Foot Drop... Advice please

Everyday living
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Hi all,

Just wondered, I have foot drop, mainly in my right foot now, whereas it used to be my left but it has swapped or maybe the right is just worse than the left so I notice that more?! Just wondering does physio help and does foot drop ever Improve? I have googled foot drop exercises and am doing these twice daily, probably more, plus going on the exercise bike as I have read cycling is a good exercise for for drop.

I am also experiencing stiffness particularly when sat for a while… Once moving the stiffness eases but it definitely doesn’t help the foot drop…does physio help with this or is medication something that could help?

Lastly my left side was my weak side, however on holiday I noticed that whilst my leg is still slightly weak, it has improved somewhat, yet the struggle seemed to be due to the right side…is it possible it can swap in this way? Do you think this is due to the last 3.5 years of my right leg compensating for the failure of my left leg?

Thanks in Advance xxxxx

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Hi, I don’t think physio will help with footdrop! Have you heard of FES? It is an electrical stimulation device you wear in your shoe. It makes your foot lift to walk safely. It doesn’t work for everyone.

Different areas have different rules/criteria for who can have it free.

There are other walking aids. Ask your Ms nurse or neuro or gp.

Poll x

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Hi Lisa

Foot drop is a total bugger. As far as I know, once you’ve got it, you’re pretty much stuck with it, at least I’ve never heard of anyone getting over it.

I used to have one good leg and one bad. My left leg was a lot weaker than my right. Then I developed foot drop on my right leg, and that legs been the worst ever since. The proprioception on my left leg is still worse than the right (that is the sense of feeling, so when I have a neuro exam, when they bend toes up & down, stick pins in etc, I can’t feel it on the left side). But, my right leg is stuffed. Not only can I not pick up my toes, my right quadriceps and my right hip are lousy too.

So, over the last few years I’ve tried various ways of making the right foot work somewhat normally. The standard old form of foot drop correction is an orthotic device. So far I’ve failed to be able to use most of these. I’ve tried:

Neurodyn - a nylon type thing with complicated straps that kind of helped a tiny bit, but not much.

A standard cast iron (I think) orthotic that I couldn’t use because my heel was the wrong shape!! Known as an AFO (ankle foot orthotic).

A ‘foot-up’ which is a polyester/Velcro strap thing that wraps round your ankle and attaches to an insert that’s attaches to your shoe. It kind of works a bit, doesn’t do much for the upper leg but is a cheap lo-tech solution.

A SAFO, like an AFO but silicon that’s designed to fit your actual foot (via a plaster cast mould). It works OK, doesn’t fit into most shoes (unless you can manage to have one shoe 2 sizes bigger that the other!). But does a good job without shoes on (like in a swimming pool/hydro pool). Again does little for the upper leg. It’s not available on the NHS.

FES. As Poll mentioned, it’s actually a functional electrical stimulation unit. Electrodes stimulate the perineal nerve that runs for knee to foot. A switch tells a unit clipped to your waistband when to pick up the foot. They work pretty well. The nerve stimulation helps the upper leg a bit, and in fact you can get a dual unit to stimulate your knee (or in fact both legs if necessary). The problem is that financing FES is a postcode lottery. Many NHS areas (the CCGs) will not pay for it. There are several makes, even areas where the NHS will fund it, will not fund all types as some are more expensive than others.

There are other options I’m sure that I don’t know about. Other people will fill you in further I’m sure.

Get some help from your local physiotherapy department. See what help you can get. They have a tendency of not mentioning options to you, sometimes because they don’t know enough about the options. But it’s really important to get your foot drop sorted, to get some help before it gets worse.

PM me if you need more info.

Sue

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Definitely keep doing the exercises, because they will help you to keep what you have for longer.

The ingenious FES is the best solution I have found and unlike a traditional splint, will help build muscle strength. This guide is useful - https://www.mssociety.org.uk/sites/default/files/Documents/Campaigns%20resources/FES%20Campaigns%20Guide.pdf

If the problem is not too bad then a “foot up” might do the trick.

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Lisa,

i have had foot drop in my right foot for years.

for a while the “Foot Up” product was ok for me. Then as the foot drop got worse, I needed something more.

I got a SAFO in 2007 and it has been wonderful for me. It cost £700, so not cheap, but the first one lasted me 8 years and for me it was well worth the money. It has 3 Velcro straps; splash some talc on the foot in the morning; put on the SAFO, fasten the Velcro straps and that’s it for the day.

i’ve tried the FES a couple of times. Once before I had the SAFO and once after. Unfortunately both the FES did nothing for me.

A good physio should be able to determine if any or all of these , or some of the other products mentioned by Sue, will be of help to you.

Hope you get something suitable.

derek

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Hi Derek (& Lisa)

The problem for me with the SAFO (& I have got one, because I thought it might be a brilliant solution even though it cost £750), is that it doesn’t look very pretty and it basically makes your foot much bigger so shoes become a problem. The only shoes that I could wear with one relatively ‘normal’ foot and one giant sized, were old (therefore worn) Ecco velcro strap shoes. As a female, whilst I have altered my expectations as to how attractive I can look, I nevertheless have found it quite difficult to wears shoes with it.

In addition, just like the foot-up (and other more conventional orthotics) it doesn’t help with the failure of my upper leg to operate the knee etc. And, because I waited too long after foot drop had set in before really getting help with it, my muscles had just about given up. Which has meant that I wasn’t capable of giving the SAFO a really good go - on dry land.

Where I’ve found the SAFO to be invaluable is in water. For quite a while I was going to a hydrotherapy pool and using the SAFO in the water to walk. I’ve used it on holiday when there’s been a hoist at the pool for a similar purpose.

Obviously though, if I’d realised from the outset that I wasn’t going to be able to use it on a daily basis, I probably would have thought it too expensive and stuck to using the foot-up instead.

I am clearly not typical though. Essentially, I had a major relapse that robbed me of walking ability and as remission occurred, I wasn’t able to walk sufficiently to ensure the muscles maintained the strength to walk. So I’m now a person who essentially can’t walk, who uses the FES and a walker a few times a day to walk maybe 10metres each time.

This is why I urge you to get help with your foot drop early and go for the best solution to suit your needs that you can find. I had useless physio help and advice. The therapist basically delayed my obtaining FES by at least a year, and that was after I asked about it. At no time did an NHS physiotherapist or orthotist help with my foot drop, rather they hindered.

Sue

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Sue,

I haven’t found that the SAFO makes my foot remarkably bigger and I don’t have a problem with shoes. Yes, my shoes need to be a wide fitting and I tie the left ( non SAFO) tighter, but I can always pretty much get the type of shoes I want - although not always straight away.

As you’ve said, they’re not cheap, so unless you can trial one before buying, it can be an expensive mistake to make.

as I said in the earlier message, I used the foot up for a while but then it wasn’t giving me enough of a lift so I needed something more effective.

In all of this, a good physio is key.

A while back, MS Matters featured an article from a physio on foot drop and outlined the various ways of dealing with it. The SAFO wasn’t mentioned at all in the article, so I sent an email to MS Matters about this. I received a reply back from the physio saying she had never heard of the SAFO which flabbergasted me. Incidentally about 5 pages further on in the sales MS Matters was an advert for the SAFO.

Derek

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Thanks for all your replies… I had a feeling foot drop does not go, but I am hoping if I keep doing the exercises and keep myself fit, hopefully then it will be easier to cope with. Well I hope so anyway. Would a stick help for longer distances? Also I find it really weird that my usual bad side seems to have swapped to my good side…maybe years of over compensating eh, but still bizarre. My good side has actually improved. All this has happened since being on Tecfideria so hope this isn’t because of the drug but never heard that it could do this. Thank you again. Xxxx

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It’s mental when your good side swaps to be your bad side. It happened to me. My left leg was always my ‘bad’ side. That was the side that wouldn’t necessarily go where my brain was trying to send it. And what I have later learned is called proprioception was much worse on that side. Proprioception is about sensory reactions (I’m kind of struggling with how to define it but I’ll try), so on my left side, during a neurological exam, they ask you to close your eyes and say whether you feel a pin prick or whether your foot or toe is pointing up or down. I couldn’t then or now properly tell what was going on with my left leg or foot.

So my left leg still has dreadful proprioception. But my right leg is the really naughty one and has been for the last few years. That’s the side I have the foot drop on. And because the nerve conduction is really awful on that side, it’s also the side where my hip and knee don’t behave properly.

Obviously I’m talking about damage that has been years in the making. It’s not at all like yours Lisa. But maybe a stick might be a good idea or what you might find would make more of a difference is a crutch. I know the idea of that is anathema, but it’s actually not a progression. It definitely makes it easier to go further.

I tried to use a stick but imagine, you’re in a shop, you have a stick in one hand and stuff you want to buy in the other. You attempt to lean your stick up against the counter when you reach into you bag/pocket etc to pay, your stick hits the floor and you’re stuffed. Cos if you bend down to pick up the stick, you’ll lose balance and struggle to hold onto the stick/money/card/bag. Imagine instead you have a crutch that has a means of being held above your elbow whilst you carry on with your life. Less likely to be dropped. Also, many nicer crutches available than sticks. Look at https://www.coolcrutches.com/ or there are many other places.

Just my thoughts on what makes life easier. You could find that you’re still a long way away from either stick or crutch. I haven’t however, heard that people’s MS improves as such with Tecfidera. Possibly you’re actually experiencing very slow remission from an earlier relapse. It can take a really long time to get proper remission.

Sorry to blether on, I hope you’ll forgive me.

Sue

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