Circle Reading Hospital
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Stroke and Ankle/Foot Orthosis: Treatment Options
Stroke and Drop Foot: Information and Symptoms
When someone has a stroke, there is a varying degree of how that will affect them. It can affect their speech; it can affect their motor function, and some people will have a full recovery.
Some people will, unfortunately, end up with a level of motor function impairment and spasticity, which is increased muscle tone, and this usually occurs across the leg and the hand on the same side.
What can happen after a stroke is weakness across one side of the body; this means that the patient’s ability to function and to walk properly and easily is impaired. The level of impairment can be varied, but at a minimum, they may end up with a development of what’s called a drop foot.
Drop foot is where the muscles that are designed to lift your foot are weak. You will therefore drag your foot, which means you have a greater risk of tripping. You may also have weakness generally across your hip and kee, which makes your walking laboured and means you’re at greater risk of falling.
As an orthotist, my job is to assess someone’s walking pattern to try to understand the mechanical deficit that has occurred following the stroke. From both a clinical and an engineering point of view, I will try to prescribe devices that will improve the walking pattern.
The aim is to make the walking as efficient as possible and to improve the energy efficiency in how someone walks, so that they’re not having to exert extra muscles from different areas to try and cope with the fact that the leg is weak. I will also try to prevent muscles from tightening up in the wrong way, which can lead to further deformity.
These kinds of patients are sometimes given very simple devices when they are discharged from hospital; while these are, at the time, the most appropriate method to facilitate discharge, it doesn’t always mean it’s the most appropriate device to be used for walking long-term.
It is important that a patient that experiences a neurological condition affecting weakness on both sides is assessed by an orthotist.
I would first need to assess and understand where the muscles are weak; where the patient has muscle tone; understand the range of movement in the ankles, knee and hip, and liaise with the neuro-physiotherapist that may be working with them.
I then need to understand the patient and their family and understand my patient’s expectations: i.e. walking on uneven ground, walking on sand etc. With that information and the clinical assessment, I can then formulate the right prescription of an ankle/foot orthosis. There is no one device that is appropriate over the other, and it is incredibly important that the patient understands that an ankle/foot orthosis is only correctly prescribed by an orthotist.
In an ideal scenario, the orthotist will communicate with the neuro-physiotherapist before prescribing an orthosis, too.
It is often feared that these kinds of things are very expensive, but I would always encourage the patient or a family member of the patient to connect to understand what the likely costs are. Patients are often surprised that things are not as expensive as they once feared.
Once the correct splint has been fitted, the patient will need time to get used to wearing it and will often work with their physio to get the best possible walking pattern with it.
It is usually a good idea to have a review once the patient has had time to wear it so that a discussion can be had regarding the pros and any cons relating to its use. It is also an opportunity to have further review discussions with the physio, as to the walking pattern and any areas where there might be an opportunity to improve things further.
Most patients are advised to have a review appointment every 12 to 18 months to review their walking pattern and if their goals or presentation has changed. This is especially important over the first five years after a stroke.