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?

WHIPS or Walk Helping Instruments and Power Scooters

Whips often bring negative and uncommon associations to mind. WHIPS as in Walk Helping Instruments and Power Scooters are necessary devices for those with impaired walking and mobility. Use of WHIPS such as canes, walkers, crutches, braces, wheelchairs and powered scooters are becoming more prevalent and help the mobile-handicapped preserve some degree of independence. For those with ambulatory challenges, the use of WHIPS may be perceived as a negative milestone. Whether temporary or permanent, WHIPS help mobilize the otherwise immobile.

In 2011, according to Cornell University statistics, 5.8% of males and 8% of females, not institutionalized, in the United States have some form of ambulatory disability. Some States have over 10% ambulatory disability statistics. The percentage of non-institutionalized, females and males, with a ambulatory disability, ages 16-64, all races, regardless of ethnicity, with all education levels in the United States who were employed in 2011 is about 24%.

At a recent Myotonic Dystrophy support group meeting I attended, many complained of balance issues when standing or walking, slow mobility, and fear of tripping or falling. Myotonic Dystrophy is a form of Muscular Dystrophy, a genetic transmitted disease, that involves the destruction and wasting of muscles throughout the body. The disease, made popular in the USA be decades of Jerry Lewis televise telethons, currently has no treatment or cure.

I have Myotonic Dystrophy. While I might have had it since birth, most symptoms became evident in the past 5 years, though I was officially diagnosed in 2011, by genetic testing. I really appreciate and mourn the inability to walk distances, skate, bike, and a whole group of things that are now past tense. Even at my less than 1 mile per hour walk, I feel potential tip-overs to left, right, and rear. My steps are very deliberate with a constant fear of falling. As such, I added more supportive shoes and use of a cane. They offered little help. Adding prescribe therapeutic braces helped restore some walking ability. I haven’t been able to use subways for over two years. I definitely rely on WHIPS and, even with those, basic movements are often challenging. Without those WHIPS, home confinement is more likely.

Yet, at that Myotonic Dystrophy support group, many people did not use canes, wore regular sneakers, and didn’t wear supportive socks. Those that did have canes or walkers had the wrong sizes. When it comes to WHIPS, few people have access to proper information regarding proper support specifications. As a cane user with a background in research, I’m now more aware of other cane and walker users. I see the inadequacies of selected WHIPS among some and the denial of using WHIPS by others. While there are different degrees of Myotonic Muscular Dystrophy, proper WHIPS are very important.

Choosing a proper, supportive cane was an educational experience. The HurryCane is a popular cane advertised on TV. It allows one to stand the cane temporarily for certain conveniences, such as swiping a credit card at the counter or near a bench. Canes can be cumbersome when shopping or sitting in public places. I ordered one and found the cane too short for support and its adjustability was too flimsy to rely on. If you’re up to 5’9″ tall and weigh under 170 pounds, the HurryCane might be adequate. I saw too many taller and bigger people bending down to use that cane and say the cane bending with their weight. A probable accident seemed evident with continued use, especially if this is to be your personal partner for support.

The generally accepted rule for proper cane size is half your height in inches. If you are 5 feet, you are 60 inches. If you are 6 feet, you are 72 inches. I’m 74 inches and most of the sold canes were up to 36 inches. There are many online cane retailers. After lots of research, I found Fashionable Canes as a great source and resource. They offer a wide variety of styles, sizes, accessories, and tips for proper sizing. I was able to get a 37-inch wood cane that fit my height comfortably so I can walk straighter.

Weight capacity is also an issue. If you weigh 180 to 200 pounds, your cane needs to have a 250 pound capacity. You often lean down on the cane for additional support. This level of inertia adds weight on the cane, sometimes as much as 50 pounds. To assure adequate support with integrity, seek a cane that supports at least more than 40 pounds of your body weight.

While Amazon offers many cane styles and sizes, I found their specifications somewhat inaccurate. If you’re a Prime member, delivery and return privileges are rapid and liberal. But the Fashionable Cane online store, physically located in Florida, is extremely accurate and the customer service is very helpful.

One of the unexpected cane features I found at Fashionable Cane is the cane tip. The tip of the cane is very important since it meets the walking path of varied surfaces. Most canes have soft, smooth tips. Fashionable Cane tips use steel supported rubber with circular treads, providing better traction than most tips. Among accessory tips that they offer, you’ll find among the selection that deliver support like the HurryCane (quad-tip) and for walking on snowy surfaces.

Vista offers a wide variety of canes found in shoe and shoe repair stores. They are also premium WHIPS but generally are around 36 inches in height for most canes. Seek them out if you are 68 to 72 inches tall and prefer to buy one at a local provider.

Another popular instrument in the WHIPS category is the medical walker and these are very popular among women. For the most part, these are used by people around 60 to 65 inches tall, though some models adjust to 72 to 75 inches high. These permit broader walking support, especially for those suffering from osteoporosis, a crippling bone disease. These often have seats and storage available. Height is a problem here too as chronic users may develop a bent-over posture due to recalibration of the spinal vertebrae. I’ve seen some people with muscular dystrophy using these and some have already developed a hunchback appearance. Proper height and weight support are key issues here and often overlooked by providers and consumers, when considering chronic use.

Another extension of the WHIPS category are powered scooters and wheelchairs. These battery powered mobile assistive vehicles have been growing in popularity. They can greatly extend mobility range and can offer independence for advanced cases of immobility.

Most powered scooters are designed to fit on public transportation devices to help save battery power (usually up to 10 miles while carrying a 170 pound load).

I had considered this option in my earlier stages of ambulatory challenge but observed some restrictions in door entry of various stores without automated doors. I was thinking of using this as a vehicle to be able to enjoy use of nearby parks, though I haven’t seen too many in parks. The reason is these battery power devices offer minimal torque for uphill and downhill use. The convenient 3-wheel scooters may tip on the uneven leveling of paved park paths.

The EMS-48 Adult Scooter would have been perfect for use in the park but is too large for use in public transportation. At speeds up to 20 miles per hour and a huge up to 45 mile range on a battery charge, this would seem perfect. It’s like a supportive electric moped. Unfortunately, that distinction makes it illegal for use in city parks.

Mobile challenges aren’t just targeted at older people, though it seems that way. I do see people older and younger than me making use of WHIPS. Being mobility challenged is disabling in many ways, shapes and forms. Using WHIPS may help make existence more palatable. There are, as in life, benefits and consequences. The biggest consequence is the challenge and often the challenge seems insurmountable.

Elizabeth Kubler-Ross is a prominent psychologist that studied patients who were dying. She came up with the DABDA process that all patients went through. The DADA process involves Denial, Anger, Bargaining, Depression, and Acceptance. I observed in my neurocognitive research that this also applies to those that find challenges in overcoming other diseases, though most remain stuck in Denial.

Muscular Dystrophy, Multiple Sclerosis, Arthritis, Osteoporosis, Cerebral Palsy are diseases that can severely immobilize and affect perceptions and choices of “I can” and “I can’t”. It feels like an invisible whip striking deep to the core of being. Fortunately, with medical guidance, family support, and the responsible use of the right WHIPS, people can accept their plights and make life appear less challenging in contrast to definitions of normality. Proper WHIPS help bring redefinition and acceptance to feel better against the odds you encounter each day.