What to ask a podiatrist?

Posted by Ray Kemble @ray666, Jun 8, 2023

Hello!
I am a 78-year-old man with idiopathic polyneuropathy. Otherwise, I'm healthy. I was diagnosed only last August. It appears my PN is either sensory, motor, or a mix of the two, Oddly enough, I have no pain, but my balance and gait are terrible. I have been wearing orthotics for decades, starting long before my PN diagnosis. Some have suggested I talk to my podiatrist (he doesn't know yet about my PN) to get his advice on PN and foot care. I'm wondering if others here have met with their podiatrists and whether your meeting proved to be of some help, especially with your balance and gait. For any stories you might share, thank you!
Ray (@ray666)

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@karleenhubley

My podiatrist concurs that SAS, Merrell and Hoka running shoes are the best. It is hard to fit Sketchers and they don't hold up. SAS for dress up, Merrils for gardening and Hokas for the grocery store. My feet like the change of presure points and the solid support. These brands are expensive and of course are not covered by insurance but they last. Good shoe stores measure your feet.

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I love your podiatrist's shoe recommendations! Those choices are mine also, after several years of experimentation. SAS shoes provide great comfort and support without appearing "orthopedic". They are expensive, but worth it. I add Dr. Scholl's massaging gel inserts for extra cushioning. The hard soles and arch support in Merrells are great for protection when walking on uneven ground. The Hokas provide good cushioning and support for walking such as when trying to walk for exercise.

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@dbeshears1 - I know exactly what you are saying. At times and more often lately, I need to use a cane and I've noticed a difference in the way people are when they see someone with a walking disability, using a cane. Folks will hold the door for you and let you go ahead of them. I do feel people are considerate and I always ...always say thanks. Before I developed PN, I did the same for other people. Here, let me get that for you was an expression I often used and most appreciated my efforts. Good post Deb, glad you brought this up! Ed

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@ray666 - Ray, suspenders popping is never a good thing especially when you need help to get them back into place. And, good thing you had a friend there to help you out. As I posted before, the little things we need to adjust for in life when impacted by peripheral neuropathy, even our suspenders!

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@dbeshears1

My best PCP ever has pretty good dictation software and was so good that I had a paper copy of my visit notes given to me by her nurse at checkout! Any mistakes in them a”we’re trivial, even sometimes humorous like when you ask Siri or Alexa something. I think it’s good when doctors do their notes in the minutes between patients (that’s hopefully part of their appointment scheduling system). When I have to wait 1+ weeks for visit notes to post on my portal, there’s a tendency for more errors or omissions. If I waited until the end of the day or later to summarize my workday, my memory would not facilitate good reports! Boy has the medical system changed - I guess it’s had to in order to keep up with patient expectations and accountability now, and understand how cost constraints make it hard for them to keep up.

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I do try to be forgiving. Understanding, too. I can imagine just from my PCP's overcrowded waiting room what a day's schedule must be like.

Your mentioning Siri reminded me of a funny moment in Michael J. Fox's memoir Always Looking Up, how when he was still not used to a smartphone, he and his wife would be in the midst of a suppertime chat and just happen to mention the name of one of their children or a friend, only seconds later to hear that child's or friend's voice coming from the phone: "Hello? Did you just call me?" Of course, it was Siri who'd made the call. LOL

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@dbeshears1

Yesterday I went to my my first (crowded) sports venue since the start of my PN. I was nervous, cane only, and logged a record number of steps for the day (4x average). It was absolutely amazing how people helped me along the way even with my husband there. Stepping off curbs, letting me ahead in lines etc. On our long way out of the stadium, one friendly chatty man took it upon himself to tap everyone’s should ahead of us to politely clear the way for us. For my safety. ( I think he was a bit inebriated as were some of the off balance people ahead of me, unless they too had PN or something 😊). I just think on the most part people are genuinely caring and want to be helpful!

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Debbie,

As I get more comfortable toting my cane – and remembering to tote it! – I'm enjoying a similar response from people ahead and to the sides of me: they're eager to be of help, and (important to a guy like me who's still a little about my need for help) without being overbearing! They're just trying to be good people.

Ray

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@njed

@ray666 - Ray, suspenders popping is never a good thing especially when you need help to get them back into place. And, good thing you had a friend there to help you out. As I posted before, the little things we need to adjust for in life when impacted by peripheral neuropathy, even our suspenders!

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Hi, Ed

My friend and I shared a good laugh about his having to help re-pop my suspenders. When we were getting up to leave – my friend is still rehabbing a second knee transplant and, to make matters worse, has a case of plantar – the two of us groaned and moaned – and then started laughing all over again! He and I met decades ago while running Denver's spring marathon. The memory of running marathons adds fuel to our laughter. Ah, the good ol' days! LOL

Have a great weekend, Ed!
Ray

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@ray666

Debbie,

As I get more comfortable toting my cane – and remembering to tote it! – I'm enjoying a similar response from people ahead and to the sides of me: they're eager to be of help, and (important to a guy like me who's still a little about my need for help) without being overbearing! They're just trying to be good people.

Ray

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Ray - I was at a family cookout in MD today, at my sisters house with 4 sibs I hadn’t seen in 18 months, and some next generation. There were 2 unsafe (for me) steps to get in the house from the patio. No railings, and with my PN I can’t even do a curb unassisted, but I could hold the door knob and do Ok by myself for those 2 steps. But each of the 4 times I tried to go in and out, some kind soul would insist on holding the door open for me. They just didn’t realize I needed the door closed so I could hold onto the knob until I was on the top step, then I could open and go through the door! They got the gist of it after seeing a few times how the closed door was a tool, but I felt blessed how they all wanted so much to help!

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@dbeshears1

Ray - I was at a family cookout in MD today, at my sisters house with 4 sibs I hadn’t seen in 18 months, and some next generation. There were 2 unsafe (for me) steps to get in the house from the patio. No railings, and with my PN I can’t even do a curb unassisted, but I could hold the door knob and do Ok by myself for those 2 steps. But each of the 4 times I tried to go in and out, some kind soul would insist on holding the door open for me. They just didn’t realize I needed the door closed so I could hold onto the knob until I was on the top step, then I could open and go through the door! They got the gist of it after seeing a few times how the closed door was a tool, but I felt blessed how they all wanted so much to help!

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Hi, Debbie

That's all it takes: two steps – two steps can be insurmountable!

Others may have heard me tell this story before, but it was just two steps that led to my quitting acting. I had known that my balance was bad, and getting worse almost every day. The night of our first rehearsal I took set designer aside and requested that any steps he was planning have good sturdy handrails. Then, driving home later that night, I said to myself, "Good lord, Ray, you've never before had to ask a set designer to accommodate your disability!" That was a wake-up call. I decided then and there – not so much to quit acting – but to take a hiatus, at least until I'm ready to toddle around on stage with a cane or other apparatus.

So, oh yes, two steps – that's all it takes! LOL

Cheers!
Ray

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@ray666

Hello!

I've been AWOL from Mayo for a couple of days. Because I'm the fellow who started this thread about talking to a podiatrist about your PN and your feet, and because tomorrow is the day I'll be meeting with my podiatrist for that very reason, I thought I'd tell you about the couple of questions I plan to ask, wondering if you've any others you'd like to pass along:

1. Can podiatry help someone (I'm 78) with a sensory-leaning idiopathic PN? (I have no pain, only a worrying balance and a way of walking (fishtailing) that only seems to be getting worse. I was diagnosed last August after an EMG and battery of spinal MRIs.)

2. What do you think of my shoes? (Nunbush) I've tried so many different kinds. I have severely flat feet (Size 13) that have seen too many miles of distance running. None that I've tried has made much of a difference. From your experience, have you a brand you'd recommend I try?

3. And then there are my orthotics. I've been wearing orthotics since the late-1980s (not the same pair!). Are there orthotics specially designed for people with PN?

4. My walk has deteriorated. I can no longer walk comfortably, even a half city block. And I know I'm duck-walking (is that what they call it when your toes point outward?) and looking down too much, all the unfortunate by-product of my PN. Should I try some PT specifically to relearn proper walking? If yes, do you know of a therapist specially trained to help persons with PN?

5. Around the home, I go barefoot (or sock-foot). Outdoors, of course, I wear my Nunbush. When I'm barefoot, my feet feel great (and my balance is pretty good, too), but after a while, my lower back begins to ache, and sometimes my knees, too. (Because of no orthotics?) And if I try wearing my shoes indoors, my backache will go away (knees will feel better, too – because my orthotics are in?), but my feet tend to feel all "crampy" (not always, and I believe I'm wearing the right size shoes). My balance (which wasn't too bad when I was barefoot) becomes more challenging. It seems one of those damned if you do, damned if you don't situations. LOL Can you give me some advice on what I should do?

I'll probably have other questions, but these are a few of my biggies. Can you suggest others?

Ray (@ray666)

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Hi Ray. I was told to abandon all my orthotics because none helped and to just wear comfortable shoes. My go to shoes have always been Crocs because no arch and wide toe box. For many years they really helped. Now I insert a cheap foam insert or wear the fur lined because the sole is then softer. Over 15 years... now looking for something else.Am taking cymbalta but not sure it helps. Can't take anything but Tylen - 1300 2x day- not good for liver but it does help.. I've tried physical therapy- my balance getting worse and sometimes walk like I"m drunk - not straight. 76 years ole and won't give up. Does anyone have suggestions? Gummies? Shoes? Help.

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@cax75

Hi Ray. I was told to abandon all my orthotics because none helped and to just wear comfortable shoes. My go to shoes have always been Crocs because no arch and wide toe box. For many years they really helped. Now I insert a cheap foam insert or wear the fur lined because the sole is then softer. Over 15 years... now looking for something else.Am taking cymbalta but not sure it helps. Can't take anything but Tylen - 1300 2x day- not good for liver but it does help.. I've tried physical therapy- my balance getting worse and sometimes walk like I"m drunk - not straight. 76 years ole and won't give up. Does anyone have suggestions? Gummies? Shoes? Help.

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Hi, cax75. I wish someone had suggested I try life without orthotics a long, long time ago. I was first fitted with orthotics in the 1980s, and they enabled me to run practically pain-free for the first time. I'd been a long-distance runner all of my life until a total knee replacement made running impossible (15 years ago). By that time, however, I was irredeemably addicted to orthotics. I'm afraid now, at 79, I need their corrective support. Thank you for your post. It is much appreciated. Cheers! –Ray

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