Barrett L. Dorko, P.T.

          Evelyn's feet had hurt terribly for many years. She'd had every imaginable intervention, including the bilateral amputation of her second toe. I was certain that my meager knowledge of orthotics would have long since been exhausted on her, and I wasn't especially confident that I could help.

          Her new orthopedic surgeon had determined through nerve conduction testing that tarsal tunnel syndrome was her most recent problem and he discouraged her from surgery. "Try to find a therapist," he said. Her orthodontist (a former patient) recommended me.

          I'm often struck by how important the first few moments spent with a patient might prove to be. I try not to manipulate this contact, but to let it flow around me. For me, therapy is not so much about control as it is about accepting the fear and turmoil surrounding uncontrollable events. Evelyn was both pleasant and doubtful. She remembered the glowing recommendation from the orthodontist, but she'd been around, and it would take something special to impress her. I countered this with a simple, quiet openness to her story that I feel will draw out the subtle movement toward correction we all possess. We danced about, and I had to be careful not to step on her toes.

          While supine, Evelyn's legs were held together, all eight toes pointed directly at the ceiling. She tells me that lying down doesn't help her pain, and that she dreads the night. It was easy to see that weight bearing wasn't her only problem.

          Sometimes I wonder how much I can truly know about any patient's response to my care. I've seen people change in many ways that didn't seem to have any relation to my provocation or presence. I joke that I'll take credit for anything that gets better, but that any worsening is due to "the crisis of change." Evelyn's sensitivity offered me the opportunity to remind her of this many times during the course of her care.

          There is one thing I do know; if the hip moves toward external rotation and abduction, there is a reduction in neural tension throughout the side.* For whatever reason, Evelyn persistently held herself from this. The result was a "lady-like" posture that reduces blood flow and diaphragmatic excursion. Not exactly a good idea in her case.

          Getting her to rest with her hips where I knew some relief might reside proved a challenge, but together we found a way. I recited to her the last few lines from a poem by Onie Kriegler called "Barely Breathing,"

          ...we search blind for the way out
          for the place of rest
          like Dorothy, we long to go home
          praying at every altar
          except the possibility in our own two feet

          And you know what? She got a lot better.

          I understand that her orthodontist is thrilled.

*Breig, Alf "Biomechanical Considerations in the Straight Leg
     Raising Test," Spine, Vol 4, No.3. 1979, pg. 242-250.

*See also "A Simple Test of Autonomic Balance" by Barrett L. Dorko

     Copies available from the author.