Physical Therapy Question

[calendulady]

 

Hi Friends -

 

I have a problem with my right foot (affected side) turning inward and rolling under. When I try to walk this foot drags somewhat and I seem to walk on the baby toe and outside edge of the foot. My orthopedic surgeon has warned me that this problem has to be taken care of soon, or else it will be frozen in that position for good.

 

Although I had my stroke nearly 4 months ago, it has been 3 months since I have had any physical therapy. Because I have no insurance and I haven't had my Medical Assistance approved yet, I am unable to receive any care or therapy at this time. However, my initial PT evaluation had ordered me to have an AFO (ankle-foot-orthosis) custom made, along with a toe spreader. The physical therapist is waiting for some kind of insurance, before we can start therapy. I have been told that the more I walk on this twisted foot, the more chance I have causing more injury. I have already aggravated sciatica on my left side from 2 herniated discs which require surgery - however, due to the stroke, I am not a surgical candidate at this time. Plus the doctor has advised that I have both foot appliances before I try doing too much walking.

 

So here are my questions Does anyone have an AFO? Does anyone know of any exercises that I might do to strengthen my leg and foot without actually doing any walking? The physical therapist did mention he could easily make the toe-spreader for me if I couldn't find one, but when I later called, he was no longer able to help me. So my third question is: does anyone know how to make a toe-spreader?

 

I apologize that this post is so long. I have lots of questions, so you might be seeing a lot more posts from me soon.

 

Debbie

[jriva]

 

 

Hi Debbie,

 

Do a google search for "toe spreaders." It will turn up lots of places you can order them on the net. I'm not sure if this is the type of toe spreader you're thinking about but they look pretty cheap to me.

 

Jean

[calendulady]

Hi, Jean - Thanks for the help.

 

Debbie

[shaylerobins]

Hi,

 

Do you live near a university or college that has a clinic? You may be able to get the neccarsy PT at a very reasonable rate. The rate is usually based on ability to pay. If you don't get some PT soon your condition will worsen.

 

In the mean time you can do some self help at home. Ask the therapist for some home exercises. Streching by Anderson is an excellent resource. It quickened my recovery. Also beginning yoga exercises are beneficial.

 

Best of Luck,

 

Shayle

[pprovost]

Hi Debbie!

I had a stroke over eight years ago and I still need my AFO. Your physical therapist should give you a home program of exercises to maintain the progress you made. i admit that I don't do mine regularly but I do walk as often as I can because I can do so safely with a cane and AFO. One exercise that I do if I am ill or just don't feel like going walking is sitting on my bed (or a chair) with feet flat on the floor, then standing up without letting my knees touch. This is something I can work up the number of repetitions until I go mental but it feels good and strengthens the quad muscles and abdominals too.

 

But most important do what you must to get an AFO if you need one because the last thing you need is to fall and break your ankle or worse your good side. Should you get an aluminum AFO with a stirrup feature that is attached to the sole of your shoe, invest in a consultation with a podiatrist in case you need an orthotic or arch support. I went through years of misery because this was not mentionned to me when I changed from a plastic AFO to an aluminum one.

 

I wish you luck and determination with this important part of your recovery.

 

best,

Pat

[calendulady]

Thank you to Shayle and Pat for your comments and encouragement.

By some miracle a physical therapist just opened a center in town. She apparently went to school with one of my husband's relatives and heard about my problems. We spoke to her today and I now have an appt with her on Thursday to discuss what she might be able to help me with until my medical assistance is approved. She said that she would provide me with a "generic" AFO for the interim. I am going to speak with her regarding a home exercise plan as well.

 

Debbie

[luckeelady66]

hi debbie, sometimes my bad foot will cramp up and want to curl in, you need to strecth your foot and ankle all the time, has a therapist or anyone shown you how? if not, stand on a bottom step of stairs that has a rail to hang onto with your good side, try to place the affected foot next to the other facing as straight foward as you can,and let your heel hang off the step, that will strecth your ankle& foot, try to hold it for at least 30 seconds, but a minute is better, and do that as much as you can through out the day, it really helps me....it also helps to massage both too........take care

[calendulady]

Thank you, luckeelady, for the exercise advice. No professional has treated this foot. I was discharged from rehab the day after this problem presented. They wanted to leave it to the PT, but PT didn't happen for 3 months.

 

I will try the step stretch - at this time my foot is trapped in this position and my balance is bad enough that I can't stand alone.

But I will try with the help of my husband.

 

Thanks, Debbie

[tom71]

Debbie,

Another way to stretch the heel cord is to place a book or 2x4 ( anything a couple inches thick) on the floor, and put the front part of the affected foot on it, while standing on it let your heel drop down to the floor while keeping the front of the foot up on the book you should do this while standing next to a counter top or table or anything sturdy you can use for balance, you should feel a stretch in the back of your ankle up to your calf I was told to do this as many times as I could during the day

God Bless,

Tom

[calendulady]

Hi, Tom -

 

I appreciate your suggestion. I will feel

much safer on the floor using a book, than standing

on the stairs.

 

My husband says "thanks", too. We are always looking

for some things we can do at home to help things along.

 

Have a good evening.

 

Debbie

[tom71]

Debbie,

You are welcome! I would do anything I could to help anyone in our situation

God Bless,

Tom

[thewizard339]

I threw away my afo years ago, but your situation is different. Unfortunately until the insurance situtation is cleared up the afo thing will not happen. That's what sux about our health care in this country. I have medicare/medicaid plus an hmo as a secondary insurance so I usually don't have too many problems.

 

You asked about exercises. stretching the leg muscles helps because it keeps the muscles from shortening. Weight bearing on that leg will help strengthen the muscles in the lower leg and help relieve the tone which is causing your foot to turn inward. But be very careful weight bearing without the afo. Have a caregiver help you. Also talk to a podiatrist about heel cord lengthening. I has that done back in '01 at it helped me out with the toe dragging and it helped my gait improve a little so now I walk a little better. But stretching everyday is VERY important!

 

Hope this helps.

 

P.S Remember, before doing weight bearing with out the afo get a caregiver to help you. I'd hate to see you break your ankle.

 

[Kriswal]

Debbie, Our PT is the best guy in the world and is using a toe spreader that you would use for a pedicure. Get it a drug store. Very cheap. I hope this works! Kris

[calendulady]

Kris -

 

Thanks for the suggestion for the toe spreader. I am going to

send my husband out to get one from the CVS down the street.

 

Debbie

Stroke Survivor 9/11/05 :forgive_me?:

 

[swilkinson]

Ray too rolls his right foot in, even with an AFO on the left one so he can't!!. The physio today said the problem is at the hip not the foot and needs a repetitive method of walking. So something like "move leg, turn ankle, foot down" said over and over each time you take a step. The foot rolled in could be a compensation for a lack of confidence in balance.

 

He also said that the best weight bering exercise is walking and has recommended that although it was orginally decided that Ray was not suitable for a rollator that I lease one and try it for a month or so to see if his gait becomes more even.

 

Ray is six years out from his major strokes, but eight months from his last one.

 

Sue.

[sharhonda]

 

 

 

 

hidebbie i have a suggestion for the toe spreader.you could get toe separators that you use for a pedicure tose are inexpensive and may be of som assistance to you

[arisaj]

PLEASE CHECK AROUND FOR A TOP- RATED PHYSICAL THERAPIST WHO SHOULD BE ABLE TO CUSTOM FIT YOUR FOOT WITH THE PROPER " AFO" designed specifically for yourINDIVIDUAL foot problem

[mljmsw]

Hi,

 

I have an AFO and have had several different ones since stroke 3.5 years ago.

 

 

Walking on your foot will also create bad patterns that will be difficult to unlearn.

 

Get your AFO made ASAP if you can.

 

Riding a stationary bicycle might give you the strength-building you want with minimal damage.

 

MyPT has warned me off walking with my bad patterns caused by pain.

 

 

 

I hope your medical assistance comes through soon. Therapy is very important for your recovery

 

 

mljmsw

 

 

[angb]

Debbie,

Hi! I'm Angie. I'm a 5 year stroke victor AND a physical therapist. Others had mentioned using the pedicure toe spreaders. That's exactly what I would recommend. I was on Medicaid and disability from 6 months post stroke up until this past fall (I'm now back to work). You should definitely lokk into medicaid. You should not be walking without an AFO because it can and will do serious damage to your foot/ankle. Keep trying to get back into PT. Look for someone who does pro bono or reduced fee PT. I look forward to hearing how things turn out.

 

Angie

[isokrzy]

Hello friend,

I've had two different types of AFO's cuz my foot rolls out same as yours when afo is not on, ut I kept reaking the plastic type so Igot this

fiberglass thing very expensive, but mdicare picked up the tab. I did just get a new type of AFO that is not as ridged as the one I currently wear so I train with it getting the flexabilty I need to strengthen, but not break my ankle It's called ctive Ankle, Active Ankle systems sounds like it may help you enough to get by I don't think it's to costly my rehab facility just gave it to me and said here try thisI have to web site for you so search out active ankle and see what you get Ipray it works for you. If you need further information just send me a P.M.

Kevin,

isokrzy