I should repost this every time it freezes in Texas. I’m a little late this year, but we’re still not out of danger in Central Texas.

We never have big fat snowflakes, like they do in Boston. We get a cold front, which pushes in rain, and then like clockwork, it freezes. If it happens to freeze while raining, we get something akin to a snow cone layer of ice over our world, beneath which lies “black ice,” a particularly dangerous and dense form of ice which looks like water. Depending on the temperature, that ice can hang around for days and even a week before melting away in the 80-degree weather which ensues.

Orthopedic surgeons have an ambivalent relationship with this weather. Think about it…we hate it, because we know no matter how much warning people get about the dangers of ice…many won’t listen, they’ll get hurt and we’re going to have to go out and work…in the ice! But on the flip side, it goes back to my old adage. Anything which makes your orthopedic surgeon money is probably something you shouldn’t do. And we do make money after a freeze, because you simply won’t stay off the ice!

To that end…STAY OFF THE ICE!

As soon as ice develops, this is what we see:

• Lots of car accidents, and when there are car accidents, orthopedic surgeons are going to work
• Lots of broken wrists on people who “had to check their mail”
• Lots of broken hips on people who had to walk their dogs and feed feral cats
• Lots of broken shoulders on those who didn’t recognize the black ice, and thought it was just a wet spot
• A few orthopedic surgeons with broken wrists, shoulders and hips…because they slipped on their driveways on the way to the ER to see the patients who slipped on theirs.

So, please prepare when there is a prediction of ice, and stay vigilant.

• Go get your groceries, toilet paper, water bottles and beer. Stay at home until the sun comes out and dries up all the ice.
• Get some ice and snow melter salt for the drive and sidewalk. This is for those who will go outside no matter what.
• For pet owners, weigh down a small tarp over an area of grass close to your house.
• When you pull it up, there will be a little patch of grass on which your dog can do its business. The feral cats will survive. It’s what they do best!
• Watch for black ice. Before you take any step onto a sidewalk, staircase, street or deck, please rub one foot or your hand on the surface to make sure it’s not ice. Don’t put your weight on it. If it’s ice, don’t do like our patients who will be on waiting lists for surgery on their wrists and hips the next week. They made the decision to walk very carefully on it.
• Just stay home. And stay until there’s a clear path without ice.

I know some of you are not going to listen this year. Even though retired, I know after the first icy freeze I will see some of you with slings on your arms a few days later. Others will tell me their mom is having surgery on her broken hip. I know my former partners will be busy.

So, I wish I had recorded my voice before I got ALS. But there are a dozen conditions, including simply aging, which result in vocal loss and changes. Simply aging is at the top of the list, because we all do it and all our voices change when it happens. You might say, “Well that’s my voice, and I’m sticking with it.” But we’re living in a time when you could continue to communicate on a phone call, podcast or a zoom meeting, using a more robust version of your own voice. We’re entering a time when you could use a voice clone to sing!

We are also seeing an uptick in diseases which can steal your voice, like ALS, Parkinson’s, strokes, and brain injuries, just to name a few. These conditions can make you speechless, but spare your cognition, leaving you with a frustrating inability to speak, even though you know what you want to say!

Voice cloning to the rescue. You can pretty easily create an “instant” voice reproduction, which sounds pretty good. But now you can also have access to professional voice cloning. For folks with ALS, it’s free, so I can’t speak to affordability or access right now, but I have no doubt that this process will get better, more malleable, more available and affordable with time. Right now, you probably have time, but you need to “save your voice.” It’s called voice banking…for a good reason.

By the time I was diagnosed with ALS, my voice had already changed, and it looked like a professional voice clone was not an option for me. The technology can’t be retrofitted. Fortunately, I had some old recordings of my voice before ALS, in the form of commercials and interviews for my medical practice, and most importantly, a 45-minute professional interview about my music. I say, “most importantly,” because in all of my professional recordings, I used my surgeon voice. You know, the one I use to tell you about your operation. It’s not the voice I use to talk to friends, tell a joke, talk to my cat or a child. In the interview about my music, I do have some moments of lightness and humor which were missing in those commercials. But again, I did not speak like I would to a child. I will never have that funny, or tender side of my voice again. Not now, and not even when I use my voice clone. When I tell my family I love them, I will sound like I’m recommending an ACL reconstruction.

To make the best, fully expressive voice clone, they need at least an hour of your voice, preferably spending some of the time telling jokes, talking to your pet, your spouse, your children or perhaps even reading a child’s book. You need to use the best recorder you can afford, recording in a quiet space with as little background noise as possible. Try not to say “Uh.” My recordings had music and background noise, so I had to have someone extract my voice from those sounds, again leaving me with a less-than-ideal clone. Don’t get me wrong. My voice clone is really good, and I’m hopeful that as the technology improves, there may yet be an option for me to talk sweetly to children or tell a raunchy joke while not sounding like I’m giving a PowerPoint presentation on tailbone pain.

If you’re one who schedules things like mammograms, colonoscopies and annual physical exams, you should add your recording to this year’s list and pass this information on to family and friends. It’s so simple.

And record your children every few years. They are not immune to losing their voices. Then bank it like you would a piece of gold or cryptocurrency.

Your voice is priceless. Take it from someone who knows.

I often saw patients between the ages of 50 and 80, who complained of walking like their Granny, and they didn’t know how or when it happened. Sometimes a family member noticed. “Dad, you’re walking like Peepaw!”

Patients who develop a limp after an injury or the acute onset of a disease process are well aware of the source, but the rest of us can develop it insidiously…a slow creep…and then it’s there.

I like to talk about recognizing the onset of your Granny’s Gait, and then discuss things you can do to prevent it. But first, let’s review the definition of a normal gait, so you can understand the goal.

A normal gait is:

Strong. Your muscles are working!

Efficient, and essentially effortless.

Purposeful. You look like you’re going somewhere and not meandering…even if you are!

Balanced. The same muscles are firing on both sides! You lift one foot off the ground, set it down heel-to-toe, followed by the other. You’re not shuffling. You’re not teetering.

Painless! You’re not limping.

You’re looking straight ahead, and not at the ground…very much.

If any of these factors are missing, you’re probably limping or shuffling. You’re focused on the ground, so you don’t trip on uneven ground or step in a pothole. You’re not getting anywhere efficiently. You might have pain. In short, you’re walking like your Granny!

There are many reasons we develop a chronic/permanent limp. Some limps are permanent and unpreventable. I’m talking about the limps which might be temporary and preventable.

Any painful injury or disease of the back and lower extremities, has the potential to lead to a limp, and depending on whether or not the process is reversable, if you recognize there is a limp, and you realize that part of wellness is recreating your normal gait, then you’re ahead of the game.

As we age, our expectations, as well as the expectations of our physicians and therapists are at risk for lowering. We’re more likely to accept a limp…because we’re old. An expectation of achieving a normal gait, and not just healing the injury, should be part of the discussion. Your expectations are that you will heal, have less pain, regain your flexibility and strength, then recreate your normal gait.

The development of a limp might be the cumulative result of repeated insults to our youthful gait.

-You might have an injury to a foot or ankle,

followed by the coincidental development of visual problems, or the use of transitional lenses.

-Then you buy a poorly fitted pair of shoes.

-Then you had a surgery on your colon, and sat around for a while with your feet and ankles flexed in a relaxed position, resulting in a slight Achilles tendon contracture.

-When you started exercising again, you developed plantar fasciitis.

Boom. You’ve got a limp!

The causes are multi-factorial, and it will be hard to correct it. The nail in the coffin is that you learned to compensate for the painful left foot and ankle, by matching it with the right side. You disguised it for a year, and now correcting it might be beyond your reach.

Prevention

• Recognize the potential to develop a limp.
• Discuss this with your doctor and physical therapist as you’re recovering from a painful condition.
• Maintain your balance by doing balance training exercises, like single-leg standing. Do them regularly if you’re able to.
• When possible, correct visual and inner ear conditions, which contribute to an unstable gait.
• Wear healthy, painless shoes. Ditch dangerous shoes, like flip flops and high heels.
• When possible, correct painful back and lower extremity conditions. Even a blister can have long term repercussions for the elderly.
• BE MINDFUL! Simply the awareness of the factors contributing to a normal gait will put you ahead, in terms of prevention.

When walking, I intermittently refer to a mindful checklist.

–Is there any pain? If so, why/what and can I fix it? If I can’t, I’m not going to continue to do the thing which reproduces the pain. I’m going to figure out where it’s coming from and if I can correct it with a modification or work-around. Is it my shoe? Is it because I’m taking too many hills, walking too fast? Does the pain go away when I stop walking for exercise? Do I need to see a doctor? Oh, right…I do have a little advantage there. I can ask myself. But you can deal with a lot of things on your own too. Resting, changing shoes and changing the exercise or the pattern of exercise, are some simple steps. Time can help. Have some patience.

–Can I take a few steps and feel secure in my ability to hold one foot, and then the other off the ground. I take a normal, healthy step. Then I extend it, and see if I can balance myself, while one foot is briefly in the air.

I’m not trying to get in between you and your own doctor. I’m not advising you to self-medicate or treat. Mindfulness of your normal gait is the key. I’m advising you to be mindful.

I have witnessed my parents (now 90 years old) slowly develop their Granny’s gait! Now, many of you would say, “Who cares at 90? We should all be so lucky as to live a long life and have peace with a little limp. Lighten up, doc! Meanie.” But they had no significant pathology. Any pain they had was addressed long ago, and in a timely fashion, cuz as a dutiful daughter, I was on it like flies on poop. It’s not a pain induced limp. It’s just an unsteadiness. It’s multifactorial; some combination of weakness, stiffness, visual and neurological changes, balance issues. It just happened. And once it happened, there was no reversing it, because it had been there for a long time, and they’d have to really devote a lot of time and energy to correcting it…perhaps to no avail. And at this point in their lives…they’re gonna have some peace with that limp.

At 70, I’m wondering if that gait can be prevented. I’m going to try. I’m being mindful. I’ll keep you updated.

I just did my annual holiday post on ladder safety, so why am I double dipping? Running out of material?

No! I’m shocked into reposting the material! Since Christmas I’ve had two friends sustain injuries by means of ladders. I’ve heard from two friends who had friends/family in the hospital, including one who might die…due to ladder accidents. My husband, who treats critically ill patients in the hospital, has recently treated several victims of ladder accidents. He’s a kidney specialist (nephrologist)…. not an orthopedic surgeon or neurosurgeon. For him to be seeing them, means they either have had major bodily, or in many cases, head injuries, which are secondarily resulting in renal failure! We’re fragile and complicated! If I get just one or two of my readers to prevent a ladder injury…it will be a job well done. That’s why I’m doubling up on ladder safety.

I climb ladders with some regularity. I have about a half-dozen ladders, ranging from a one-step stool to an 8-footer. I’m always prepared. Like you, I’m impulsive and don’t like to wait for someone else to take care of something I think I can do. Recently, in the middle of the night, the low battery alarm went off for a smoke detector upstairs. The ceilings upstairs are much lower than downstairs. They’re easily accessible with a four-step ladder we keep handy up there. Last year, I changed them downstairs, with the 8-footer. It was scary, and I decided never to do it again. Going forward, I will hire someone once a year to come change all the batteries. You should do the same.

No matter from what height you fall off a ladder, it’s almost always bad. Worldwide, there are approximately 37 million injuries requiring medical treatment every year. These are just the folks who show up in the ER! It is the second leading cause of unintentional injury deaths. And it’s PREVENTABLE! 100%. Not like car accidents. A lot of the time, they’re probably preventable. We’re driving too fast, texting while driving, or tired. But sometimes, it’s truly unpreventable. Someone else falls asleep. Drinks too much. A nail and a blow-out.

We have to drive cars. We don’t have to climb ladders.

What I Do

• Avoid them when I can, and I’m not getting up on the 8-footer. Keeping it, cuz I like my little collection of ladders.
• Wear shoes.
• Have someone by your side…mainly to call 911. Gravity makes it hard to keep someone from the landing.
• If alone, wear some kind of fall detection device or use an app, so when you don’t answer, it will notify 911, and you might be able to avoid lying on the ground for hours. For that matter, while you’re at it, go ahead and unlock your front door, so EMS doesn’t have to bust it open in order to save your life or limb. If that act alone doesn’t make you think twice…then go for it.
• Use the right ladder. It must be tall enough, so ideally, you’ve got structure against your belly and thighs. No standing on the top, or even third-to-top step.
• When possible, load your tools on the ladder’s shelf or top step ahead of time. Or your trusty-fall-prevention helper can assist.
• Make sure your ladder is set on stable ground!! You’re a daisy if you climb a ladder which is propped on moist garden soil. I kid you not. I can’t count the number of patients, including some friends, who sustained grave injuries doing this.
• Plenty of light on the subject.
• Hire a handyman. Now I’m not discounting the lives and limbs of handymen and professionals. I appreciate the heck out of them…and I’m calling one from now on.

Photo courtesy: https://www.dreamstime.com/clearvista_info

It’s time to hang lights and decorate Christmas trees, and it’s also a time when orthopedic surgeons get busy with ladder-climbing injuries! It’s a fact! I’ve always said that what makes your orthopedic surgeon money, is often something you shouldn’t be doing. All of us intuitively know climbing ladders is dangerous. I climb them all the time! But every time I do it, I know I’m taking my limbs, and potentially my life into my own hands.

My first recommendation is to get someone else to do it, especially if you’re older, have poor balance or lack the proper ladder.

If you’re going to ignore that solid recommendation, coming from someone who has seen the devastating ladder-climbing injuries firsthand, then the next step is to make sure you have good health insurance, life insurance policies are up to date, and someone has your power of attorney.

Now, you’re still determined to put up your own Christmas lights and decorate that 15-foot Christmas tree. Then please take the following precautions:

• Make sure you have a solid, stable ladder. If possible, avoid ladders which rest against the wall.
• Make sure it’s the right ladder for the job. It must be tall enough.
• Don’t climb up to any height where you can’t hold solidly to the ladder in front of you.
• Wear solid shoes. No slippers, flip-flops, or stocking feet.
• Don’t drink and climb ladders…or drive.
• Pay attention to every step going up and coming down. Many injuries occur when people miss the last rung, thinking they’ve arrived at the bottom!
• Put ladders on solid Setting ladders in garden mulch or wet sod is madness.
• Avoid long reaches from the top of your ladder, like putting the star on the top of your Christmas tree.
• Have someone assist you from the ground, and be there to steady you, should you need it. They can also call 911, if necessary!

Have a safe and happy holiday season!

As Ben Franklin said, “An ounce of prevention is worth a pound of cure.” And I think it goes double for joint stiffness. The good news is that in most cases, it can be easily and predictably prevented.

The most common joints to stiffen as we age, and even more importantly, to cause functional problems, are our shoulders, knees and ankles. Let’s get down to business, starting with shoulders, per my neighbor’s request.

Most shoulders stiffen because of disuse after injury…even the slightest injury. As we age, and don’t really need to use our shoulders in their fullest range, stiffness becomes more prevalent.

Our shoulders are truly amazing. They have the greatest range of motion of all of our joints. With a little help from our torso, we have almost 360 degrees of reach. That enables us to do mundane stuff like reach over and put our seat belts on. Scratch between our shoulder blades. Discipline our kids without having to pull over. And clean our privates, no matter what country we’re visiting! Think about it…long term…that’s probably THE most important thing our shoulder helps us do. But you have to get a stiff shoulder to truly appreciate it.

I injured my shoulder about 20 years ago, and fully recovered with no treatment. I babied it for about 9 months, and it got well. In anticipating the writing of this post, I tested that shoulder range of motion for the first time in 20 years! The right goes all over the place. I can use that right arm and shoulder to reach almost every place in my body, with the exception of a baseball-sized area of the back of my left shoulder. Not so with the left, previously injured shoulder. The area I can’t reach is larger. Where I can lay my right shoulder and arm against my head, without using my neck to get my head to the arm, I lack about an inch of being able to do that with my left arm. There is absolutely no functional problem, unless I have a mosquito bite on the back of my right shoulder. There is absolutely no pain. I simply did not fully rehabilitate it after that injury 20 years ago. Because I didn’t need that range to accomplish anything functional, I just let it go. Well, I’ll never make that mistake again!

From now on, I will check my shoulder range of motion at least every other day. I’ll do the same for all my joints. Just take them through their entire painless range. For my shoulders, I will reach above my head. Across my chest. Reach behind my head, neck, back and butt. If there is a painful restriction, I will approach it gently, never shoving it to the full range. I might gently push it. Warm it up when I take a shower and try again. I won’t do this with any resistance or weight. Just the basic motion of reaching. I’ll compare both sides, keeping in mind that not everyone is born with extremely flexible shoulders, and on the flip side, some people have injured both shoulders.

Like me, many of you will already have some loss. This can be due to:

• normal anatomy and the shape of our bones
• a current or chronic injury
• a current or chronic condition
• arthritis

In my experience, the most common cause of shoulder stiffness is rotator cuff disease (strains, tendonitis, tears, and arthritis due to chronic rotator cuff tears). This is what caused my shoulder pain 20 years ago. It usually occurs in people over 40, and is often not due to injury. Many of us are just susceptible to developing rotator cuff disease. And some of us get injured.

The immediate response after an injury or after the onset of pain is to protect the joint. In a way, stiffness is our body’s natural splint. Picture a caveperson, with no casting materials or braces. Muscle spasm, swelling, immobilization and rest are your body’s natural way of protecting the injured wing. Once the pain diminishes, it’s time to begin moving. And your goal should always be to regain full range of motion. Maybe you can do it yourself. Maybe you need medical supervision and physical therapy. If you don’t make progress with stiffness as soon as healing allows, you might miss the boat, and wake up one morning, realizing that you can no longer reach the top cabinet in your kitchen…or your butt. Then you rearrange your household, and get a Butt Buddy on Amazon.

Sometimes you’ve damaged the limb to the point of no return to normal range, strength, shape or function. So be it. You make modifications and let your doc and PT guide you. Otherwise, your goal is full function and full range of motion, until your doc tells you otherwise. Unfortunately, as we age, our significant others, including some doctors, don’t necessarily have that expectation for us. But I can tell you that at 69, my expectation, right here, right now, is to regain all function and range of motion.

Next time…knees.

As always, consult with your doc if you have questions regarding your own status. My recommendations are based on my experiences, both professional and personal. They are not meant to conflict with the recommendations of your physician.

High heels

High heels

High heels

Other unhealthy shoes (tight, pointed, small, backless, flip-floppity, Chinese foot binding)

Acute injury

Repetitive injury

Failed surgery

Successful surgery

And now I’m adding SOCKS to that list.

Why the lowly sock? Because it’s too damn tight. I spent a lot of time telling patients…and myself, to wear shoes that look like they fit the foot. That means if you put the shoe next to your fully-weight-bearing foot, and look down…does it look like that foot will fit in that shoe? If you were to make a cutout of your foot on a piece of paper, would it fit in your shoe? That answer, especially for women, is almost categorically, “NO.” And if it is “NO,” then your shoe is simply squishing your foot. That doesn’t just mean it’s tight. It means it is squishing the little delicate nerves, tendons and muscles which live down there. And if you wear shoes like that every day, every week and all of even part of your adult life, you will be doing structural, metabolic, neurological and every other kind of damage to your foot. And we will have pain.

The guys aren’t so bad. They stopped wearing high heels after 1972. They survived having poor parents who made them wear the same pair of shoes for two years, and hand-me-downs. Once they had control over their own shoes, guess what they did? They wore wide toe box shoes and sneakers. The majority of patients complaining of painful conditions of the feet are women. And it’s because we essentially started “binding” our feet from the time we were little girls. I remember my mom buying me pointed, little “Mary Janes.” But she never allowed me to wear a high heel. I had to wait until I made my own money to do that, and bought high heels with my first paycheck from Palais Royal. But just those few, early developmental years of not wearing high heels, might have spared my feet from the severe pain many of my friends and patients experience. Now, it’s a different story. Girls start wearing high heels at a young age.

But I digress. I wasted a lot of time getting folks to wear shoes that fit, and forgot, that underneath those shoes, we were wearing socks. Again, looking at history…we wore socks without much elastic, and the elastic we had was weak. It wore out quickly. Shortly after buying them, our socks would begin to sag at our ankles, and we would darn them (sew them up) when we wore holes in them! We didn’t buy packages of six socks. We owned 2 pair, and they did not squeeze our feet, because they were old and worn out. It wasn’t just a fashion statement. It was popular because most of us couldn’t afford nice socks. If your parents had the money to buy new shoes and tight-fitting socks, you scuffed up the shoes and stretched out the socks to look like all your friends’ shoes and socks.

But the inexpensive socks of today are made with some kind of tenacious elastic. They shrink when we wash them. And they squeeze the shit out of our feet. I used to notice that after about an hour of walking in my expertly fitted jogging shoes, my feet would begin to tingle. I got wider shoes, to no avail. I figured I must be developing neuropathy. I had been telling many of my patients to stop wearing support stockings, for this very reason. They simply cut off the circulation to the foot, either by just being too tight, or because they roll up around the ankle and calf, forming essentially a tourniquet. I had also stopped wearing regular, shorty jogging socks, and gone to the more loosely woven “diabetic” socks, with some success in terms of foot pain and numbness.

I stopped wearing any sock resulting in even the slightest indentation in the skin of my foot or ankle. If there was an indention at the end of the day, then they were putting pressure on the delicate structures along the top of my foot, where there is no padding, or in between my toes, where the digital nerves live.

One day I was out watering the lawn in my cheapy-lawn-watering-slip-on-Sketcher-knock-offs, when I decided to go ahead a take my evening walk. I just forgot to change into my high-dollar, well-fitted athletic shoes, arch supports and diabetic socks. I realized the omission a mile or so into the walk, because my feet weren’t burning. And my cheapy shoes were actually pretty comfy. After that, I stopped wearing socks with athletic shoes, and now…with most shoes. I don’t wear the little socklets with my flats. This fall, I might try it with my boots. Fortunately, I don’t suffer sweaty or stinky feet (TMI?), but if I did, I would just wash my shoes more often, and certainly not wear the same shoe two days in a row! Novel idea, right?

Long story short. Your socks might be the culprit causing your foot pain. Stop wearing them and see!

*As always, my posts aren’t meant to get in between you and the recommendations of your personal physician. Check with them if you have any questions regarding whether or not my recommendations would be appropriate for you…stinky feet notwithstanding.

Don’t wait to start having symptoms, and then start doing the exercises. Start when you’re 40-years-old, or as soon as you read this!

Now, I wish this could go without saying, but if you experience a lot of pain when you do these exercises, then don’t do them anymore…and go see a real doctor…or one who hasn’t retired.

Morning Back Stretch

Despite not really having back problems, my back feels stiff when I get up in the morning. One of my patients told me about his daily morning stretch, and how it eliminated that ache. It sounded too simple to be effective, but I gave it a try, and now I do it every morning. I can feel the stiffness resolve within moments.

While lying flat on your back, face up, gently press your heels into the mattress. You don’t have to actively stretch your back. It will simply happen as you press those heels down. At first you might feel a tad of discomfort, but that quickly resolves as your back slightly extends. I do it a couple of times. Boomshakalaka. I’m almost ready to jump out of bed…except for there’s exercise #2.

Morning Foot Stretch

As we age, that first step we take in the morning can be a painful one, and for many women especially, can actually result in the onset of plantar fasciitis or Achilles tendonitis, as these contracted structures acutely and forcibly stretch when we put our feet down, and add our body weight on top. This can tear the stiff tendons and result in chronic damage, especially if you do it the next morning…and the next.

Don’t wait to sustain injury. Start now.

Swing your legs around (after you did that morning back stretch), and set your feet on the ground, without applying all your weight to them. Then press them up and down, applying only part of your weight on your feet, kind of like a kitty kneads the ground with its paws. As you can sense that the bottom of your foot is okay, and there’s no pain, then gradually increase your weight, until you’re able to stand up without discomfort. For those of you who have no issues, this will only take a few seconds. If you feel a stretchy discomfort, or even acute pain, back off the weight you’ve applied and keep stretching. You can also do this stretch if you’ve been driving or sitting for a long time.

Single-leg Standing (SLS)

SLS is an exercise proven to prevent falls, and thereby prevent fragility fractures in those of us of a certain golden age!

Simply stand on one leg, and get to the point where you can do that for 30 seconds…longer if you wish. And less, if 30 seconds causes pain in a weight-bearing joint, such as the knee. Start out someplace like your kitchen, where there is a countertop to use for support, and you can get conditioned to just  standing on one leg. Then stand on one of your legs, and intermittently remove your hand from the counter. Eventually you will be able to remove your hand, and stand on the one leg for longer and longer periods of time, as you develop your balance. This might take weeks to even a few months, as you may be de-conditioned to standing on one leg, never mind standing on one leg with no additional support from your hand on the countertop. Eventually, you will be able to stand on either leg…no hands…for 30 seconds! You can do this intermittently during the day, like when you’re cooking, brushing your teeth, standing in an elevator or on a line! You don’t have to take time out to do SLS! Embrace the multitasking.

Knee Extension

Those of us who are susceptible to developing arthritis in the knees or hips, will begin to get stiff as we age. It happens insidiously. It’s kind of natural for the arthritic knee to begin to stay bent, as a way of limiting pain, or as compensation for a stiff hip or ankle. You might develop a habit of resting with it in a bent position. It stays bent all night. It feels better that way! And suddenly, you realize that it’s stuck. You can no longer straighten it all the way. You now have a contracture, and it’s usually permanent. This in turn causes a bent-knee gait…or a limp.  But you don’t have to end up like this, even if you have arthritis.

Every day, at any time, when you’re sitting down, straighten your leg out all the way. It’s hard to judge straightness by just standing with it straight, or sticking it out in front of you. Make the knee like a bridge. Put your heel on the ground, on a coffee table, or a chair, and let that knee completely go straight. You can even press your thigh, just above the knee to help it along. Then contract your quadriceps muscle, in order to hold it there. If you’ve developed arthritis, this could be a little uncomfortable. So, do it gently. If you just did this once a day, starting before you get that contracture, it could prevent it completely. After you already have a contracture, you can try to straighten it, but will likely need help from a physical therapist.

Sitting heel stretch

With age, deconditioning or diminished exercise, our Achilles tendon might begin to shorten. This is particularly prevalent in women, because we’re shorter and more likely to sit with our foot pointed down and our Achilles tendon shortened. We’re also more likely to sit with our feet tucked up under us, also resulting in a shortened Achilles tendon. Wearing high heels can have the same effect. This can become chronic and in turn lead to painful mechanical problems with our feet and ankles. So, at some point every day, starting when you read this, spend some time during the day with your feet flat on the ground, and even better, with your ankle resting behind the line of your knee, so that there is some stretching of your Achilles tendon. It kind of goes along with my Sit Like A Man (S.L.A.M.) concept.

Start these simple exercises sooner than later, so you’re not behind the eight ball, and working to correct problems rather than to prevent them.

I did the artwork myself! Been thinking of a new career. If you’re interested in custom medical illustration, don’t hesitate to contact me…

I bought my first pair in 1970, Italian rust-colored suede mounted on top of a tremendous 4-inch blocked heel and platform. I was probably protesting my mom, who would not allow high heels because I was so tall…and had bunions. Now I can say she was right. But back then…Well, I bought them with my first real paycheck, considering that at 50 cents an hour, babysitting money was not real, and not enough to buy those gorgeous shoes from Tootsies in Houston. I had surgery on my feet at 17, just so I could wear strappy, high heeled sandals to my senior prom. So, you can see I was as dedicated to the use of high heels as any of you. Even after becoming an orthopedic surgeon, and understanding the complexity of my foot problems, as well as the detrimental effects of high heels on our amazing, delicate feet, I continued to wear them…until I couldn’t!

Making a successful preemptive strike at protecting my feet in my forties, I started wearing “healthy” shoes, thereby resting that large ball joint of the forefoot, which is so detrimentally affected by bunion deformities and high heels. Even though I had successful surgery, there are long-term effects of having bunions, no matter when you have them fixed. But I simply started wearing thick-soled, over-the-ankle, lace-up hiking boots with my scrubs. Fashion perks of being a surgeon. I also stopped wearing high-heels for the most part, wearing them only for dress-up. I slowly eliminated them from my wardrobe, except for the occasional stacked-heel boot. I attribute my current, pain-free state to that educated decision. My orthopedic training…worth it.

Via practical and professional experience, I also began to see the problems with backless shoes. A mule stays on the foot either by being tight across the delicate structures of the forefoot, or holding it on by crimping the shoe tight with our toes. Neither is good for our feet.

High heels, flip flops, mules and backless slippers are a source of income for orthopedic surgeons, and you know what I say to that.

“If it makes your orthopedic surgeon money, it’s something you probably shouldn’t be doing.”

You can really quote me on that, and I’ll own it.

At least as we age, we should begin reassessing our shoe wardrobe, and we should try as much as possible, especially when it doesn’t matter…to wear “healthy shoes.” You can search through my blog to find my definitions of “healthy” shoe wear. Doesn’t really have to be ugly.

Should we ever wear high heels? Hell no. Easy to say now that I’m not worshipping them and I’m married (because you have to wear high heels to catch a mate, right). But high-heels have become very exaggerated and almost incapacitating. They alter the way we walk. Besides ruining our feet and damaging our joints, they also put a woman in the position of not being able to escape from danger. They make us vulnerable. In those terms, it’s not unlike the not-altogether-ancient practice of Chinese foot-binding.

Foot binding, was practiced for over 1000 years, and at its height, almost every girl in China had her feet bound for the purpose of having what appeared to be, a tiny (3-5 inch) foot.

A painful process was performed by every good mother, to deform them into a grotesque shape, which they thought looked like a lotus blossom. Besides being a symbol of status, it also disabled a woman. It was a sign of wealth when a woman couldn’t walk or work, and had to be carried about. The tiny, misshapen foot was also considered erotic, much as the wearing of a sexy high heel is today. Eventually it became a cultural norm, and women in lower classes had it done as well. The stiff-legged gait that developed as a result of the painful deformity became essentially a fad, even to be imitated by those who opted out.

Pressure from Western missionaries and feminists eventually brought the barbaric practice to light in the early 1900s, but it took another century to curtail the tradition. It was finally outlawed by the Communists, so the women could join the workforce. There are still elderly women alive today with the deformities of bound feet!

Courtesy Jo Farrell

In many ways, we are doing the same thing to ourselves through the use of high heels. The desire to wear them is robust in our culture. The higher the heel, the more desirable the shoe…to the eyes of men and women. The deforming forces are strong, and can be permanent. The high heel damages bones, joints and nerves. The pain and deformity of bunions, hammer toes and neuromas is exacerbated, if not caused by the use of high heels. A woman cannot walk with a normal gait in them. She has to bend forward, flex her knees, sway her pelvis and stomp, because a normal heel-toe step is impossible to perform in them. The affected gait is considered sexy to men. She is in some ways, hobbled by them, just like the women of China. And like the women of China, she is considered more desirable when wearing them. Studies show men find women wearing high heels to be sexier! They like seeing them bound up in those shoes. They like to imagine taking them off…or not. But then there are those bunions, blisters, squished toes, sweat and redness. Euwww.

This warning isn’t new. My mom told me. I knew it when I was a young woman, even before becoming an orthopedic surgeon. I could feel the destructive forces. Then I saw women in my practice, with blistered, red, scrunched, swollen toes, wearing the exact shoe which reproduced the pain!

It might require a revolution to make us stop wearing them! All studies indicate that both men and women judge women to be sexier in high heels. We adore them. We’re not imagining ourselves during the 2-4 decades we’ll call the “golden years.”

Mothers…usually right…discourage your daughters from wearing high heels as a rule.

Ladies, consider wearing them less. Less is better.

Fashionistas…provide us with adorable, comfortable, sexy, flat shoes which accommodate our growing feet!

Courtesy Grosescu Alberto Mihai

So, you’ve got your holidays, when we start climbing ladders to hang ornaments and lights. That used to start after Thanksgiving, but now that Halloween has become less about trick or treating and more about decorating the house, I’d have to say that season starts in October.

You’ve got winter, which refers to a colder time of the year, but to the orthopod it’s ski season, resulting in an uptick in ACL tears and other injuries, so much so that large orthopedic groups set up offices at ski resorts in order to capture those patients right at the bottom of the mountain, rather than let you get home to see your perfectly skilled local orthopedist.

As noted in the previous post, winter also brings a surge in injuries related to the formation of ice.

You’ve got football season…for the obvious reasons.

And then you got January…the month following New Year’s Day, and therefore the first month to put into effect our New Year’s Resolutions. Along with trying to save money, reading more books and watching less TV, some of the happy consequences of our resolutions are healthier eating, more exercise and weight loss. There also comes an unfortunate surge in “repetitive strain disorders,” such as stress fractures, tendonitis, bursitis, the exacerbation of arthritic conditions, and degenerative meniscus tears, to name a few. These disorders put an end to good intent, every bit as much as the mind can.

Here’s the good news. It’s all preventable!

-Everything in moderation.

-Start slow and build up.

-Stretch.

-Get help from a trainer.

-Wear the right shoes.

-Exercise in the right places.

-Pay heed to your limitations and liabilities.

-Be mindful.

-Don’t work through bone and joint pain.

You know these things, but many of you will ignore the warnings. January would otherwise be a slow month for the orthopod.