[McCann]

One of the articles within the new device for paras stated, "NICE has produced this guidance because the procedure is quite new. This means that there is not a lot of information yet about how well it works, how safe it is and which patients will benefit most from it.
This leaflet is written to help people who have been offered this procedure to decide whether to agree (consent) to it or not. It does not describe drop foot or the procedure in detail – a member of your healthcare team should also give you full information and advice about these. The leaflet includes some questions you may want to ask your doctor to help you reach a decision."


Dropfoot (aka plantar flexion) can be helped through several methods, but first a brief on how it works within one's body in easier terms. The body has many push/pull muscles like the bicep and tricep (most known). Regarding drop foot the problem area is the gastroc or calf muscle (3areas-inner, outer, and soleus/middle) is tight or "cramped" causing plantar flexion (analogy is as wearing high heels so ability to walk heel toe doesn't happen). Think of it as the "push" muscle.

The "pull" muscle would be your anterior tibialis. One well known/understood method is patients with drop foot get injected in the gastroc/calf (usually all 3areas of the calf) with botox (and not to make your calf look younger,lol). The biggest myth is that botox weakens the muscle and would make walking much harder/difficult, Wrong. Botox relaxes the tightness or "cramp" in your gastroc/calf and when that happens, one gets an increase in range of motion that would allow for dorsi flexion (heel toe). The problem is that your anterior tibialis has been out of function (atrophied) for so long, you don't have the strength to dorsi flex repetitively and properly as you walk.

Two good ways to check your dorsi flexion strength are to:
!) sit and attempt to tap your foot repetitively (as playing bass drum or tapping your foot to a fast beat of a song) and compare it to your "better leg for a time length of about 30seconds-1minute.
2) stand and try to walk on your heels and how many steps can you hold to walk on your heels until it fatigues/is back to the floor (notice that your stronger/better foot will tend to stay up on that heel longer).

Okay, how do you build strength in your anterior tibialis. As in the phases of ProjectWalk the first phase involves reactivating/activating your anterior tibialis to produce proper dorsi flexion. If you have slight anterior tibialis strength and can lift off the floor/surface do strengthening exercises or try FES. The problem with typical DC current FES machines is that they only work the percentage of muscle fibers already active. In other words if only 20% is active then that's the percentage the FES uses and fatigues. The other 80% will stay inactive not to mention the skin and nerve damage from prolonged use of it.

If you don't use an AC current NMES then a helpful strategy is doing the dorsi flexion exercises in water, on land placing ankle weights (progress from light to heavy) on top of your foot, foot reflexology, and calf massages.

Retrain your CNS by breaking down larger movements to smaller ones. Gross motor first then fine motor.

This post has been edited by McCann: 11 August 2009 - 10:54 PM

[SnoFl]

Hi McCann,

I think I followed your post okay. To give you support, it sounds similar to my Physical Therapist's teachings about the calf muscles and how they perform. My PT wants me to do both the toe tap and the heel walking exercises that you mentioned in your post (On the heel walking, I use my trusty ole walker while the PT holds me with a belt around my waist).

Regarding the toe tapping, my PT told me to alternate between right and left foot while exercising. She doesn't want to see me do 5 repetitions of right foot then 5 repetitions of left foot. When a person taps his toes alternately, it "simulates" walking. It makes sense, but no one has ever told me that over the years.

I do not have an opinion on the new device. The "devices" that I've tried over the years didn't aide me at all. I remain skeptical but hopeful on anything new. The truth is in the results.

See you around.

-Barb

[McCann]

SnoFl, on Aug 11 2009, 01:32 AM, said:

Hi McCann,

I think I followed your post okay. To give you support, it sounds similar to my Physical Therapist's teachings about the calf muscles and how they perform. My PT wants me to do both the toe tap and the heel walking exercises that you mentioned in your post (On the heel walking, I use my trusty ole walker while the PT holds me with a belt around my waist).

Regarding the toe tapping, my PT told me to alternate between right and left foot while exercising. She doesn't want to see me do 5 repetitions of right foot then 5 repetitions of left foot. When a person taps his toes alternately, it "simulates" walking. It makes sense, but no one has ever told me that over the years.

I do not have an opinion on the new device. The "devices" that I've tried over the years didn't aide me at all. I remain skeptical but hopeful on anything new. The truth is in the results.

See you around.

-Barb

True thhe alternating of toe tapping does simulate walking, but you have to work the muscle in several ways. Besides I said to perform it to test the strength/endurance compared to that of the good leg.

I'm not sure if you are familiar with workouts and the results produced and how/what kind of strengthening is done. Think of it this way, exercising for power is different than exercising for tone and/or "bodysculpting," and they both differ from exercising for endurance. Also fast twitch muscle fibers are invoked separately during certain exercises than slow twitch muscle fibers.

How many times does an "un-injured" person use their lower extemities for everyday basic activities? Now compare that to an "injured" person wanting to get back to "normal" use, yup high repetitions but constant assessment of self strength is necessary.

This post has been edited by McCann: 11 August 2009 - 10:49 PM

[chickadee]

Botox wouldn't do a thing for my stunningly beautiful gams!

I was fitted with a foot brace in May, and that helps me out a lot. It also helps me 'feel' my foot in relation to my leg, my knee, etc. Also, my PT chick told me to work on stretching my ankle (due to spasticity), and then practicing leaving my foot in an upward 45 degree angle (or whatever my actual angle would be...) without letting it fall or have my toes tweak it downward. She said just stretching really helps, because muscle fatigue is what's dragging my foot down. I also was told to write letters with my big toes back and forth. It helps with placing my toes to the rest of my foot and ankle.

[McCann]

chickadee, on Aug 11 2009, 09:52 PM, said:

Botox wouldn't do a thing for my stunningly beautiful gams!

I was fitted with a foot brace in May, and that helps me out a lot. It also helps me 'feel' my foot in relation to my leg, my knee, etc. Also, my PT chick told me to work on stretching my ankle (due to spasticity), and then practicing leaving my foot in an upward 45 degree angle (or whatever my actual angle would be...) without letting it fall or have my toes tweak it downward. She said just stretching really helps, because muscle fatigue is what's dragging my foot down. I also was told to write letters with my big toes back and forth. It helps with placing my toes to the rest of my foot and ankle.

Botox reacts negatively in some people however stretching seems quite "universal" in the effect it has, positive. I know braces do work at times. I have one that I used for a very short duration but it ended up causing me to walk/get clonus (foot shaking) while trying to walk with it on and the same therapist that initially suggested I use it told me to stop wearing it(disruptive to my knee extension, stability, and caused clonus).

As said in ProjectWalk's philosophy they are against braces. In my opinion they work well temporarily (bandaid like) but doesn't address the causes. Also as you get stronger the brace acts negatively when using them.

Think of it from this logical aspect, when does one no longer have to wear the brace (especially during walking)? How is that achieved?
When stretching what muscle(s) or types of stretch do you do?

This post has been edited by McCann: 12 August 2009 - 04:11 AM

[chickadee]

Quote

As said in ProjectWalk's philosophy they are against braces. In my opinion they work well temporarily (bandaid like) but doesn't address the causes. Also as you get stronger the brace acts negatively when using them.

Think of it from this logical aspect, when does one no longer have to wear the brace (especially during walking)? How is that achieved?
When stretching what muscle(s) or types of stretch do you do?

I think for me it's not just the foot drop on why I prefer the brace... I also have trouble with my foot rolling, and my lefty juts out at a 90 degree angle. I think for me it's great for a safety-feeling aspect. Plus, it becomes way easier to drive, because I can 'feel' my foot with it on. I agree with the 'how do you know when it's time to throw' the brace. I've been wondering myself the same thing. I've also had my PT chick look into having this electrical shock stimulus thing stimulate my muscle in my leg and foot to walk correctly. I'm not sure how I feel about it.

For stretching, I'll take my ankles in my hands and do the ABCs as well. I also have this squishy 'stress ball' that people usually use for squashing around in their hands I put under my foot, and use my heel as a pivot to push down and lift up (as if to practice using an accelerator pedal in a car). My left foot doesn't do much of anything at all, so I help it with the tip of my crutch pushing down and lifting it up. I'll do this for about 10 min on one foot, 20 on the other (split in half - morning and night).

I dunno. I try to do as much resistance and strength training I can, if only to wake up the muscles. For stretching, I try to do the same ballet and gymnastics stretches I did before, with more concentration on my problem spots. To make sure that the different muscles are being used, I push in slightly to feel the contraction.

I'm not one to say one way is right over another - I'm far too new for that! But, I figure - do what you can to make it feel better.

[McCann]

chickadee, on Aug 12 2009, 12:28 AM, said:

Quote

As said in ProjectWalk's philosophy they are against braces. In my opinion they work well temporarily (bandaid like) but doesn't address the causes. Also as you get stronger the brace acts negatively when using them.

Think of it from this logical aspect, when does one no longer have to wear the brace (especially during walking)? How is that achieved?
When stretching what muscle(s) or types of stretch do you do?

I think for me it's not just the foot drop on why I prefer the brace... I also have trouble with my foot rolling, and my lefty juts out at a 90 degree angle. I think for me it's great for a safety-feeling aspect. Plus, it becomes way easier to drive, because I can 'feel' my foot with it on. I agree with the 'how do you know when it's time to throw' the brace. I've been wondering myself the same thing. I've also had my PT chick look into having this electrical shock stimulus thing stimulate my muscle in my leg and foot to walk correctly. I'm not sure how I feel about it.

For stretching, I'll take my ankles in my hands and do the ABCs as well. I also have this squishy 'stress ball' that people usually use for squashing around in their hands I put under my foot, and use my heel as a pivot to push down and lift up (as if to practice using an accelerator pedal in a car). My left foot doesn't do much of anything at all, so I help it with the tip of my crutch pushing down and lifting it up. I'll do this for about 10 min on one foot, 20 on the other (split in half - morning and night).

I dunno. I try to do as much resistance and strength training I can, if only to wake up the muscles. For stretching, I try to do the same ballet and gymnastics stretches I did before, with more concentration on my problem spots. To make sure that the different muscles are being used, I push in slightly to feel the contraction.

I'm not one to say one way is right over another - I'm far too new for that! But, I figure - do what you can to make it feel better.

Ok just a thought regarding your drop foot (left I believe) that juts/points out 90 degrees. If I'm wrong then simply say but I will assume that this same leg that has drop foot has a weaker quadricep? It's best seen/known via reaction when trying to straighten that leg fully or "hamstring-curl" while standing or seated?

The quadricep is made up of several muscles and the brace tends to allow/give support for full knee extension. To avoid that then look up the roles the hip flexors play (namely tensor fasciae latae and tensor fascia lata, two differing parts but the latae being a tensor of the lata play important roles in hip abduction and internal rotation (which will help the "foot" that points/faces outward 90degrees). Also look up the role your vastus lateralis plays in your quadricep.

I will say that these two parts are what is weak so not to allow for full leg/knee extension and cause the external (outward) rotation of the foot. These muscles gaining strength and becoming active or activated are a better permanent way to address the cause.

Has your PT therapist ever tried to activate and strngthen those specific muscles to truly address the "cause" and not symptom?

Like I said if I'm wrong then I missed something but based on what you have stated, this weakness seems to be the "cause" for this specific matter we're addressing. But I'd love to know if that same leg with drop foot has what seems like either a weaker quadricep or a slower reaction time compared to the other leg?

If I'm right or close I speak from experience and extensive research.

This post has been edited by McCann: 12 August 2009 - 06:30 AM

[chickadee]

Quote

Like I said if I'm wrong then I missed something but based on what you have stated, this weakness seems to be the cause. But I'd love to know if that same leg with drop foot has what seems like either a weaker quadricep or a slower reaction time compared to the other leg?

TBH, I dunno if I'd say it's simply an issue with the quadriceps. Most of the muscles in my low back, hip, thigh, and down through my leg and foot aren't turned on. I'm wondering if the 90 degree angle is coming from the hip flexor (I walk similar to a penguin - hip-hip-hip-hip) that isn't straightening up once the last step has been taken. I do know that most muscles in my left leg's quadriceps aren't working whatsoever, along with the muscles around and behind my knee. There's a small strip on the interior of my leg that does work, but that's about it. My right leg mostly is fine, but has issues with the hip flexors. However, since it's the more strong of the two, I'm thinking that it might be less noticeable when compared to the left. Again, though, I think that my working out, stretching, etc are hugely key factors in why I have been dealing with less foot-drop issues (i.e. tripping or falling). I'm thinking that the brace is acting similar to braces on teeth - guiding the foot back into place, but is in no way permanent.

I am no way very knowledgeable with body mechanics (I'm learning though so much more everyday!), so it's hard to even identify what I think is going on to my PT specialists. It's hard for me to even know, without any feeling, definitively what's going on. However, I try to focus in my brain on how each small piece should fit together (picking up toes, rolling the foot, bending slightly at the knee when possible, swinging hip), visualizing it in my head before I practice.

It's so strange, changing my brain from engineering to body mechanics! Some things carry over, and some things are just a mystery to me. I simply try to follow the PTs and the folks at Courage Center's advice (local rehab place).

[McCann]

chickadee, on Aug 12 2009, 02:09 AM, said:

Quote

Like I said if I'm wrong then I missed something but based on what you have stated, this weakness seems to be the cause. But I'd love to know if that same leg with drop foot has what seems like either a weaker quadricep or a slower reaction time compared to the other leg?

TBH, I dunno if I'd say it's simply an issue with the quadriceps. Most of the muscles in my low back, hip, thigh, and down through my leg and foot aren't turned on. I'm wondering if the 90 degree angle is coming from the hip flexor (I walk similar to a penguin - hip-hip-hip-hip) that isn't straightening up once the last step has been taken. I do know that most muscles in my left leg's quadriceps aren't working whatsoever, along with the muscles around and behind my knee. There's a small strip on the interior of my leg that does work, but that's about it. My right leg mostly is fine, but has issues with the hip flexors. However, since it's the more strong of the two, I'm thinking that it might be less noticeable when compared to the left. Again, though, I think that my working out, stretching, etc are hugely key factors in why I have been dealing with less foot-drop issues (i.e. tripping or falling). I'm thinking that the brace is acting similar to braces on teeth - guiding the foot back into place, but is in no way permanent.

I am no way very knowledgeable with body mechanics (I'm learning though so much more everyday!), so it's hard to even identify what I think is going on to my PT specialists. It's hard for me to even know, without any feeling, definitively what's going on. However, I try to focus in my brain on how each small piece should fit together (picking up toes, rolling the foot, bending slightly at the knee when possible, swinging hip), visualizing it in my head before I practice.

It's so strange, changing my brain from engineering to body mechanics! Some things carry over, and some things are just a mystery to me. I simply try to follow the PTs and the folks at Courage Center's advice (local rehab place).

Ok well if you can do engineering, "simply" switch to "anatomy engineering," lol. I know that yes the brace may guide the foot back into place but it doesn't strengthen the muscle/fix the problem. Your leg's turning is attributable to those two muscles/parts, hip flexors and quadriceps. If you can overcome the inactivity in those two muscle groups then things would be much easier to further your progression.

I'm sure standing it's easier to hip abduct or lift your leg outward on one side than the other?

Your glutes probably have strength but not as much as needed. Your quadriceps (ultimately entire body)are working on under 80% especially since the vastus lateralis is an important (large&long) muscle in the body. I talk about the NMES because I know what it does versus the Walke-aid but I get flack for my speaking of strategies that work.

Problem is that there currently aren't any other publicly known ways to jump start inactive muscle fibers besides the NMES I spoke/speak of. But as time continues when one doesn't address or fix the problems the body only breaks down further and learns to compensate or picks up bad habits. When axon sheaths begin to demyelineate then problems truly begin.

This post has been edited by McCann: 12 August 2009 - 06:59 AM

[benok]

McCann,

Could you care to comment because my situation is that whenever I stand up, my left leg is triggered by spasticity so I stand plantar flexed on the left leg.
Is is because of the calf muscle or also an influence of the heel cord?