Connect
← Return to TKR out of the question when you've got PN?
Discussion
TKR out of the question when you've got PN?
Neuropathy | Last Active: Nov 29 8:01pm | Replies (42)Comment receiving replies
You are very welcome, and, wow. That's quite the saga.
I will say that not every PT is qualified to do this, or has the training and experience to do it well, so that's a question worth pursuing.
The PT I worked with was a deep believer in strengthening muscles rather than using supports to replace muscles, and had me buy new shoes without any sort of arch support. I had been using custom insoles for decades after plantar fasciitis surgery, and ceasing to use them was very strange. I now switch off between shoes with mild arch support and a large toe box, and barefoot shoes with no support and also a large toe box -- made the shift after the peripheral neuropathy diagnosis about a year ago.
Gait is a commitment on your part. It took at least six months before I stopped focusing on how my foot performed with every step I took. The hip brace came partway through, when it became more clear that changing how the muscles in my feet operated was insufficient. I now know that all this eventually traced to back scoliosis that was sufficiently minor that it was never treated, but which caused torque through my entire lower body, and is ultimately why my pain focuses in my right hip and left knee. (I wore the brace for several months on my left hip, and to this day I need to focus not to stand hip-shot with my weight on a single leg when I stand still.)
This is probably not your issue, so I give you the saga mostly to show that you need someone who can really pick apart the details of how you stand and move, grasps the root causes, and has the experience and patience to gradually change that. It was not a lot of physical labor -- it's hardly cardio -- but it is a lot of focused attention every. frigging. time. you. stand. and. walk. Which can get a bit old. But as I was, you sound motivated.
I also did not have balance issues at the time. If you need to tackle both at once, it's even more important to have someone who can adapt to your more complex situation. It wouldn't surprise me if that's a big reason why this is not a common solution -- between the skill your PT needs, and the habit changes you need, and (at least in my case) the stripping away of supports that were recommended by a doctor in the first place, I can see why most doctors just wouldn't go there.
But it's pretty harmless, you can stop at any time, you do see (slow) progress as you go along, and it doesn't interfere with meds, etc. I suspect that if you are using a walker or cane or walking poles routinely now, it may take even longer to resolve, but that doesn't mean it can't be done -- it just means the process might be a bit trickier and have more steps.
Babies start with crawling, right? So we've already done something like it once, and now we just need to substitute some discipline for the enthusiasm that pushed us through the first time!
You'll have to keep us posted.
Replies to "@ray666 You are very welcome, and, wow. That's quite the saga. I will say that not..."
@projfan I still work on gait and balance after therapy for both 25 years ago. I had to learn to walk again and developed balance issues. Car accident
You are correct not every PT is as trained in depth as others.
@ray666 the specialist might be good also for more in depth balance - brain- training.
My trainer from the gym that runs Parkinsons classes is high on core strength to prevent falls. You have to be strong in those muscles to self correct when an uoset occurs.
You can strengthen your leg muscle by simply standing on one leg. I always brush my teeth like a flamingo.😂
Blessings to both of you
debbieo
Connect
Hello, projfan (@projfan)
Your messages have me stoked! Since yesterday, all I can think about is gait, the importance of good gait, the deterioration of my gait, the need for me to emphasize gait recovery, and the many months and hard work it's going to take for me to recover some semblance of good gait. My PT is also not an enthusiast of braces, belts, and straps. He does understand (or at least he appears to) my need for my orthotics. If, when he arrives at my home for an hour's session, he sees I'm sock-footed, he'll often say, 'Okay, let's do a short workout with you only in your socks, but then put your shoes on. Let's not aggravate your knee more than we have to.'
Just for the heck of it, a few months ago I tried a random sampling of other kinds of shoes. Like most of us here on Connect, it's hard not to hear of others' favorite shoes. Among the kinds of shoes I tried were the much admired Hokas (even my podiatrist wears Hokas) and a pair of barefoot shoes. Neither worked for me––or were "good" for me. The Hokas were too "cushy;" made me feel less secure, not more, walking about; and the barefoot shoes did what I feared they might: radiate too much firmness of the ground to my arthritic knee (the feeling was much the same as the one I get if I spend too much of any one day walking about here at home in only my socks).
I've developed a little at-home discipline to relieve stress on my knee and see if I might "teach" myself to walk about more naturally: I put my shoes on (with the orthotics onboard) not long after I get up each morning and then see how it feels if I leave my shoes (plus orthotics) on for as many hours as possible. What I've been discovering is that the longer I go about in shoes, not only is my knee happier, but also I walk "better," more normally, more like how I used to walk. Something I've noticed, however: I do have to PAY ATTENTION––pay attention to each and every step. If I let my attention stray, all of a sudden it's 'Uh-oh, I feel wobbly! Better be careful, Ray. Better pay attention!'
I, too, have scoliosis, and mine, too: never serious enough to require treatment. I'm sure now, between my poor gait, my PN, and my scoliosis, whenever I'm going about, indoors or outdoors, rough ground or smooth, familiar surroundings or unfamiliar, I'm challenging my body's internal gyroscope big-time. 🙂
I'm glad to hear that I sound motivated. I'd like to think I am. Yesterday, I did an online search for gait specialists in my area (although I believe, with a little conferring between the two of us, the PT I'm working with will be of genuine help with my gait); I found a few local clinics offering gait therapy, none of which (unfortunately) is truly "local." I'll see what my current PT and I can accomplish before I commit to a 3/4-hour or hour's drive.
You mentioned walkers, canes, etc. I do use a cane, but not 24/7. I have found (to my surprise and delight) that when I've been going about in shoes for as little as a 1/2-hour or 3/4-hour, and if I'm PAYING ATTENTION (!!!), that having a cane at the ready fades in importance.
I will keep you posted on how I proceed. They have been a real tonic––your messages––and have me re-focusing on gait.
Cheers!
Ray (@ray666)