Home / Thoughts / Other's Thoughts / Chloe's Thoughts / New Shoes
New Shoes
Written by Chloe on Sunday, April 26, 2009
I was a bit nervous about my first visit to an orthotist; not quite sure what to expect. As soon as I transferred from my car to the wheelchair, the anxiety vanished. Wheelchairs will do that.
First Visit
When I had told my partner that I was going to an appointment with an orthotist, she thought it was about my wrist. I explained that I wanted a system such that I could use just a left leg brace (KAFO), but with matching shoes.
There was a nice ramp down from the parking lot into the orthotics/prosthetics office. I can never resist opportunities for speed.
I’d allowed a few extra minutes to fill out the paperwork; just a bunch of boring crap. After handing it in I was asked for the prescription. Oops… No prescription! I said I didn’t have a prescription, but she could call my GP. I gave her my GP’s card. Since my GP had written me a prescription for the wheelchair, I figured (hoped) that KAFOs wouldn’t be a problem either.
It seemed very comfortable to be in a waiting room with<em> </em>others requiring orthotics or prosthetics. After a few minutes my name was called, and I was ushered into a room to await the orthotist.
I told him that only my quadriceps had been affected by the minor spinal compression, more so on the left side than the right side. A true statement after all! Lack of functioning quadriceps are the primary indication for a KAFO. No quadriceps; no KAFOs; you fall down.
The orthotist had me transfer to sit on the bed, which could be raised up and down, so that he could check out the extent of paresis in different parts of my legs. As he was playing with my rather floppy legs I was thinking "Wow, this would be a great job for a devotee!"
Right leg first: I faked paresis of the right quadriceps, no more. Then to the left leg: I faked complete paralysis of the left quadriceps. Then he checked the muscles on the underside of the left thigh. He noted a lot of twitching there, and said that was indicative of partial paralysis (paresis). This was good news, though not particularly surprising. For the last two years those muscles have clearly been more flabby and floppy than on the right side. They also have a strange kind of ache to them. In addition I experience minor muscle spasms there. Had I not faked complete paralysis of the left quadriceps, the orthotist would have found twitching there too, though much stronger.
Next he went to the left foot and ankle, just as he had done with the right. He said "Ah yes, you’re going to need a fixed ankle here"… What! I was really taken aback… I wanted to say "You gotta be kidding me!" I had explicitly told him that there was no paralysis at all in my lower legs; and I wasn’t trying to fake anything there. He went on about how there was weakness in both the dorsiflexion and plantar flexion (I think that’s what he said) which would mean I wouldn’t be able to balance properly without a fixed ankle.
Afterwards I thought about this issue in depth. Much as I would like to, I just don’t believe it. There is definitely no sensory loss below the left knee, no significant muscle spasms, no obvious weakness. My conclusion is that if you want a body part to be paralysed it can appear that way to others even if you are not consciously faking it. (Thanks for discussing this with me, Sean). At least I can now honestly tell people that my orthotist said I DO have something going on with my left lower leg.
At any rate… I wasn’t about to argue with the orthotist if he was saying that I have more paralysis than I was claiming!
Now that the orthotist had figured out what I would need in terms of bracing, we needed to address the specifics. My preference would be to have custom molded thermoplastic KAFOs. He calculated the cost: $5000. Argh!!! I explained that was beyond my budget. He checked out my current KAFOs, which I had brought with me but wasn’t wearing. He said they were of good quality, in good condition, and could be modified to have new shoes; with an extra pair.
The next step was to measure my feet. I explained to him that my left foot is unusually wide and deep. He confirmed the width at a 4E. He said we would buy the shoes to fit the left foot, and use inserts to get a good fit on the right foot.
We looked through a couple of orthopedic shoe catalogs together to see what might work with my braces. It turns out that having a foot that used to belong to Frankenstein’s monster rather limits one’s choice. However, we agreed upon a pair and it was time for me to head out.
I had spent well over an hour with the orthotist, and I drove away feeling very happy about the experience. I was glad that I had not gone in there with an attitude of demanding anything. I had made it clear that I was relying on his advice and expertise.
Second Visit
The orthotist gave me a call when the shoes came in. The first thing to do was to try them on. He said the left one was a bit tight in the width despite it being a 4E. Alright, so I have a freak left foot! It’s not really on my list of things to worry about. Anyway, he said they would work fine.
We discussed the range of ankle motion. He suggested that five degrees on both sides would be a reasonable place to start. If I found that wasn’t working for me, I could come back and he would change it.
Next he had to order new stirrups, and put all the parts together. I pointed out a place on my right brace where a rivet had come off. He said he would fix that too. End of visit…
Third Visit
The orthotist called to say that he had put everything together except for the mechanisms to make the ankles semi-rigid. He didn’t have the parts for that and it would cost extra. However, we agreed I could just pick up the braces, and try them out with free ankles. If I found that I needed them semi-rigid, I could come back and he would fix it. He wasn’t going to be in the office for the next couple of days. But since we already knew that the braces fit and the shoes fit, I could just pick them up any time.
I went in the next day (today). It had turned out that I hadn’t needed a prescription, but I was glad that I’d brought my GP into the loop just in case. Everything went smoothly with picking up the braces, except for the fact that I was having a hard time wheeling. The ski crash earlier in the week had triggered a bad fibromyalgia episode centered in my left wrist, so I was in pain and wearing a wrist brace. Someone helped me with getting my leg braces to the car.
As I sat in the car, about to leave, a smile came over my face. I was amused by all the hardware. Firstly I was wearing a wrist brace and a back brace, for genuine physical reasons. Then, in the car I had two crutches, a wheelchair, and two leg braces; just cos I’m nuts.
Now here I am at home, wearing both KAFOs as I type this. Everything fits perfectly. Everything works perfectly. Very nice.
Tags: Back Brace, Crutches, Devotee, KAFO, Leg Braces, Muscle Spasms, Orthopedic, Orthotist, Paralysis, Paresis, Prosthetics, Stirrups, Transfer, Wheelchair, Wrist Brace
This entry appears in Chloe's Thoughts. You can follow any responses to this entry through the RSS 2.0 feed.
You can skip to the end and leave a response. Pinging is currently not allowed.
5 Comments
Chloe, I’m glad things went well. You just keep giving me ideas on what to write about. My orthotist visits were interesting. One thought, though - after my injury, I had thermoplastic KAFOs and AFOs (oops, I’m giving stuff away) and they were terrible. I’ll tell you about some alternatives if I can EVER get time together to put pen to paper…well, you know what I mean!
Lane, I am absolutely dying to read all about your experiences with leg braces, injury, wheelchairs, and everything else :)
So, regarding the ankles, the guy at first said you would need fixed or semi-rigid, and then actually delivered free ankles, is that right? He “didn’t have the parts” and they “would cost extra” … something about this sets off subtle alarm bells.
Within the context of orthotics and disability, the “normal” mindset is to want less paralysis and bracing. It occurs to me that the profession has ways of dealing with “people like us”, which could include measuring how far from normal the mindset a client is, in the context of wanting or accepting more bracing than is physically necessary.
In my experience with guys who accepted my business without a prescription, one was nonchalant up to a point but was firm and clear about not crossing a line, and I respected that. The other guy was clearly uncomfortable with the whole idea, and actually tried to lecture me. He obviously did not understand our side, but he did understand his business enough to charge me more than we had agreed on. No respect for him, except for the workmanship on the “introductory” item.
@Nobody. I’m very bad at figuring out what people’s hidden motivations might be. I take what people say at face value. I think the orthotist might have assumed that I already had the parts to make the ankles fixed or semi-rigid. I’m not sure why though, because I had been explicit about not having any paresis below the knees. He seemed genuinely convinced that I have sufficient paresis affecting the left ankle to warrant it being semi-rigid at least, though certainly not complete paralysis.
Another factor could be that it is more usual to have just the lower leg affected than just the upper leg; hence the utility of an AFO. So perhaps the orthotist was not used to a lower leg being fine when there is paresis in the upper leg. Well, usual or not that’s the way things really are with my left leg. I want to keep things as close to reality as possible so I don’t have to tell outright lies to people.
I told the orthotist that I had been able to get around okay with free ankles on the KAFOs. The upshot is that’s the way they still are and I’m fine with that.
Post your comments
© transabled.org - 1994-2010 - All Rights Reserved.
1 On 26 April, 2009, Sean said:
I’m very happy things went well for you with the orthotist. These guys (and gals) are generally quite nice and helpful :) As I keep telling Claire and Sasha ;)