The Agony of the Feet, Part Three

The Thinker by Rodin

(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.

White Christmas

The Thinker by Rodin

Our unofficial snowfall from the storm that began a week ago was twenty-one inches. The storm set a December record for recorded snowfalls in the Washington D.C. metropolitan region. Typically, if we get massive snowfalls they arrive in February, often at inconvenient times like Presidents Day Weekend. Many of us Washingtonians were caught with our snow pants down this time, counting too much on global warming and figuring our rarely used snow shovels would carry us through whatever mild dusting we could get.

In the last week, the snow has not so much melted as collapsed under its own weight. It is now about half its size. A snowplow finally came down our street on Monday, threw some sand on the streets but could not be bothered to actually plow to the curb. Since then, it has retired to wherever snowplows go. While this approach keeps our taxes low, it also means that to get your car onto the street you must shovel six feet or more into the street. I knew there was some point to all that weight lifting I was doing. Shoveling snow turned out to be excellent cardiovascular exercise. My arms were stiff as a board three hours later, but my back was intact and I felt only winded. Our street is still a mess of half cleared pavement and packed ice and snow. Driving down the street is like driving over a washboard.

The upside is the first genuine White Christmas in my thirty years of living in this area. The streets are mostly clear of snow but at least a dozen inches of snow solidly cover the ground, and most roofs are still covered with snow. The snow looks likely to hang around through the New Year.

In many ways once the frantic rush of holiday preparations are behind me, this is the best part of the year. At work, so many people are on leave that the building is half (or more) empty. I walk largely alone down darkened corridors, even in the afternoon. The usual hundred or so emails that clog my inbox are down to about twenty. Work feels more like a vacation. I find time to do things I don’t usually have time for: reading back issues of IEEE Computer and slogging through a book on software testing. For me, these sorts of activities are almost fun. It is far more interesting than budgets, supervising employees, reviewing travel authorizations and working on requirements. Now I too join the vacationing crowd, with plenty of leisure at home until I return to work on January 4th.

The presents under our tree were fewer this year, in part due to snow that made shopping the last week before Christmas a living hell. I tried on Christmas Eve to make a final run at a Barnes & Noble. I should not have bothered. Cars were queued a dozen long waiting for a free parking space. Heaps of snow occupied other parking spaces. Still, our Christmas was cheerful enough. There was ample time today to enjoy the first DVD in my new set of Horatio Hornblower episodes.

Mostly this holiday season I am struck by how fortunate I am in a time when so many people are hurting. I am in my peak earning years with little likelihood of unemployment. Even if unemployment were to strike, I have ample money and decent job skills that should see me through bad times. Overall, we are doing exceptionally well. Most of the medical issues that bedeviled my family and me are behind us with a few exceptions. One that still bedevils me is the tarsal tunnel in my right foot. This hopefully will be solved on January 14 when I undergo tarsal tunnel surgery along with nerve release surgery from this guy at Georgetown University Hospital. Then I get to enjoy a couple weeks at home recuperating, where my largest problem will be keeping the stitches on my ankle from rupturing for three weeks. Whatever work I can do will have to be done at home. Our cat Arthur will be quite happy.

Until then, I look forward to leisure and clearing the detritus out of our house and off my desk. I hope your holidays are happy too.