spastic gait, walking on forefoot/toes

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Kristina1

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The main reason I use a walker at home, wheelchair out is my spastic gait makes walking very difficult and a huge fall risk. My spasticity is such that I can't put my heels down when I walk, I walk on the front of my feet, almost on my toes, and put my weight on the outer sides of my feet.

At this point my neuro said my left foot is turning inward when I walk. She has my husband doing stretches with me, and I'm on baclofen. When PT came out she said I could wear leg splits at night, but I already have hand splits and biPAP the idea of leg splits makes me feel claustrophobic like a mummy. She also said we can look at AFO but it doesn't sound very comfortable. Thoughts?
 

Nikki J

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My afo is pretty comfortable.

My sister had inssues with her foot twisting of alignment getting it back into position so it would be ok for transfer took a lot of work including wearing a very uncomfortable splint. Act on this aggressively now so it doesn’t go there. Ask them for their most experienced orhtotist
 

Doglady

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My AFO is also pretty comfortable. I use it daytime only And ha e struggled to find a nighttime solution. Tried many options that just keep me uncomfortable and awake. But my clinic PT says keeping the foot up is important to prevent contraction. The style of AFO that I got doesn’t totally prevent ankle twisting though. Hope you can get one made for you that is comfortable and does what you need for safe walking.
 

ShiftKicker

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Kristina, has anyone spoken to you about botox? It may not be feasible, depending on the muscles involved and if it could create too much weakness for weight bearing, but can help prevent contracture.
 

Idaho2790

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I have an appointment for AFO next Tuesday. Is there something I need to know before I go? My right foot almost kicks out when I walk. I use a walker because of it, but have no idea whether one wears it 24/7 or daytime only. Is that something that is decided by the neurologist? Or the firm I am seeing next week?
 

Nikki J

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If it is an afo as opposed to a positioning splint you wear it while you are up.

If your leg is kicking out to the side/ making a kind of circular swing? that is compensation for drop foot.
 

Idaho2790

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Thanks, Nikki. I have the order to take to the people who will make it and it specifically calls it an AFO. My PT at the ALS Clinic has told me to walk with my heel hitting the ground first. I try that, but it doesn't always cooperate, lol! This firm has wonderful reviews, so I'm looking forward to meeting with them.
 

Kristina1

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Thanks guys. So to clarify, does AFO actually help with preventing contracture and keeping heel down when walking? I thought is was more for sort of the inverse of my problem- isn't drop foot a weakness thing not a spastic thing? It's confusing to me what exactly drop foot is and if I have it. I know you can test by walking on heels and toes-- I cannot walk on my heels at all. But I can walk on my toes...or my forefoot (kinda the same thing?) and as my post describes, that's part of my problem, I'm often so tight I can *only* walk on forefoot.

Sometimes I feel like my neuro and PT just follow an ALS checklist instead of really diagnosing issues as they come up...like any kind of ankle issue- time for an AFO and let's call it drop foot because that's what happens in ALS. Meanwhile I'm sitting here not convinced that's what's actually wrong and no one bothers to explain clearly to me what is happening to ME using MY BODY in examples to explain the diagnosis. Instead it feels very copy-and-paste generic-ALS. Not sure if this little rant makes sense lol it's hard to explain.
 

sassy

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Not to be funny but my husband's AFO is the best thing we own....he is able to walk on his toes but not his heels. Without the AFO, he trips when he turns....and has fallen twice lately without it. He said he feels more stable with it on and doesn't lift his leg so high when walking to compensate for the foot drop.

Sassy
 

KarenNWendyn

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My AFOs are comfortable and I am unable to walk without them. My foot drops are floppy (flaccid), not spastic, however. That is, if I were sitting barefoot on a tall chair, my forefeet would flop down, and I would not be able to raise my feet at the ankle joints. Nor can I stand on my toes.

I think Kristina is asking what if the foot drops are spastic rather than flaccid, would AFOs help?

I think they would help to prevent worsening of the contractures where the toes point down below the level of the heels. But this assumes the contractures can be reduced enough so the foot can fit into a shoe with an AFO. The AFO would keep the foot steadied at a 90 degree angle to the lower leg.

Significant physical therapy with range of motion might be needed to reduce the contractures so that the feet can be placed in AFOs, and in extreme cases, it may not be possible.

Hope this makes sense.
 

lgelb

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Kristina,

Not knowing whether you are using shoes at home, if the spasticity is driven by a certain foot position, you could consider insoles that either lower the heel, thereby relaxing the calves a little, or the opposite, to let a higher-wedged heel absorb more of the force of your step for more stability. You could test if either one might help by using wadded up pantyhose, foam or tissues in your existing shoes or slippers.

If the purpose of the proposed leg splints at night is to stretch/relax your lower leg, you might be able to use a fabric tie looped around both pressure boots like Prevalon for a kindler, gentler splint.

You can ask for a podiatry referral if cut-and-paste is not working. S/he can look at your feet at rest/gait from a mechanical standpoint, since, as you say, the problem is high rather than low tone.

Best,
Laurie
 

Idaho2790

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It just occurred to me that I have no idea what an AFO is! Does it go on over your shoe? Is it worn instead of a shoe? Do I need to buy a special shoe that will accommodate the AFO? Almost every day I realize that there is something coming that I know nothing about!
 

Nikki J

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Ankle foot orthotic. Generally it goes inside your shoe. Mine needs a removable insole on top of the afo footplate I needed different shoes because of this but I would have anyway. I had to get a full size larger and much wider. I was recommended new balance and they do work well. I searched for a decent shoe that I could wear with a skirt. They were all hideous and not that comfortable but if you are desperate for an event like a wedding propet was the best I found.

Everyone says hang onto your nice shoes for when you are fulltime in a chair.
 
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