Foot Drop
Foot drop is a common walking challenge caused by stroke. People with foot drop can’t raise the front part of the foot because of weakness or paralysis of the muscle that normally lifts it. With foot drop there is difficulty “clearing” the foot while walking, often dragging or scuffing along the ground. Foot drop can result in poor positioning and unsteadiness of the ankle and knee while standing. Balance problems are common. People commonly compensate by adjusting the way they walk. “Steppage gait” involves bending the hip and knee excessively to lift the foot higher. “Circumduction gait” occurs when the leg remains straight and swings to the side in a semicircle to move forward.
The results are slower walking, fatigue at short distances, higher energy use, pain and lots of falling. All of this has a direct effect on quality of life.
There are many treatments available:
- Strengthening
- Stretching
- Balance training
- Gait training with assistive devices
- Braces and orthotics
- Electrical stimulation
- Surgery (This is rare.)
Two of the most common treatments are bracing with an ankle foot orthosis and functional electrical stimulation. An ankle foot orthosis is a device that keeps the ankle and foot in position to help the foot clear the ground. It’s usually prescribed early in rehabilitation. This may improve walking speed, balance, posture, safety and confidence. There are drawbacks, though. Rigid materials often limit air circulation around the skin. Also, it makes it harder to feel the walking surface, which is important for balance. However, benefits often outweigh the negatives.
Functional electrical stimulation, or FES, sends small pulses of electrical stimulation to the nerve that controls the muscles lifting the foot. This is delivered through surface electrodes placed on the skin. Stroke survivors are good candidates for FES because the injury causing the foot drop is typically in the brain.
One warning: Patients with cardiac pacemakers or defibrillators can’t use FES based on Food and Drug Administration guidelines. The benefits of FES include improved walking speed, ability to walk longer distances without fatigue, lower energy expenditure and fewer falls. Many survivors prefer FES over ankle foot orthosis. They report feeling steadier, more balanced on their feet.
Foot drop is a challenge, and the appropriate treatment must be tailored to your personal needs. Advances in technology are rapidly improving independence and quality of life for many people suffering with this condition.
