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« Going Backward? | Main | Stroke Revovery Marches On »

01/18/2013

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dean reinke

Ellen, does your therapist understand that wearing an AFO prevents exercising the muscles that would overcome foot drop. Unless you are given instructions to not wear it and then exercise. My wearing of it caused me to hip-hitch to clear the ground, actually making my gait worse. But then I'm not medically trained to give any advice.

Julia

Dean, I totally agree with your comment about AFOs and foot drop. I am a relatively young (57) stroke survivor, and a physician. I too was given an AFO initially. It was painful and actually delayed my starting to walk. An understanding and intelligent PT gave me a PLS which got me started with walking, but when I began to sense that it was holding me back, was okay when I stopped wearing it. My understanding of foot drop is that it is mostly a peripheral nerve phenomenon, not a centrally mediated one such as the problem a stroke survivor has with gait. The problems we have with gait are multifactorial and complicated, involving strength, sensory issues, and coordination , and inadequate dorsiflexion is only a part of it. Correct just one part and you can create more problems than you solve. My walking has improved dramatically since I stopped wearing the PLS, which limited movement at my ankle. You simply can't walk normally without ankle mobility. I don't understand how you can ever dorsiflex your foot if your ankle can't move. Bracing can be a good tool to get started, but, like any crutch, it needs to be eliminated as soon as possible, but many patients are not given any guidance on this, and most PTs consider bracing permanent. I took off the brace because my calf muscles were almost nonexistent, and now they are almost a match for my good side. Getting rid of your brace might not be right for you, but it's definitely something to think about. Also buying shoes is much easier and more fun.

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