Tales from the human pin-cushion project: “the incredible shrinking feet”

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Alice (not her real name) is tall, thin, pretty and stressed. She appears almost as I would imagine a Victorian artist would sketch her, fine long bones, and skin white as fairytale snow. Anxious. Her wispy hair slightly shades her eyes as she tells me about her shrinking feet, and I wonder secretly whether there is a tiny bottle hidden in her hand labeled “drink me”. Twenty one years in practice as a physio, and I still never cease to be amazed at the wonders that present in my sunny office. Alice is P2G2 with UF and OAB; in non-medical parlance, she has a cranky pelvic floor following the normal pregnancy and birth of two children. The shrinking feet seem to be an aftermath of this process, getting tighter, shorter and higher, while her peers in motherhood suffer the ignominy of post-partum foot spread. These feet have steadily shrunk from a US size 9 to a size 7.5 over the past 6 years. Alice has “failed” many trials of orthotics, both custom and over-the-counter, moving from Merrells and Keens, to narrow Nike and New Balances, finally to barely there ballet slippers.

I examine her in standing, her long, thin feet, with their high longitudinal and transverse arches, her skin barely touching my floor. An otherwise normal musculo-skeletal examination passes, we move onto the pelvic floor examination. Her breathing quieted, and she squealed to me as I hit the hot spots in her hypertonic pelvic floor. Unable to relax even with visualization and breathing, Alice recounts how she has always had “tension” here, with a childhood history of constipation. Afterwards, I scrub my hands, she dresses, and we chat about the connections of mind and body, of memory and muscle, of embryonic neural connections long divided and sent to far flung regions, meters away and decades old, but with strong and pertinent contacts remaining. The feet and the bladder. The soles connecting us to the earth, and the internal lock, Mula Bandha. She got it.

We discussed dry needling, how her feet were too tender and hyperaesthetic to needle, but as a volunteer participant for my dry needling education, she was willing to try other parts. We decided on an experiment of n = 1, one leg, shin muscles only. Three needles, 60mm x 0.30mm. Tibialis anterior. Slowly and with some trepidation on both our parts, the needles were inserted, left for 5 minutes while we waited for something a.k.a. “the magic” to happen, and then withdrawn. Alice slid off my plinth onto the floor, gliding from one foot to the next, watching her feet, feeling the ground with her soles. “Amazing” she declared. “One foot feels slippery rubbery and low, and the other like a high, brittle 80 year old foot”. I crouched down to ankle level to watch her medial arch on one limb descend, while the other stood tall and tight. “Amazing” I replied. Thinking she must be making it happen, then realizing that she couldn’t, at least volitionally. Silently, the scientist in me wished that I had made an imprint of her feet before we began.

The next session, we tried each shin, with similarly good and lasting results, and have now included, at her request, her lumbo-pelvic and sacral spine. With breathing, cues for allowing her new feet to accept the floor, gait and posture re-education drills, visualization for pelvic floor relaxation, and lots of patience, we are unraveling Alice’s feet, with the aid of some long pointy filaments of steel. Her bladder is a longer project, but I suspect it too will release its secrets, and relax its hold on Alice before too long.

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About sineadpt

physical therapist, PhD candidate, bike fiend, swim nut, run loony, multisport athlete, bike fitter, coach, general life enthusiast
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