My Left Foot: Part One



My Left Foot: part one Teresa Frisch, RN, RMT, IARP 4.9.09 If you are short in stature, you’ll know exactly what I’m talking about. Grandma Effa had a couple of sayings that stuck with me: “ain’t no sin to be born poor, just damned unhandy” and “God built us close to the ground.” If I had my ‘druthers and could have, I think I would have traded some cash for some height in a New York minute. I won’t tell you what I think every time I need to get a patient gown down from the top shelf of a cabinet that is evidently eye-level for some six-foot-plus plant-design engineer- architect out there somewhere. I’m five foot three and some change, and most of the time my feet don’t touch the floor when I sit in a chair. I adapted by curling up, and usually to my left. Something told me I’d pay for that someday, but I thought it would be just a matter of stretching out some ligaments and tendons. Nobody told me about metatarsus adductus. I’ve evidently sat, with my left foot curled up under me for so many years that the bones have been affected. I remember our pediatrician telling me not to let my youngest “w sit”, meaning, don’t let him sit with his rear on the floor and his legs bent up and back like the letter “W” because it’s hard on the lower extremities. Sitting on my foot like that is a variable of the same. I don’t recall that my left foot was larger when I was younger. Treatment now is repeated castings to straighten it out (Joseph). I never had problems buying shoes and being from a farm family with not much money, that would have been a memorable event. Extra shopping, or trips to the big city, or going to doctors, all of that. What I do have is a pair of flats from the 90’s that stand out: after I wore them so much the left one is very much wider than the right. I had been adapting and I had no idea how long. There were signs along the way but I didn’t pay enough attention to them. It takes awhile to first notice, then analyze and find a pattern. Just like a pre-cardiac arrest with pre-event markers, if I had only known the pre-event markers with my left foot I might have picked up that I was subconsciously adapting. I learned to avoid rough ground, like our three acre lawn. A rubberized track was better. Treadmills bothered me, which made no sense because I walked all the time. Treadmills are walking, right? Not quite. It’s the rapid heel-toe-heel-toe and my left foot would ache after I walked on one. I tried elevating it a few degrees; in retrospect that may have made it worse. Rotating through padded, spring form exercise stations brought the same aching result. Eventually I found no-impact elliptical machines which hopefully will be my saving grace as I’ve tried most everything else. Pain is a great deterrent to trying. Those were the signs that I missed. One day I was working the North station at work, and when I stood up and pushed off with a normal step, I heard and felt this sickening “crunch-crackle-crack” at the base of my second toe. It was only three or four steps to the counter / chart rack divider in the middle of the station, and with tears in my eyes I wondered, “What the hell was that?” The look on my face was enough to make our unit clerk, Steve, ask if I was okay. A couple of deep breaths later, I gingerly tried weight-bearing and babying it, then limped off to finish doing whatever it was I needed to do. Three months and a few anti-inflammatories later, I saw an orthopedic surgeon and then a foot surgeon. No fractures found and we added orthotics to the regimen. The pain kept up and I followed up as directed. I had point tenderness under my left first toe, not the great toe, in the ball of my foot. I had things to do and the specialist was two hours away. One of our attending physicians in the ER is married to a podiatrist. She had a wonderful reputation among the nurses on the staff as a practitioner, as well as the type of orthotics she prescribed. She was half the distance, too, which helped. I decided that whatever was causing this pain I would try to hit it with as much ammunition as possible. Another of our attendings has a private acupuncture practice and I added her to my treatment regime. I found a practitioner in Quantum Touch / Reiki and Qigong an added his as well. My podiatrist took one look and she knew, but it was the way that she looked that was the key. Instead of putting me on a table and having me dangle off the side, looking down on my foot, she uses dental type chairs. She sat at the foot and looked at both of my feet bilaterally, from the bottom, and explained that it would be harder for me to notice the asymmetry when I’m above looking down. My left foot was twice as wide as the right but it was my left foot. It had happened so gradually that I hadn’t noticed. I had metatarsus adductus. Not unusual, I had the beginnings of a bunion but that wasn’t causing the pain. All of the mid-foot bones were bent to the right. It was a neuroma between two of the bones that was causing the pain, and it was becoming compressed to the point that I could hardly bear weight anymore. Every time I pushed off and did a heel-toe, it hurt. Her films didn’t show any old fractures either, but comparison films showed just how severely the bones in my left foot are bent inward, and my toes aren’t: right at the junction of heel-toe. I initially avoided the bunionectomy and removal of the neuroma but it was less than a month before I was begging to be put on the surgical schedule. It had gotten to the point that I was walking on the outside of my foot to avoid any weight bearing on the ball. Just before surgery she took one last set of films and found a little boney chip floating, right in the area of the base of my second toe. She had the film flipped up toward the light, and turning to me she exclaimed “Girlfriend! You’ve got a chip fracture!” Finally. The surgery went great. Everybody says that on a pain scale of zero to ten, bunionectomies are a firm twenty. Not mine. I even refilled the pain prescription just in case because everybody told me the pain was going to be so awful, but I never needed it. The neuroma had been much more painful than the bunionectomy, which requires breaking the bone to fix. The neuroma was also much tougher and bigger and difficult to remove than anticipated. I have a scar above my third toe, more or less, but it healed and is fine. No more pain. I do still have pain at the base of my second toe as it isn’t seated at the joint as it should be. My surgeon advised eight weeks for healing and I did everything I was told to do. It hurt so much before surgery that I didn’t want to risk revisiting the pain, right down to this nagging worry that I might drop a can on my foot and ruin her work. I have no idea why I thought that I might drop a can on my foot, but I did, and I was very careful every time I was in the kitchen. I forgot about the shower. I bumped a can of shaving cream when I was in the shower and it fell. Directly on top of my left foot. Gritting my teeth I waited for the initial impact-numbness to wear off. It hurt, but not too much compared to pre-surgery. My incision was already well healed, but I called, knowing I would hear the inevitable. Come back in for x-rays and my post-op leave was almost over. I needed to be back at work. Thankfully, repeat x-rays showed no new fractures, but frowning, she kept flipping the films up and staring at them to the extent that I asked her if something was wrong. Putting the films down, she turned to me and said something like, “I can’t find your fracture. I can’t find it anywhere.” I, in turn, asked what that meant. She replied, “I should be able to see it. It’s gone. It’s healed already.” I, being the ever-curious type, persisted and asked how long she should have been able to see it. Looking at me, she said “A year. It usually takes a year until we can’t see it anymore and you healed in nine weeks. Amazing!” No wonder there weren’t any visible signs of fracture after my crunch-crackle-crack episode. I didn’t see an orthopedic surgeon for three months and if I had any fractures, they might have already healed. I’m a Reiki practitioner, but I don’t practice it, I live it. According to the National Center of Complementary and Alternative Medicine (NCCAM), discussing energy therapies such as Reiki and Therapeutic Touch, “there has been little rigorous scientific research. Overall, these therapies have impressive anecdotal evidence, but none has been proven scientifically to be effective (“Energy Medicine”). So go ahead and call me ‘anecdotal.’ I don’t mind.