They know there are others dancing the same dance, limping the same limp, who really do get it. Who know that some stupid 1-10 scale is meaningless, who know how to dig very, very deep inside themselves to squeeze every ounce of life out of life. They face the battle with determination, because that is the only viable response. And I am happy to be among such fearless warriors, who help me lift my feet every day.

A Happy Hour, A Happy Life

I spent more than 30 years working with people by working with my hands - making shoes and orthotics, helping people walk better, with less pain, find a little more happiness in their lives. And I was pretty good at it.

But then, my hands went on me. That is, they began to go numb after not much use each day, and would become quite painful. So - it was time to change careers. And give up riding my motorcycle. Never got over either, really. So, things being as they are, I don't get to work with my hands as much as I'd like to. Until a few days ago.

My shoes had worn quite a bit, and my usual guy is now 86 and no longer doing the work - in fact, I'd been urging him to retire since he turned 75, but shoemakers are a stubborn lot. Fact, yeah! So, I went to my old colleague Arnie Davis at Davis Foot Comfort Center here in SF, and he just pointed at the shop and said, "have at it." So....

I spent two hours, fighting the numbing, but still - shear joy! As painful as it was, I found my hands and eye have not lost any of the skills I spent years developing. Dust, the smell of shoe dye, the noise level, the strain - none of it detracted from the shear pleasure of making something right again. To build, and shape, and finish to a beautiful surface, to find I can still achieve a perfectly balanced shoe....

If you have not been a maker of things, this may mean little to you. So few people are true makers anymore - it is not very fashionable, especially to have to spend years learning a very complicated and not very profitable skill. Let the computers and the robots do it seems to be the prevailing thought today. But to actually make a thing, especially something that has a use, that changes people's lives, that makes a difference? Well, I feel sorry for the people who don't ever get to know this joy.

I may not get to do such things many more times in my life, but to see that I still have the skill, that my hands, my eyes, my being remembered, acted, created - well, that is worth more than money can ever compete with. That, my friends, is real happiness.

Muddy Waters

A recent kerfluffle between several  clubbies on a to-be-left-unnamed group site showed how once again, there is a conflict between what we clubbies have come to know as the truth about our situation, and what the medical profession continues to misrepresent to the parents of children born with talipes. In their continuing effort to a) not upset the parents, and b) to keep the parents believing that the medical profession has all the right answers, they would have all believe that they can "correct" and "cure" club feet. This is such an insidious construct that even when such parents hear from us, people who have had to endure the weight of that lie all our lives, they react with sometimes angry responses, telling us that we are lying. Even in the face of those who have had to live with post-CF all their lives, such parents cannot abide hearing anything that contradicts the lies they are being fed.

Even with the application of Ponsetti treatment, there remains a failure rate of about 20%. But this, too, is misleading. Failure rate, as measured by both traditional and Ponsetti-focused practitioners, is based on how far the feet remain deviated from positional "norms". This is an important distinction: it affirms that the entire medical establishment focused on talipes remains convinced that positional deviation is the entirety of the talipes condition. The first clue is in the descriptive term itself - talipes equino varus/valgus - each word describes a positional aspect of the foot. Nowhere is there acknowledgment that the condition is other than positional. Yet there is substantial research showing that there are other elements, most notably, the distortion of the muscle fibers of the lower leg, that contribute to, attend, and potentially point more concretely to a more accurate etiology. The continual willful ignoring of this and other issues that are raised by both research, and by the actual life experiences of post-club feet sufferers by the medical establishment speaks volumes, and merely makes the divide between truth and fiction ever larger.

While I do not in general blame parents for wanting something positive to anticipate for their child, I find it beyond bizarre how, once faced with this new information, there remains a desperate desire to remain ignorant of the truth. However, it is their problem to deal with, not mine. I will continue to shake the trees of the medical profession until at least one reasonable professional emerges to start facing the realities we clubbies face, and who is willing to begin grappling with the true nature of club feet.

As for those who feel insulted by the use of the term "clubby": I will continue to use it, as a reclamation of the truth of what I endure. Those who object to this term are free to not use it. It is basically that simple.

 The following is an excerpt from a publication in the © 1981 British Editorial Society of Bone and Joint Surgery 0301 -620X181/30S6-0417

A HISTOCHEMICAL STUDY OF MUSCLE IN CLUB FOOT
D. H. GRAY, JUNE M. KATZ
From the Departments of Orthopaedic Surgery, Middlemore and Auckland Hospitals, and the Department of Surgery, University of Auckland, New Zealand 

Abstract 

A histochemical analysis was made of 103 muscle biopsies taken from 62 patients with idiopathic club feet. Any reduction in the diameter of the muscle fibres associated with wasting of the calf muscle was recorded. Histochemical abnormalities existing in these biopsies were revealed by comparison with normal biopsies obtained from the normal legs of 13 children with unilateral deformities. No significant difference was found between the diameter of the muscle fibres taken from normal and affected legs aged under six months. This indicates that wasting ofthe calfmuscle is due to a reduction in the number of fibres rather than their size. The muscle structure was normal excluding denervation and reinnervation. The soleus muscle in patients aged under six months contained 61 per cent Type 1 fibres in the affected legs, compared to 44.3 per cent in normal legs. Similar values were found in the normal and abnormal tibialis posterior muscles, long flexors of the toe and peroneal muscles. The change in composition of the soleus
muscle and the reduction in the number of fibres may be caused by a defective neural influence on the development of the limb in club foot.

 The next is the last paragraph of the Discussion:

The development of a full complement of fibres is under neural control in all types of muscle. Therefore defective neural influences on the development of the limb could account for the wasting of the calf and the maturation peculiar to the soleus. It is unknown whether this latter abnormality is an aetiological factor in the generation of the club foot, or merely concomitant with the primary genesis of the deformity in the bones of the feet. Isaacs et a!. (1 977) have also suggested that idiopathic club foot may have a  neurogenic basis. There appears to be increasing evidence that the nervous system is involved in the genesis of club foot, and we suggest that the result of such involvement is defective myogenesis.


It should be noted that this is merely one of 11 such studies I have located so far. There is nearly always a speculation as to the role played in the etiology of talipes, yet there is no parallel response from the same medical community as to how these factors might actually shift thinking, how they might cause some reconsideration of treatment, and most importantly, how they might re-shape how and what doctors tell parents about the true nature of talipes as it may affect their child. The silence, one might be pressed to say, is deafening.