Drop Foot

[Shawn]

I'm sure this (drop foot) is something we all experience as a result of a SCI injury but, what can we do about it? My doc informed me a while back about tendon transfers or something like that, i'm not sure. Does anybody have more insight or experience in this regard? I'm walking with a pair of crutches (locked knees)and keep tripping or getting stuck because of my drop feet. I've tried footsplints but, it's too much of a hassle for me so, i was wondering if there's anything else i can do or use that would make my walking easier.

http://sci.rutgers.edu/forum/images/smilies/smile.gif

[zaziwe]

Hey Shawn,

I have drop foot pretty badly also. I am c5,6 incomplete. I do a few things that seem to help.
here are a few ankle exercises-
Lie on your bed face down with your feet hanging off the end. Then get on your knees so your butt is between your legs, your feet still hanging off. I lean forward and rest my forearms on the bed. Pull your feet in toward the bed, hold 3 seconds, and release. I do many reps and sets of these.

exercise2-lie on your back with your knees bent to your chest. Put an ankle weight (ones with velcro straps) on your foot. Lift your foot, hold it 3 seconds, then slowly let it down. I do lots of reps and sets of these also.

The other thing I do is stretch stretch stretch. I place wedges < in the bottom of my standing frame to stand on. I took the tray off the standing frame so i can lean forward which really stretches my hamstrings and achillies. This really helps to keep my range of motion.

I always wear shoes, and try to keep my feet properly supported.

How are your spasms? Do they interfere with your walking? What level are you?

peace

[Shawn]

Thanx for the exercises Zaziwe,i can't wait to try it out when i get home today. Fortunately, i haven't had any spasms inteferring with my walking thus far, touch wood. To be quite honest, the only thing my doctor told me was that, i'm an incomplete paraplegic. He never mentioned what level and from what i'm able to do today, i assume i'm a L1 - Incomplete. I intend seeing another doctor next week who specializes in SCI and then i can confirm my injury.

Dr. Young or SCI-Nurse: do you have anything to say with regard to my question on "tendon transfers" to rectify my drop-foot dilema?

[gustasaenz]

Hey all, i am from S. America (Uruguay) and have foot droop since my accident. Actually using functional electic stimulation with two elecrtrodes and a little box attached to my belt and use it all day long. It really helps me when walking. I am C5-C6 incomplete and walks with difficulty but since i use this method it really has helped me a lot. They have recomended to do tendon transplant but i really don´t know what to do. Do anyone of you has any experience in this or is using FES as me? Thanks

[SCI-Nurse]

There are two types of drop foot. One is due to muscle weakness in the front of the shin, which can cause toe-drag during walking. It is inefficient and very fatiguing to walk this way as you must hike your hip, and over time not only can you end up with low back pain and hip joint problems, you are likely to trip and fall, risking breaking a hip, etc.

second type is a contracture that can develop from lack of range of motion exercise or improper positioning. This type cannot be corrected with a brace, and may require tendon lengthening or cutting procedures or even orthopedic bone surgery to correct. It can also occur over time if the first type is not properly braced or supported or if there is significant calf spasticity that is not properly managed.

FES can only be used on upper motor neuron injuries. If your injury is at L-1 or lower (is that the fracture or your neurologic level) you may not be a candidate for FES to the anterior tibialis (the muscle that pulls your foot towards your shin) if the nerve involved has a lower motor neuron injury. Using FES directly on the muscle may require such a high current that tissue damage can occur.

Unless you have an extra muscle to spare in your calf that works and it could be transferred to your anterior leg, I am not sure how a tendon transfer would work in the leg. I have never seen one done. Generally it is done in the upper extremity.

Most people at your level do use foot splints. What type were you using? Plastic AFOs are easy to apply, lightweight and fit inside any flat soled shoe. Metal uprights are harder to apply and only on on one shoe, plus they are heavy. (KLD)

[Antonio Spagnolin]

Tendon transfer can be useful also for redirecting the pull of an anterior leg muscle in order to make it more effective in keeping the toes up. For example, a tibialis anterior who is strong but not helped by long toe extensors can be transposed more centrally on the dorsum of the foot to gain a better toe clearance.

Be sure the surgeon and his team are experienced in this kind of procedures and supported by a good gait laboratory. Ask for a detailed explanation of the proposed surgery (i.e.: which muscles are transferred where? Which muscles, if any, are to be surgically lengthened?). Ask for the functional gains to be expected (i.e.: is just to get rid of the FES apparatus? Or will you achieve a faster/safest/easiest/better looking gait?). With these info, you could take a more informed decision.

Antonio

[Shawn]

SCI-Nurse: Yes, i was provided with plastic footsplints but, i don't use it because of the inconvenience of putting it on and taking it off time and again. I'm not quite sure what level of injury i have (I assume L1 - Incomplete)but, i intend finding out on Monday when i visit the SCI-Rehab. The type of dropfoot that i have is, muscle weakness in front of the shin and this makes my walking difficult. My left side is bad but,on the right foot, i can flicker my toes upwards and pull the foot to my shin slightly. What about transferring muscle from the upperbody to rectify my dropfoot?

[SCI-Nurse]

A muscle transfer is not a transplant. It is not the muscle actually that is the problem, but the nerves to the muscle. In a muscle transfer, a muscle that works is kept connected to its nerve supply, and generally is disconnect at only one end of the muscle, then swung into position and sewn in place to move a different joint. The blood supply and nerve supply to that muscle must not be disrupted.

This can often work in the arm, for example, moving part of the deltoid muscle (shoulder) to substitute for missing or weak biceps (elbow bending) because they are close by.

Obviously moving a muscle from an arm to a leg and having it function is not possible, at least not at this time.

(KLD)

[gustasaenz]

Me again. Thanks for answering my question. As i said i have already used platic braces but didn´t work. I have weakness muscles. I now use FES directly on the muscle and after 4 years nothing has happen to my tissues or muscles. This method really helps me a lot in my walking and in mantaining range of motion in my toe.

[Shawn]

SCI-Nurse: thanks for the clarification on the muscle transfer, it makes alot more sense now. I don't mean to be a bother or sound stupid but, what's the difference between a muscle transfer and a tendon transfer, i.e. tendon vs muscle. Is it one and the same?

[SCI-Nurse]

Yes, these terms are pretty much used interchangably. No dumb questions, just dumb answers!

[etexley]

To begin with, make certain that if you sleep on your back rather than prone, that the bed sheets at the bottom of your bed are untucked. You don't want to go to bed with your feet plantarflexed.

Exercise your ancles!!!

http://www.haemophilia.org.za/HemAnk-1.htm

Passive standing also helps.

Eric Texley

[etexley]

BTW SCI Nurse...


I had a MAJOR compound break in my leg when I got hurt (4 pcs.) I've got a metal rod in place. My therapist told me I couldn't do my gastronemius or interior tibula because the metal would "heat up."

This doesn't make any sense to me at all. Metal is a BETTER conductor of electricty than skin, and the greater the resistance the more heat something gives off when it passes electric current. I asked Dr. Young this question awhile back, and I don't think I described it well. Is this true, this "heating up" or is it a bunch of houie?

Eric Texley

[SCI-Nurse]

Eric - When I read your post, your question was not clear. Does your comment about "heating up" refer to the use of electrical stimulation or that the presence of a metal rod contradicts the use of electrical stimulation? CRF

[etexley]

Her comment was that the use of electrical stim on a limb which was stabelized with a rod insert would be a bad thing because the metal would heat up with the current was applied.

Eric Texley

[SCI-Nurse]

Eric - In my work with Computerized Functional Electrical Stimulation (CFES), I had two patients who were able to resume their CFES therapy following the placement of metal screws and plates. (Both broke their legs during their participation in CFES; one was in a water-skiing accident and the other had some one carelessly lift and move her, catching her leg at a door way) Neither had any problems with the electrical current in relation to the metal implants in their legs. Very early in the use of this technology, it was contraindicated to use electrical stimulation in the presence of metal implants. However, this is no longer listed as a contraindication for such therapy.

Low levels of electrical stimulation have been shown to promote new bone growth in the presence of fractures and implants....most of the studies that I found were at the animal level. There was one note that the effect on the surrounding muscle tissue needed to be researched. CRF

[nypdp]

Any ideas about shoes for optimal gait? MBT's are amazingly right for me in all respects but weight. They're TOO HEAVY to haul around and I fatigue in no time. Suggestions, please.

[SCI-Nurse]

AFO insert in to the shoe.Need to get a prescription for it.

CWO

[mxc59]

After the surgery my left leg was dead with no control or feeling in my foot and toes apart from the nerve pain which was unbearable.
To walk i had to use a splint on my left leg-foot and crutches.
I started physio and pool work straight away. The lack of control in my foot was so bad i feared even putting socks on after the pool work in case in bent my toes
and broke them as i had no feeling in them what so ever.
I continued with my pool work twice a week and exercises at home with very little improvement. i was in total dire straights and in a dark unpleasent place.
Around the end of December i was by chance given a different physio. he asked me to walk up and down the room a couple of times and afterwards
told me that i was walking like a person who was recovering from a stroke.
From that day He completly changed my workouts and exercise routines and encouraged me back to my gym for daily workouts.
For the next year up untill December 2009 i had phisio twice a week and went to my local gym 4 times a week.
I had very slow progress and got to the stage where we both thought we had reached the end of the line in terms of any further progress.
My foot was still very painfull due to the nerve damage and still very weak with little control. One exercise which really brought it home to me was just trying
to stand on just my left leg which i could manage for about 1-2 seconds on a good day.
I was depressed but still continuing with all the hard work even though it seemed to have little effect untill came the turning point.
While walking home one night i slipped on a pot hole twisted and went right over on my weak ankle tearing the ligament in my left foot which left
me whicing on the floor for a few minutes before i could compose my selfe enough to hobol home in pain.
The next day my ankle came up like a ballon and i was back on crutches for two days.
But now here is the odd thing, as my foot repaired its self i found that i slowly began to get more control over my foot and toes and over the following year
i had significant improvments.
By early summer i was at the stage when sometimes i would even forget i had a pain in my foot and my walking emproved. By christmas 2010 the only problems
i have is mild pain in my foot and walking with out footware can be a little awkward but i can now wiggle my toes and move my foot in all directions and it is still
emproving and getting stronger.
2011 will be an other challenge but is a challenge i will now meet head on as i am sure that the light at the end of the tunnel which i thought had blown out for me is
now getting brighter and closer each couple of months.

i will now list some of the things i did which i considered helped me over the last two years. this is a routine i stick to, it seems to work for me but
please consult your physio before you take up any of this as everyone is different and it may not be for you.

1. footwear. try wearing different footwear. boots one day trainers the next and shoes the week after. try very thin soled shoes then thick soles.
2. Put foot on floor and try to use it as a wipper blade action left and right pivoting at the back of your foot.
3.use an electric foot massager most days.
4.gym work. 1.bike lots of peddle power.
2.cross trainer. try keeping foot flat on peddle then try with lifting front of foot on each rotation then lifting back of foot on each rotation.
3.rower but very light setting and just keep bending those toes and foot.
4.holding onto equipment and standing on tip toes up and down.
5. try standing on one leg.
6. march on the spot.
7. while sat on the chest press machine try pushing away the foot bar with just your foot up and down several times.
8. while lying on your back raise leg about 1 foot off the ground and try to do the wiper action with just the foot.use a ball to rest leg on.
9.use a balance board.
10. NEVER EVER GIVE UP. THINGS DO GET BETTER BUT SOMETIMES THEY NEED TIME AND A LITTLE HELP.

[Footmind]

I work for a company that specializes on the foot and ankle. We are developing a brace for foot drop and would appreciate any feedback that you would be willing to give. Please take our survey so we can create the best brace out there. Thank you - we appreciate your time and help.

The link to the survey is http://www.surveymonkey.com/s/T8GZBDD

[LIP26]

after nearly 6 months since my accident, I still experience foot drop and use and AFO on my right foot; I occassionally use a cane. My gait is abnormal and i have slight hip drop on the left side. I'm very positive that I'll continue to see improvements in my foot as I've exploring many different avenues of treatment.
Hip drop won't go away until foot drop is remedied?
Even though I currently don't have much strength to push my foot down, if I gain muscle in my shin, will I be able to dorsiflex?
Possible for one foot to heal, as much to balance on it, and one foot to not heal as well?

[arndog]

Lip - did you have a SCI? What kind? You are obviously incomplete. You can hope and expect return for the first 24 months. After that, you can only make what you have stronger to a point. If you have residual nerve damage like most people here, you will have a gimpy walk and use an AFO and possibly be thankful that you aren't a complete, able to ambulate a bit, although all injuries are not fun.

I am a 10 yr post SCI caudal equina incomplete crutch walking AFO person among other things.

[lonecoaster]

Your doing great for 6 months, strenghten your core muscles, it will help your hip drop and improve your gait.