#52 Orthotics: When it’s Not Always a Walk in the Park

For many people experiencing neuropathy,  foot drop or drop foot may be a developing symptom that is uncomfortable and frustrating. The National Institute of Neurological Disorders and Stroke (NINDS) characterizes drop foot as the struggle or inability to lift the toes and front area of the foot, due to weak muscles or damaged nerves. In consequence, people experiencing drop foot have the tendency to scrape their toes against the ground or react with what is referred to as a steppage gait, where they raise their knees higher when walking so as to reduce the scraping. Depending on an individual’s circumstances, drop foot may be temporary or permanent. Although a variety of muscular and neurodegenerative disorders cause drop foot, it is common in nerve disorders like Charcot-Marie-Tooth disease or other developed peripheral neuropathies.

Treatment for drop foot varies based on the specific cause. Although physical therapy that strengthens feet and leg muscles may improve symptoms, the most popular intervention involves orthotics. Orthotics are customized supports for the feet, ankles, and/or legs. Therefore, according to Mims Cushing and Norman Latov, MD, not only are orthotics useful in cases of drop foot but in other uncomfortable manifestations of neuropathy. This may include dorsiflexion or walking on your heels and pronation or the experience of flat feet and arching ankles.  Orthotics are utilized to improve gait and comfort, by increasing support, decreasing unhealthy areas of pressure, and improving foot, ankle, and leg positioning. For the improvement of drop foot, NINDS suggests discussing possible home exercises or physiotherapy options, as well as orthotics, with your healthcare professional.

Cushing and Latov highlight and recommend orthotics in You Can Cope with Peripheral Neuropathy, noting the importance of consulting your doctor first, since using orthotics too soon after the first symptoms of drop foot occur, can weaken your muscles or worsen your symptoms. Orthotics are created specifically for your experience by  a podiatrist, orthopedist or certified orthoticist. Casts or impressions of your feet are taken and from the mould a suitable orthotic is developed. From soft to rigid, orthotics come in all shapes, sizes, and materials, based on the treatment needed; felt pads, cork, moulded nylon, plastic, rubber and silicone are shaped for your feet and body needs. Ideally, a person should be able to relocate their custom orthotic between all pairs of shoes so as to maintain the treatment across their life’s activities. Customized orthotics prove to be most effective since they are   personalized to your experience, although over the counter products claiming orthotic qualities like arch support may provide you with relief as well. Furthermore, just as your eyes and glasses prescription may change over time, so too may your orthotics. Therefore, it is important whether it be your first experience with orthotics or not, that you return to your orthotists to discuss refit or readjustment if you are experiencing discomfort at any point in time.

If orthotics interest you, it may be beneficial to take some time to learn about the variety of orthotics available before speaking with your doctor. For further reading explore, Ortho Rehab Designs at http://ordesignslv.com/cmt_guide.php, recommended by Alan Berger, MD, which provides some interesting readings, particularly in regard to Charcot-Marie-Tooth disease. Consider exploring orthotic options like shoe inserts and braces to improve neuropathic symptoms that impact your movement, so that you may continue experiencing the things that you enjoy, in a manner that is more enjoyable!

References

1. Cushing, M., & Latov, N. (2009). You Can Cope with Peripheral Neuropathy: 365 Tips for living a full life. New York: Demos Medical Publishing.
2. National Institute of Neurological Disorders and Stroke. (2018, July 12). Foot Drop Information Page. Retrieved from: https://www.ninds.nih.gov/Disorders/All-Disorders/Foot-Drop-Information-Page
3. Ortho Rehab Designs. (2018). Charcot-Marie-Tooth Guide for Orthotics. Retrieved from: http://ordesignslv.com/cmt_guide.php