Drop foot: how to get rid of your brace

 Please do not see this blog as medical advice. Don’t do what I did, please. Because I don’t want you to fall and get hurt. I was lucky enough to not fall badly, even though I was near falling a lot of times…

When my ex-husband asked the doctors and physios (I couldn’t talk then) “ Will Linda ever walk without a brace? ”

They answered: “Get used to that brace” 

Look, you are now 10 months after your stroke, hardly anything happens after this period” One of the many physical therapists told me….

Really?

Why did I NOT accept it?

Because it was against all logic

Think about the following…

After a stroke, (I can of course only speak from personal experience) you regress to baby-like behavior on your affected side.

This includes your feet:  In other words, the feet move inward, they want to move inward, it is “save” to move inward, and it is scary to have the foot straight, It is like the big control of your mature brain doesn’t exist anymore (which in a baby gets rid of the in-turned foot position).

[Note from Arjan: The sole of the foot is turned inward because the muscle at the back of the leg, like the gastrocnemius and soleus muscle, are relatively stronger. They pull the foot down and help the foot to supinate. Thus the tendency of the foot to give way and roll outward after a stroke. To counterbalance this the weaker muscles need to be reactivated as much as possible. When you develop from lying down as a baby to be able to stand upright and walk unassisted this happens because the brain develops, as the brain develops you activate the smaller, weaker muscles from the top down. This is exactly why the activation of the anterior, front, muscles is weakened after a stroke, hence decreased foot lift, and pronation (inward rotation)]

Although I think that the natural progression in developing a straight foot (by learning how to walk, fall, running…) as a child does, may not be reached anymore (the connectivity of neurons) when you suffer a stroke.

This however doesn’t mean that you are not capable of the “scary part” of putting your feet straight and learning to walk probably again! Even though you are not a child anymore "filled up" with neuroplasticity.  

In short: This is how I did it:

-I threw away my stick and brace and started to wobble around (please don’t do this!)

The struggle for balance that was needed to walk (I didn’t know it back then), triggered neuroplasticity 

-I was walking barefoot a lot of times on uneven surfaces because I needed to provide the feet with loads of sensory input.

-I trained the “overruled muscles”: those muscles which are weak to start off (and normally through higher cortical control get activated and stronger) start to become ignored after a stroke and both brain and body treat them as “non-existent”…hence your movements will consist of big stronger muscles “compensating around them”.

I mean muscles like the hamstring, gluteal, the “lifting-the foot-up" muscles.

[Note: The most important muscles in the front of the leg are the anterior Tibialis -foot lifter-, the extensor Digitorum and Hallucis muscles -the toe lifters-, and the Peroneus muscles that reside more to the side. They help with in rotation of the foot and prevent the foot from rolling outward. One way to help the activation of these muscles is to tape them with Kinesiotape from origin to insertion in a way that increases tension. Another way to leverage the capacity to use these muscles is to sort of overrule the big movers like the quadriceps and iliopsoas muscles (the muscles that run from the spine through the pelvis to the inside of the hip and flex the hip plus torso on the hip). This can be done by lying on the stomach, pillow or towel under the stomach, and position the thigh in an extended position by putting a pillow under the knee of the affected side. the leg is in an extended position. Now the muscles that are stronger to begin with are at a disadvantage and the weaker muscles like the gluteus, hamstrings, and anterior (front) muscles of the leg are closer to the point where they can be activated.  ]

For me personally, It was a heck of a ride, to get rid of the footdrop after my stroke. From only being able to move my big toe one cm, a year after stroke to no foot drop now.

Start slowly

You can start slowly, getting used to living whiteout your brace, with assistance. Walk without your brace with someone beside you (to catch you when you fall), if you can, barefoot. Train the “overruled-muscles” 20-30 minutes a day.

[Note: practicing dorsiflexion of the ankle, and/or lifting the toes while inwardly rotating your foot can be of great assistance to improve foot stability. You can literally do this anywhere for a couple of minutes. Even the tiniest of movement will be of help. Do not be discouraged if you can not move the toes or foot up at the ankle at first. The majority of stroke survivors with a foot drop have problems with this, to begin with. Even thinking through the exercise will activate the networks and pathways that help to accomplish these movements.]

Don’t believe

So my advice to you when dealing with a foot drop after a stroke: Don’t believe what they say to you like no toddler will ever say:  “no….I don't believe in walking. Walking is not for me…

X

Linda