Have we gone mad?
By now, many you will have read the intriguing piece in the May 3rd New York Times, My Left Foot: The High Costs of Fallen Arches. It’s a detailed account of one man’s battle with flat feet and the extensive corrective surgery that he endured to return his body to “normal.”
There is so much to say about this piece that it’s almost impossible to know where to begin. The questions just leap off the page: How did the author get to such a state that “required” massive surgical intervention on both feet? There is no mention of attempts at barefooting or other functional rehab approaches. So why the rush to surgery? Why the assumption that the supposed structural abnormality was the cause of the patient’s pain? Isn’t there a normal variation in foot arch? How would this person have fared in prehistory?
Depending on your perspective, this story is either a) a dramatic example of the success of modern medicine or b) a dramatic example of medicine gone completely off the rails.
I have my own opinions on this of course, but I want to hear yours.
Please comment.
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Frank,
This is off topic, but did you see this:
http://conditioningresearch.blogspot.com/2010/05/exercise-in-outdoors.html
I have one type of flat feet (overlong metatarsals according to the podiatrist) – I have a very low arch, my feet roll in, there is too much pressure on the ball of the foot and you get ‘claw toes’ – and I have to say that wearing my orthotics in a wide comfortable walking shoe is more comfortable and probably better for my feet (and thus for my knees, hips and back) than going barefoot. If you have one of these conditions you have an actual skeletal deformity – and in my case at least, no amount of barefoot walking would help. I grew up in Australia and was barefoot most of the time I wasn’t at school or uni (and I mostly wore flat shoes, rather than heels because of my ‘difficult feet’) but it didn’t make any difference. By the age of 30 I was at the podiatrist with numbness and pain in the right foot. My opinion, based on experience, is that in prehistory, people like myself would have had sore feet – and the sore knees and hip and back problems which go with it.
How did the author get to such a state that “required” massive surgical intervention on both feet?
I wouldn’t know, are people born with flat feet? Are there archeological records of homo sapiens with flat feet? Then again, whatever the cause a cure is needed for the pain.
So why the rush to surgery?
If you’ve got a hammer, everything looks like a nail, you and I would’ve probably tried some other alternatives and not go to the extreme of surgery. However, if nothing helped, then I’d take extreme measures as well. So rushing into surgery: bad, but it’s good that it’s an available option.
Why the assumption that the supposed structural abnormality was the cause of the patient’s pain?
I wouldn’t know, haven’t studied for it and I certainly did not diagnose this man. Did you?
Isn’t there a normal variation in foot arch?
I’d say yes, and this might be an extreme case, just as there are extreme cases with bad eyesight. I can imagine that with a lot of physical features, there are optima for certain activities, maybe extremely flat feet and walking don’t play well.
How would this person have fared in prehistory?
Again, same goes for bad eyesight, still prevalent in our society but we have our measures against it.
I sure would like to hear your opinion :)
I think a big part of the problem is communication. There are two many quacks on both sides of the fence. How is a regular joe supposed to get solid, balanced advice and treatment? In this (dis)information age it is becoming increasingly difficult for people to know who to trust when it comes to matters of health.
One thing that strikes me when looking at stories like this in contrast with the wisdom put forth in movements such as EA, Primal BP, MovNat and other like minded endeavors is the great damage that has been done by ‘Advance Learning’. Have you ever heard, “according to an old wives tale, a high carb, low fat diet has been proven to reduce the risk of heart disease.” Nope those types of ‘research’ are always prefaced with “According to experts at the reverred research Mecca of blah, blah, blah.” To my way of thinking many times all those ‘Piled Higher and Deeper’ and ‘Medical Dufus’ awards only seek to protect bad science from the light of day (also read logic and common sense).
Well…you asked for opinions!
Having suffered through one (bad) foot surgery and 6 corrective surgeries, I am now more skeptical (and certainly fussier) about who I go to for what. Sometimes you just have to have surgery, otherwise you can’t do all the things you like to do and that can definitely make you go mad.
However, 2nd and 3rd opinions are a really good idea, as well as a good referral from an existing patient of whatever doctor you go to see.
I was just born with misaligned bones. Who knew? But knowing what I know now, maybe I could have prevented the need for surgery way back then. But maybe not.
In prehistoric days, I would have been relegated to the cave to watch the kids and do the cooking because it would have been too painful for me to go out and do the gathering. Ya, I don’t think so. Do what you gotta do.
My 2 cents
How did the author get to such a state that “required” massive surgical intervention on both feet?
Probably through a combination of misuse and disuse. That’s typically how people get into bad physical situations (barring other disease).
There is no mention of attempts at barefooting or other functional rehab approaches. So why the rush to surgery?
Science likes to look at “things.” It thinks it can “understand” “things.” So when the foot is broken, it looks at the foot, and what is broken in the foot, and treats that. Forget about the rest of the body the foot is attached to. The rush to surgery comes from a misplaced egocentric idealism that assumes it is possible to know the “cause” of a “problem,” and the ability to “solve” that “problem.”
Why the assumption that the supposed structural abnormality was the cause of the patient’s pain?
Same reason as above. The scientific enterprise is usually analytical, not synthetic. It also (and maybe, therefore) assumes that symptoms or “problems” have some immediately identifiable “cause.” This assumption usually takes the form of “we can fix it by working directly on it.”
Isn’t there a normal variation in foot arch?
Not only is there normal variation in foot arch between people, but there is variation in foot arch within single individuals. But how do we know the foot arch had anything to do with it? The foot arch could have been a symptom of valgus knees, which could have been a symptom of poor hip strength or mobility, which could have been a symptom of thoracic spine dysfunction, which could have been a symptom of cervical spine dysfunction, which could have been a symptom of any of a number of things.
However, to your point, if you do a quick Google Scholar search, you’ll find a US Army study that says that people with “fallen” (low) arches are actually less susceptible to ankle sprain/injury than people with high or moderate arches. In fact, there is a great deal of literature that shoes that the notion of an arched foot is not a functional necessity (or even really desirable for good function), but an aesthetic and culturally-created ideal.
How would this person have fared in prehistory?
He probably would’ve done really well. The witch doctor would have sacrificed his shoes to the God of Hell, lacerated his entire body with a whip, fed him a gallon of moonshine made from the rotten hides of honey badgers mixed with lemon juice, crucified him to a tree for four days with honey poured all over him, and then cut him down and taken him to a hut full of virgins who would’ve given him some serious “deep tissue” work for a couple of weeks…
After that, and a nice BM, he would’ve been back to normal!
There are no cultures in the world that are barefoot that have flat feet. None.
Flat feet (and it’s varying degrees) have to do with improper biomechanics and posture stemming from a variety of sources, most of which can be traced back to shoes and sitting. I discuss this more in depth here:
http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/
It’s sad but most things about the medical industry follow the money. This is especially true with pharmaceuticals… but the same is true of orthotics and surgery.
Couple that with the fact that people want a QUICK FIX rather than changing the habits that got them into the situation in the first place… and you have a huge amount of health issues.