by Mike Foxworth
Joe Trepenning, of Infinite Technologies (local provider, <Website>), discussed flexibility exercises to AVOID (or minimize) use of ankle braces to treat “drop foot“. Drop foot (<Described in this PDF>) is a common symptom of PN since the nerves/muscles in the feet and lower leg tend to die/degrade first. Drop foot is one of the most dangerous aspects of PN, because it risks tripping and falling. Braces to help with it are called “Ankle Foot Orthotics” (AFOs).
Insurance, like Medicare, will often pay for an AFO; they’re the standard “quick fix.” Expensive to Medicare because they are custom and need fitting. Cheap to the doctors because paperwork is minimal. The Medicare standard AFO is a completely inflexible piece of hard plastic that fits in your shoe and straps to your thigh. Treppining advises that use of standard AFOs should be minimized or avoided, if possible, due of their downstream health consequences to your mobility, balance, gait and knees.
Trippening’s company, along with companies like Hanger, fits and sells AFOs. But he recommends physical therapy exercises be tried first or concurrently to strengthen the affected nerves and muscles. The PDF cited above describes some of these exercises. If an AFO must be used, he compared standard types (with a fixed ankle angle) to newer flexible kinds that are safer and allow walking to be somewhat more natural. Since Joe’s visit, we have seen references to other new types:
- The Helois is an example of custom devices designed to help preserve the body’s natural “springiness”. Normal walking minimizes fatigue by taking advantage of the body’s ability to preserve energy from one step to the next. These types of devices are designed to make safe walking less fatiguing by preserving some flexibility.
- FootUp by Ossur: For moderate cases, where there is still some ankle strength, over the counter, less expensive (<$100) solutions are available using strong elastic straps that pull your foot up but still allows the flexibility to walk nearly normally. An example is FootUp by Ossur, available online in forms for use with or without shoes. (Note: after a year, I found that the Velcro was starting to fail. I got some Velcro “cable wrap” strips to use as reinforcements. With that, now on both ankles, they are still going strong and I never have gotten anything more expensive or harder to use.)
Personal Note from Mike Foxworth: In 2013, when I got really serious about Physical Therapy for my PN, I started working very hard on almost all the exercises. BUT I failed to grasp the significance of the drop foot exercises. I did not give them the time and diligence they deserve. Started tripping. Got a standard AFO. Hated it. Painful, limiting, hard to use. Made walking a dangerous nightmare. But I still didn’t do my drop foot exercises. Time passed and the drop foot got worse. NOW, I do my drop foot exercises every day and try variations frequently. I’m mostly keeping drop foot at bay. I don’t use my AFO. I hope I never have to.
I sometimes wish life didn’t keep throwing me these intelligence tests.
In June of 2018 I got an Ossur FootUp and my walking is much improved (or, at least, safer). I also found a YouTube video that showed a new exercise, where I use a cane handle to pull up the foot front and, isometric-like, try to keep it from falling back down. I also try to push down hard on my knees while raising my heels. Not sure why (no scientific claims here), but my foot strength (toe and heel raises) seems to be improving (from bad to less bad). My water aerobics partners look on in amazement as I am almost able to lift half-way up on my toes while half my body is supported by the water and I wildly wave my arms in my struggle not to fall backwards. I take little victories where I find them.