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Psoriatic Arthritis – Things to do when your feet hurt.

Okay, just like the “Things to do when your hands ache” this post is for my own benefit. If I’m having a bad day then it can be hard to think of things to try, at least if it’s written down I’ll have some hope of remembering the good advice I’ve received. Actually, I plan on writing another post on all the BAD advice I’ve received, because I’ve heard quite a lot of that too. Anyway, much of this post will overlap with the one on sore hands, but, if my hands hurt painkillers are top of my list. I’ve yet to take a pain killer that dulls the burning pain in my feet. Obviously there are some I haven’t tried but for the constant, Achilles tendonitis/plantar fasciitis I’ve not taken anything that helps and I’ve had sore feet for more than twenty years.

Things I’ve tried that help sore feet

1 Sit down

The only thing that works. Not standing. I’ve been moved on from the steps of art galleries and museums all over the world for daring to sit down when I just couldn’t bear to stand any more. That’s the trouble with being young and having arthritis, you look perfectly fit and healthy so it is just assumed you are sitting because you are lazy or selfish. My feet started hurting when I was 10 years old, the arthritis wasn’t diagnosed until after the birth of my first child, in my late twenties.

2 Pacing

The idea of pacing is that you sit down before it hurts, I’d like to say I do this but I don’t. I’d never get anything done, but at least in theory I know that I don’t need to wash all the dishes in one go and can work for 10 minutes, sit for 5 minutes and then get on and do another 10 minutes. Just as with the sore hands I picked up these tips from Living Well with Pain and Illness and using the Gymboss timer helps.

3 Shoes

I don’t like shoe shopping, having spent most of my teenage years trying to find shoes that fit the (useless) over the counter orthotics suggested by various GPs, I developed an aversion to shoe shops. Clearly I’m missing out on some valuable part of the female psyche, but I usually only have 2 pairs of shoes I can wear at any one time and they have to do all occasions (including my own wedding!)

At first I loved Birkenstocks, expensive but comfortable and had lots of room for orthotics and funny shaped toes. When I eventually got to see an NHS orthotist (after having sore feet for 20 years) he was delighted that I wore Birks because it made his life easy, the custom orthotic was easy to fit as the shoes were deep and practical. A few years ago I gave up on the orthotics when I discovered MBT shoes. These have a rocker in the sole and I discovered that I could walk half a mile, in relative comfort and use a lot less energy to do it. I was a convert. I wore them religiously for years. My first pair lasted a couple of years, good job too at over £100. My 2nd and 3rd pair didn’t fare so well, they were knackered within 6 months and I could not afford to keep replacing them. The squashy bit in the heel would wear unevenly on one side and this would give me hip pain. It was a relief to discover the hip pain was being caused by worn out shoes and was NOT the arthritis progressing, but anyway, I gave up on the MBTs, my bank balance couldn’t handle it.

Next I tried Skechers Shape Ups, same idea as MBTs, rocker bottom soles but for less money. I still wear these today. So what happened to the custom orthotics? Well, I still have them, the orthotist put a rocker on the bottom of my Birks to combine with the custom insole, but I never found that as effective as the MBT/Skechers. I think the rocker bit is in the wrong place, but I’ve moved and haven’t seen an orthotist or podiatrist since. Anyway the skechers are working for now so I’ll stick with them. One of the “rules” for plantar fasciitis is NEVER go barefoot (easier said than done), so in the house I wear a pair of Birk Noppies, with lots of knobbly bits on the soles. I’m sure millions of people would find them uncomfortable but I think they are great and have been wearing them for more than 10 years. Well meaning relatives who give me “novelty” slippers for Christmas are always disappointed to see me in my hippy sandals.

4 Walking Stick/Cane

Oh this is a big topic.  Yes it helps my feet but it hurts my hands. I’d rather have sore feet than sore hands. For me personally, it hurts my pride most of all. With a few notable exceptions (work conferences), I’ve only used a stick on holiday where I can be sure that I won’t bump into anyone I know.  For a start when you are a fit looking teenager and “all” that’s wrong with you is a sore tendon its impossible to explain why you would “want” to use a stick. Especially as tendonitis and plantar fasciitis are self-limiting conditions (i.e. they should get better on their own).  Trouble was my tendonitis and PF weren’t self limiting, they haven’t gone away and they were caused by auto-immune arthritis.  With hindsight, I should just have used a stick when I needed it and not cared about my family and friends comments but hindsight is a wonderful thing and even now I find it hard to use a stick, when I KNOW I have arthritis and my joints are swollen like grapefruit. For me this subject has best been summed up by Rheumatoid Arthritis Guy (a true super hero), in his post “On Becoming Visible”.  The trouble with using a stick is the vast majority of people don’t know I have arthritis and if I used a stick I would have to explain why and I’m not ready to do that (I’d rather be in pain, go figure, what does that say about my messed up psyche?)

Anyway, my first stick was too long, it was solid wood and it was beautifully carved.  I loved it.  I could walk for miles, in fact within a couple of days I wore out the rubber end and discovered that it wasn’t a standard size and that those rubber ends were actually very useful.  After a few days I realised how much I was using it when I developed an angry welt on my hand and all the bones felt like they’d been crushed.  Yes, yes, I should have gone to a physio, got a proper sized NHS stick with an ergonomic handle.  But at that point the physios were still telling me the reason I had the tendonitis was because I wasn’t doing their exercises and if only I would be a “good patient” I wouldn’t bring this pain on myself. Anyway, I was on holiday, my pride wasn’t up to using a stick at home.  I soon solved the problem with my hand by using a lovely pair of mountain biking gloves with a padded leather palm. I loved those gloves, sadly I leant them to a friend who needed to use crutches for awhile and never saw them again. They looked a bit like this.

My next stick was a more considered purchase.  I went for one of those leki hiking poles, a lot more trendy.  The handle was made of cork and more comfortable and the suspension took a lot of strain out of my wrist.  It’s also a damn site easier to get replacement rubber tips for the end. However I would still only use it on holiday.  Next time my ankle flares I may be tempted to bite the bullet and explain to everyone I know that I have arthritis, I have a sore ankle and the walking stick helps. Having said that I spend most of my life pushing a pushchair and I don’t see how I could combine the two, I’m actually dreading having to get rid of the pushchair, it’s great having something to lean on (and no one knows that I need it more than my toddler!). It also doesn’t attract any rude questions or pitying stares.  Obviously you need to have a toddler in it or it would be a somewhat less effective disguise 😉

5 Heat Helps

My feet are cold even if it’s 20 C out, they also go vivid shades of purple/red and white. It has to be seen to be believed. Heat helps ease the pain, but it isn’t really practical to go about your day with a hot water bottle strapped to your foot. I like my microwave hottie, it’s great for sore backs and hips, but only really good for sore feet if you are lying in bed. I think that is why I like hot baths too, a bath relaxes all my muscles, although it plays havoc with my psoriasis.

6 Relaxation/Meditation/Visualisation CDs

I have a few of these, some have exercises specifically for your feet and legs, I think I’ll write a separate post on them.

Things I’ve tried that haven’t helped

1 Nightsplints

The idea of a night splint is that it holds your foot in an L-shape overnight, this keeps the Achilles stretched and should reduce the “first step” pain in the morning.  The trouble is I can’t sleep with them  on and no sleep makes me more cranky than sore feet, so the night splints have been consigned to the back of the wardrobe.

2 Physio

Yes, I understand the theory that I need to stretch my Achilles.  Years worth of toe raises, wobble boards and hamstring stretches have utterly failed to bring me any benefit or relief and quite frankly life is too short to pick marbles up with your toes or roll bottles of ice under your feet. Ultrasound never helped me either. One thing that DID help me were the “Personal Foot Trainers”, basically they are two poles with plastic bits on the end, you push your feet towards you and away from you to exercise different muscle groups.  It definitely helps and if you stick at it for a few months your feet will feel stronger (mine did and I thought I was a hopeless case), the idea is that you do the exercises in bed, before you stand up in the morning.  The trouble with this is these exercises only help if you do them (!)  I have three kids under 5, the days of exercising in the morning are long gone, maybe when they kids are a bit older I’ll get back to using them.

3 Cold or Contrast Baths

Heat helps, cold is agony. While I understand the theory behind plunging your feet between hot and cold buckets of water, the actual act of sticking my feet in a bucket of cold water makes me want scream. I tried it and the costs far exceeded any benefits. That’t not to say it won’t help you.

4 Insoles/Arch Supports

I’m not talking about custom orthotics here, I mean the things you can buy in Boots. The various gel pads, heel lifts, arch supports and insoles. I’ve tried heaps of them. Several GPs seemed to think that these would “cure” me. How I wish that was true. Sadly none of them worked.  I even saw a NHS podiatrist once (waiting list 1.5 years), who took a pair of over the counter insoles and stuck a bit of cork to the bottom of the heel.  He seemed to think that would be the answer to all my problems. I can’t begin to tell you how wrong he was, they gave me the worst knee pain I’ve ever had, Ipersevered for weeks but eventually gave up. They didn’t even make it to the back of the wardrobe, they went straight in the bin.

Things I haven’t tried but I would consider if I have a flare

1 Crutches

Yes, even more obvious than a walking stick, but easier on the hands.  Not really practical when you have small children to chase after. I do like the idea of crutch covers (skins to stretch over your crutches so you can change their colour), crutch clips/magnets, so you can pay for stuff in the shop without looking infirm and useless as you struggle to hold two crutches and a purse (screaming toddler and tutting onlookers optional). In fact there are loads of crutch accessories here, some of the stuff, like the crutch tips/ferrules are stocked in the UK but I’ve never used this company. Chic-aid and Funky Arthur both stock some cool coloured crutches and sticks with ergonomic handles and are in the UK.

2 TENS

1 A TENS machine (perhaps with a TENS sock?)  Llyods Pharmacy have some reasonably priced TENS machines.

3 Hydrotherapy

I don’t even know if there is any hydrotherapy in this area, I’ll need to look into it, chances are it will be over a hundred mile round trip so the childcare costs alone would probably make it prohibitive.

4 Perching Stools / Ironing Stools

I know having a stool in the kitchen would help but they are all so UGLY. Plus the kids would use it as a climbing frame.  What i need is a very large kick stool (you know the type you get in libraries), so I could whizz round the kitchen but always have it close at hand to sit down when I needed to. And for the record, I never iron, a pointless task if ever there was one.

So, there you go.  If you’ve got arthritis some of these ideas may (or may not) help you. A good source of information is heelspurs.com, they have active message boards where you can get tips from other people with foot pain and an “Ask the Dr” section where you can post questions to a US-based podiatrist and orthotist, not everything suggested on the site is sensible. Some of the suggestions on diet or infrared lights has little in the way of scientific evidence, but like the rest of the internet, you need to use your common sense. It’s also good to talk to other people who understand, I like the Arthritis Care forums (UK) and the National Psoriasis Forums, (US) a little sympathy can go a long way  If you’ve got any tips or suggestions for coping with sore feet, I’d love to hear them, please feel free to leave a comment below.

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Ugh, I am so tired. Fatigue and psoriatic arthritis

The title says it all. I feel so tired. I ache. My arms and legs feel like lead. The worst time is between 4-6pm. Even if I lie down for half an hour at 3pm, I still struggle to get dinner ready, entertain the kids and get tided up afterwards. I wish there was a drug I could take to make me feel less tired.

WebMD has 10 tips to fight psoriatic arthritis fatigue, there are some good suggestions but I still don’t know how to get through the evening meal/bed routine.

1 Change your schedule – well I used to work a full time job and a part-time one on top, now I just look after the kids and work from home.  There’s not much more I can cut out!

2 Get enough sleep – I usually take 30 minutes to 1 hour to fall asleep, I always have, once I am asleep I sleep through, I could try going to bed earlier, but then I’d lose the little free time I do have. I am definitely getting a good 6-7 hours sleep a night, so I’m not complaining, long may it continue.

3 Excercise 30 minutes a day -well, we have two dogs, I walk them twice a day (my husband walks them first thing) so I am getting excercise.  Anyone who has two toddlers will know that you don’t spend much time sitting still.

4 Prioritize – Playing with the kids is more important than housework.  Yep, no arguments there, as long as my house isn’t a health hazard I’m not too bothered .

5 Seek Support – So far I’ve online done this online, checking out the National Psoriasis Forums (http://talkpsoriasis.org) and Arthritis Care Forums, both  have loads of information and a supportive community. I think that most of the local groups are likely to be full of 60-80 year olds and I’d feel quite out of place.

6 Treat depression – My life is good, I don’t feel depressed, just tired. I always feel happier when it’s sunny though, maybe I should try some vitamin D supplements?

7 Eat Right- I do enjoy food and I don’t want my children eating crap, so we do eat three meals a day, very little of what we eat is processed. I’ve heard that potatoes and tomatoes can make arthritis worse, but I like potatoes and tomatoes and I don’t want to cut them out of my diet.  I did try and avoid tomatoes for a while, do you know how many things contain tomatoes?  A lot more than I realised!

8 Support your joints – Use braces and supportive footwear when your joint are inflammed. I always wear MBT shoes, they are one of the few things that help, although my last pair have worn out a lot quicker than any of my previous pairs, I might look for other shoes with rocking soles when I need to replace them, MBTs are too expensive.

9 Do something you enjoy. – Well, I like to play the flute, I still can, even with my swollen fingers, I’m glad I don’t make my living with music, or I’d be in real trouble. I usually pay for it the next day my fingers are ofter more red and painful. Maybe I should find a more “arthritis freindly” hobby. I probably only have time to do fun stuff once or twice a week, it’s hard when the kids are so little, I don’t get much time to myself.

10 Streess Reduction – I do have a breathworks relaxation CD that I use once or twice a month, maybe I should use it more often.  I also have a CD by Jon Kabat Zinn. I really appreciate the time I spend at Quakers, but I know I need to make more time for daily silence. So easy in theory, so hard in practice!

Well, lots of ideas, but I don’t think I’m any further forward in coping with the tiredness. I’m waiting on the results of more blood tests to rule out anemia and thyroid problems, but last time these were checked they were fine, so I do think the tiredness is down to the psoriatic arthritis. I wish I could figure this one out, maybe I just need to accept that this is how my life will be, at least until I start on the DMARDs.