Arches

Every time I have a huge epiphany, I think, “I need to blog this.”  And so here it is…I was visiting an MD pediatrician friend of mine.  She took her 3 year old daughter to see a podiatrist, who, pretty much, did nothing for her.  Now my friend wants me to refer her to a children’s orthopedic doctor.  It seems that her left foot flattens out.  Other terms for this ‘condition’ are ‘flat foot’, ‘excessive pronation’, ankles roll in, yada-yada-yada.  The first question to ask is why is it just one foot?  Why not both?  Is she truly flat of feet?  So we start with a gross examination of the feet without weight bearing and the effects of gravity.  She sits down and looking at the underside, plantar surface, she does have a mild arch on both sides.  No, she is not truly flat footed.  Then we watch her walk.  Yes, the left medial arch flattens and the foot rolls on the inside.  Most people think the the next logical step is to fit her shoe with an arch support.  Oh, she needs an arch support.  Wrong.  The pure mechanically unstrained body should not need anything.  This will be problematic as a child’s foot will grow.  Fit her every 3rd month as she grows?  Impractical!  What if she wants to wear sandals or flip flops?  Future non-compliant patient.

As an osteopathic physician, I want to think differently and ask different questions.  Through the mid-phase of her step, why does the arch not hold on the left?  Why does the right one do pretty decent job.  If she were prone to flat feet, why not both?  But then we saw that without weight bearing the arches look pretty much the same.  The answer simply for why the left arch gives in is that the load that is borne by that foot is much greater than the right.  She is mechanically strained.  Remember, that for us osteopaths, ‘disease’ is the end point of  a process of strain.  How do I know?  I know that she is a rambunctious little girl; they call her their ‘little monkey.’  Many times I have seen this little girl tumble, fall, hit her head.  She has multiple traumatic strain.  Her body is heavier and denser than a girl’s should be.  I check her pelvis and it is tight and stuck.  This makes sense.  When she walks, the hip looks tight.  It feels tight.  She can not swivel and pivot.  The load of her body standing up against gravity is unequally distributed over the left and right pelvis.  I examine the bones and they are heavy and dense.  i will have to prove I am right.  I proceed to treat her.  Ta-dah.  The bones change right under my hands.  I instigate and witness tissue transformation.  The pelvis  no longer feels tight.  She gets up and we watch her walk again.  Her mother and I observe that the left ankle does not roll as much.  The arch seems to do a better job.  My friend asks what should we do next.  Should she make an ortho appointment?  I replied no.  All she needs is another visit.

I was talking and trying to figure out Carla and her feet.  Carla mentioned that  she needs arch supports.  I asked why?  She replied that she needs something soft up against her arch so that there is something cushy for the arch to sink into.  I was perplexed by her answer.  The purpose of an arch is to support weight.  If I walked through a doorway arch, I should have no fear that the structure above my head will cave in on me crush me to death.  Architectural, structural arches are not designed to give.  Why should our feet be that way?  The answer is that our feet should not be that way.  That in fact, our arches should be structurally solid able to bear the load of slim body standing upright against gravitational pull.   In our most natural state, hunting and gathering to survive and feed our young, we walk.  We do not sit around all day, storing calories in fat cells.  Our feet should be calloused from all that walking .  Our arches would support our slim frame.  If we could not run away from our predators, those of us with weak arches would not survive. 

I then had another thought.  Looking at ancient structures that have withstood time, how come those arches maintain?  Do you ever see braces and struts up against these arches?  No!  Have you ever seen an ancient roman aqueduct in need of  repair ? Of course people have been conditioned to think that they NEED.  No, if you NEED, then you are strained.  You have the option to have me, an osteopathic physician, figure out why and where you are mechanically strained, treat you once and resolve your issues.  But of course that is never the case.  Because one single mechanical strain does not cause pain, most people are satisfied with a  simple shoe insert.  Most people are even okay with being talked into buy fancy-schmancy custom orthotic arch supports.  It is only after multiple strains that people start to hurt that they go to a doctor, usually an MD.  Once they hurt, people go to all kinds of lengths to get relief.  By the time people get to me, they have layers and layers of junk strain and even mechanically induced strains from chiros, PTs, even deep tissue trauma (from even massage), of course it is more work for me.  Please people, if you just deliver yourself as a pure unadulterated mechanical strain, it will be easier to prove to you.  Keep reading and I hope I can convince you.

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