(upbeat jazz music)
- Hi, I'm Bob Schrupp, physical therapist.
- And I'm Brad Heineck, physical therapist.
- And together we are
the most famous physical therapists on the internet.
- In our opinion.
All right, today, Brad, we're gonna talk about foot drop
and we're gonna keep it pretty basic, here,
but we wanna describe what foot drop is
and just some of the basic bracing they might try.
We're certainly no experts on it.
We're not orthotists at all.
- Right.
- But we do wanna show you what is available.
So to let you know- - Right.
By the way, when you have the brace,
it really, isn't very apparent.
It's really pretty well hidden, so...
- Right.
- What are the cases in which you might get foot drop?
- Well, real commonly in the clinic, you know,
we'll see it with stroke people.
People have a stroke,
one side, that leg is not gonna work well,
and the foot...
Can you drop down on this?
Let's let's describe foot drop-
- Yeah, exactly
- 'cause some people aren't clear, there.
- [Bob] Well, first, can we just show 'em my foot, Brad,
how the weakness is bringing the foot up this way?
- Right? Dorsiflection, we call that.
The anterior tib muscle, the muscle belly is right here,
the tendon comes down
and it contracts and pulls your foot up.
- [Bob] Lifts your foot up. - Yeah.
- [Bob] And I can't do that.
If Brad asked me to do that I wouldn't be able to lift it,
or if I did, I couldn't hold it up there.
- Right.
- [Bob] He could easily push it down.
- Right. So if I let go, it just drops right down.
- [Bob] Yeah.
- [Brad] That's called foot drop.
- [Bob] That's foot drop.
You know, it describes what it is
- Right.
So we got there with people with strokes, polio,
if there's a spinal nerve that's impinged
and it doesn't allow that muscle to-
- Yeah, my mom got it after back surgery.
- Sure, yeah. - She got foot drop, because-
- That's common after back surgery.
- And probably one of the most common ones, now,
where we're gonna run into it,
is a peripheral neuropathy which you get from diabetes.
- Yep. Some of the older people,
I've had some patients that had polio-
- Polio, yep. Multiple Sclerosis is another one.
- Sure.
- You never know
where the weakness is gonna show up with that. So...
- And one of the, what we call the gait pattern,
are you still down here, Nancy?
You can actually hear the person coming.
What they'll do is they'll bring up their foot like this,
and they'll come down
because they're unable to do a heel strike, what you call,
and come through.
So they have to lift up their foot here,
and sometimes you can hear 'em slap that foot down.
- [Bob] Yeah, down. A foot slap, yep.
The knee is also tending to, let's say it's on this one,
you know, these sometimes back knees on 'em too,
because they don't have that support.
- [Brad] Yeah, but it'll hyper extend,
so it can lead into knee problems from the foot drop.
It makes a high risk for falls.
So, an AFO it's an ankle foot orthosis.
- Foot orthosis - Yeah.
- Orthosis, I looked this up, Brad, is Greek-
- Ah, Greek!
- Is Greek for alignment or straighten.
- Oh, very good. - So, what we're trying to do,
is align the foot or straighten the foot.
So, an orthotist makes braces that align or straighten.
- Sure.
- Now, what this is actually, is one that's off the shelf
and it comes in different sizes. This is a medium.
And what you're gonna find, now,
they have a great variety in how these braces look
and they're all trying to do different things.
They're all trying to provide pressure points
at different spots.
But this is the old, what we call the Sammons one,
is what I used to call it.
The Sammons used to provide these, S-A-M-M-O-N-S.
So, this one is actually a little bit small for me
but I'll show you how it works,
unless you have further comments right now, Brad.
- Well, one thing, you know, is they make these for style.
- I mean, - Yeah.
- You can get colors. - Oh, absolutely.
You can get Green Bay Packer emblems on there...
- Yeah, why would you? But, yeah.
Yeah, so, you know,
they're trying to help out the younger person
that may have to wear it
and make it more of a fashion statement.
But again, you know, as I'll show you here,
it really doesn't show much. - Right.
- Unless someone's looking for it,
a lot of times you really don't even see it, so...
- Unless you wearing shorts.
- Unless you're wearing shorts, yep.
So, you're gonna pull the pan leg up
and you're just gonna put it on there.
A lot of times it has two straps, now,
- Yeah.
- Sometimes it'll strap around the ankle.
But again, this basic one probably only has one.
- Almost always Velcro straps.
- Yep. Easy to apply.
Now, you're gonna slide the shoe over,
and as Brad and I were talking, in some cases,
especially with, maybe, a custom made brace,
you might actually
have to have a shoe that's a little bigger.
You might have to actually get
a shoe that's one size bigger.
- Right.
- Which is a real pain we understand.
But you know, now this one, this is my normal shoe
and it actually feels fine.
- Right. - So...
- But this is, again you said, off the shelf,
and that's versus a custom.
And a custom AFO, they actually cast your leg.
- Yeah. - And they send it in.
And I just got the price on one of these
from one of my patients.
It was over $900.
- And that's what I saw online, anywhere from $600 to $900.
So yeah, they're very expensive where these are,
I don't know, what are they? 30, 40, 50 maybe?
- Right.
- Depends on where you get 'em.
- And these can be molded, too.
I mean, you know, once you get it,
you can use what it is called a heat gun,
and you wouldn't be doing this, obviously,
but it can be molded a little bit.
- Right.
- So if it doesn't fit quite right, you can-
- You can take it to your orthotist
and they'll take care of it in a matter of minutes.
- I've even seen art done on it once in a while.
But see, once the pan leg is down, you don't even see it.
- [Brad] And because of that on, you know,
he's gonna come down, he's gonna heel strike point.
- [Bob] Yeah. - [Brad} It's not gonna drop.
- [Bob] Right. it's gonna hold my foot up.
- [Brad] Right
- [Bob] Now, if you have weakness in your hip,
which I've seen sometimes-
- [Brad] Sure.
- [Bob] If you have a weakness all the way along there,
like, they still may drag the foot.
- [Brad] Yeah.
- [Bob] So then you gotta work on strengthening your hip,
but otherwise, yeah, this holds up my foot right.
It actually feels pretty good, right?
- [Brad] Yeah. - [Bob] I'm kind of surprised.
- [Brad] Yeah, you're right,
it looks good and you can't even tell it's there.
- [Bob] So, that versus this. (device clicking)
This is a molded one,
and they usually use like, a polypropylene,
and this is a molded one with actually a hinge on it.
And you normally wouldn't need go to this extent
for a foot drop.
This is more providing, what we call,
lateral/medial stability,
where your ankle could possibly turn, you know,
where you have a ton of weakness in your in your foot,
probably from a stroke
where you don't have any strength at all,
And you're at risk for turning your ankle, too,
and not just the foot drop.
- When it comes to these more complicated ones
they're usually custom
and I usually just send my patients to the orthotist-
- Right.
- And they take care of it all.
They're the experts, and you know,
they'll answer a lot of questions.
But just so you know,
there's the hinge ones and there's other variations.
- Oh yeah, there's a whole plethora.
- Plethora. Excellent. It's a haiku.
- All right, thanks a lot.