Fighting Foot Drop in Humans Translates to Pets, Too!

Fighting Foot Drop in Pets

This Post:

  1. Helps you understand why the foot doesn’t go flat on the floor
  2. Gives you suggestions to fix that condition
  3. Helps you see how human rehabilitation can be helpful for pets

RehabDeb Comment:

Employing these techniques for foot drop in pets is what I do and is highly successful. You may also build neuromuscular strength in pets by doing proprioceptive training.

Boots and Splints –

I use foot-bed hard splints and  dorsi-flex assist soft boots on a case-by-case basis for foot drop in pets. Both of these helpful tools serve a different purpose; they are not necessarily interchangeable in use!

People sometimes order a soft boot with toe flexion help when they actually need a hard splint and vice-versa. Please confer with an experienced rehabilitation specialist who has used both of these products. They should have experience with a large variety of cases so that you don’t waste resources or damage your pet.

I also urge you to listen to your common sense in the matter of braces or splints. Sometimes staff at brace or splint companies have suggested to mutual clients equipment that is too generic.

The course of action with assistance tools should be based on a broad problem-solving thought process. Each client will do best with a solution unique to them. I have had discussions with physical therapists at brace and orthotic companies to point out functional and physics errors in their designs for some few cases. I love that orthotics for pets are available! Getting the wrong fit leads to unnecessary expenses, possible pet injuries, and not as much help with recovery. Plus you have to spend lots of time on the phone working out the problem. Meh.

Making Braces at Home –

See the end of this post for a brace I made for Anatolian Shepherd Parker with hind limb dysfunction and partial paralysis. I purchased the materials at local stores for less than half the cost of commercial boots. This method was less expensive, however the client had also paid for a commercial boot I measured and ordered.

We needed the boot right away and the boot we ordered was going to take almost two weeks to arrive. I wanted to give the caretakers proper tools for the situation and use those tools to avoid paw dragging and new sores on the top of the paw. The commercial boot works better, in general, than my temporary boot. If I spend more time on my creation boot, then it works as well as the commercial boot. Regardless, we had mine to help in the meantime while we waited for the other one.

I create many helpful tools for pet rehab on a case-by-case basis. I know what results I am hoping to achieve and have a lot of MacGyver-type experience. If you try this at home, I recommend you get a veterinarian or a human physical therapist to help you with design. These professionals should have the most experience with neurological problems and help your pet get the best results.

The standard education for most veterinarians and veterinary rehabilitation specialists does not train them in advanced neurological problem drills. I am not slighting them; I am guiding you so that you may have more options for helpful tools. That is why I suggest a human physical therapist, hopefully one with lots of neuro experience. Your veterinarian will usually tell you if they have a lot of advanced experience with diagnosing and recovering neurological cases. Many veterinarians do not have this experience because of the advent of great veterinary specialty education. Board-certified veterinary neurologists are a thing.

From “Advance Journal for Human Physical Therapy”

The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen

Originally Posted on: December 20, 2012

Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.

A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.

Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.

Gaining Control –

The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.

“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.

Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.

“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?

After Diagnosis –

Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared. (Flaccid limbs or muscles in pets are the ones that need range of motion drills, NOT limbs that the pet moves moderately well on it’s own – Deb).

According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.

“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”

Focus Work –

We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.” (I focus on these principles with my patients that have neurological problems-Deb).

Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.

“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.

The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.

Enter the AFO –

If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.

The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.

Goals –

“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”

Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.

The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”

In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.

FES, Another Option –

Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.

The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.

Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.

“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”

The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements.

AFO or FES?

“If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and [you will have to use] a passive AFO system,” Thomas shared.

If disease or injury interrups the patient’s spinal cord in any way, then retraining the muscles is often very difficult.

An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments. Those conditions will all interfere with operation of a foot drop system.

Complying at Home –

For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”

Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and go through the exercises the first day and send them home with illustrations. During a quiz at the beginning of the next session I will ask them to demonstrate the exercises I assigned.”

With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”

Therapy When?

When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”

Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier.

“There was a lot less I could do for her compared with what I could do right after her stroke”. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”

Rebecca Mayer Knutsen is senior regional editor of ADVANCE and you may reach her at atrmayer@advanceweb.com.

(Updated February 23, 2018)

Links to Books and Best Boots for Traction

Hey!

I finally finished adding the links for my books on the first four weeks of recovery post-op and post-injury on this page:

Books!

And you will find links to purchase the booklets from most Amazon platforms around the world. I include Amazon links because the booklets are available on Kindle, and I offer some promotions on both Kindle and paperback versions that are only available on Amazon.
You may purchase the books through any bookseller by asking for them using the ISBN. You may find all the info you need to order from another bookseller by clicking through to the Amazon link and copying what your bookseller requires from the details below the book.

I do not currently offer the booklets in a language other than English, however I hope to translate into Spanish, French, German, and Italian in the near future as well as add other translations too!

I continue to work on editing the new version of the booklets, so clinics and rescues and shelters may still take advantage of the offer I have had in place for many years. You may easily use this page to order at a discount for clinics, rescues, and shelters:

Ordering for clinics, shelters, and rescue organizations!

I also just finished locating the boots and shoes I use to help pets with neurological problems to gain traction and stability (plus for hot pavement, ice, snow, jagged streets and terrain…) on many Amazon platforms around the world, including the USA, so I posted the links here:

Boots & Shoes for Traction + Instructions

I have included a lot of instruction and helpful hints from my 12+ years of working with different boots, shoes, socks, and more to gain traction for pets on this page and even more instructions are in a separate post linked from the page in the link just above this paragraph. I have a lot more items to post about that will help around the home, besides boots, shoes, etc…but this is what I have finished now, and I didn’t want to wait to put this info right in front of you.

Thank you-

Blessings-

Rehabdeb

2/22/17

Boots and Shoes for Pets

(boots and pants and boots and pants and…boots and shoes!)

Due to limited time in my schedule and my wanting to post about boots for over five years and NOT having made a time slot for that post…

I’ll put a few bullet points on here:

I really like one brand of boots that I have recommended overwhelmingly for about 9 years, and they now have a couple of styles. Some of their styles are slightly difficult to put onto the foot/paw, yet they all have substantial traction to help a pet with nerve and strength issues. They don’t make small enough boots for some smaller feet/paws, but I have other solutions for those furry kids. Also, fyi, numerous attempts to contact the company for their support with my rehab practice went unanswered years ago, and I haven’t had time to pursue their collaboration since then, so as of this writing, I am not a paid sponsor or rep of the company…jus so’s you know. Regardless, they remain my favorite choice to solve the traction issue, and they are fairly widely available, plus it’s not their fault I’m too swamped on many fronts to query them to do more work with me.

There is another brand with great customer service and also with great traction, out of Canada. Those boots are more expensive and are “high tops”. They work better for some pets than the low-top version. The high-top version isn’t really suited for lots of pets I have worked with. Overall I think they are best for snow and mud and for some few pets with long, skinny legs (small pets, too). I don’t think this boot is great for trail hikes or rocky hikes, in general, but they are better than nothing in a lot of cases and better than other products for the traction solution.

The low-top version tends to slide around on the foot because the person putting it on the pet has to very firmly tighten the velcro tarsal strap. If you follow my use recommendations, below, making the strap tight shouldn’t pose a long-term problem.

I have noticed some other boots on the market that will work to assist with traction on slippery floors, and I have seen, as have most of you, probably, MANY boots and shoes that are NOT helpful with traction and function.

Don’t waste your money on the slippery sole shoes and boots unless the leg to be protected is dragging all the time or unless you are using them to protect the toes and tops of paws while a dog drags around in a cart. Better yet, suspend those dragging hind legs in stirrups behind the dog in the cart 🙂 Here is a pic of a boot/sock that is good for a foot that is dragging behind a cart but not good for traction:


NO for traction, YES for a foot/paw on a paralyzed leg dragging behind a cart.

Don’t waste money and time on the toenail gripper plastic thingys.
Some veterinarians in my area began selling them to mutual clients, and when I encountered them at my visits, I was gently able to explain why they don’t solve the traction problem plus don’t help with functional improvement. I say that because dogs will try to claw and grip their way across a slick floor or other surface. This is a behavior that is truly meant for mud and ice and the like. If your dog is trying to grip concrete or tile or wood to walk in her/his normal habitat (your home or office or the vet clinic), then I will bet your dog has a neuromuscular function problem or an orthopedic one or all of it. When dogs lose function in the hind end and I introduce traction boots or shoes or socks (in some cases), and I put them solely on the hind feet if the majority problem is in the hind legs, that works on solving the problem. The hind paws, which are attached to the hind legs with weak muscles and neurological problems, are then able to gain purchase on the ground, get a grip, so to speak. When the dogs also begin my foundational strengthening program (here), they work on core and foundational muscle strength…and the boots assist in going forward. They need better n-m strength to get a footing to rise off the floor. For some pets, some few, this will never be possible because they are already paralyzed without recourse. For the remainder, which is the majority in my experience, the right traction boot/shoe/sock will only complement the foundational work program and dogs improve little by little. The toenail traction plastic dealies encourage gripping and pulling, especially in the front end, and that is NOT what will improve overall, longer-term function. Your dog is already pulling up steps and off the bed and in various other ways that you have likely not noticed because their slower dysfunction is a process that sneaks up over time. Understand what I’m saying so far? Toenail grippers won’t help unless claws are trying to grip, and gripping claws are not helping overall functional improvement for a dog with neurological problems and muscular wasting or strength deficits. Traction boots/shoes/socks only on the hind feet for a hind leg deficiency is the best way I’ve discovered to passively help improve function. If the front end doesn’t work well, then boots there, too, but otherwise, dogs with hind-end problems are already overusing their front end and not working on fixing their hind end, unless we are really focusing on helping them with that. So, no additional help for the front in most of the cases with neuro problems in the legs (because most cases are predominantly hind-end issue cases). Good? Good.

Save time and money and make more improvements with the right tools for the problem 🙂

I do not like to use the balloon shoes, the paste-on-the-pads grips, or the toenail grippers. I am after ease of use and functional benefits. Those products are either too hard to put on, compromise overall function, and/or don’t tackle the deeper issues of function. Already noted that the boots are often hard to put on; the others in this paragraph are harder or less functional or both.

I use the boots on the two most affected limbs, usually the hind, inside if the floor is slippery, only on during the day, only on when the pet caretaker is home. Take them off at night. Take them off when going outside for drill walking or pee/poop. Take them off when you leave the house. Taking off the boots allows for the feet to breathe and taken off using these parameters usually thwarts sores from forming.

You don’t need boots on most carpet, but some carpet is as slippery as a tile floor, so use them on that carpet.

I prefer for my client animals to feel the ground outside, generally speaking, and nerve conduction can benefit from this action as well. If the ground is not too hot nor too cold, is not dangerous and the pet has traction, they may walk on the ground without boots. There are many exceptions to this rule of mine, but I will have to discuss them at a later date.

I think I can guarantee if you leave on the boots for extended periods, not following the least protocol I mention above, you will create sores and stinky feet. I’ve had plenty of veterinarian clients use loose interpretations of my recommendations and end up with stinky-feet-sore-and-ulcer dog toes and legs, so don’t think it couldn’t/wouldn’t happen to you and your pet 🙂 If it does happen, then you cannot use the boots at all, usually for about 2 weeks, while the sores and/or fungus/bacteria issues resolve.

Just say “no” to boot overuse.

Other boot points:

There is no need to use traction boots on a dog that does not have enough strength or nerve conduction to walk once assisted upright.

There are “easier” and “better” ways to assist a dog that is knuckling or dragging one or both hind, yet is able to advance both hind legs. Boots only encumber efforts in these cases and the pets need to build strength and nerve conduction using dynamic action first…then we will concern ourselves with working on correcting knuckling. Build strength using land and gravity. See my homework(s).

If you do create a sore by leaving on boots too long, or by other means, do NOT put topical antibiotic cream on it for the pet to lick off. I have yet to see a pet that doesn’t lick its sores doubly when topical treatments are applied. The way to stop licking is by using an e-collar. Yes, I know we all “hate” the e-collar, the cone of shame, so let’s start by considering it a party lampshade, the one your drunk cousin puts on their head just before the shirt comes off and table dancing begins…

See? Now it’s more fun to use the e-collar and get the healing over with and hopefully avoid infection. Licking will cause infection…I have yet to see more that .05% of cases where it didn’t. Yes, I’m guessing at the number. It’s taken me years to just put up this post; I’m not going to read through hundreds of case files to find out how correct that number is. Try to trust me on this one 🙂

If you are running your pet on rocks or walking on hot pavement or doing search and rescue, then buying four boots, as they are commonly sold, will suit you. Do know, though, that the front paws are almost always slightly larger than the hind paws. You may purchase boots two at a time from some sources.

The measurements for the boots that are given and the instructions about measuring are not really complementary to the actual size of the paws when the boots are in hand and fitting them ensues. That means that very often the size you thought you measured doesn’t fit. Do your best to get a standing, weight-bearing, measurement and/or find a local source for boots with good traction that you may fit and return. I’ve gotten some clinics in my area to carry them, and peeps may purchase one at a time or 100. I doubt they have 100 in stock, but, you know…

I don’t advocate using the socks that are often sold separately from the boots. They cause additional friction.

Wash the boots and make sure they dry very well before using them again. You will cause stinky funk if you don’t wash and if you don’t completely dry. If you have a dog that frequently pees on or otherwise soils the boots, then you are better off buying four at a time.

There is more to say, but I’m out of time, and this suffices for the basics!

Blessings-

Orig post, 11/8/14
Updated some on 2/19/17