I can never think of a good title to my questinos. Sorry.

October 14, 2009 8:57 PM

I need help with creating a plan to diagnose a possible alignment problem with my right leg what I can do do fix it.

I have always had a funny way of walking. I tend to lean forward and walk closer to the front of my feet than the back. It is not a perfect heel-to-toe movement and it makes me bounce. I am very self conscious of this and when I am in public I try to walk normally, resulting in a burning sensation on the bottoms of my feet. Think of when you were a little kid and you had to walk around the shopping mall all day and your feet hurt. My feet make an L-shape when I am standing still; my right foot clearly turns out more than the left. Another way of saying this is that my knee does not line up with my foot.

I used to run and work-out a lot. I ran the Kona Marathon about four years ago and at about mile twenty, my right knee felt like it was going to come unhinged. It was a strange kind of pain so I walked the rest of the way. I also noticed when I did squats that my right foot would turn out (heel inward) and I would have to reposition myself.

So.

I think the first thing to do is get a doctor's opinion. I don't normally deal with doctors and I can't say I really trust them. What kind of doctor should I go to? What sort of tests and procedures should I expect?

If I end up having to get surgery, what is the most effective way to pay for it? I have crappy insurance now, and I am going to be a full time student starting in January. Should I go out of country?

I am not sure what information about me would be relevant to figuring this out but:

I am 28 years old, American, employed until December with basic health coverage, well within weight standards and generally healthy, and a military veteran.

Thanks for taking the time to read this.

posted by Brandon1600 to health & fitness (10 comments total)

My only advice: try to make sure the doctor you go to specializes in sports injuries. Many doctors used to dealing with older patient populations have very low standards for an 'active life', in my limited experience.
posted by benzenedream at 11:41 PM on October 14

I think a physical therapist is what you want. Every time I've had a body mechanics issue, regular doctors have either said suck it up or surgery is the solution. And every time a PT has gone on to accurately diagnose (through extensive range-of-motion tests, listening to my description of the problem, and watching me move) and fix the issue within about a month. This has applied to shoulder, back, leg, hip, and foot issues. I can't recommend them highly enough. If there's a good runner's shop in your area they might be able to give you some names. Good luck!
posted by cocoagirl at 3:35 AM on October 15

I recently have been working with my doctor and physical therapist for a very similar problem with one of my knees. Like you, I ran for years without issues, and then suddenly started noticing pain and feelings of weakness in one knee, and the out turned right foot.

My regular doc did a quick feel around the knee for any obvious bone problems, of where there were none, and sent me off to a Physical Therapist for diagnosis and treatment. The first visit with the PT, he had me walk around with and without my shoes, so he could observe my movements. He did some measurements of different angles of flexibility for the joints, comparing the "good" and "bad" legs. After making the assessment, he said he was pretty sure he knew what the issue was, and to confirm it, taped my kneecap down so it can't twist out improperly, and then retested my walk and movements.

Since then, we have been doing lots of exercises that should help hold the kneecap in the correct alignment. Your doc will try lots of things before they recommend surgery, unless there is an underlying structural damage that has to be repaired.
posted by nomisxid at 7:44 AM on October 15

What city are you in now, and where will you be in January?
posted by peep at 10:06 AM on October 15

If I end up having to get surgery, what is the most effective way to pay for it? I have crappy insurance now

Are you planning on getting non-crappy insurance soon? You might want to wait to put this on your medical records if you will soon have better insurance, unless you know for sure that it won't exclude pre-existing conditions.

On the other hand, maybe you meant that soon you won't have any insurance.

In any case, see a sports medicine doctor and/or a PT. I would try everything else before surgery. I believe you can get treatment of all sorts at a VA hospital without needing to pay (?not sure on that), probably your PT also. Whether this would be where you would want to get treatment, I don't know.
posted by yohko at 11:29 AM on October 15

I actually have a very similar thing: right lower leg 'turns out' below the knee. I've never had surgery even mentioned to me; what keeps it under control is occasional (every two months or so) visits to a good physiotherapist, and more frequent focussed massage therapy when I'm really active. You may be able to reduce the severity over time with exercises to resolve the musculoskeletal factors that cause it. What's key is to think about it (and to find a therapist or doctor who thinks about it) in systemic terms: the symptom is localized, but the lower leg is part of a kinetic chain. My therapist generally a) does soft tissue work on the right calf, b) does light adjustments and work in my lower back, and c) works on my ankle and foot to release stuck metatarsal segments. Works wonders, but any of the three alone is useless.

How to find a good therapist? Two choices: find a good sports doctor, who may or may not work with good physiotherapists. Or, if you're in a large-ish city, find out who handles physiotherapy for the local ballet company and go see them. I guarantee they've seen this sort of thing before.

At any rate, I'd try a lot of things before surgery. MefiMail me if you want any more detail or have questions — maybe we should start a gimp tibia support group.
posted by sixswitch at 3:08 PM on October 15

peep
What city are you in now, and where will you be in January?

I am in Austin, TX and I plan to stay here.
posted by Brandon1600 at 3:38 PM on October 15

ah, sorry. I had a recommendation local to me. You might try Egoscue. It looks like they have practioners in Austin.
posted by peep at 12:54 PM on October 16

What you want is an orthopedist (bone doctor) who may prescribe physical therapy. Usually you have to have the rx from an MD in order to get physical therapy so the orthopedist is the best place to start.
posted by radioamy at 9:47 PM on October 16

Egoscue, Egoscue, Egoscue! After 17 years of dealing with a chronic bad back from an injury on one side, then a bad foot injury that thoroughly messed up my back on the other side from being all torqued to one side on crutches and a cane, I was six weeks into the worst sciatica attack of my life and feeling desperate to get out of pain and off the opiate painkillers (which OMG do not agree with my system). I got Pete Egoscue's book Pain Free from the library, and four days after starting the exercises realized I'd gone without any Vicodin or Tylenol with codeine — not because I was toughing through the pain, but because the pain was so much better I'd forgotten to take any.

That made such a difference that I went to the clinic in SF. I've been doing the exercises regularly for about a year and a half now, and they really have been life-transforming. I no longer consider myself somebody with a "bad back". (I no longer consider the concept of a "bad back" useful or relevant, in fact.) I'm taller, stronger, and more flexible. And, despite my only previous experience with running having been failing the running test in junior high and high school PE class, I've recently started training for my first marathon.

Oh, and I'm now planning to study and become an Egoscue-certified postural alignment specialist and quit my desk job and work as a personal trainer helping people get themselves out of pain. Did I mention it was life-transforming?
posted by Lexica at 9:55 PM on October 16 [1 favorite]