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Hello. Hello and welcome. Thank you so much for tuning back in. Today we're going to be talking about foot drop and specifically why it's happening. If you have ever caught your toe on the ground while you're walking, or shuffled your feet or had a near fall while walking, so you almost fell but you caught yourself. Foot drop or drop foot might be part of what's going on. And what I have found as an Ms. Specialized physical therap therapist is that there's a lot of people who have foot drop, maybe mildly, maybe severely, and they don't even know that that's what they have. And today what we're going to be talking about is what it is and why it's happening. Because if you can understand why it's happening, then it's so much easier to start seeing improvements because you're doing exercises for the reason, the cause, the culprit of why this is happening to you. And I will also be mentioning a few different things like exercises or braces that can help if you are experiencing foot drop. The big question is, how does someone
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with Ms. Actually improve their mobility, strength, energy independence, the list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple sclerosis specialist. Welcome to the Missing Link podcast. Tune in as I share the top strategies and exercises to help you gain control over your life with Ms. Using research driven insights and advice from top industry experts. Whether you're newly diagnosed or have had Ms. From over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode. Ready? Let's dive in.
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Let's just dive right into. What is foot drop. My simple definition is that you have difficulty lifting the foot front part of your foot so your toes and your midfoot when you're walking. And what that results in is stubbing your toe or catching your toe or shuffling gait or there's this phrase called foot slap. And you'll know you have foot slap because you can hear your foot slapping the ground with every single step that you take. You might notice step scuff marks in the front of your shoes where your toes are. You might notice that you are tripping over the front of your shoe or that the front of your ankle muscles are more sore than they used to be. All of these are signs that you might be experiencing foot drop. Additionally, your walking might have changed. Specifically, you might be swinging your leg around more. This is called hip circumduction. Or maybe you're hiking your leg up more. This is called hip hiking. Those two things can happen when you're not lifting your ankle as much. So lots of different ways. But if any of those sound like, yeah, I think I do experience that, then you might be experiencing foot drop. The reason that I think it's so important to identify this specific, specific symptom as it relates to multiple sclerosis is because it can significantly increase your risk of falling. And it really boils down to two things. Number one, the clearance, the ability of your foot to clear the ground so that you are lifting it high enough where you're not catching your foot on the floor and tripping or falling. And then secondly, the timing. So your foot needs to lift at the appropriate time in your gait cycle or your walking cycle. So if either of those two things are off, if you can't clear your foot enough because you can't lift it high enough, or the timing of lifting it is off, you significantly increase your risk of falling and or tripping. So let's walk through a few of the most common reasons that foot drop occurs specifically, specifically with multiple sclerosis. The number one cause that I see is weakness, specifically weakness in the front of your ankle muscles. These muscles are called either the tibialis anterior or anterior tibialis. The peroneal muscles are. Or fibularis muscles are on the outside, but these are the muscles on the front or front outside part of your ankle where their main job is to lift your foot up top your forefoot. So if you are sitting on a chair and your feet are flat on the ground and you attempt to keep your heel down but lift the rest of your foot, those are the muscles that we're talking about here, those anterior tibialis muscles. You need strength in these muscles to lift your ankle up. And multiple sclerosis, as we all know, causes demyelination, which, which can make any movement more challenging or it can make a movement not possible. We are able to rewire our brain and find a new way to make it possible. That's what neuroplasticity is. We've got other episodes on that. But if you have weakness in the front of your ankle, we've gotta strengthen your ankle. We'll get to that in a bit. Another reason that is really common for people with Ms. Of why your foot drop might be existing is tightness in the back of your lower leg. So your calf muscles. So the first one was weakness in the front. This second one is tightness in the back. And with multiple sclerosis in particular, this can be a really common area for spasticity or muscle cramping or tightening. But when your calf muscles tighten it, it pulls your foot down and it pulls your heel up, toes down, which is the exact position of foot drop or foot scuffing. So if you have tightness in that area, then the solution would be stretching that area again. We'll get to that in a second. The third reason that you could have foot drop, and this one is not discussed as frequently, but it's the same sensation, or lack thereof in the bottom of your feet. Our whole body has sensory stimulation, meaning we can generally tell if something is hot or cold or sharp or dull. We can feel things that touch us. But as you might know as someone living with ms, that can change with multiple sclerosis. And it's very possible that you might not be able to the bottom of your foot as much as your other foot or as much as you used to, or maybe not at all. Or it's very limited. If you can't feel the bottom of your feet, and therefore you can't feel your shoe or you can't feel your sock or the ground, that is going to significantly impact what your foot does while it's moving. If it doesn't know where you are in space, if it doesn't know that you're supposed to lift your ankle at this time, then, then it's not going to. So the solution for this would be improving the sensation in the bottom of your feet, which we'll talk about in a second. And last but not least, the fourth major reason for foot drop is lack of range of motion. Range of motion is more specific to your joint. It's less about your muscles, so it's less about weakness or tightness, and more about your actual joint, the bony alignment of your ankle. If your joint is very stiff and rigid and you can't move it up and down even when your ankle is fully relaxed, or you can't roll it in a clockwise or counterclockwise rotation, that again can significantly impact how your foot is going to move when you're walking. So we want to work on ankle range of motion in addition to these other culprits, if that is something that is causing your foot drop. Now, other factors that are worth mentioning that also contribute to foot drop, these aren't main culprits, but they are things that play a role are things like spirit speed. So our ability to move and use our muscles at a faster speed. The faster you walk, the less time your muscles have to lift and the weaker muscles often can't keep up or balance. If you are unable to balance long enough for your leg to lift your ankle, then your foot drop is more likely to be present or stamina, or sometimes called endurance. If your ankle muscles do lift, but they fatigue quickly, which is very common in ms, then your foot drop is going to kick in sooner. You might notice this if your foot drop is fine for the first five, 10, even 15 minutes of walking, but then after the 15 minutes or whatever it is, then it kicks in. It could be a stamina or endurance issue. It also could be a a heat intolerance issue. When we are moving and walking, even if it's in cooler months, it increases our core temperature. And when your core temperature increases, any symptom can worsen, including foot drop. So if you don't notice your foot drop for the first several minutes or length of walking, whatever distance that might be, but you do start noticing it, eventually, it could be a heat intolerance issue. So there's lots of additional things at play here. These are some of the most common things to be thinking about and what we think about in the missing link as we are suggesting exercises and strategies based on what's happening specifically for you. So as we move on to talking about what can actually help, like, great. We understand hopefully now why this is happening and what might be happening in your specific situation. Now, it's also important that we're trying to reduce foot drop. So what can we do? I often like to use a cane. It just seems to have a really great place for your foot to relax and for you to use your arms to help pull towards you. So again, your ankle is trying to stay relaxed and ideally you'd be feeling this stretch somewhere on the back of your calf, anywhere from your heel all the way up to behind your knee. The third culprit was sensation. So my favorite tip here is to use a tool to help. So. So I really love the company called Naboso. They have insoles, specific ones called neuro insoles that you can put in your shoes. And they have tiny little pyramids all over the insole that allow you to help feel your feet more. If you can feel your feet more, the more your foot can do what it's meant to do at the right time. You also can use some desensitization exercises. We have a different episode and conversation about that, but essentially you put your foot in a bag of dried rice or dried lentils and you just move it around. We're trying to Desensitize it and wake up the sensory neural pathways. You also could take your shoe off or your sock off and just use your fingernails, tap the bottom of your feet. We're trying to wake up those sensory nerves. And if the fourth culprit felt true for you, which is the ankle range of motion, so the joint, one of the best things that you can do is have your leg sitting on top of your opposite leg. So you're in this Figure 4 position where one ankle is sitting on top of the other knee and then you're just going to grab with your hand, your foot. I like to grab around my forefoot and move your ankle around. You might have to use your other hand to hold your leg. On this leg that you are trying to relax, the ankle should be completely dead weight. You can roll clockwise, counterclockwise, up and down, and you're applying a little bit of overpressure in all of the directions. Because we're trying to improve the joint range of motion. There's also other things that we can do that are not exercise related, such as AFOs or ankle foot Orthoses. We had a somewhat recent podcast episode all about the differences between AFOs and ankle braces and which ones do what things. So I will link that down in the show notes and description so you can check that out. But essentially it's a form of a brace that either holds your foot in a specific position or assists your foot in lifting. You also could use support from things like electrical stimulation. We have an upcoming podcast episode on electrical stimulation and what it is, how it works, different examples out there. So once that has been posted live, I will also share that link in the show notes and description as well. Essentially the way that it works is by stimulating the nerves that we are trying to strengthen. So it helps you with lifting your foot. And I just want to remind you that using tools or devices, mobility aids, like these things that I've mentioned, like the insoles, an afo, an ankle brace, electrical stimulation, those things ideally are always done along with your exercises. You never want to use a supportive tool on its own own without also pairing it with the strengthening exercises or stretching or whatever the culprit was for you. Unless your goal is just to improve foot drop in any way, shape or form possible, not necessarily by improving your strength or your flexibility. If that's your goal, then I suppose you don't need to pair the two. But 99.9% of the people that I work with, they're looking to improve their strength and they're looking to not become dependent on AFOs or ankle braces or electrical stimulation. So if that's your goal and you want to actually improve your muscles, not just depend on a tool, then you should always pair your exercises strengthening, stretching, et cetera balance with these tools. There are also shoes you may or may not know about Cadence Sneakers, but Cadence Sneakers are specifically built for people with foot drop. I'm a big fan of those. Again, especially when paired with your exercises. The whole goal is to keep you moving safely and confidently while also building the underlying strength that you need to see lasting improvements. So if you do have foot drop and this really resonated with you, then just know that the exercises that I mentioned here are the exact type of work that we do inside the Missing Link membership. Our members get Ms. Specific exercises and programs and calendars that target specific symptoms like ankle strength and gait, balance, endurance, etc. Etc. Outline specifically with which exercises to do each day and with demonstrations so that you understand exactly what to do, how it should feel when you're doing it correctly versus incorrectly, ways to modify and if you aren't feeling it in the right place, how to modify so that you do start feeling it in the right location. So if you are looking for that level of guidance and structure and support, especially because Ms. Is so different for every person and each day or each hour can be different, then you might want to check out the Missing Link. Our newest feature is Dr. Gretchen AI which allows you to put in your symptoms and ask your questions 24 7. I have trained it in all of my knowledge possible so you're able to ask the AI version of me your questions. You if you don't prefer that option. We do have monthly Q&As as well where it's actually me answering your questions. So lots of ways for you to get the support and guidance that you need. If that does sound like something that you are interested in, I'll put the link down in the show notes and description so that you can see what the program entails and if it's a good fit for you and your goals. And just to recap, Foot Drop has real explainable causes and culprits and I personally think that's really motivating because it can give us real actionable solutions when you're aware of what it is that's causing it. And the fact that you're learning about this right now means that you're already doing something right. The more we can become aware of what's happening to our bodies and why it's happening and that can then lead to a solution. The better off we're going to be. So thank you so much for tuning in today. I hope you found this helpful.
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Thank you for listening to today's show. I am so grateful to have you as a listener. If you'd like extra resources such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your questions, head to missinglink.com insider. That link will be shared in the show notes along with links to my social media handles. If you loved this episode and think a friend or family member with Ms. Would benefit from listening, please go ahead and text or email this podcast to them right now. Share Sharing this podcast will help me educate and empower as many Ms. Warriors as possible. Thanks again for joining and be sure to tune in next week for another episode of the Missing Link podcast.