Way back in 2005 when I was still relatively new to my job I wrote about what it meant to be a professional based on what I saw within my own team. They really wowed me. So many people claim to be professionals but in my estimation so few are. So when I see it, it makes an impact. I am happy to report I have found a new member of this slim group: our humble local pedorthist.

You are probably saying, “pedor…what?” That’s what I said too when a local podiatrist gave me a prescription to see Mark, the local pedorthist. A pedorthist is a specialist in modifying footwear so that people like me can wear shoes with little or no pain. Mark has been a godsend and simply would not quit on my case until every last foot pain was gone and I was completely satisfied.

If you are a professional like Mark it helps to have enthusiasm for your work. Pedorthics does not sound like something that would be that stimulating but for Mark it’s a passion. It causes him to work past his scheduled hours most days. Evenings he will often be found in the back of his shop grinding, extending and shaping orthotics (fancy inserts that go into your shoes) until your walking becomes natural and pain free again. Monday he is supposedly off but this is when he does most of the hard work in the back: shaping and tweaking orthotics and shoes that he can’t get to the rest of the week.

Admittedly it was hard to get an appointment to see him. I waited more than a month and endured considerable pain and discomfort during that period. What I didn’t understand was why my orthotics weren’t working for me. A podiatrist I saw back in Virginia had gotten me a new set and of course there is quite a protocol for getting good shapes of your feet so the orthotic would fit. Still, it wasn’t enough. The metatarsal lift I needed wasn’t nearly enough, causing pain to radiate down my toes, mostly on my right foot. I had given up running (too much pressure on the feet) but persevered at walking several miles a day, often with some discomfort despite my orthotics.

Once I finally got in to see Mark, things quickly improved. First I found him both passionate and personal, characteristics I’ve never seen in so-called professionals like physicians. He spent a lot of time listening to me, pressing my feet and looking at my shoes. Then he started fine-tuning my orthotics.

The result was better but not anywhere near being a pain free experience. So after using them a few weeks I went back to see him again (no charge). He listened to my feedback and a few days later I had a version two set of orthotics to try on.

These were much better but not quite perfect. It took me months of experimenting to figure it out. I got a new set of shoes and since they were narrower they were a better fit. But something wasn’t right. So I got a set of walking shoes. These had something the other shoes hadn’t: cushion. That was the clue: I needed both the shape and the softness. So three months later I went to see Mark again.

That’s when version three was created that finally solved my problem. This success inspired me to get a pair of sandals, which I preferred to wear in the warmer month due to my naturally sweaty feet. He let me look through catalogs to find the right one: closed-toed were what I wanted, but soft. We found the pair and after they arrived he made these innersoles match the orthotics I used in my other shoes. All this was done for the price of a new pair of shoes ($159) plus one fitting fee ($43).

It was a bargain, but I also got something I did not expect: to spend some time with a really interesting man who opened up a lot on his life, treated me with respect and great concern and who reiterated over and over again to let him know if there were any issues. He refused to stop until I was satisfied. It took five months, but I have escaped my foot purgatory.

Mark embodies the myth that seems to elude most of us: he made a successful and meaningful life for himself. He owns his own small business, he give his customers complete satisfaction, he is not owned by a Wall Street conglomerate and he takes immense pride and joy in his work. Through knowledge, tenacity, close listening and feedback he makes dozens of us foot sufferers happy every week.

I think he is lucky: lucky to have a passion for his job, lucky to carve a niche for himself in our local market where it’s hard to find a job that pays decently and one that provides a service of immense value. If you haven’t suffered from chronically painful feet consider yourself lucky. I was the luckiest one. He brought me relief that more than ten years of podiatrists could not quite solve.

Now I feel like I can live life fully again. I am grateful and more than a little wowed by Mark. If you have foot problems, look for a local pedorthist. They are harder to find than podiatrists, but probably of more value. If you can find a pedorthist like Mark you will be in good hands (and feet) indeed.

If the shoe fits, wear it

I need to add owning good shoes to my list of things I must do from now on.

Finding properly fitting shoes is no problem for most people. Go to Payless, find something that fits and feels sort of comfortable, spend fifty bucks or less and you are done. Finding comfortable shoes is harder. Sometimes you can find a comfy pair at Payless, and the younger you are the more likely they are to feel comfortable. Get up in years and even with a pair of custom orthotic shoes inserts (like me) and a pair of Payless shoes is still likely to feel uncomfortable, if not hurt. If you have larger, wider or narrower feet than average (like me), you often find yourself buying okay shoes instead of the right shoes.

That’s what I have done throughout life. I generally don’t shop at Payless, but have bought most of my shoes at DSW, where it is hard to walk out of the store without a good pair of shoes. However, even DSW does not normally stock unusual sizes. If you are a guy with long feet like me you can usually find a size 13, and sometimes a size 14 but if you want a 13 ½ then you are out of luck. Moreover, if your feet are size AA, like mine are, then likely whatever you buy will not feel snug. In my case, the right foot is size 13 ½ and the left foot is a size 14. When I slip into a size 14 at DSW unless I wear thick socks its extra width means my feet will tend to slosh from side to side. Size 13 is usually a wee bit too small; my toes end up right against the front of the shoes. This means that if I kick something with my shoe, it is usually a painful experience. What this has meant is I have bought size 13 shoes most of my life, because a size 14 was either too big or not in stock, and a size 13 ½ was simply never available. My feet have not been that happy with my pragmatic choices, but there did not seem to be a whole lot of alternatives.

Yet in any city of any appreciable size, if you search them out you can find stores that sell odd sized shoes. The Holy Grail is to find a store that has both odd sized shoes that are also well-constructed, well-engineered and attractive shoes. I struck out at the first store my podiatrist had on his list. I was told to try the store’s web site. The idea of buying a pair of shoes via the mail seemed a bad approach. Still, having dealt with more than my share of foot problems over the years, and with my new orthotics in place, I was determined to get shoes that both fit and were well constructed.

I finally found a shoe company that met my standards. Now I could kick myself for having settled for less for so long. Wearing shoes has finally become a comfortable if not welcome experience. I don’t mean comfortable in the sense that my feet now feet like they are walking on pillows. I mean comfortable in the sense that my feet now feel solidly anchored in my shoes, they don’t hurt from an active day of walking around, my toes don’t end up occasionally sore and squished and, thanks to these foot orthotics and a lot of chiropractic therapy, my chronic case of sciatica is largely gone. I am considering taking up running again, but I want to take things slowly. I am afraid that I will jinx things otherwise.

I never spent more than $100 for a pair of shoes before. This pair of “slim” size 14 shoes cost me $159 at a SAS Shoes outlet. Moreover, I discovered that Made in America can mean much better quality than Made in Some Third World Country. SAS stands for San Antonio Shoes. They are hardly alone in the high quality shoe industry, but they do not outsource their shoe making. Their shoes are meticulously crafted in their factory in San Antonio, Texas. It’s clear that whoever is making these shoes knows how to engineer shoes, and part of it is making them in half sizes, often going up to size 15, and making normal, slim and wide width shoes in all sizes. “Slim” is probably an A width, not a perfect fit but so close to my AA width that I cannot tell the difference. I’ve rarely been able to find a size 14 shoe, but never found a size 14 in a narrow width before.

Weeks into wearing this new comfy pair of shoes, I keep discovering features of this Pathfinder model that I bought that attest to its quality. One is the quality of the leather: soft, flexible and yielding around the sides but engineered with a sole just a tiny bit larger than most so that, at least so far, I’ve managed to not scuff them even once.  Inside I find that the shoe has a sturdy floor with partially aerated pads near the toes and in the heels.  The ringlets for the shoelaces are a brushed metal, and the shoelaces are wide, flat and nylon reinforced, which makes them easy to tie and unlikely to untie themselves. The shoe’s tongue has a small piece of elastic connecting it to the inner side of the shoe, facilitating proper placement and movement of the foot in the shoe. The stitching is well done and flawless. Aeration holes on the shoe facilitate the shoe’s ability to breath. My only complaint about the shoe is that it cannot be re-soled. But I do like the style because it allows me to wear it both casually and as a dress shoe.

People with unusual shoe sizes have always had problems finding the right size of shoe, but I am suspecting that Americans overall have elected to trade a shoe that fits for a shoe that is okay to save money. Now that I understand otherwise, it is unlikely that I will ever spend less than $150 for a pair of shoes again, unless maybe I am in San Antonio at the SAS Shoes factory outlet. I don’t see myself traveling to San Antonio any time soon, but if I do I have found a new destination.

It’s better late than never for me and maybe you as well. $150 is actually a reasonable price to pay for a comfortable and well fit pair of shoes. I am glad to know that in doing so I am employing actual Americans.

Some things are made better here in America if you don’t mind paying the actual cost to manufacture them here in America. I will not rue that cost anymore.

The Agony of the Feet, Part Three

(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.

The Agony of the Feet, Part Two

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.

The Agony of the Feet

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!