Thinking it through

[cjsmith]

Problem:
- The foot surgery didn't work and I am now back to feeling moderate pain with every step
- In a very short conversation, my doctor mentioned "PT and orthotics" for the non-neuroma foot problems
- My insurance won't pay for any more PT or any more orthotics this year
- PT (4 different bouts) and orthotics (multiple designs) have been demonstrably useless so far anyway

The tools I have available without spending lots of time or money:
- Cushiony insoles
- Metatarsal pads
- Massage
- Anti-inflammatory meds
- My adjustable Chaco sandals
- My post-op shoes

Tools I will have available later, once I've healed more fully from surgery:
- Discuss my ideas with my podiatrist
- Find (HOW??) a doctor who treats professional athletes and thus is less likely to wave away the problem
- See an orthopedist

Here are a few possible theories, with data that seem to support or contradict them and what action I should take if the theory happened to be right. It's quite possible that more than one of these guesses is right. It's also possible they're all completely wrong. Trying things might give me more information. It's something to do while I'm waiting.

1. Despite the MRI image not showing inflammation, the problem is inflammation
Support: the pain *acts* like classic chronic inflammation
Action: big buckets of anti-inflams
Contradiction: anti-inflams have done zilch the last several times I have had this thought and tried them

2. Pain is triggered by impact, not pressure
Actions: snug down the straps on my sandals, add LOTS of cushiony insoles, add metatarsal pads, use post-op shoes sometimes
Test: stand up without walking, for a very long time, and see whether this pain flares up

3. Pain is triggered by pressure, not impact
Actions: loosen sandals, add metatarsal pads, use post-op shoes sometimes
Test: while seated, strike the ball of my foot on the floor a bunch, and see whether this pain flares up

4. Pain is triggered by twisting/turning
Support: square dancing for two hours seems to be much worse than walking all afternoon
Actions: get snug, supportive shoes?
Test: walk at a moderate pace mostly in a straight line for a long time and see whether this pain flares up

5. Pain is made worse by correcting my pronation
Support: I had much less pain in the post-op shoes with no arch support at all
Actions: wear post-op shoes sometimes, cut out the arch area or whole medial portion of some insoles (to counteract my sandals' arch support) and wear those
Cautions: this will not be good for my ankles or knees, I shouldn't attempt to run this way

6. Pain is due to tissue damage which can be healed
Support: flexor tendons and plantar plate are the only remaining things that looked wrong on the MRI
Actions: deep tissue massage, vitamins, alternating heat and ice
Contradiction: tissue that can heal usually will and yet this hasn't for nearly two years

7. The pain is because my third and fourth metatarsals ride very low and have no fat pad underneath
Support: well, they do ride very low and have no fat pad underneath
Actions: orthotics with a "hole" under those metatarsal heads, add metatarsal pads, add LOTS of cushiony insoles, try to stretch the intermetatarsal ligaments by pushing on the bones multiple times a day
Alternate actions for later: discuss this with my podiatrist, find an orthopedist and discuss this idea

8. The pain will get better when some scar tissue goes away
Support: well, scar tissue IS abnormal
Actions: scar massage, waiting
Contradictions: much of the pain is far away from the scar tissue, I had this pain before surgery

Comments

[quasigeostrophy.livejournal.com]

Seems pretty comprehensive. How do you think you can best determine the difference between #s 2 and 3? Also, even if you don't go back to PT, do you still have anyone there you can contact? They might know a doctor who treats athletes - some PTs I've seen here over the years have worked directly with members of the Colts.

[cjsmith.livejournal.com]

Mmm, asking the PTs for a good doc is an interesting angle. Thanks.

Those tests are as good as I could make them on the spur of the moment. I might be able to think up better ones given time. The challenge, of course, is finding a big enough chunk of time that does not also include square dancing. I deteriorated at my first post-op dance, last Monday night, and I still have not recovered. I've simply got to quit. I don't want to face it, I really wish it weren't so, but I've got to quit.

[davidlevine]

Waah!

[cjsmith.livejournal.com]

Yeah... :-( I had very little pain before last Monday and I'm now in it constantly, just like before surgery. It's the damn square dancing. I am already starting to mourn the loss. All those people I will otherwise never run into...

I f*cking hate being disabled.

I suppose I could be like Pat only more so: dance one tip every convention.

[quasigeostrophy.livejournal.com]

...but I've got to quit.

Take this for whatever it's worth (you've referred to me as an optimist more than once in the past ;-)), but perhaps a permanent decision like that shouldn't be made as long as you're still investigating things to do to improve the situation. Sure, maybe you need to quit for longer than you had thought, but permanently? If you're not giving up hope on the feet, don't give up hope on what all you can do with them yet. :-)

*big hugs*

[cjsmith.livejournal.com]

It wouldn't be permanent if a miracle occurred. I could always take up square dancing again. But in order to recover, I'm pretty sure, I have to not square dance. At all.

[datagoddess.livejournal.com]

Too bad you're not here - there are some docs around here that specalize in foot pain and treatment, since there's a lot of foot injuries in Indy car racing.

[cjsmith.livejournal.com]

My doc apparently specializes in foot pain and treatment as well. I'm a little cynical about doctors at the moment. :-(

[lesliepear.livejournal.com]

I did a google on sports medicine san francisco and got this:

http://www.stoneclinic.com/
http://www.iasm.com/
http://www.physsportsmed.com/clinics.htm
http://www.ucsfhealth.org/adult/cgi-bin/prdListDoctorAlias.cgi#Sports%20Medicine

[cjsmith.livejournal.com]

There's a sports medicine clinic in Palo Alto, too, not too far from me. They might know who treats the professionals -- the people who have to change careers if they're not cured.

[firecat]

That reminds me, because the OH's mother is a Feldenkrais practitioner who has worked at a sports performance clinic - have you tried Feldenkrais at all?

[cjsmith.livejournal.com]

Mmm, no! Heard of it, haven't ever tried it. I guess I sort of lumped it in my head with yoga, a thing I *do* intend to start. I suspect it really doesn't truly fit there. :-)

[firecat]

http://en.wikipedia.org/wiki/Feldenkrais_method

[cjsmith.livejournal.com]

Yeah, I got there this morning, googling based on your comment. :-) It sounds potentially very interesting.

Diagnosis of the day -- my completely untrained guess, that is -- is flexor tendinitis. I'm sure I'll have a new one tomorrow!

[ambar.livejournal.com]

Funny, I have been in and out of the sports medicine dept at PAMF for my shoulder. I know they have a podiatrist on the team. And Dr. King, who worked on my shoulder (hence not a podiatrist) has creds with the Raiders, many Stanford teams, etc.

FWIW: http://www.pamf.org/sports/staff/saxena.html

*hugs*

[just-cyd.livejournal.com]

i bet this is very helpful for you, this thinking-out-loud stuff. makes me think i need to do more of that, or just do it at all!

i'm really sorry that things aren't looking so hot, and you're facing giving up even more things that you enjoy. this sends me into a big messy "it's not fair!" tantrum.

FWIW, i hear good things about the "gel" insoles. if i could ever remember i want them when i'm at a store that sells them, i'd be glad to give you a first-hand account.

Re: *hugs*

[cjsmith.livejournal.com]

Thinking out loud helps me a lot. Writing it down helps me see patterns. For example, some things are contradictory (tightening versus loosening the sandals) but some things NEVER hurt (cushiony insoles) and some are useful in lots of different cases (metatarsal pads, wearing post-op shoes).

Yep, it's not fair. I know the tantrumy feeling. Boy do I. :-( If it's any consolation, I feel the same way about what you go through too. NOT FAIR.

I have gel insoles on now. Plus some Dr Scholl's cushions. The two stacked up together are quite the cushy footbed. Heh! Know what? These shoes I'm wearing are as wide as a men's size 12 gel insole. I just had to cut several inches off each end for length. This factoid amused me.

[lesliepear.livejournal.com]

I'm sure you will miss the square dance community - but is there anything you can do short of dancing - call dances, write choreography, make costumes?

Maybe you can join me in a quest for a new hobby/outlet while your feet recover?

[cjsmith.livejournal.com]

Oh, I can DEFINITELY call. I sure don't want to give that up! 8-) And since Rob will still dance, I might wind up traveling to more square dance conventions than I would if I were single and only going to the ones where I'd call.

And yeah, new hobby/outlet! Definitely! I'm on the prowl. What sort of thing do you want your new hobby to be? Brainy? Crafty? Social?

[quasigeostrophy.livejournal.com]

Hobbies? We gotcher hobbies here! I've had so many over the years I've had a heck of a time just trying to concentrate on a few I could get decent at. You can have some of mine. :-)

[cjsmith.livejournal.com]

Most excellent! Now THAT would be a good swap meet to go to. Hobby swap!

how to find sports medicine types

[moriamerri.livejournal.com]

Hi again,

A few months ago I had a sudden pretty acute problem with
an elbow. It didn't disappear in 24 hours on its own
so I started to worry (--what will I do if it goes on
like this?--)
I posted on the El Camino Reelers list and on the
Baylands Frontrunners list asking for sports medicine
practitioners.
I still have all the many referrals I was given, which
I can pass on to you if you want them.
(My elbow is fine BTW.)

Re: how to find sports medicine types

[cjsmith.livejournal.com]

Oh, that'd be excellent! Thank you! Either a (big?) comment here or an e-mail would be great for me.

Re: how to find sports medicine types

[moriamerri.livejournal.com]

okay, I'll send it in email-- may take a day or three --
the info is in a bunch of emails and needs to be copied
and pasted in bits. (I need to do this anyway,
so this will hopefully be a good reason for me to finally
get this glob of info together :)

random thoughts on #2

[moriamerri.livejournal.com]

is there a kind of shoes (or pads) that provide more BOUNCE?
Oh, actually I think I've heard of this. I don't remember
what it was called, but they sounded bizarre. I think this
came up during a discussion of rebounders (which are the
little mini trampolines). Oh, I think I remember who said
it. Some really unusual bouncey shoes.

While I'm here, #6 "contradiction": MIGHT get more healing
using HBOT. Not necessarily. (You can google it with just
the letters--- everyone generally abbreviates it.)
But this is VERY VERY expensive, so this is more just
sorta an interesting thought.

Re: random thoughts on #2

[cjsmith.livejournal.com]

I suppose there are these "Z-Coil" shoes I've seen square dancers wear, and somewhat similar ones, and the occasional homemade one.

Mini-trampolines makes me think of these "Moon Shoes".

Then there are the Powerisers. Man oh man, if those didn't require feet for use, I'd SO want them.

I own a pair of these. They, too, require feet. That was an expensive mistake.

Heh, I got wordy! I love the idea of bouncy shoes. I've even assembled some stuff (mainly a variety of springs) to try to make my own. So far, my own shoes have for some reason failed to materialize. :-)

And yeah, hyperbaric chambers are pricey!! :-)

Re: random thoughts on #2

[moriamerri.livejournal.com]

I managed to find the reference I was thinking of: they're called jump boots. See: http://www.kangoo-worldsite.com/ The person who told me about these *raved* about them. Your air-kicks look kinda like the same thing? Maybe very close.
Your shoe sites are all quite fascinating.

another option regarding dancing

[moriamerri.livejournal.com]

I say this knowing very well that
1. this idea may be a long shot
2. not being able to dance sucks, so options that are
less-than-the-real-thing also tend to sound pretty dismal
3. even if you had the people to do it, it could just
be too darned painful emotionally

So, the option is: find which parts of dancing you CAN
do (assuming there are some), figure out which calls you
can/can't do and which need to be modified,
and get enough people to be in a square and do some
modified version.
(Modified might mean they also modify the movement,
or it might
mean just YOU modify and they merely have to
know the details of what you are up to so that they don't
get really confused about it or try to scoop you over
to someplace else etc.) Modified could include you stand
still or walk to where you are supposed to end up, if
other modifications would not work.

I know this suggestion sucks, honest I do.

How much of a longshot it is depends upon how much
you can/can't do, what modifications would help, and
how many other people want or need (or would cooperate
with) those modifications. Clearly this would complicate
forming a square, among other things.

Also, the steps I mentioned about "figure out what you
can/can't do" and which calls and how to modify them:
all these would need to be done repetitively with lots
of detail, lots of minute consideration, lots of
gathering on-going feedback from your feet about
what is/isn't workable. But I'm sure this is quite
apparent........ (Hey, at least there are a lot of
obsessed dancers and callers who can come up with
dozens of ways to modify any call....)

Also, how much this is workable or not even AS AN
IDEA would depend on how much you can/can't do and
what types of movements you need to avoid.

When I was recovering from the broken foot I did some modified
versions of English Country dances. That was temporary
and was largely a way to express extreme frustration.
It was also fun -- one of the people in the incomplete
set was a good friend of mine who also had serious
physical limitations at the time (from an injury).
We did hand gestures for the things we could not do
with our feet (I'm not kidding). It was very funny,
but a somewhat different situation because these were temporary
limitations/injuries. (I also "danced" sitting down,
when I couldn't dance otherwise.)

Have you already tried dancing at different levels?
Maybe mainstream is easier on the feet? Maybe C1 is
easier on the feet? Maybe not, but may be worth
trying (in small amounts of course!)

Are there any associations for dancers with physical
limitations?
Would anyone have thought through the types of pressures
and movements feet make in different calls?

Um, (another horrible question here): is there any other
TYPE of dance that might be easier on the feet.

I say it again: I DO know these ideas suck, honest.
(To be more precise: these idease APPEAR to suck,
because the situation sucks.)

Re: another option regarding dancing

[cjsmith.livejournal.com]

...figure out which calls you can/can't do and which need to be modified, and get enough people to be in a square and do some modified version. [...] I know this suggestion sucks, honest I do.

I'm chuckling. I can imagine your tone as you say this. :-)

Actually, it's not as sucky an idea as it may appear. The tape group I dance with is notorious for cheats and short cuts, and while I'd love to have the ability to dance each call fully, it's great to be with a group who can react with perfect aplomb when I don't. They would occasionally even adopt my movement as a new "standard cheat" they'll use in the future!

Even with that, though, I'm going to have to stop. Square dancing even with those modifications is making me flare up very noticeably.

(Mainstream turns out to be horrid. "Swing your partner" makes me hobble for about four days.)

We did hand gestures for the things we could not do with our feet (I'm not kidding). It was very funny, ...

I love the mental image of gesturing with your hands to indicate what your feet WOULD be doing! I've been to conventions where exhausted square dancers sat in a square-shape on the floor and talked about dancing via laser-pointer. :-) Never done the laser-pointer thing myself, but I can imagine. :-)

Um, (another horrible question here): is there any other TYPE of dance that might be easier on the feet.

Possibly. This is where the hobby swap idea came from -- I am actively looking for another hobby I can pour my heart into. I'm not going to quit calling, and I will leave myself the possibility of coming back to square dancing if/when I recover, but I can't dance now and I am on the prowl for another hobby that will suit me as well. (A tall order!)

(To be more precise: these ideas APPEAR to suck, because the situation sucks.)

Yeah, that's what it really is.

Who knows? Maybe six months off is all I need. (Heh, hope never dies.)

Re: another option regarding dancing

[moriamerri.livejournal.com]

Who knows? Maybe six months off is all I need. (Heh, hope never dies.)

Well, hope is spozed to not die. That's a GOOD thing. :)

The tape group I dance with is notorious for cheats and short cuts, and while I'd love to have the ability to dance each call fully, it's great to be with a group who can react with perfect aplomb when I don't. They would occasionally even adopt my movement as a new "standard cheat" they'll use in the future!

Sounds like a lovely group, with just the right sort of spirit!

Even with that, though, I'm going to have to stop.

Well, that is reasonable, and I hope you find something
hobby-wise that makes the non-dancing as painless as
possible. Something wonderful enough to have you so
distracted that you don't think much about what you
aren't doing. I'd like to someday have the time for
scrapbooking.