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Stroke Smart Magazine

May/June 2007

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New Help for Foot Drop

By Pete Lewis

Three years after her stroke, Maggie Fermental is walking, driving and working as a nurse in a Boston hospital. However, like many stroke survivors, Fermental has had to adjust to foot drop, also called drop foot, which is a condition caused by weakness or paralysis of the muscles involved in lifting the front part of the foot.

Fermental's stroke damaged the part of her brain that normally would send signals to her ankle. As a result, she is unable to flex her ankle and raise the front part of her foot.

When people with foot drop can't flex their ankles, they often drag a foot when walking or overcompensate by using the knee to raise the entire lower part of the leg so the foot clears the ground.

Many people with foot drop are fitted with an ankle-foot orthosis (AFO), a brace that stabilizes the ankle and foot. While AFOs help people with foot drop walk more safely and efficiently, the devices have drawbacks. AFOs usually are made of rigid plastic and can be uncomfortable. And since they are worn inside the shoe, they limit the types of shoes a person can wear. AFOs also are intended to hold the foot rigid so the foot and ankle can't move very well.

“People with drop foot often develop nasty habits,” said Sue Golden of Good Shepherd Rehabilitation Center in Allentown, Pa. “They refine their walking patterns to compensate for the foot drop. This requires more energy, which means they tire more quickly and can't walk as long, or as far.”

New technology called electrical stimulation can enable people with foot drop to walk better. With this technology, a device stimulates the nerve that controls the ankle-flexing muscles. The device straps around the leg, under the knee. It has sensors that activate electrodes, adjusting for walking speed and inclines.

These devices have been used in Europe since 1988, but only recently were cleared by the Federal Drug Administration in this country. Unfortunately, Medicare and most insurance companies don't pay for the devices, which cost $1,200 to $5,000. But that may change.

Dr. John Chae, a physiatrist at MetroHealth Medical Center in Cleveland, is doing research that compares electronic stimulation devices to AFOs. If he can prove that the new devices are as good or better than AFOs, he said Medicare and insurance companies will be more likely to cover their costs.

“We believe these devices are as good as the brace and may actually aid in recovery because they don't inhibit movement like the braces,” he said.

Maggie Fermental is already convinced. After wearing an AFO for two years, she was fitted with a stimulator device in October. She wears it up to 12 hours a day and hasn't needed an AFO since.

“I hated every minute that I wore the AFO,” Fermental said. “Now I walk more normally and can wear any type of shoe I want. I notice the little buzz when the electrodes activate, but it's not a bother.”

The stimulators must be fitted by a trained professional. But they require little training and can be put on and removed by the user with one hand.

For more information, ask your doctor about stimulator devices, or visit these Web sites: www.walkaide.com, www.bionessinc.com and www.odfs.com.


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