The day came for us to view our daughter. I was terrified and frightened. I did not want to go. The viewing would only make things real. It couldn’t be real! Would I allow my children to see their sister, dead? Could I bare to see them go through that? I couldn’t make that decision for them. I wouldn’t make that decision for them. They said they didn’t want to go. Could I blame them? I didn’t want to go. Read more…
The term “isometric exercise” means tensing a muscle and holding it in a stationary position while maintaining the tension. Isometrics are strengthening exercises that can be used to build up individual muscles significantly. In some patients with severe OA involvement in the knee, exercise can actually move the patella slightly so that it tracks a little differently and uses a slightly different area of the cartilage, thus relieving some of the pain. Read more…
The Canadian researchers were interested in learning how wearing supportive shoes alone and using either soft orthoses or semi-rigid orthoses inside such shoes affected the pain, swelling and foot functioning of patients with RA erosion in their MTP joints.
After almost a year of studying 24 men and women with metatarsalgia caused by rheumatoid arthritis, Chalmers’ team found that patients achieved significant pain relief only by wearing both supportive shoes and semi-rigid orthoses at the same time.
Supportive shoes worn by themselves or soft orthoses worn by themselves did not provide metatarsalgia pain relief.
The research also pointed out that none of the combinations of shoes and orthoses effectively reduced MTP joint swelling or improved joint function, even when pain relief occurred.
Richard Berenter, D.P.M., podiatrist and professor of biomechanics at California College of Podiatric Medicine, strongly endorsed the Canadian team’s findings. “Supportive shoes and the right orthoses are essential to foot pain relief,” he said. “In our extensive clinical experience with arthritic foot pain at the college, we have found it’s like a marriage — you have to have both aspects well-matched to each other for either to work.”
Supportive Shoes Not Your Style?
In a recent interview discussing his team’s research, Chalmers noted that the first thing individuals with metatarsalgia pain should know is:
“The shoes you wear are very important!”
Ignore visions of feet encased in ugly, black, lace-up oxfords, Chalmers says. Support shoes aren’t necessarily bulky or unsightly; they are traditional, functional, attractive leather shoes that provide appropriate support for aching feet.
“Shopping for shoes is a part of the orthotic work we do with all our metatarsalgia patients,” Chalmers explained. “We take them to look for shoes that are commercially available and give support to their feet. We look for ordinary, everyday shoes that are suited to each patient’s tastes, support needs and feet. What’s most important is that they are supportive in the heel and toe, with sufficient depth and width for the individual’s foot size and shape, and a firm enough sole to support an orthotic insert.”
As his team’s research concluded, even the best supportive shoes alone aren’t enough — it’s the addition of the appropriate orthotic inside the shoes that delivers long-term pain relief.
Berenter explained that orthotics work by slowing down motion within the joints of the foot and absorbing shocks that would otherwise be transferred to the metatarsals or toes. “There’s no question that the right orthotic support and cushioning for foot joints provides significant relief from postural fatigue and pain,” he said.
The Right Orthotic
All the orthotics Chalmers’ team tested were custom made, based on patients’ unique foot characteristics. From previous clinical experiences, the researchers knew standardized, off-the-shelf, nonprescription shoe inserts aren’t generally useful. “The products that are commercially available to fit everyone basically don’t fit anyone,” Chalmers pointed out. “They just do not work to provide effective pain relief for the foot joints involved in rheumatoid arthritis.”
For this reason, the orthotics laboratory at Vancouver General Hospital’s Arthritis Center, like many others around the world, fabricates two types of inserts for patients. One is known as a “soft” orthotic; the other is known as a “firm” — or “semi-rigid” — orthotic.
Patients in the Canadian study wore their supportive shoes alone for 12 weeks, their supportive shoes with a custom-made, soft orthotic for 12 weeks, and their supportive shoes with a custom-made, semi-rigid orthotic for another 12 weeks. To make the study stronger, the order in which patients tried each treatment was randomly assigned: Some started with supportive shoes alone, some with soft orthotics in supportive shoes, some with semi-rigid orthotics in supportive shoes.
At the end of the study, pain relief was judged to be superior when the supportive shoes were worn with the semi-rigid orthotic.
According to Chalmers, the study highlights the need to have competent, professional diagnosis and treatment for all aspects of rheumatoid arthritis, including expert guidance about the best footwear and shoe inserts.
He believes for patients with metatarsalgia, supportive footwear and prescription orthoses used together provide a good alternative to sitting down and hoping the pain will pass.
A Stairway, A Sketch
This decision supposedly places me directly in opposition to the wishes about/from the body, and it is now literally (at times) as I had always imagined (projected?) my main conflicts to be: staring at my body across the table, or in a mirror, eyeing its desires, its potentials, what it claims to be its destiny and its main purpose in its life. What of my life? What of the life of the will, the personality, the mind, the parts of the body that are free from these desires? Are we (they) to have no part in the decision? Are we to just bow before the “lesser” (baser) will of the body because we are told (by the body, by the world, by the way the body interacts with the world and its own desires…most of all by the way the world seems to reflect its desires, the way that the world fits into its desires like interlocking puzzle pieces) that this is the way it must be? With the despair of not reproducing, of feeling like I am missing something in my life that not only should be but which is almost a divine (or natural) mandate, comes into conflict the opposite despair (fear) that to reproduce is to miss what I consider my destiny (yes, illusion), something that I will not achieve if I have to care for children or, what’s worse, I have the responsibility for other lives, a responsibility I could not take lightly and which would change my life forever: changing my character, my goals in life, my pleasures and pains. Is the fear of fatherhood a fear of change?