♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(Bob clapping)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Yeah, we are the most famous
physical therapists on the internet.
- In our opinion of course, Bob.
- And we have the best three foot drop tests
and a how to walk normal again.
So this is after a stroke, or nerve damage,
or what else Brad?
- Right, you could just have weakness from a injury,
you know, if you, car accident,
maybe injured your legs in a.
- Neuropathy would do it. - Yeah, oh there ya go.
- There's lots of ways you can get foot drop.
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- All right Bob, so we talked about the foot drop,
the common causes, and I don't know,
I think I probably work with it most with stroke people
but I've certainly worked with it with people
with a back injury.
- My mom has it. - Yep.
- And she had nerve damage - Sure, sure.
- from a back injury, yep.
- So, if you think you have it,
one of the tests is very simply, when you're walking,
if you find that foot, like your toe catches,
and you're stumbling and you can't figure out why.
I have a pair of shoes that does this.
I'm pretty sure I don't have foot drop,
but for some reason,
I'll do that every now and then.
But if you find your foot dropping
or like you're gonna fall
'cause your foot catches on the floor,
that's the sign of foot drop.
Then you should go to one of the next tests.
- Well it could also be a foot slapping.
- Oh, sure good point.
- You might hear a sound on one side,
kind of making the sound
- Right. of a slap on the floor.
- Yep.
- Just on one side.
- Just on one side, right.
- So I'm gonna...
- demonstrate one of the tests
- Yep, the first one.
And this is what tests that they use all the time,
you go to the doctor, even at a general physical,
they'll say, "Can you walk on your heels?"
- Yep.
And what they're looking for is anterior tib,
which is L5, is that correct?
- Sure. - Yeah.
One way or another, it is a test.
Now if you have foot drop, the strong leg,
if your left leg is strong, it'll be fine,
and this one'll kinda fall.
I've just worked with someone just like this
that couldn't hold that toe up.
And that's a pretty positive sign.
- Were they surprised?
Or did they know it?
- Well, there was a lot of other issues going on,
so it was kind of, - Just a minor
- Yeah, it wasn't surprising to me.
- Sure.
- And I didn't. Yeah.
- But I was just saying, 'cause I had a patient who,
I mean, he was a runner.
- Yeah.
- And he had foot drop and he didn't know it.
I mean it was really surprising to me.
- Compensating very well then. - Right, right, he was.
- The third test,
is a simple manual one. - So the first test was
hearing it or seeing it. - Yep, just watching someone
watching yourself. - Catching yourself.
- Yep, is your foot dragging, are you slapping?
And then do the heel walk. - Sure.
- And then number three, is a manual muscle test,
that all therapists are all familiar with,
but it's simple enough I think.
- Yes. - Anybody could do this.
- Have somebody, a friend or a partner there,
- Yep.
- That's gonna have to... You got some weird color socks on.
- I gotta go to work Bob,
I couldn't put my nice fancy ones on.
- So you're gonna have, yeah. - They're gargoyle
- look at that.
- Yeah, argyle.
- All right so we're going to go ahead and he's going to
take his toe and bring it towards him.
- Right, so I'm going to pull it up as hard as I can.
I'm going to hold it.
- And I'm just going to go and pull on it.
And this is a strong muscle normally,
so you can pull as hard as possible and if it holds,
it's doing fine.
- Right.
- If you go like this and it gives way, there's a problem.
- And it may be a partial thing,
maybe they can't even do this, - Why?
But they may be able to get it up.
But when you pull, it breaks.
- Yeah, it breaks.
- And it should be equal on both sides.
- Right, they're not able to hold it.
- So between those three tests,
I think you get a fairly good, this is not one of those
proud things well you're going to have to be a therapist
to figure it out. - Right.
It's pretty clear between those three
I think if you're positive on all three.
- And you might have some numbness
and tingling along with it too.
- Right, yep it'd be indicative of nerve damage.
- Sure.
- So how are we going to treat this?
We got to work on getting the anterior tib muscle,
right here get those socks out of the way.
I shoulve known better today.
Anterior tib muscle that pulls that up,
which is right there.
There's a lot of different ways to treat it.
As a matter of fact I'm not going to go
through a lot of them, just one.
Because it's my favorite way to do it,
particularly with stroke.
We've got someone right now, he's had a stroke
and we're using it with him
and it gets him to walk normal so that he can walk normally,
doesn't compensate.
- And you're hoping then that other parts of the brain
will start kicking in - Right.
and helping out and learning to hold that foot up.
- There are just strengthening exercises
and if you go, we've go got a video
just for anterior tib strengthening for foot drop
and it's called, if you Google Bob and Brad,
10 exercises for foot drop,
that specific video should come up and you can view that.
This is on there as well, at the end of the video.
- So he's got a big length of what we call
TheraBand or exercise band.
- Yip, it won't work very well with tubing,
you should have the flat band.
- Sure.
- You could try it with tubing but it won't work
on the foot as well. - And you can get this
- on Amazon.
And then extra lengths. - Yeah, if you can get it in
- lengths.
You should get, bought 10 foot length.
Cause it needs to be about this long when it's slack.
And you're going to take it like this,
step on it in the middle on the forefoot,
not on the heel,
but it has to be over the forefoot,
over the toes,
put a little stretch on it, cross it once,
cross it twice.
it works better if you cross it twice.
And then get the cross down by your foot.
As you can see I'm down there.
And then, this is the hard part.
Sometimes you may need help doing this,
going behind your foot, you cross it behind the leg,
actually but just below the knee level,
and then you're going to make a cross in front,
over the quadriceps.
So you're going to pull it, not real tight, but snug.
It should feel snug.
And then from here, you cross it there.
You've got to go between your legs, around here.
Oops, I'm sorry, we don't go between the legs,
we go over the hips. - Over the legs.
Sorry about that. - There we go.
I'm a little nervous you know its my first time on camera.
(laughing)
And so you can see what the back looks like.
And you go around, and this is important
that we get the pressure on the thighs.
And if you can get this to come up
over the hip a little bit, that can help start
give the hip flexors some indication to work.
There we go.
And don't tie this real tight like a big knot,
because you got to get it undone.
- Yeah, and you'll be difficult to get undone.
You'll end up cutting it off.
- (laughing) Exactly.
So what happens here is
everything works together, helps get the quadriceps going
as you step through, it pulls up the toe
to help that dorsiflexion.
And the gentleman that we've worked with,
he's really dragging his foot.
We've put this on him and all of a sudden he's, well
he's not perfect normal,
but about 80% improvement with this.
- Are you getting some help with your hip flexor too
with this?
- Yeah, I think so.
It's probably not as much, but that's why
you get as much as you can. - Yeah, I was going to say.
- So what I'm saying is it's helping
lift the leg up like this
and Brad saying yes, right.
- Yes, and this one is the key one for that coming up,
that's why you want to over that
pack as much as possible. - Over the front of the, yeah.
So obviously you're not going to wear this all the time,
but it's a good way to get started.
- It's a good training tool.
And again remember safety first
always on these things, make sure if you're unstable
if you have somebody as a belt on.
- Right, not doing this by yourself.
So if you work this and you're working other exercises,
to strengthen that tib.
And if you're doing it for probably four to six weeks
and you're not gaining anything and maybe longer than that,
you may need to get an AFO.
And typically a custom AFO which means Ankle.
- Foot Orthosis.
- Right, this is just kind of a generic one,
but this is actually custom fit.
And these, they make them now, this is a little older,
but they'll make them that don't look so obvious.
- Right, bulky, they have some very sleek ones now.
- Yep.
- Carbon fiber, they look nice.
You will have to get it probably custom fit.
I don't know if you're gonna find anything
off the shelf.
- Sometimes they're off the shelf
and they make minor adjustments to them.
- Sure, they're coming a long way, and I'm not going to go
into too much detail for that.
- But this one that has a hinge on it actually
and it's molded, it's for a larger person as you can see.
- Right.
We used to actually just have people wear
high top tennis shoes sometimes.
- Sure just a little support.
- Yeah if they are minor, its a minor foot drop,
you can get away with that. - Exactly.
Or boots.
- Right. - Cowboy boots.
Do you own cowboy boots?
- I did when I was 24, I went out bought a pair,
I was going to be the Rhinestone cowboy
or something like that. - (laughing)
But it never worked out.
One way or another I didn't have foot drop with them.
- Yippee ki-yay!
So thanks everybody for watching.
- You bet.
- Is there anything else to say?
- Well Bob, once again we can fix anything.
- Except for a broken heart. - There you go.
We're working on it.