Tuesday, April 29, 2014

Podiatry Appointment

When I saw the rheumatologist who specializes in EDS a few weeks ago she suggested I see a podiatrist for my hypermobile feet and ankles. The hope was that this would help not only my feet and ankles to have less pain, but also that my calves, knees, and hips would have less pain as well.

I saw a local podiatrist and he was absolutely wonderful! He was amazed at how hypermobile my feet and ankles are, but yet how tight my muscles were. This is very common in EDS and many joints all over my body. The connective tissue is so loose and hypermobile that the muscles tense up to hold the joints in place. The first thought that we had was to put custom inserts into my shoes. The front, middle, and back of your feet all move separately, so with a custom insert he is able to adjust to the different needs of each part of my feet. I have high arches in the middle, but they collapse towards the back of my foot and roll outward. Well the doctor's assistant called my insurance and they would not cover these inserts. They cost upwards of $600, so obviously I was a little unhappy with that option. I then brought up that the rheumatologist had more of an ankle-foot orthotic (AFO) in mind, instead of just the foot orthotic. Thankfully he thought this was the right path to go for me and my insurance DOES cover these. This will be a brace that goes up to the ball of my foot and extend up above the ankle. It will include the foot support that the shoe orthotics would have, but it also holds the ankle in place so that I do not roll it and sprain it so often. The type of AFO that this is will not cause dependence or weakening of my muscles because I am still using my own muscles, this is just supporting me. He recommends that patients start with one foot at a time so that your body can get used to walking with the AFO on. I decided to do my right foot first since that is the one that gives me the most problems. The doctor's assistant took a mold of my right foot using the same material that is used for orthopedic casts (such as if you broke your wrist), but far fewer layers. We just waited for it to dry and he was able to cut it off. This will now get sent to Arizona where they will make an AFO for me. This will take about 3 weeks and then I will be able to pick it up. After I pick it up I will wear that AFO for about 4 weeks and then go back in for a follow up appointment. If I like it and am happy with the results we will then go ahead and go through the same process for the left AFO.

As I mentioned the doctor was alarmed at how tight the muscles in my calf are. There are two groups of muscles in the calf: one, called the gastrocnemius, is higher up towards your knee and one, called soleus is down lower towards your ankle and runs underneath the gastrocnemius. The gastrocnemius is the muscle that is causing me tension and pain. To remedy this the doctor is having me place a non-stretchable item, such as a towel, under the bottom of my foot while I am laying on my back and pull it upwards so that my foot is flexed towards my head. This is then held for 15 seconds and then repeated four times for each foot. I have to do this twice a day: in the morning and at night. This will help gently stretch the calf muscles out so that they are not so tight. In addition to these stretches the doctor sent me home with a night splint for my foot. This is what it looks like:



It looks really big, but it is not that bad. It is not tight enough that it holds my foot firmly in place (I can still move my foot around). It is simply meant to keep my ankle at a 90 degree angle. When you are relaxed your feet naturally drop down and for most people this is fine, but since my muscles are over compensating we need to keep my foot at a 90 degree angle to stretch out those muscles. I wear the splint on one foot one night and then switch it to the other the following night. This gives my muscles a chance to relax every other night so that they are not stretched to the point of injury. I wore the splint on my left foot last night and it is definitely a little bit sore, but nothing unbearable. 

No comments:

Post a Comment