Foot drop - or drop foot as it's also known - is a rare condition that few people have any real knowledge or understanding of; save for sufferers, or those working in medicine.
Until I suffered a serious knee injury, which also permanently damaged a nerve, I too had never heard of it; and I am quite versed on medical conditions as I deal with medical law in my career.
The reason I wanted to write this blog was twofold - firstly, to raise awareness for those who are not in the know; secondly, to help others who are suffering with this life-altering condition. Both sufferers and sufferer's family - I welcome you to contact me.
PLEASE NOTE: I am not medically qualified, and you are not to take the advice in this blog as medical advice. This blog is about my experience and how I have been affected by foot drop. Please do not rely on my articles as medical advice at all, but as simple guidance based on my own experience. Sorry to be a bit formal in saying this, but I don't want anyone to get hurt by trying to follow what has happened to me when it isn't appropriate to their situation.
I won't be waxing lyrical about the medical science of the condition. I want to focus on how it affects people.
I can give you first-hand experience of this as I'm a foot drop sufferer myself. Mine is permeant with no chance of recovery, and it's 'full' in that I have complete peroneal nerve palsy, and therefore complete foot drop.
The peroneal nerve is the nerve that I damaged when I suffered a sporting injury that saw practically all my knee ligaments ruptured. The peroneal nerve runs through the knee joint and unfortunately got caught in the crossfire.
The nerve was stretched like an elastic band. Nerves, in case you're wondering, are not supposed to stretch and be elastic. As such, the nerve was damaged beyond repair with the inner fibres rupturing / splintering with the force of the stretching.
There is one only option for recovery - a sural nerve graft. Sadly, chances of a decent recovery are (from the last time I checked) in the region of about 8% - yes, eight percent. In my view, it hardly seems worth it.
The procedure is usually performed by a plastic surgeon who will take sections of nerve (sural nerves) from the back of the leg and ankle and then "bridge the gap" of the damaged section of nerve by removing and replacing it with the healthy sensory (sural) nerves.
Ultimately, as my surgeon reminded me, nerves "don't like to be disturbed" and so any nerve injury can easily be permanent. I was discharged a few months after my operation with the unfortunate news that the operation was not successful, and that there was nothing more than can be done for me.
What is foot drop / drop foot (briefly)
It sort of does what it says on the tin. It's the inability to raise the foot. If you place your foot on the ground, you can lift it upward. Foot drop sufferers can't do that. We can push down and move the foot to the right a little, but that is, in practice, fairly useless.
When you walk, your foot raises and then plants on the ankle and gently descends flat. This is a part of the natural walking gait. A foot drop sufferer will have to raise the foot with the knee and then 'slap' the foot on the ground because we can't plant the ankle on the floor. You can "throw" your leg with the knee a little which can allow for it to be easier, but, all in all, you will limp.
How is foot drop managed?
The condition is managed using splints and braces, usually referred to as an AFO (Ankle-Foot Orthosis). The NHS - through occupational therapy - will normally furnish you with a brace or two; but, to be honest, you're better off going online and buying your own in my opinion.
I was given the standard plastic one you see sticking out my boot in the image at the top here. I was then given the "Blue Rocker" AFO which is probably the worst one I've ever used. It's bulky and metallic, uncomfortable to wear, and you're literally standing on a metal in-sole. I cannot recommend enough that you avoid using it.
The plastic ones are OK, but can also be uncomfortable. I will blog again about my experiences with foot drop splints in a separate post, so if you want to know more about them, I'll try and get one uploaded soon.
How do AFO's typically work?
Usually they keep your foot at a 90 degree angle, meaning the foot is fixed in a better position for walking. You still need to use your knee to move the leg, but you won't be slapping the foot on the ground. Keeping it at the 90 degree angle allows for the ankle to hit the ground first rather than the base of the foot which happens when the foot cannot be raised.
You will still limp, and the foot will "plant" quite harshly sometimes, but the primary point of splints is to stop you tripping. Since the foot is always pointing downward, you trip on your toes. With it being at a 90 degree angle, tripping is vastly reduced. In reality, splints are pretty much designed for that purpose.
Life with foot drop
It was hard hearing the news that I'ill never walk properly again (or at all) as a young man in my mid-twenties, with a whole life ahead of me, and having been active in various sports like football, rugby, and rock climbing. I always hoped that I would be one of the luckily ones who would see a decent recovery. I never stopped wishing for it, and I knew I was fortunate enough to have a fantastic surgery team. But the operation failed, and now I have to live with the condition for the rest of my life.
I will say at this point - which I mean from the bottom of my heart - it could be worse. In no way am I taking away from the seriousness of this debilitating condition, but I can walk. It's painful, awkward, and I limp; but I can walk. The first thing I would always ask a sufferer of foot drop to remember is this very important fact.
It could be worse. If you can at least walk, and you have your mental health, be thankful.
But that doesn't mean it's easy. I can't play sports anymore. I can't properly exercise with impact cardio (like running) anymore. I used to rock climb - and I can't do that anymore.
There's a lot I can't do anymore, and it does get me down on occasions. I had a dream that I was playing a game of rugby the other day, and I woke a little upset, knowing that I can't do it ever again.
What are the worst things about foot drop?
Walking around isn't easy. Stairs and even turning corners can be hard as you can't use the ball of the ankle to move the foot around. The limp can be annoying, but the medical concern with it is that it can cause arthritis in the knee: possibly in both knees with the added stress on either side. The opposing hip can have problems because the natural (and unstoppable) overcompensation on your healthy side will likely stress the hip. Future hip replacements are common. Finally, the spine can be misaligned through the overcompensation on the healthy side as well.
Sorry if this scares you, but the health issues are said to be more of an issue when you get older. I was 25 when I suffered my accident, and four years on, I do get back and hip pains; but I'm not by any means suffering so badly from the back and hip that it's a massive issue.
One of the main things I hate about the condition is, oddly, the mental side of it. It took me a while to adjust, and I accept that I went through a rough period emotionally when having to deal with it all, and deal with the truth of how things would be in the future. I don't care at all that people stare at me when I limp, or stare at my brace if I wear shorts. It's not vanity that is the issue. The issue now is thinking about walking.
I spent 25 years of my life never putting a second thought in to the act of walking. It's natural. Now, I can't walk a few paces without thinking about walking. Again, it's not about worrying what other people see - like I said, I couldn't care less. But I can't just walk around without being conscious of the act of walking. It really bugs me.
I assumed it would go in time, but I'm starting to accept that it might not.
How will my foot change?
You have to be really careful in the initial stages to make sure the foot is always kept in a splint. You should be provided with a night splint (a big, ugly - but rather soft - blue splint) and you must keep this on for a while. Because the foot is pointed downward, the Achilles tendon can shrink (in a matter of days) meaning the foot could end up fixed in a downward facing position. This can make walking extremely hard.
What needs to happen is the muscles and tendons on the top of the foot to shrink before the Achilles tendon does. This will not mean your foot permanently points upward, but it will stop a small degree of the downward angle. This is fine in my opinion, and you will of course lose practically all muscle mass in the shin area and the ankle and the top of the foot. They're no longer in use - so muscular atrophy takes place.
You won't be able to feel the top of your foot either, and the side and ankle areas will end up numb if you have the sural nerve graft. It's hard to explain the inability to feel; when you touch your skin and it's just permanently numb. The sensory loss is, of course, the least of your worries though.
What things can I still do?
It's not all doom and gloom. Like I said earlier, be thankful you can still walk!
I was fortunate enough to have suffered it on my left leg, so I drive an automatic car where I only need my right left for the gas and brakes. If you suffered it to your right leg, I don't know how to address that to be honest.
Cycling and cross trainers are good for exercising. The issue is with impact cardio - i.e. anything like running where the foot will be lifted and then hitting the ground. That's the dangerous area which can easily cause re-injury and serious damage to the knee and ankle. However, with cycling and cross trainers, the foot remains planted on a pedal, so both are great for trying to keep in shape.
Will you ever be the same again?
To be perfectly honest, no. It can be hard to understand just how bad it can be for a non-sufferer, but it's bad. Prepare yourself for a lot of adjustments, and understand that it can be a very difficult condition to cope with. But I'm writing this because I want to help people and connect with people who also suffer with the condition, and I want others to know that you're not alone. It's bad, but it's not the end of the world.
I'll blog more about this, but I hope this has helped to give you some insight in to my experience so far. I know I haven't given you any good news as such, but the main point of this is to remember the salient fact that it really isn't the end of the world. I can still work and function almost normally; I just limp and suffer with pain. So, you'll survive - trust me! But it's one hell of a ride, and if you don't want to go it alone, please, please, please contact me.
Although I wear my heart on my sleeve, I'm instinctually prone to keeping things to myself, and I went through a really rough patch in the initial phases. No one understood what I was going through, because it's such an unknown condition. But work with your medical team and rehab team, and you too can make the best recovery you can.
Put it this way: my surgeons told me that the biggest part of the recovery process was the amount of work I would put in to the physiotherapy. It was true. When I was discharged from physio, my personal physio (who had been great) challenged me to try and jog. So I did. And then he called some of his supervising staff to watch me, and they all looked on in awe as I managed to jog up and down the corridor.
Don't get me wrong; it was by no means glamourous! But I could jog. It's not really recommended, because impact cardio can be dangerous, but I managed to do it. And a senior physio simply said something to me that I'll never forget for the rest of my life:
"You shouldn't be able to do that."
Well, I did!
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