Legs: How do they work!?
September 15, 2013 5:24 PM   Subscribe

I'm a 42yo overweight female. I've been on an ongoing and very successful weight loss program, and have no issues with my diet at this time. My issue is, I seem to have forgotten how to walk...

I moved to a new city about 6 years ago, and for the first two years I worked from home. I spent about 90% of that time on my ass. When I finally started working in an office again and had to move around, I ended up injuring my left ankle (chronic insertional achilles tendonitis) and my right foot (something wonky and painful on the top of the foot when I push off.)

I've been limping around for a few years, unable to properly push off with either foot when I walk. This has led to steadily increasing knee pain, but never more than I could manage with tons of advil. About two years ago, I got serious about my eating and lost about 100 lbs (about half of what I NEEDED to lose, leaving me about 80-90 lbs overweight right now.)

My diet: Paleo
My exercise: 100% biking, and quite a lot of it

The weight loss has not helped either my knee pain or my foot pain (either side). I've been to physical therapy a lot, I've been to doctors who basically said I was fat and over forty so I should take more advil and suffer. I've been to even more physical therapy. And just recently, because I was almost unable to walk at all, I finally talked a doctor into giving me cortisone shots in both knees. That helped quite a lot, but now I want to figure out how to start fixing things on a more permanent basis.

To wit: I walk funny. I think it's been a slippery slope. I can't push off with my feet, which weakens my calves and my hamstrings and glutes, which puts huge pressure on my quads and the tendons around my knees. When I walk, I feel more like I'm dragging myself forward than anything else. I can't tell if this is helped or made worse by biking, which seems to do a lot for my quads and not much for most of my other muscles. My legs right above the knees, in front, are always extremely tight - so tight they feel swollen. Stretching helps minimally, but not much.

I know the root cause is my feet, but I don't know what to do about that. I've had an MRI on the achilles on the left side, but all anyone wants to do is send me to more PT that doesn't work and hurts like hell, or put me in a walking boot. I've done both of those things so, so many times. Nobody is even willing to talk about the right foot, I haven't even been able to get it X-rayed. Docs write it off to arthritis and pretend that is somehow treating the problem.

While I work on trying to find a doctor who will actually help with my feet, I'd appreciate some advice on how to strengthen the parts of me that I feel have basically withered away: Hamstrings, gluts, calves. I'm hoping that if I can get my hamstrings and calves and butt in working order, some of the instinct for how to walk will return. My body no longer remembers how my legs or hips are supposed to behave when I locomote.

Please note, I am PHYSICALLY INCAPABLE of rising up on my toes, on either foot or both together, so calf exercises have to come in some format that doesn't involve me standing on my toes. Any other advice/instruction would help.
posted by anonymous to Health & Fitness (24 answers total) 2 users marked this as a favorite
PT is what you need for this problem. A list of exercises from strangers on the internet is merely a pale imitation of what should be exercises specifically tailored to you and assisted by a trained professional -- that's PT. If your experience with physical therapy so far has been a bad one, you need a different physical therapist.
posted by telegraph at 5:27 PM on September 15, 2013 [8 favorites]

Yes, PT! They can and will teach you how to walk properly and help you deal with the obstacles to that end.

And under that guidance I wonder if some combination of pilates and yoga would help to stretch and strengthen your leg muscles. Lengthening those hamstrings and calf muscles would likely make walking easier once you've dealt with the foot issues. Good luck and way to go on your journey to being healthier!
posted by AnOrigamiLife at 5:45 PM on September 15, 2013

There is a wide, wide range of PTs out there. I've dealt with several and only experienced results with one of them. The difference in diagnostic accuracy, skill level and work ethic was obvious and immediate. Sorry, you just need to keep looking. (If you trust your orthopedist you can get her recommendations; but better would be to canvass your friends and get the ortho to refer you.)
posted by fingersandtoes at 5:49 PM on September 15, 2013

Response by poster: You need to find a good PT. And you have to be really diligent about doing the exercises they give you as often as they recommend and implementing the changes they recommend into your daily life. Physical therapy is a constantly evolving science and some of the old guard employs methodology that's not as effective as it could be. If you can find someone with some experience in SFMA you're on the right track--though keep in mind just taking the courses in SFMA doesn't necessarily mean you're effective at implementation.
posted by Anonymous at 5:58 PM on September 15, 2013

I would actually go beyond PT and consider seeing a qualified and recommended podiatrist. I have had very positive experiences with a good podiatrist, who helped me in several ways with problems that some PTs didn't really have the skillset to deal with.
posted by smoke at 6:01 PM on September 15, 2013 [2 favorites]

Yoga would be a good way to get started with low impact muscle development. It won't directly address the walking, but you'll gain endurance in the other supporting muscles which may help. You'll also likely feel pretty good.

Have you done any time with an elliptical machine at a gym? I don't know if that would be helpful at all, but since your feet always follow the same path, and there's no impact, it may help to develop some of those muscles.
posted by markblasco at 6:05 PM on September 15, 2013 [1 favorite]

You may, under the advice of a professional person, want to look into rowing -- indoors, to start, on an erg. It's low impact (runners who have destroyed their ankles or knees can row) and it's a full body workout. If you are doing it properly, you will engage and use all the muscles in your legs, not just your quads.

Good luck.
posted by Medieval Maven at 6:26 PM on September 15, 2013

You can also check into seeing a DO. They have extra training from MDs in areas of how all the body systems are connected. So a DO might find for instance, that your foot and knee problems are coming from (I'm totally making this up) a hip misalignment.

While an MD is going to just look at the knee and foot, the DO ought to have you lie on a flat table and assess your whole body alignment.

There are Podiatrist DOs.
posted by bilabial at 6:28 PM on September 15, 2013

Thirding the physical therapist. I was having chronic knee pain and saw the orthopedist who sent me to the PT who worked her miracle magic and suggested a simple fix: move my seat back in my car when driving to lengthen the knee. Voila! Knee pain gone, sang praises of PT to orthopedist who's only help was to send me to the PT.
posted by tafetta, darling! at 6:31 PM on September 15, 2013

What kind of shoes do you wear? Do you have supportive insoles? If you think that your walking issues go back to the feet, maybe a good set of custom insoles could make the difference. Podiatrists know what to do about foot pain that seems weird and random to other doctors.

When I got my insoles, the podiatrist watched me walk and determined based on that, plus examination of my feet, what was causing my foot pain and how she could fix it. The insoles were expensive and are a pain because they interfere with cute-shoe-wearing, but they make so. much. difference! My feet stopped hurting and have continued to be pain-free so long as I wear the insoles often, not even all the time.

In summary: Podiatrists. They're good.
posted by snorkmaiden at 6:51 PM on September 15, 2013

I've been in PT for, oh, 7 weeks now? Looking down another 3 months or so. I broke my leg, but I also feel to an extent that I've lost control of a part of my body, which is deeply unsettling. I really feel for you.

I think a big part of this is finding a PT you connect with. Trusting some stranger with your very painful limb is a big leap of faith. If you get the sense that they're brushing you off, don't take you seriously, or are not competent there is not going to be any kind of relationship that you need. Don't feel bad about finding another practice or therapist. You can take your doctor's PT prescription anywhere. I also gained a lot of trust reading about the amount of graduate school and fellowships that are needed to get your DPT and MPT. It can rival getting an MD.

So, not being a PT or a MD, just some random person on the internet, I was surprised to learn how important the IT band is to normal walking. The IT band keeps your legs going straight and forward while you walk. At PT they might get you onto a foam roller, doing IT stretches and side leg lifts.

And yes. PT hurts. Didn't they tell you that PT stands for Pain and Torture? You've probably got scar tissue, tendonitis, over tightened muscles, maybe arthritic debris, and maybe worn down cartilage. Everything about that hurts. You need to find ways to keep your skeletomuscular system supporting those weak points. You need to break down that scar tissue. You need to lengthen those muscles and tendons. And the only way to build more muscles is to break them down. Pain!

You know that little pain chart with the faces where they ask you to rate your pain 0 to 10? I have a very very clear conception of what 10 is, thanks to my wonderful PT. Mind you, I didn't think she was so wonderful at that exact moment, (in fact this is also the only time I can think I've seriously wanted to commit an act of violence against another human) but after that manipulation I gained 12° range of motion over the next few days. Again, have faith and find someone you can trust.

After getting off narcotics after surgery I was really glad my (RN) mom had me ask for an Rx for Celebrex. Its an NSID usually prescribed for arthritis, and I take it twice a day. I'm also maxing out extra strength tylenol and bought several CryoMax ice packs. All this combined keeps me pain free most of the time. PT still hurts mind you, but I'm not in pain at rest.

All in all, it boils down to PT or surgery. If you truly cannot get what you need out of PT, they should refer you back to your Ortho for a surgical consult.
posted by fontophilic at 7:16 PM on September 15, 2013 [1 favorite]

I echo the exhortations to see a podiatrist. They can do a gait assessment (look at how you walk) and recommend things as a result, which might include a combination of stretches, physical aids like orthotics if necessary and recommendations for shoes or other treatments that would be helpful.

In terms of you yourself getting a better sense of how your legs, feet, bum, etc all work together, definitely yoga. Iyengar yoga specifically has an emphasis on the physical aspects at its beginning levels which I think is really helpful. They also use lots of props so have a chat with your yoga teacher at the beginning, they can recommend the right aids to use so that you gradually develop your muscles rather than overtaxing everything.

Physiotherapists are also very good and you may just not have found the right one. But if you are looking for something non-physio to try, I would go with podiatry and yoga.
posted by Athanassiel at 7:19 PM on September 15, 2013

I am not a doctor/ this is not medical advice.

Swimming? Aqua jogging/walking? Aquacise?

You might also be able to use some of the weight machines at the gym to strengthen your legs. There are also strengthening exercises using your body weight/ resistance bands.

I would suggest getting an instructor to watch your form. You don't need any more injuries!

To help with muscle tightness have you considered massage/ use of a foam roller?
posted by oceano at 7:24 PM on September 15, 2013

If I wanted to realign my gait and correct my walk, I'd invest in a few sessions of Alexander Technique with an experienced practitioner. Some practitioners double at PTs, too, but that's not really why I'd consult one.
posted by DarlingBri at 7:44 PM on September 15, 2013

I'd nth finding a better PT, preferably one who is also a personal trainer. I found one in NYC when I was having knee and ankle issues and he was very helpful. I'd also suggest trying to find a different doctor, preferably an integrative medicine practitioner, and definitely find a good podiatrist. I have been there, overweight and being told that OMG FAT is why I was having all the problems I was having, and it is not fun. But if you can't physically raise up onto your toes, you have a physical problem with your feet that needs to be addressed. Once I got my foot issues sorted via a decent podiatrist and a good integrative medicine doctor, my knee issues got a lot better.
posted by bedhead at 8:29 PM on September 15, 2013

When you describe the pain and tightness in some of your muscles and problems potentially resulting from you moving your body out of alignment to compensate for injuries, thereby causing new injuries, it made me think a good body worker/massage therapist might give you some relief in the short term and a REALLY good body worker could potentially offer some insight about some of your problems. Seek out people who maybe are specialized in sports massage or recovery from injuries, connective tissue work (if you feel like that is your problem, you mention your achilles tendon issue...). If this type of thing interests you, some people swear by structural integration therapies and/or rolfing, they deal a lot with posture and alignment.
posted by dahliachewswell at 9:20 PM on September 15, 2013

my right foot (something wonky and painful on the top of the foot when I push off.)

I had a stress fracture last year and I would have described it similarly. The foot/ankle doc I saw specialized in sports medicine, so you may want to try that. Good luck!
posted by emkelley at 2:10 AM on September 16, 2013

Podiatrist. Pronto.

I found it excruciating to walk for about three years. I saw a number of GPs - each had a different answer and nothing helped. I resorted to wearing old ladies' shoes because of the vast amount of cushioning. I wore insoles recommend by one doctor. They made things worse. I limped and felt increasingly isolated because I couldn't go for walks.

Then I saw a podiatrist. First thing she said as I was taking off my coat: "You have hypermobile fingers. Interesting." and then she had me walk first in my shoes and then with my bare feet. She took a cast of my feet and explained how my hypermobility meant I was always off-balance and my feet were constantly readjusting themselves: she put the cast of my feet down and they wobbled like nobody's business.

So. I wobble. I wobble even when I'm standing still. And the podiatrist made me insoles that stabilise my feet (and I had to relearn how to balance when I started wearing them). I'm no longer in pain, I wear regular shoes and I don't even have to wear the insoles on a regular basis anymore.

Podiatrists are the best.
posted by kariebookish at 3:06 AM on September 16, 2013 [1 favorite]

What's your bicycle setup like? Clips or clipless? Are you pulling up on the pedals on the upward stroke?

Can you flex your ankle while sitting in a chair lifting the foot off the ground? What sort of stroke do you use to bicycle if you can't push off with your foot?

A sports medicine specialist might be helpful. Or an excellent PT. It sounds like you've been sent to PT for just the left foot, you really need to tell the PT about your right foot as well, and also about your other activities like biking. Yes, PT will be painful.

Don't go into the PT and say that you know the root cause is your feet -- you don't know that.

See a podiatrist as well to make sure there aren't any unaddressed issues they can help with, but you probably need something else as well.

Have your bike professionally fitted at a bike shop. Tell them about your mobility issues.

Get recommendations for all of these professionals.
posted by yohko at 5:40 AM on September 16, 2013 [1 favorite]

If you could ask a mod to post your city and a throwaway email address, you might get some specific recommendations for the various practitioners that folks are recommending.

I have a lot of the same problems that you have and I'm still in the process of trying to solve it, so I don't have any answers but a few suggestions to go along with what others have said. People keep telling you that PT's vary and you need to find a good one - that's true, but it's also true for Podiatrists.

My podiatrist works one day a week in a running shoe store, so I thought he would be really on top of everything, but when I went in, he didn't really do much of an exam at all. He watched me walk, and he asked me to describe my pain and symptoms. He did find a Morton's Neuroma on my left foot, and I feel like he stopped there, but that doesn't explain why my right foot hurts nor why the whole bottom of my foot feels fatigued all the time. It's possible that he really analyzed my problems, but he didn't verbalize that analysis to me, so it feels to me like it was just OMG FAT, let's put you in insoles and see what happens. He took a cast of my foot and made me custom orthotics which I wore for 9 months and they didn't help.

I went to the Ideal Feet store in my city and got fitted for insoles. They make me feel about 75% better. Not all the way better, but a lot. I've gone back twice in the past year to say "now THIS part of my foot is hurting" and they give me a new pair of insoles for free with a slightly different shape.

One other thing you might want to address is your statement that "Docs write it off to arthritis". That's garbage. Doctors have tests to tell if you have arthritis. My GP sent me to a rheumatologist who did dozens of blood tests to see that yes, I have the "markers" for inflammation, but I don't have whatever else the tests should indicate for arthritis (and about 50 other immune-type disorders eg lupus) AND she took x-rays to look at the joints. So, my point for you is that if your doctors say you probably have arthritis, they can test for that, so maybe go see a rheumatologist at least to rule things out.
posted by CathyG at 9:15 AM on September 16, 2013

Pilates really helped me with balance issues, and there are a lot of laying/sitting exercises that strengthen the butt and legs. Some studios are more rehab-oriented, some are more based on aesthetics, so it's worth doing some research.

Barefoot walking can also help some people--I am not a doctor, and don't know if it will help you! But it can be positive for some people with foot/leg issues, since your feet move differently and more naturally barefoot (or in those barefoot shoes).

Swimming also works your legs without putting too much pressure on your feet.

You don't mention your shoes, but "office-appropriate" women's shoes are often bad for your feet; high heels are awful, and those little ballet flats aren't very supportive. Something like Danskos might help while you get the other issues sorted out.
posted by Nibbly Fang at 9:41 AM on September 16, 2013

I have to Nth the call for a good PT. As the first post said -- You can download a list of exercises anywhere, but only a good PT can give you exercises that work for you.

When I read your post, you talk a lot about strength, but brush off flexibility. I'd be willing to bet that you're entirely strong enough -- if you can bike "quite a lot" you have not withered away -- but you're locked up tight and unable to move. Proper locomotion require a range of motion in all of your joints.
posted by Dashy at 1:48 PM on September 16, 2013 [1 favorite]

Unfortunately, I find your description of your walking difficulties very, very familiar and I'd recommend you be checked for something called "cogwheeling rigidity" as soon as you can. When I began having trouble walking, especially getting started - initiating the first step - and found myself walking with my head out in front of my feet, trying to pull myself forward, I guess, I went to a rheumatologist because I thought I had some sort of arthritis. I felt like I was dragging my left leg and was uneasy walking on uneven ground sometimes. My kids told me I was "walking funny" and literally every time they watched me walk they commented on it. When I complained to my regular doctor about my thigh muscles always being tight/tense, he wanted me to see a physical therapist, but he couldn't really identify exactly what the problem was. I thought there was more going on - expected some sort of chronic arthritis or spinal degeneration, so went to a rheumatologist I knew to be an excellent doctor.

I was found to have Parkinson's disease - I was 48. The doctor found it by a simple test of my arms, which weren't giving me any trouble at all - and I had no tremor, either. He referred me to a neurologist, a specialist in movement disorders, who checked me with many tests to rule out other things and then started me on Sinemet - levodopa. I was shocked, frightened, angry, weepy - everything. It was not a happy time.

But - the levodopa has been good to me and I've come through pretty well so far. I'm 67 now and still kickin' (albeit slowly) - and I still don't have much of a tremor. I hope you don't have to deal with this, but if you do, the meds work well, so there's that. If I'd just gone to PT and tried to exercise it all away, it wouldn't have worked and it would have delayed the initiation of the medication that has saved my baggage. I have had PT since, did do an exercise routine established by the physical therapist for Parkinson's for a long time, and still do what little I can.

A clerk at my neighborhood grocery caught my eye one day and I knew immediately that she has the same thing - no tremor, though. We talked for a few minutes and she had been diagnosed but had not yet started the levodopa and she was miserable. She's now on the meds and says she feels 100% better.

Please do ask your doctor to have you checked specifically for Parkinson's; the cogwheeling test is quick and painless and is a fair place to start. Good luck to you.
posted by aryma at 10:25 PM on September 16, 2013 [2 favorites]

Seconding yohko here -- if you're doing 100% biking for exercise, but your bike is improperly fitted, you could be exacerbating things. For example, I ride around all the time - but my knee sometimes bugs me on short 1.5 mile trips on a bike-share cruiser, while when I'm on my fitted road bike everything is dandy for 25-50 miles at a shot. My bike fitting included getting shims between my cleats and my shoes to make sure my feet are angling properly into the pedals, so there are all kinds of factors that might affect your feet/ankles. And the fitter should definitely be able to address your muscle tightness/shortcomings issues so you can ride in comfort without injury. You may be able to do this in combination with physical therapy so you get a really all-round solution.

Just make sure you go to a good bike shop that does fittings, not someplace that just got an adjustable fitting bike last week and is offering the $50 in and out special. A real fitting will probably take several hours and cost a couple hundred bucks (plus whatever parts they advise you getting in order to fix the fit issues), but it's so worth it. If you need recommendations, stalk your local triathlon and cycling racing clubs; they'll have all the good gossip on who the go-to bike shops are.
posted by sldownard at 4:01 AM on September 17, 2013

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