The wrong shoes !

Having written a gently humourous piece here about the ‘wrong trousers’ i had a completely ‘LOL’ moment yesterday when a very helpful physiotherapist told me that basically i am wearing the wrong shoes !.

I have been waiting for several weeks now for an appointment with the occupational health department physio having failed to get a self referred appointment with the main physio outpatient department (they refused to see me) .  The actual referral was related to my recent back problems but that is now some 6 or 7 weeks past and i have slowly got on top of that so what i wanted to talk to the man about was the various problems i am having with one ankle and knee on the same side.  For some time i have been going unaccountably lame on my right foot and sometimes within minutes of setting off walking in the morning : then by the end of my shift i have been hobbling around with quite a lot of pain.  On top of that my right knee really started getting painful and boggy…feels inflammed : i wouldn’t be surprised if it was just age related and also due to the fact that i have spent a lot of time on my knees over the years….canoeing for example is very tough on them.

Having been seen by the same department years ago when i had the gastroc tear i wasn’t expecting great things : on that occasion the physio berated me for even contemplating weight training ‘at my age’ (i was about 52) and the departmental nurse didn’t even seem to have read the obviously googled document about the injury management.  At the time i didn’t think that their primary concern was anything to do with my rehab and ‘care’ but simply to get this bum back on that seat : pain/immobility notwithstanding.

What a contrast to this time though : i was there for an hour, the physio took a full history and did a thorough examination of ankles and knees, standing, laying, under load etc etc.  The basic story is that i probably do have some age related deterioration in the knee joint and there isn’t a fantastic amount that i can do about that but i can improve the pain, the swelling and the range of movement. The main problem is in my feet : it seems that my arches have flattened a bit and my feet are pronating under pressure and that has caused inflammation in a small tendon to one side of the ankle and probably some underneath the foot as well….and that problem is accentuated by me wearing really flat open shoes most of the time both at work and home.  Most of the time when i am not at work i wear ‘keens’ open shoes and they don’t have much arch support so that and that my clinical shoes being very similar could be causing most of the problem.


It will be interesting at work because the hospital and the department might be a bit sniffy about me wearing trainers on the job : which is what the physio has said to do. At home or at least outside i know not to go for long walkies in my keens but to use really good trainers or my lightweight boots and even then maybe change the insole for a higher arched one.

Numbers :

Today i weighed in at 97.2 kg which is a positive drop, i actually weighed twice because the first reading gave me 96.8 which i didn’t believe.  I make that a 5.4kg or a tad under 12 pounds down.

Today also takes me up to having achieved 25% of my planned heavy carry work : 25 out of 100 loads of firewood rucked out and this is most of what that looks like. (below)

On exercise progression : usually now i do most sets of press-ups as 15 a set, for the last few days i have been trying for over 60 a day, yesterday i got 65 for the first time.


There is also a back-story here.

In another post i was talking about self-reliance and preparedness and talking about levels within that : from the practical everyday stuff right down to the deeper psychological layers.  In the middle layer i talked a bit about the world’s most boring subject (outside tennis) ie risk management.  I didn’t explain how it is that i came to know the professional basics of that subject but it was largely through my actual outdoors work of being a one-time canoe and bushcraft instructor and professional sailor. In sailing for example its a key goal to bring the same number of guests home at the end of the voyage as we set out with and to bring the same guests home with the same number of fingers and toes….not always easy on a maxi-yacht and especially when half the ‘guests’ (clients) are irredeemably stupid !. Anyway that’s where i learnt basic risk management and then in one job i had to use that skill to do the same job in the clinical environment to make the management happy that we had done our risks work.

I won’t say that i did it especially well at first because i really didn’t know what would happen and had to do a lot of speculative thinking about everything that could possibly go wrong with a new team, new responsibilities and new competencies.  A lot of what i thought could go wrong never happened and i missed a bit of the small things that can cause larger errors but i didn’t really learn any of that until i went looking for the evidence. I found that by accessing a data base of all adverse incidents that are reported and the frequency of reports is about 120 a month……and for several years i read all of them and mainly in my own time.  Even after a few months of that i realised that i was probably the only person in the entire organisation at that time to fully understand the hospital from the perspective of its errors and adverse incidents.  Alongside reading the reports and collating them into groups or categories i also completely re-studied the whole subject of patient safety and clinical risk : 2 years of mostly doing that alongside my own clinical work and i could talk to any person at any level about genuine evidence based risk because i had the recorded facts at my fingertips.

The punch-line here is that i also realised that a lot of people, especially a certain type and level (usually low level management and many in local government) will bandy around terms such as ‘health and safety issues’ and i know now that when i hear that one term then the person using it most likley knows diddly-squat about the actual subject and its easy to run rings around that person just by asking them for example what the natural frequency of the incident they are talking about.  Usually the person looks instantly confused because they really are just bullshitters and really don’t know the subject at all but are just using the H&S ‘issue to sound important.

There was this one time when a manager tried to stop me wearing ‘the wrong shoes’ because as she said “there might be health and safety issues” : i of course smelt blood ! and asked her what the actual frequency of adverse incidents was with that kind of footwear , she started to bluster a bit and said that there must be ‘loads’ of incidents. Now i knew that the number of reported accidents/incidents was zero and challenged that manager to give me evidence of a single one and of course she couldn’t….i even showed her the zero evidence.  Of course that wasn’t the end of it because managers like that can never lose….especially certain female ones but its good clean fun riling them with facts and evidence.

Comments :

Peter Cash wrote :

“Peter said, not me more the pity,
“In a hierarchy, every employee tends to rise to his level of incompetence.” …
He was incorrect, should be “his or her” in your case.
Of our current policical and troubled world, he once said,
“Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it.” …
My hero.”
Me : Blake or Hitchens ?
On a slightly serious note though i do actually believe that risk management done properly can tell us vitally important facts about things that we do.  Its my contention that healthcare is generally ‘risky’ and unpredictable but that the subject is poorly understood and even more badly taught in hospitals particularly.  On the other side of the fence its also wrong to compare say aviation and its safety record with healthcare as our previous government tried to do.    I don’t regard life as ‘safe’ at all but when i am responsible for other people’s lives (even the dickheads) then i use every available tool to make sure i get them home…..besides the paperwork is a bitch when it goes wrong !

1 Comment

  1. Peter said, not me more the pity,
    “In a hierarchy, every employee tends to rise to his level of incompetence.” …
    He was incorrect, should be “his or her” in your case.
    Of our current policical and troubled world, he once said,
    “Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it.” …
    My hero.


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