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foot drop, AFO and shortened heel cord

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During a back surgery I sustained a nerve root injury at L4, L5 and S1.
That was 8 months ago.
I am now in an AFO that is hinged with dorsiflexion assist since I am getting some flexion movement of my toes but no dorsiflexion at all.
I did physical therapy outpatient and they terminated my treatment after there was no further progress and said that maybe down the road a few months things might be a little better and I could come back for re-evaluation.
We also have an excellent inpatient rehab center but they felt I could not do enough to participate in their rigourous program at this point.
I had hoped to be released at least with a cane but the therapist said a walker was necessary because I still had frequent falls.
What more can I do?
I am doing some excercises at home, the rest of my body is strong and pretty sculpted, but it just seems that nothing I do will make my foot work or strenthen the little flexion I have in my toes…it is very weak and even with TID work it has not become any stronger.I am 36 with an active husband and son and the degree of impairment I have (largely do to falling) is pretty large.
I have heard nerve injuries can still heal up to 18 months post injury.
So I have 10 months to go.
I want to be jogging and playing with my family at the beach again and I am afraid because of insurance considerations (22 visits per year of physcial therapy) that I am not going to get the aggressive work that needs to be done to give me the highest level of functioning that I will be able to achieve. Also, I the AFO, but without it my foot rolls completely in on itself all the way to the medial ankle nearly touching the floor if I am barefoot and with just a shoe and no AFO my foot violently whips out laterally to the point that it swells up and bruises…thankfully I have no feeling because it looks like it would hurt pretty darned bad.
It seems to me that the AFO is allowing my ankle to become very weak so that it will not support weight. Could the AFO be a bad idea as far as ankle stability in the future is concerned.I am under no treatment for my foot now.
I was turned over to physical therapy and physical therapy has released me.
The surgeon who did my back surgery is a neurosurgeon and does not deal with peripheral nerve problems (although EMG did show it was a nerve root injury at those levels) So I have no doctor…I’m not sure how that happens that a patient is released to ..no one…just herself…yikes!
I do not even know what kind of doctor I would make an appointment with?
Podiatrist? Neurologist? Ortho? Another PT?

5 COMMENTS

  1. I like, JS, have suffered”foot drop” following bi-lateral knee surgery. However, my foot drop is not as severe and I am able to maintain a 45* angle but now I have a heel contracture which causes me to walk on my toes and the outer edge of my footand ankle. My foot in turning “in” because of the nerve damage to the peroneal and tibial nerve. I am 5 1/2 mo post op and the EMG shows muscle activity to support walking but my foot is frozen. My ortho surgeon wants to lengthen the heel cord but a second opinion suggested I try botox and more PT which I have done with no improvement. Where do I go now ? A foot/ankle spesensoredt, should I try surgery to unfreeze my ankle and lengthen the heel cord or wait 12-18 months for the peroneal nerve to regenerate ? Or wait for total foot atrophy.

  2. It sounds like I have a somewhat similar problem, but I don’t fall.I have been going to Dr. Hauser in Chicago. It’s worth the drive as he knows the human body!He does prolotherapy and injections on weak ankles. They strengthen joints & ligaments to hold you up by injecting a proliferant solution into the ankle joints and wherever your having issues. He’s an amazing doctor! I’ve been to everyone and he’s the best!Don’t despair. Go to http://www.caringmedical.com and you can locate one in your area hopefully if Chicago is out of the question.Hope that helps.

  3. Sound like you may have some proprioception issues…can you feel the bottom of your foot? If you close your eyes can you tell where your foot is in space? Whether it’s up in the air or down? Do you have the type of AFO that fits inside your shoe?

  4. I always have the AFO on unless it is when I am in physical therapy and they need me to do something with it off and in that case they physically brace my ankle for that minute or so.The falls are…hmm..largely I would say they occur when I am in a place not so familiar (eg:not home} or in a hurry. I can’t tell the position of the right foot and sometimes it is too close, or pigeon toed in or whatever and I step on it with the other foot. I have a hard time sensing my position so as i fall I am not certain immediately where I am going. My hands are on the walker so I can’t really pinwheel to catch balance…it all happens very quick. Either I manage to immediately avert the fall, if it is not split second, it’s too late. The prostetist who made the current AFO says some of the balance problems that are not stumble related are because of the short heel cord. It just makes a rough situation more difficult. I was wondering if there were other types of AFO that might work differently.My insurance covers that very poorly so I was trying to hold off making another appointment unless i knew something that might work.

  5. You have the footdrop due to nerve damage. Yes, peripheral nerves can regenerate over time (slowly), but it all depends on the extent of nerve damage. And you can do all the exercises in the world and it will not strengthen your ankle dorsi flexion…it has a damaged nerve. There are no nerve impulses to the muscle. Your AFO is supporting your weak ankle, not causing your already weak ankle to become weaker. I suggest you wear your AFO as it sounds like you are setting yourself up for a nasty ankle sprain.Why are you falling? Is it with your AFO on or off? Did they work on balance training?

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