Don’t Drag your feet get your toes off

Street observations often show that quite a few people of all ages seem to drag their feet, gliding slowly on pavement. Some walk slowly, taking small steps, careful not to trip or fall. Are these people tired, weak, in pain or depressed? Sometimes all of these are in play. Emotion disorders for some may loosely involve motion disorders. This mode of walking is called Foot Drop. It is where the ankle does not elevate your foot to stride comfortably. The key to a normal and smooth gait is placed on what is called a dorsal muscle that, basically, works to get your toes off the ground. In some cases, a Toe-Off orthosis might help lift your toes off for better walking.

The ankle of each foot lies at the base of each leg as it meets the foot. It is often vulnerable to sports injuries or falls. How many kids complain about sprained ankles? How many game players have to sit through a season because of an ankle problem? Usually, these wounds heal. For others, there are diseases that chronically affect the foot. This makes walking difficult and painful. This makes walking alongside friends annoying. Most people adapt to it while others use orthotics, canes, walkers, and wheelchairs. These are entirely different perspectives than those that normally walk.

The joint at which the leg meets the foot is called a dorsal joint. This connecting joint consists of bone, ligaments, and muscles. There are four muscles involved – Tibialis anterior, extensor hallucis-longus, extensor digitorum longus and fibularis tertius. The largest and most evident of these muscles is the tibialis anterior, which can be seen superficially in the front of the lower leg. Dorsiflexion involves these muscles for just a couple functions, primarily lowering and lifting the foot for walking. It also aids left/right motion for smoothness and capability of coping with hills. Dorsiflexion helps establish the toes off and toes on movements that are necessary. When dorsiflexion doesn’t function, the foot remains in a dropped position. Getting your toes off for a normal gait is virtually impossible.

There are other muscles that help the dorsal muscles function. Nearby, Plantar flexion involves lifting the whole body. These go together because the world does not exist as a straight plane and body’s weight creates all sorts of subtle adaptations to the differences of weight, angles, and voluntary movement. Because the ground constantly has variables, human feet need to adapt to smoothly interface with it swiftly on contact. In normal function and anatomical position, the ankle joint has flexion (dorsiflexion) and extension (plantar flexion). Foot draggers have a lot to do to get their toes off the ground.

For many foot draggers, a trip to a physiatrist might help deal with the problem. Some may require physical therapy to help break old habits. Others may need a prescription orthosis. The latter occurs when certain diseases chronically influence the dysfunction of the dorsal muscles. One particular orthosis for helping people get their toes off the ground is a bracing device called Toe-Off.

Toe-Off is part of a group of products, called an Ankle Foot Orthosis (AFO), that help replace the action of the dorsal muscles, when the muscle group has been compromised. This is common in muscular dystrophies, myopathies that can waste these muscles to the point that your foot can longer raise on its own. Toe-OFF is a new generation AFO, covered by several patents. While most AFO get your toes off and up to facilitate a more natural walking gait, and share some similarities, Toe-Off is lighter and easier.

Toe-Off is known as a dynamic AFO. It is made of a lightweight moldable carbon fiber composite material and works with various shoe types. It employs a high activity design that enables freedom of motion and allows for simulated walking that functions and appears as if you aren’t using any form of brace, with the exception of a few chronic cases. Whether custom of off-the-rack, a dynamic AFO encourages range of motion, allowing children to learn movement by moving and providing minimal support, only where the patient needs it. Scientific research on dynamic AFO devices show improved performance, though studies must be further explored.

Many AFO allow use of your own shoes. You remove the insole of the shoe, slide Toe-Off inside and then replace the insole. Most shoes aren’t adequately sized to hold your foot and an AFO. Sometimes you may find greater comfort by shifting to a wider shoe. New Balance and Dr. Comfort are recommended brands. Do not anticipate normally long wear from your shoes. Typical daily wear might be around 6 months and leather shoes should be changed every 6 weeks or so to keep it supportive (as leather stretches).

Toe-Off uses a Swedish technology that uses a carbon fiber for support or action. When worn, it does take your toes off the ground. Your walking gait is more normal.

Toe-Off resembles an over-the-calf shin guard, set in place by adjustable Velcro straps. Shoes are ties normally. It provides leg support and foot support as it aids that toes off process.

To say that use of Toe-Off will let you run marathons or play basketball is a rare exception. It helps a foot dragger with foot drop walk virtually normal. That is remarkable.

The feel of the Toe-Off is like standing on a suspended rocking chair. It rocks your foot into the appropriate position. Depending on your condition, getting up from a chair or using stairs may be a little difficult. Toe-Off primarily focuses on replacing the simple dorsal inaction that results in foot drop. Maneuvering other than walking may still be difficult or impossible. For someone who can’t walk normally, Toe-Off is a necessary option for those who want mobility without resorting to a scooter or wheelchair device.

Because even smoothly paved roads have variable surface changes, use of a cane is helpful in those cases. Many times you may not need it or use it lightly. When the walkway has cracks, embedded rocks, or other surface irregularities, that cane could be the difference from walking to falling.

A physiatrist or sports physician usually must prescribe an AFO and Toe-Off requires a prescription. It’s an expensive technological tool but is covered by many health insurances. Usually, your doctor sends you to an orthosis specialist. Prothotic Labs is a New York based progressive Prosthetic and Orthotic facility. David Zwicker is one of their specialists. He is particularly attentive to patient’s comforts in using any of these devices. While Toe-Off, for example, is an excellent product, it may need to be fitted for comfort for individualized use, Zwicker specializes in this. Developing a cordial relationship with your orthosis specialist is necessary. Finding one is crucial. An AFO is a walking mobility device that replaces poor natural muscle control. You and it must act comfortably as one.

As for support, there are 3 Toe-Off models that cover children, moderately affected adults, and severely affected adults. Due to Myotonic dystrophy (one of the muscular dystrophies) I use the Toe-Off BlueRocker pair – their offering for severe cases. It is designed for helping Footdrop from disorders such as stroke, MS, post-polio, Myelomeningocele, Cerebral Palsy, Muscular dystrophy, CMT, and forms of Neuropathy. This is my second Toe-Off AFO and I find it to be very supportive. It does require the Comfort Link accessory for extra padding around the leg.

Braces have changed a lot since the days of President Franklin Roosevelt. They help easily mobilize the otherwise immobile. Getting your toes off the ground as a means of alleviating foot drop means you have many choices to explore from exercise to using an orthosis. A dynamic AFO, like the Toe-Off family of products, may just be a possible answer. So don’t drag your feet when walking. Get your toes off and seek professional help. Treatment is often easier than you might think.

Toe-Off is not a miraculous cure for the causes of dorsiflexion. You may or may not be comfortable using it, and may not restore your walking range before your ankle disorder. Depending on the severity of your condition, Toe-Off helps provide a sense of dignity at the challenges of achieving upright mobility when walking. Many people do regress to needing scooters. It’s an acquired, adaptive taste and a quiet idea of walking using your own two feet, albeit with an AFO brace like Toe-Off. A dynamic AFO, under advisement from your physician, may help you cope with walking challenges a little differently (at least for a while). Isn’t it time to get your toes off and walking?

Toe-off braces against foot drop

While most evident with aging, foot drop is a condition when ankle muscles or nerve signals cause your foot to drop when walking. Foot drop makes it difficult to lift the front part of your foot, so it might drag on the floor when you walk. It can affect people of different ages as well. While some mild foot drop conditions respond to physical therapy, moderate to severe cases often require a brace that helps reposition your foot to a normal gait. The Allard Toe-off is one such brace and the best of its kind. There are others as foot drop is more common than most people think. Statistics are difficult to ascertain because so many people function with foot drop and don’t recognize the mobility challenge. Certain diseases, however, make it a clearly disabling symptom. Toe-Off makes that disability somewhat less disabling for young and old challenged walkers.

Foot drop can be associated with a variety of conditions such as flexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Basically, Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion during movement as you walk and stand. You drag your foot while walking. Some compensate when approached by hills and steps by elevating the hip. The result is a Frankenstein-monster like foot drop that results in imbalance and consequences like frequent falls. On level ground, the feet drag on the surface. Carpets and walkway cracks can often be threatening as a foot fails to lift.

Allard ToeOFF is a leader among several manufacturers making devices known as Ankle Foot Orthoses for children and adults to help cope with chronic foot drop. These are braces that fit into shoes and create a rocking motion at the base of the foot. It helps the foot simulate a smooth walking gait by lifting the toes off the ground, as evident in foot drop cases.

Foot drop may also be evident in young babies who have difficulties toddling at toddling ages. They have difficulty standing and walking. Pediatricians may recommend a Supra Malleolar Orthosis (SMO) if the child is 18 months or older.

Up to age 3, the diagnosis is usually hypotonia. Hypotonia is the medical term for decreased muscle tone. Healthy muscles are never fully relaxed. They retain a certain amount of tension and stiffness (muscle tone) that can be felt as resistance to movement. When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years. There may be several reasons for hypotonia in babies, including nerve, muscle, and metabolic syndromes.

An SMO is shorter than an AFO and usually has a baby-friendly decoration. It will help babies stand. Walking may require physical therapies. Sometimes a pediatric physiatrist (medical specialist in rehabilitation medicine) may organize a team of multifaceted supporters. Small studies indicate that the SMO with phased rehabilitation may help children overcome foot drop and walking issues within a couple years. After that, genetic testing may be required to determine whether hypotonia is more of a symptom of another disease than a condition itself.

Hypotonia is not the same as muscle weakness, although it can still be difficult to use the affected muscles. Depending on the cause, weakness may sometimes develop in association with hypotonia. As people age, muscle weaknesses may develop along with normall loss of lean tissues. Hypotonia influences the movement, condition, and action of muscles.

Foot drop is very evident in diseases like Muscular Dystrophy, Cerebral Palsy, CMT, Stroke, and Multiple Sclerosis patients. An Ankle Foot Orthosis (AFO) helps relieve foot drop. It resembles a brace but it fits in most of your shoes. Worn beneath long pants or skirts, an AFO is practically invisible.

While an AFO may not directly repair dorsiflexor problems or neuro-muscular conditions, it helps deliver a near-normal gait when walking. The key is near-normal but that is a vast improvement. You may experience difficulty ascending and descending stairs. Your speed may be slow, but significantly faster than dragging. Your maneuverability may be somewhat compromised. Compared to foot drop, an AFO is a very significant mobilizer for the somewhat immobilized.

The Dorsi-strap is the least invasive AFO and also relatively inexpensive in the $150 range. While users should first consult a sports medicine doctor about using it, purchase does not require a prescription. The manufacturer seems to promote its use as a cure-all, even supportive for obese and big people, but the Dorsi-strap is really only effective for very mild foot-drop conditions.

For moderate and severe foot drop, dynamic braces are often prescribed. These are light, generally made of carbon fiber, a foot-length foundation is placed in your shoe and covered with shoe’s (or your) orthotic. A vertical support goes up and the brace attaches to your leg by one or two Velcro straps. A dynamic response Orthosis helps support a stable, balanced gait for walking and enable better posture while doing so. These are expensive but when you’re immobilized, they help you become (somewhat) mobile. They are covered by Medicare and most insurance providers.

Some people might say that, if you’re immobile, why not get a wheelchair or scooter? It’s a good question from an outsider’s view. There are classes of stubborn immobilized adults who want the illusion of mobility as a biped (not including cane support) in a world designed for most healthy people that can walk normally. There are fewer doctors and people aware of dynamic AFO devices so few are seen. They are used, though a minority compared to wheelchair devices.

Among dynamic AFO manufacturers, Allard’s Toe-Off family recognizes this for adults with varying degrees of disability. They also remember children who can suffer at many levels when confined to wheelchairs when they have foot drop as a main concern. Allard’s KiddieGAIT offers innovative options that have never been available for AFO management of these challenges. Functional environments can be created that supplement gait function instead of immobilizing and inhibiting that function.

Designed to provide dynamic toe-off assist with maximum control for the unstable ankle, Toe-Off is available in five sizes from X-Small to X-Large to fit children through adults. The unique, patented design features a lateral strut which “wraps” over the instep to provide maximum medial-lateral and rotational control of the foot and ankle complex, when none or little normally exist. Approximate weight variations are Size 01 (XS) weighs 3.6 oz., Size 02 (S) weighs 4 oz., Size 03 (M) weighs 4.9 oz., Size 04 (L) weighs 6.4 oz. & Size 05 (XL) weighs 6.7 oz. This permits an almost invisible sense of added weight. There is, however, a training period to get accustomed to the rocking support of these braces. Significantly advantageous, the Toe-off AFO fits into the shoe like an insole and accommodates most shoes without having to increase shoe size. New Balance sneakers are recommended for daily use.

Beyond the KiddieGAIT and the regular Toe-Off AFO, Allard has introduced the Toe-Off BlueRocker to their AFO family. BlueRocker is identical in shape and design as Toe-Off but offers more orthotic control. It is developed primarily for bilateral patients and those with more involved pathology. The extra stability will improve both balance and posture and give the wearer greater security, especially individuals with weak quadricep muscles.

It is also the most preferred orthosis to be used in conjunction with a socket and toe filler for management of partial foot amputations. Every BlueRocker should be padded on the inside towards the tibia crest. The SoftKIT padding system is designed specifically for use with BlueRocker for optimum patient comfort and product performance.

There are several other dynamic response AFO brands available for all degrees of foot drop. Helios (Helical Energy Loading Integrated Orthotic System) focuses on the category that the Toe-off BlueRocker targets. Helios is quite different as it does not use Velcro straps but requires a custom wrap-around shell for additional support. The double-helical construction is designed to correct skeletal structural deformities and provide an increase in walking function. This unique energy loading design offers the potential of normal walking. Because of its energy return in walking, the manufacturer claims there is less fatigue. Like the Toe-Off, it targets muscular dystrophy, peripheral neuropathy, CMT, Stroke, Cerebral Palsy, Polio, and many other neurological and muscular diseases that compromise function of the dorsiflexor.

If you find walking painful and your feet are consistently dragging, find a physiatrist or sports medicine doctor. These doctors study and serve patients with movement disorders. Orthopedists primarily deal with bones. A thorough exam will help form a diagnosis. Physical therapy may help most people. If it doesn’t, an AFO may be prescribed. Use a recommended practitioner.

I was advised to go to Prothotic Laboratory for my AFO orthosis. While there are hospitals and other providers, this place was highly recommended by my physiatrist. David Zwicker is their certified orthotist and was a pleasure to work with. He suggested the Toe-Off and considered the basic model as satisfactory. I must admit that, once I put the Toe-Off on, it seemed a radical improvement. As with a cane, I’d advise moving up to the Toe-Off BlueRocker for maximum strength and support, though it does require a suitable get-comfortable period. Zwicker offers seasoned experience and provides an intuitive, independent approach to help maximize comfort. When using an AFO device, your relationship with the orthotist is very important. Do not get an AFO unless you are certain that your orthotist is right for you. If you are in the New York City area, David Zwicker of Prothotics offers excellent service, although many pediatricians and physiatrists offer AFO and SMO devices.

There are varying degrees of foot drop and many reasons behind it. There’s no assurance that a dynamic AFO will get you running or even fast-walking. In cases of muscular dystrophy (and my Myotonic dystrophy), happiness comes from the ability to walk without foot drop, or the use of a wheeled scooter. The myotonia is still there and instability and weakness may dominate. Using the Toe-off offers significant help in walking from point-A to Point-B. Without the Toe-off AFO, trying to walk is a monstrous challenge. Be thankful that world technology is designing products to help the significant few sample the illusion of normalcy again.

Ultimately, an AFO or SMO is an aid to enhance mobility against foot drop due to weak muscles and nerves. Seeking medical or rehabilitation help may be advised to avoid accidents or falls is advisable.