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)

Braces for Dogs With Knee Problems

Braces for Dog Stifles (Knees)

This post is not meant to trash knee braces; no, instead it is meant to point you, the reader, toward more broad thinking. I have utilized tarsal and carpal braces very often in my practice, and soon I hope to write about the benefits and timing of using them.

I have the knee brace discussion occasionally with veterinarians and every time they ask my opinion. Most of the time, it seems that vets hear about therapy concepts at seminars or in journals, and they naturally think, “that’s a good idea!”.

There are lots of “good ideas” out there in the world. I am working to broaden the idea pool in my corner of practice with concepts I have encountered in over 35 years of athletic program design and wellness practice. Many ideas crossed over into veterinary medicine are not the greatest for our companion animal friends; however they have been a start to get a bunch of balls rolling.

Braces are a good idea for stabilizing a leg instead of surgery, especially if the person(s) designing or desiring stabilization don’t have any strength and conditioning program design experience. Most rehab practitioners and veterinarians do not have this valuable experience. Notably the veterinarians are busy with a plethora of medical issues. Strength and conditioning is its own specialty, and rehabilitation practice is often a subset of this specialty. Physical therapy in human medicine ties into this subset as well, however the designs of physical therapy work best with an intuitive practitioner that is well-versed in strength and conditioning protocol. Volumes of time and money have been spent to prove this point, and I won’t rehash it here!

In marrying several aspects of science, I believe we can practice toward a better outcome.

Stabilize the leg and joints by building the strength of the connective tissue, muscles, joints, and even bones. No, this is not exactly the same as stabilization by surgery, however I will say that not all knee surgeries “work”, and if you do opt for surgery, you STILL need to do a 12 week (optimal) progressive recovery program. As it is, all of my cases with torn knee ligaments that have followed protocol have had successful outcomes, returned to very good or great function, and more often than not, surprised the veterinarian. Most vets who see these results then embrace the protocol for their patients, however this protocol does require an owner follow the guidelines or pay me, another practitioner, or the vet to do the work! (ahhhh, the caveat…)

I do often point out that surgery is not magic, and in practical recovery using science and biology as a basis, any of us should be doing rehab after surgery or injury…

Volumes of research have been done regarding evaluation of the best gravity-based exercise methods and protocol. Since our companion animals have bones, nerves, muscles, ligaments, tendons, etc…just like we do, the research regarding strengthening is valid across species. While I haven’t had money to run research projects and individually prove the concepts I use for Great Danes, Doxies, Maine Coons, and New Zealand’s, just to name a few, I do have the knowledge to build individual and collective programs. There are and there aren’t one-size-fits-all formulas, however some basics weigh in equally across the board.

For a start on the homework for torn knee ligaments, please go to this page: http://rehabilitationandconditioningforanimals.wordpress.com/category/how-tos-for-you-to-rehab-your-pet/homework-instructions/knee-issues-homework-homework-instructions/

Problems that I have found with braces:

*very expensive

*often very difficult for most people, including veterinarians and me, to put on the pet

*cause additional abrasions and actually stifle (no pun intended) “normal” movement and recovery.
fitting is difficult, and, as in the case of bandaging after surgery (which has thankfully           been eliminated in most areas and cases), rubbing causes additional problems that often outweigh any potential benefits of bandaging…

*well-intended, however not a great substitute for a well-designed return-to-function program.
the braces came on the market about the time I was beginning to write exercise therapy and sports- medicine-based activity programs.
Following the programs I have designed, as written, will substantially increase function       and stability naturally, and such programs weren’t in evidence in animal rehab when I came into practice at the end of 2004. I marry concepts of advanced athletic recovery and simple sport science with veterinary rehab to achieve simple programs to improve function and recovery from surgery, injury, neurological conditions, and arthritis.

*if the brace is used in lieu of an active recovery program, people get a false sense of stability regarding their dog’s knees (or other joints), and when the dog does more crazy activity in the brace, they run the high chance of going ahead and tearing the opposing ligament, which is already a recognized issue in veterinary medicine.
If you follow my simple and progressive return-to-function programs for 12 weeks, you will see a gentle and stabilizing treatment of injured limb(s) as well as the other limbs (arms and legs, if you prefer :))

*so, to save money by not purchasing something you may not need and to promote the best interest of your pet as well as acknowledge good tools at hand for non-surgical
interventions, work toward doing 12 weeks of active, progressive recovery, which                 should level out bilateral leg use and potentially help with some other health issues along     the way and THEN if the knee are still unstable, get the brace if you want to hike                   mountains with your dog!

Thank you!

RehabDeb, revised August, 2014

 

 

Elderly Sheepdog With Neurological Problems – Homework Review

Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.

To Abby’s Caretakers:

Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I re-evaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains. As always, I am available to do this work and especially if you need assistance because it is hard on your own body or even just to make sure it gets done so that Abby may recover well! 🙂

I can’t emphasize enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:

https://rehabdeb.com/pet-massage/

And do it as best possible without cutting corners. You will get the best outcome if you follow the video instructions, and I’d really like it done daily to better encourage healing on several levels. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realized from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.

For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. I chose 15 minutes because you said she has already accomplished doing 10 min walks for a week, 3-4 times per day. Before that, she laid a foundation with 3-4 five minute walks daily for a week. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.

For the week following the twice daily 15 min walks, please walk her 2×20 minutes in the same manner, and only if the 15 minute walks are completed well for a week. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. That’s because we spent time building the base. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not wanting complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt to and accomplish.

I really would like her to wear two supportive hard braces during these walks, and I realize you have only one. She hyper-extends both her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and deficits in this case, and that has been a problem since I began giving you instruction for her over a year ago.

After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my Facebook rehab page that depict several home-based cavaletti designs. Please be sure to read the descriptions below the pictures, because not every type of cavaletti is for every pet 🙂

Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.

After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.

During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month-I’ve had good outcomes from doing this with similar cases.

I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading for the past many months…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.

Thanks!

Blessings-

Deborah January, 2013