(Read Part One and Part Two first, if you missed them.)
It’s been exactly five years since I first wrote about the agony of my feet. In the intervening years, I have certainly been probed, tested and even sliced open by plenty of doctors. I even underwent three surgeries last year hoping they would alleviate the chronic inflammation in my feet. My foot problem is not gone, but at least the agony has morphed into the occasional annoyance. For me, this is great progress.
I have learned a lot along the way, and not all of it is flattering to our medical establishment. My primary care physician was of little help. He never studied foot problems in any detail but was glad to refer me to specialists. The podiatrist said the pain and numbness, mostly in my right foot, could be a number of things. Initially he started with steroid shots injected into certain spots in my foot. They seemed to help a bit, but the symptoms recurred later with worse pain. I pointed him to my varicose veins, predominant in my right leg, and wondered if that could be the problem. The conservative approach seemed to be to remove some veins on the theory that blood was pooling in my feet and this was adding to the pressure there, thus causing the pain. One vein was cauterized last May. I spent weeks wearing compression stockings, which due to all the leg compression made the pain worse. Later last summer I had the more egregious surface veins on my right leg removed and spent more weeks in compression stockings. The surgeries did little to reduce the pain, but I must say my legs look great.
The podiatrist also sent me to a neurologist, who confirmed tarsal tunnel syndrome in my right foot and well as various neuropathies elsewhere. This eventually resulted in the tarsal tunnel surgery I had in January. If you have tarsal tunnel, this should mean that a nerve is compressed in your ankle, right? It seemed a reasonable assumption. However, after surgery and three weeks staying at home, at best I had only a little relief. I knew the surgery did not have a great success record, and sometimes it took months for symptoms to moderate, but I could think of nothing else to do. There was no one specialist to go to who could put it altogether. Each specialist saw my problem in relation to their specialized training only.
I did notice that the back of my thighs also felt irritated. Could the problem not be in my feet, but further up in my sciatic nerve? Could I be compressing nerves elsewhere and feeling the result acutely in my feet? After a follow up with the surgeon, I asked and received a referral for physical therapy to chase possible sciatica. Perhaps through the right kind of exercise elsewhere better results would trickle down to my feet. It seemed a wild idea, but it was worth a try. I had few other options.
It took only a few sessions with Donna and Rebecca (the physical therapists who worked on me) to realize this is where I should have started, not where I ended. Most likely, all the other surgery could have been avoided, along with thousands of dollars in medical costs. Granted, physical therapy is not a lot of fun and takes a lot of time. However, the proof is in the pudding. My symptoms are 50-70% improved compared to when I started physical therapy a month or so ago.
I had no idea that our nerves are sheathed inside tubes, and with the right stretching your nerves will slide inside these tubes. These exercises forced my nerves to move from their favorite spots, where they may have been stuck and thus more likely to feel compressed and inflamed. Good physical therapists (and both Donna and Rebecca are excellent) will note connections. It seems I have bad posture. It was nothing I gave much though to before. Of course, everything in your body is connected, so stressing and stretching nerves the wrong way (such as via slouching, leaning back in chairs, hunching over my desk or not sitting in an ergonomic position) were all contributing toward the major problem manifested in my feet.
Now I spend about an hour a day stretching my muscles. I do pinformis stretches. I do hamstring stretches. I do supine nerve glides and horizontal braces. I do leg marches. I use a tennis ball to massage my plantar fascia (the bottoms of my feet). I do calf stretches and pointing ankle-strengthening exercises. I do other exercises too numerous to mention here, all of which take a lot of time and are boring as hell but which seem to alleviate symptoms quite well. I am in good hands with Donna and Rebecca, literally, because they are often massaging my feet, legs and surgical scares with cream and very firm strokes. They are also big believers in ultrasound, which they use liberally on my surgical scar. Through repeated therapy, I went from having the tightest legs and ankles they had seen in six month to relaxed calves and feet like normal people.
I also pull on long, stretchy rubber bands, mainly to improve my posture by strengthening my back muscles. I also sit on big bouncy balls and place a ball between my legs while I lift my calves. I also learned how to properly get in and out of bed. Apparently, the way I had been doing it for the first 53 years was wrong. You have to roll in a certain way and drop your feet toward the floor while pushing yourself up with your hands. There are many secrets these masters know about how not to stretch my sciatic nerve.
A good ergonomic chair is also helpful for us desk dwellers, but sitting properly in any chair is also important. Sitting up straight still does not come naturally to me. However, I discovered that making sure my feet, knees and waist form right angles when I sit could relieve many symptoms. One thing I was doing wrong was sitting too high in my chair. This obtuse angle simply put extra pressure on the bottom of my thighs, aggravating the sciatica.
It all seems to come natural to physical therapists that as a class seem to be skinny, beautiful, have great skin and, naturally, great posture. They eat right too. No processed foods (it seems) for these specimens of great human health. They’ve got it all figured out, and they practice what they preach.
Are my foot problems solved? Not yet, but thanks to my excellent physical therapists, I am seeing great changes in a chronic problem that has dogged me for more than five years. Perhaps next time you have any muscular or nerve related problems, you should seek out a good physical therapist first. It may be all you need.
April 7th, 2010 at 07:17pm
Posted by
Mark |
Life 2010 |
no comments
I am feeling a bit like Peter Pan these days. Peter Pan was the only male I knew who regularly wore green stockings. I understand that during the Middle Age, men also wore stockings. These days though men who wear stockings are either getting in touch with their feminine side or suffering with vein disease. In my case, it is the latter.
The agony of my feet, which I described more than four years ago, never totally went away. In recent months, it has gotten considerably worse. It was manifested in numbness in my right foot (on a good day) or a constant aching and burning feeling in both feet (on a typical day). More recently, it has sent me scurrying to various physicians (podiatrists, neurologists and vein specialists) to see if I can do something about it. I now know that since I have varicose veins I have vein disease. Vein disease means that the veins in your leg have a hard time returning blood from your feet to the heart. It affects many Americans sometime in their lives, more as people age, as you might expect. In the typical case, your legs feel heavy and mostly unconsciously, you spend a lot of time with your legs propped up on chairs and stools. In the latter stages, walking becomes painful and even sitting with no pressure on the feet still hurts. I seem to be approaching the latter stages.
After doing some fancy tests, my neurologist also confirmed I have tarsal tunnel syndrome. It is like carpal tunnel syndrome, except it applies the feet. I also have neuropathies at various places in both feet as well as possibly in my leg and spine. This means that certain nerves are not doing a good job of communicating with my brain. These too are common with age. In many cases, people simply ignore them.
What to do about these conditions? That is still being triaged by my team of doctors, so the extent to which I can find relief is unclear. Vein disease never goes away, however removing veins from the leg usually results in more blood pressure in the remaining leg veins, often alleviating symptoms, at least for a while. Legs in the vein though are not limitless and the veins cannot be restored to normal functioning. At some point you either have to deal with a lot of discomfort or pain or do what I am doing: wear thigh high compression stockings and hope they relieve the symptoms. These compression stockings essentially provide more pressure to the feet and legs making it easier for veins to do their job. This results in less blood pooling in my feet and legs and, I am happy to report, a lot less misery during the course of my day.
Of course, these taupe stockings I now wear are hardly a fashion statement. Fortunately most of the time they are easily hid underneath jeans, but there are certain times of the year when wearing jeans is not desirable. Nor are they terribly comfortable to wear, feeling at times like vices on my legs and itching my thighs. I suspect in time I can get used to them, but I do not want to. Putting them on is quite a challenge and can leave me sweating because they require a significant amount of agility and force. If vein surgery means I can ditch the stockings I am all for going ahead with the surgery.
My mother had varicose veins. To my knowledge, she never had any veins removed, although she probably should have. In her last days in the nursing home she was, like me, wearing these Jobst compression stockings. Varicose veins seem to be largely heredity, but are often manifested by too much standing or stooping. She did plenty of that chasing after my seven siblings and me. She often said we gave her grey hair. It is more likely we gave her the varicose veins.
For now, these support stockings are a relief more than a burden. As annoying as they are to put on and wear around, they beat going around all day with tired, aching and burning feet. As my vein specialist suspected, they are also identifying the root of my foot problems. It appears that my poorly functioning veins are at the root of my tarsal tunnel syndrome and probably helped create my neuropathies. As best I can figure out, because of my suboptimal veins, my legs and feet have suffered from high blood pressure for years, and this has been wearing on the various nerves, bones and tissue in my legs and feet. I still have some numbness in my right foot but I am hopeful that it will recede as vein pressure in my legs improves.
My point in whining about this is mainly to draw attention to vein disease. If you have varicose or spider veins, or find yourself habitually propping up your feet, or your feet regularly feel tired, or worse, numb, aching or burning you should not do what I did and largely ignore the problem until it becomes acute. Rather seek early medical attention so you can avoid neuropathies as you age and problems like tarsal tunnel syndrome. I wish someone had drawn it to my attention. I have been dealing with it so long I assumed everyone propped their feet up after walking for a while. If you spend prolonged hours at a desk or in front of a keyboard, you should also consider footrests for your feet. A combination of these strategies may make your life livable again.
May 30th, 2009 at 11:49am
Posted by
Mark |
Life 2009 |
no comments
I have foot problems. I wish it were something minor like a bunion. In some ways I wish it were something major because then at least I would know what was going on. But instead I just have some weird foot stuff going on that seems to never get better nor worse. As I work with my podiatrist it looks like there is no silver bullet. I need to resign myself to months or even years of treatment and discomfort. Ouch!
It’s a mild pain that is usually there. The original symptoms were a numb feeling in the smaller toes of my right foot that sometime felt like it was burning or my skin was scraped raw. Since it went on for a few weeks I finally saw the foot doctor. His hypothesis was that a nerve juncture between two of my toes was inflamed. He prescribed some Superfeet and built up a little spot that should have given the spot in question some relief. And for a couple days it sort of did. And then it didn’t and nothing had changed.
One day I was feeling reasonably okay so I decided to go for a little bike ride. Actually it was 37 miles. But I had done long bike rides before and it had been no big deal on the feet. This ride though was different. Although I don’t recall much pain at the time, for the next several days both of my feet hurt and felt inflamed. I wished I could go back to the numbing feeling again. I was alarmed that I was now getting the feeling in the other foot. The podiatrist suggested it might be all the force I was applying to my feet when I was biking. Terrific. One of the reasons I took up biking in the first place was because the stress from running was causing weird ankle and knee pains. Even getting on the elliptical machine in our basement hurt. What was I supposed to do for an aerobic exercise?
I’d suggest a wheelchair for myself but that wouldn’t solve the problem either. Because resting my feet on practically anything hurts. Even flexing my feet in certain directions and positions, even a little, hurts. I’ve tried mainlining ibuprofen and that didn’t even dull the pain. Certainly there must be some inflammation down there but this didn’t seem to be helping at all.
Certain shoes for some reason hurt more than others. I thought maybe my shoes were too narrow or too short. I do after all sport a pair of Size 13s. But no dice. All my shoes have plenty of wiggle room. Loosening the strings didn’t help. I recently bought a pair of sandals that feel modestly comfortable most of the time. Just looking at them there is no particular reason that I can tell why they would feel better than my other pairs of shoes. So I drag the sandals around with me. I wear my regular shoes to work then slip on my sandals once at work. I look pretty dorky wearing dress socks with my sandals. I guess it’s a good thing I don’t have to wear a suit and tie too.
I wonder if it has something to do the chairs I sit in. I’ve got three chairs in my office and I switch between them a lot because I am rarely comfortable for long in any of them. One accommodates my height well but offers poor back support. Another doesn’t allow me to rock backward, which is important if you are tall like me (6′ 2″) and have long legs. In fact with my long legs pretty much all the chairs out there are inadequate. I need more thigh support but the chairs usually leave a couple inches of my thighs unsupported. The computer equipment I use is not always comfortable to use either. When I started my job and designed my office I did have the office ergonomics expert adjust things to my liking. The problems with my chairs took a few weeks to manifest.
I wonder if it is arthritis that is at the root of my pain but I don’t think that’s it. I’ve had occasional twinges of arthritis in my fingers and it felt different than this. I feel like I need hobbit feet. Perhaps I need more calluses or something on my pads. I think: if my feet had support and the ground was made of rubber maybe it wouldn’t hurt.
A few years back I had a case of Plantar Fasciitis. This is a pain at the bottom of the foot that typically hurts first thing in the morning, or when you try to get out of bed and stand on your feet. There is no telling what caused that problem, although I suspect the extra weight I had at the time played a part. That problem, which took about six months to go away, may have been a consequence of just being 40-something. After all my wife had a similar problem. This pain feels a bit similar but is primarily along the side of my right foot. Applying even mild pressure to the right side of my foot makes it hurt. Standing up and putting weight on the right side of my foot makes it hurt too. Okay so logically shift the weight to the other side of the foot and the problem is solved, right? But that feels unnatural and it makes the bones near the problem spot hurt. So I’m guessing my foot doctor got the diagnosis wrong. It feels like a ligament or two have been stretched too far and are inflamed.
I hope this too will pass but as this has been going on for a couple months now I wonder if this will be some sort of long-term condition that I will just have to live with. It’s not an acute pain but it is annoying and it sometimes throbs. But I remain disturbed that there is no painkiller I can take to make it go away.
So I will continue to live with it and continue to consult with my podiatrist and hope he can find the root cause. But I suspect that this is one of many similar problems inherent in my aging body that I will have to reckon with in the years ahead. Mother Nature is giving me yet another signal that I am not immortal. I need to get with her religion.
Meanwhile, ouch!
April 7th, 2005 at 06:21pm
Posted by
Mark |
Life 2005 |
one comment
