The fact that your remaining foot has more than twice as much to do post amputation is not something you really think about – till something goes wrong and you are literally left without a leg to stand on!
I now realise this is a fairly common side effect of becoming an amputee. Wish I had known this at the outset, I would have looked out for the early warning signs sooner. As it is I bumbled along doing my own research, which is not ideal.
I have been focusing on trying to improve my walking for some time now. It has been a tough slog and not without many hiccups and pitfalls. So when I finally managed to get to walking 5km on parkrun on two feet I was super stoked. Then things started to come unraveled.
I started getting foot pain, I mean stop you in your tracks type foot pain. I am a definitely a problem solver so I set about applying my medical knowledge best I could to figure out what was wrong.
I wondered if it was alignment related and perhaps the orthotic needed refreshing so I went to see my physio.
Several issues have developed.
Flat foot
I already wear an orthotic and have for many years, due to having had slightly flat arches in my feet. So it seemed logical to start here.
It was confirmed to me that yes, my foot is even flatter than it used to be. In addition to that, the ankle was also rolling in a lot more than it used to (pronating). So the orthotic was no longer supportive enough. Due to the ankle roll, a muscle called the tibialis posterior was working overtime, and as you can see the attachment is the foot, so this was also giving me heel pain. I knew it was not the Achilles but had not figured out that this was the issue.
Interestingly I have since found out from research that this is a very common problem in amputees due to the increased load the remaining foot is under. Problem is the specialists where I live just don’t see enough (if any) amputees due to the very small population. So again, I am learning with the help of google only.
Cue podiatrist.
She took a look at me and confirmed that the support needed to be rebuilt. She also said I was hyper mobile in the foot (I already knew I was prone to hyper mobility). This has not helped the issue at all.
A new orthotic was made.
Interestingly, this time the support has been put in the arch and mid foot rather than tilting my heel over as you can see on the left. I am not sure what I was expecting but the new one instantly felt better and almost like I have nothing in my shoe at all.
But, I still had pain up the front of my foot. So back to the physio to ask more questions.
Muscular issues?
It seems that somewhere along the line I have extended my stride (perhaps to improve my walking speed) and hence, now I heel strike (which I already know is bad!!) dammit. I spent a lot of time fixing this issue in my 30’s when I first took up running! I looked at the sole of my trainers and yup…
When you have a tendency to overstride the tibialis anterior is put under undue strain. so, there’s the root of this part of my problem.
And…. Tight gastroc (calf) and Achilles. This has reduced the dorsiflexion in my ankle too.
Treatment plan
- New custom made orthotic from a podiatrist, not an orthotist (more specialist knowledge in feet).
- Stretching the Achilles and gastroc regularly to improve dorsiflexion.
- Stretching the tibialis anterior to alleviate pain
- Shorten stride when walking, focusing on loading through the mid foot.
- (As an aside, it was also found that I also need to strengthen my hamstrings both sides)
- Back to regular walking, focusing on stride length and correct loading through foot and hip. (Starting with very short distances.)
Signs to look for if you suspect similar foot / arch / ankle issues.
- Shin pain / front of foot pain specially when dorsiflexing under load.
- Arch or heel pain (sole of foot, in front of heel / back of arch)
Additional considerations for me to bear in mind
My added complication is the right leg lymphedema. If I do too much on two feet I can worsen the pain and symptoms of this. So I have no option but to do things in very very small incremental steps. The lymphedema is not taken into account at all when Any sports are categorizing me for para sport. This is why I have chosen to disengage from that field completely and work with events directly as and when I want to enter, to make them accessible for me, within the scope of an able bodied race.
It is sad that I have had to make this choice, it takes away from me the competitive edge / spirit that I have by default. But, I must choose what is best for me personally and my own mental / physical health.
