Top INDEX
• What is Foot Drop?
• Article: What is Foot Drop?
• Article: Common Types of Drop Foot.
• Article: Symptoms of Drop Foot.
• Article: Causes of Foot Drop Injury.
• Article: Drop Foot (Foot Drop) and Steppage Gait ....
• Legality: Victim's Right to Recovery.
• Article: Treatment of Foot Drop.

• - What is Foot Slap.
• Causes of Foot Slap.
• - Blog : Treatment suggestions for Foot Slap.
• Answer: Treatment for Foot Slap.
• Motion: Foot Slap Gait.

• Personal: Stroke damage benefits from New connections.
  
  

• Insight: Drop foot is not a disease but a symptom of an underlying problem.
• Insight: Depending on the cause, drop foot may be temporary or permanent.
• Insight: Drop Foot can affect any person of any age and can ... 1 foot or affect both feet.
• Insight: Walking becomes a challenge due to the patient's inability to control the foot at the ankle.
• Insight: Many stroke and multiple sclerosis patients with foot drop have had success with FES.

• Insight: Every time your leg swings out the back, let your hip swing back with it.
• Insight: Foot slap can be controlled by (a) flexibility and strenghtening program.

  -Focus-: Monographs on Toxins and Enhancers.

What is Foot Drop? INDEX
https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/
peripheral_nerve_surgery/conditions/peroneal-nerve-injury.html
Johns Hopkins Medicine, Maryland, USA

LINK 2: https://en.wikipedia.org/wiki/Foot_drop
last edited on 22 August 2018

The peroneal nerve is part of the peripheral nerve system, and branches from the sciatic nerve in the leg.
Injury to the peroneal nerve can cause foot drop, a distinctive way of walking due to an inability to bend the foot upward at the ankle.
Parkinson’s disease, multiple sclerosis, ALS and leg or spine trauma can cause injury to the peroneal nerve.

Drop Foot/Foot Drop: A Symptom
Drop foot is not a disease but a symptom of an underlying problem.
Depending on the cause, drop foot may be temporary or permanent.
Often drop foot is caused by injury to the peroneal nerve deep within the lumbar and sacral spine.
The peroneal nerve is a division of the sciatic nerve. The peroneal nerve runs along the outside of the lower leg (below the knee) and branches off into each ankle, foot, and first two toes. It innervates or transmits signals to muscle groups responsible for ankle, foot, and toe movement and sensation.

Article: What is Foot Drop? INDEX
https://www.medmalfirm.com/drop-foot

Drop Foot, or Foot Drop, as it is also known, is the inability or difficulty to lift the front part of the foot making walking normally difficult. It is due to a weakening of the muscles in the foot that stops a person from being able to flex their foot fully. Individuals with this condition find themselves dragging their toes along the floor while walking as they lose the ability to point the toes upwards.

They might find themselves bending the knee to lift the foot higher than usual to counteract this.
Drop Foot can affect any person of any age and can be contained to either one foot or affect both feet.
It is a symptom of an underlying condition – either neural, muscular, or skeletal. Drop Foot symptoms can be caused by a progressive condition or as the result of surgery. For those with conditions such as Parkinson’s or Motor Neurone Disease, Drop Foot may be a lifelong issue. For others, recovery from Drop Foot can be possible through a number of noninvasive or surgical treatment methods. ...

Article: Common Types of Drop Foot. INDEX
http://www.alfirm.com/drop-foot

Some of the causes of Drop Foot are from disorders of the spine, brain, muscle, or from nerve injury or trauma, including:

• Lower back conditions
• Stroke or tumour
• Diabetes
• Parkinson’s disease
• Motor Neuron disease
• Injury to the foot or lower leg
• Multiple Sclerosis

Article: Symptoms of Drop Foot. INDEX
http://www.alfirm.com/drop-foot

LINK 2: http://www.losangelespersonalinjurylawyers.co/
foot-drop-surgery-error-medical-malpractice-lawsuit/

LINK 3: https://www.spineuniverse.com/conditions/sciatica/
drop-foot-foot-drop-steppage-gait-footdrop-gait
Written by Stewart G. Eidelson, MD
Updated on: 11/22/17

It is important to recognize the symptoms of Drop Foot in order to monitor the condition and know when to seek medical advice.
In some cases Drop Foot symptoms can recover partially or completely but for others it is a lifelong condition.
Some of the symptoms of Drop Foot are:

• Limp foot
• Tingling or numbness in the foot
• Aching or pain in the foot
• Muscle atrophy in the leg
• Exaggerated swinging hip motion
• Difficulty lifting the front part of the foot
• High steppage gait
• Inability to point the toes away from the body

In spite of the fact that there are treatments available for many who suffer from these symptoms, it is debilitating both socially and emotionally and can come with a lot of pain. Using braces or splints that keep the foot at a certain angle to improve walking are options that can help an individual, but often it it still difficult to buy and wear proper shoes in the summer. Physical therapy to strengthen muscles or surgery to repair damaged nerves may also help to alleviate the condition.

Diagnoses – Noticing the Signs of Foot Drop

Some of the most common signs and symptoms of foot drop include the following.

• Unable to point toes in the correct direction; towards the body.
• General pain, weakness and numbness.
• Loss of function in the foot.
• Steepage gait or foot drop gait – a high stepping walk.
• Dragging your foot.
• Inability or difficulty in lifting the front part of the foot.

Foot drop may be an indication of severe nerve damage which can worsen in time resulting in

• paraplegia,
• incontinence,
• Regional pain syndrome, and
• impotence in men.

Article: Causes of Foot Drop Injury. INDEX
https://www.spineuniverse.com/conditions/sciatica/
drop-foot-foot-drop-steppage-gait-footdrop-gait
Written by Stewart G. Eidelson, MD
Updated on: 11/22/17

LINK 2: https://en.wikipedia.org/wiki/Foot_drop
last edited on 22 August 2018

Peroneal Nerve: Causes of Injury
The peroneal nerve is susceptible to different types of injury.
Some of these include

• nerve compression from lumbar disc herniation (eg, L4, L5, S1),
• trauma to the sciatic nerve,
• spondylolisthesis,
• spinal stenosis,
• spinal cord injury,
• bone fractures (leg, vertebrae),
• stroke,
• tumor,
• diabetes,
• lacerations,
• Parkinson’s disease,
• multiple sclerosis,
• ALS,
• gunshot wounds, or
• crush-type injuries.

Drop foot is found in some patients with Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), and Parkinson's Disease.
Sometimes the peroneal nerve becomes injured when stretched during hip or knee replacement surgery.

The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor).

Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg.
The anterior tibialis is the muscle that picks up the foot. Although the anterior tibialis plays a major role in dorsiflexion, it is assisted by the fibularis tertius, extensor digitorum longus and the extensor hallucis longus. If the drop foot is caused by neurological disorder all of these muscles could be affected because they are all innervated by the deep fibular (peroneal) nerve, which branches from the sciatic nerve. The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space.

Occasionally, spasticity in the muscles opposite the anterior tibialis, the gastrocnemius and soleus, exists in the presence of foot drop, making the pathology much more complex than foot drop. Isolated foot drop is usually a flaccid condition. There are gradations of weakness that can be seen with foot drop, as follows according to MRC:

    0 = complete paralysis,
    1 = flicker of contraction,
    2 = contraction with gravity eliminated alone,
    3 = contraction against gravity alone,
    4 = contraction against gravity and some resistance, and
    5 = contraction against powerful resistance (normal power).

Foot drop is different from foot slap, which is the audible slapping of the foot to the floor with each step that occurs when the foot first hits the floor on each step, although they often are concurrent.

Treated systematically, possible lesion sites causing foot drop include (going from peripheral to central):

• Neuromuscular disease;
• Peroneal nerve (common, i.e., frequent) —chemical, mechanical, disease;
• Sciatic nerve -- direct trauma, iatrogenic;
• Lumbosacral plexus;
• L5 nerve root (common, especially in association with pain in back radiating down leg);
• Cauda equina syndrome, which is cause by impingement of the nerve roots within the spinal canal distal to the end of the spinal cord;

• Spinal cord (rarely causes isolated foot drop) --- poliomyelitis, tumor;
• Brain (uncommon, but often overlooked) --- stroke, TIA, tumor;
• Genetic (as in Charcot-Marie-Tooth Disease and hereditary neuropathy with liability to pressure palsies);
• Nonorganic causes.

If the L5 nerve root is involved, the most common cause is a herniated disc.
Other causes of foot drop are diabetes (due to generalized peripheral neuropathy), trauma, motor neuron disease (MND), adverse reaction to a drug or alcohol, and multiple sclerosis.

Article: Drop Foot (Foot Drop) and Steppage Gait (Footdrop Gait). INDEX
https://www.spineuniverse.com/conditions/
sciatica/drop-foot-foot-drop-steppage-gait-footdrop-gait
Written by Stewart G. Eidelson, MD
Updated on: 11/22/17

Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular (nerve and muscle) disorder that affects the patient's ability to raise their foot at the ankle. Drop foot is further characterized by an inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle inward or outward. Pain, weakness, and numbness may accompany loss of function.

Walking becomes a challenge due to the patient's inability to control the foot at the ankle.
The foot may appear floppy and the patient may drag the foot and toes while walking. Patients with foot drop usually exhibit an exaggerated or high-stepping walk called steppage gait or footdrop gait.

Legality: Victim's Right to Recovery. INDEX
http://www.losangelespersonalinjurylawyers.co/
foot-drop-surgery-error-medical-malpractice-lawsuit/
Normandie Law Firm (NLF), California, USA

Foot drop or Peroneal nerve injury is a serious medical condition resulting from damage to the sciatic nerve. Every year thousands of individuals suffer from foot drop as a result of back surgery and other medical procedures that are improperly conducted by physicians. Victims of medical malpractice including neurological damage are entitled to compensation under the law.

Patients who have suffered harm during a surgery or medical procedure due to the negligence of a medical professional are entitled to compensation for all harms suffered. However certain states including California have placed some restrictions. A list of all types of harm compensable include the following…

All medical and health related costs incurred.
All future medical and rehabilitation costs.
Non-Economic Damages including Pain and suffering and punitive damages:
In the state of California non-economic damage compensation limited to $250,000.

Economic damages – including loss of income and loss of future earning capacity.

Article: Treatment of Foot Drop. INDEX
https://www.spineuniverse.com/conditions/sciatica/
drop-foot-foot-drop-steppage-gait-footdrop-gait
Written by Stewart G. Eidelson, MD
Updated on: 11/22/17

LINK 2: https://en.wikipedia.org/wiki/Foot_drop
last edited on 22 August 2018

LINK 3: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/
peripheral_nerve_surgery/conditions/peroneal-nerve-injury.html
Johns Hopkins Medicine, Maryland, USA

Drop Foot (Foot Drop) Treatment
The type of treatment is dependent on the underlying cause of drop foot.
Some patients may be fitted with an Ankle Foot Orthosis (AFO), brace, or splint that fits into the shoe to stabilize the ankle/foot.
Gait training may be incorporated into the patient's physical therapy treatment plan.

Surgery may be an option to correct or alleviate the underlying problem causing drop foot.
For example, if drop foot is caused by nerve compression from a lumbar herniated disc, then a spinal surgical procedure called discectomy (disc removal) may be required to relieve or 'decompress' the nerve.

In some cases, drop foot is a complex problem.
Determining the underlying cause of drop foot is one of the physician's first considerations.

The underlying disorder must be treated. For example, if a spinal disc herniation in the low back is impinging on the nerve that goes to the leg and causing symptoms of foot drop, then the herniated disc should be treated. If the foot drop is the result of a peripheral nerve injury, a window for recovery of 18 months to 2 years is often advised. If it is apparent that no recovery of nerve function takes place, surgical intervention to repair or graft the nerve can be considered, although results from this type of intervention are mixed.

Non-surgical treatments for spinal stenosis include a suitable exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery that is minimally destructive of normal structures may be used to treat spinal stenosis.

Non-surgical treatments for this condition are very similar to the non-surgical methods described above for spinal stenosis.
Spinal fusion surgery may be required to treat this condition, with many patients improving their function and experiencing less pain.

Nearly half of all vertebral fractures occur without any significant back pain.
If pain medication, progressive activity, or a brace or support does not help with the fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be options. Dynamic advanced orthosis for drop foot

Ankles can be stabilized by lightweight orthoses, available in molded plastics as well as softer materials that use elastic properties to prevent foot drop. Additionally, shoes can be fitted with traditional spring-loaded braces to prevent foot drop while walking. Regular exercise is usually prescribed.

Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is primarily used to restore function in people with disabilities. It is sometimes referred to as Neuromuscular electrical stimulation (NMES) The latest treatments include stimulation of the peroneal nerve, which lifts the foot when you step. Many stroke and multiple sclerosis patients with foot drop have had success with it. Often, individuals with foot drop prefer to use a compensatory technique like steppage gait or hip hiking as opposed to a brace or splint.

Treatment for some can be as easy as an underside "L" shaped foot-up ankle support (ankle-foot orthoses).
Another method uses a cuff placed around the patient's ankle, and a topside spring and hook installed under the shoelaces.
The hook connects to the ankle cuff and lifts the shoe up when the patient walks.

Treating peroneal nerve injury and foot drop involves addressing the underlying cause.
In addition, your doctor may recommend nonsurgical treatments for mild cases, including orthotics, braces or splints that fit inside your shoe and help you walk more easily. Physical therapy can also help you improve your walking and mobility.

For more severe peroneal nerve injuries, your doctor may recommend a surgical procedure to decompress the nerve, repair the nerve with grafts or sutures, or transfer other nerves or tendons to support function of your leg and foot.

What is Foot Slap. INDEX
https://myemail.constantcontact.com/Get-Ready-to-Run-II--The--Shin-Splints
--Foot-Slap--Foot-Drop--Muscle.html?soid=1101121545271&aid=hP3wRQbm2S0
by Your Friends at The Pressure Positive Co.

LINK 2: http://www.letsrun.com/forum/flat_read.php?thread=1189510

LINK 3: https://ouhsc.edu/bserdac/dthompso/web/gait/kinetics/footslap.htm

During Loading Response, the Ground Reaction Force produces a Plantar Flexon moment at the ankle.
Activity in the dorsiflexors ordinarily opposes this plantar flexor moment.
When dorsiflexors are inadequate, the foot slaps audibly on the walking surface.

The Tibialis Anterior is the most important muscle that controls the speed at which the ball of the foot hits the ground when running. A weak Tibialis Anterior (due to trigger points, for instance) will cause the foot to slap down onto the ground quickly after the heel strikes. You might have heard this slapping sound when someone was running and wondered what was causing it. Foot Slap can cause excess shock to the feet, ankles, knees and on up. It can also reduce performance, including speed and distance of running.

...
What happens for some folks who are working on a midfoot strike, is that they notice their feet tend to slap the pavement more then they used to. If this happens to you it’s a sign that you’re on the right path to getting a midfoot strike, but it’s also a sign that there’s more work to do in other areas of your stride.

... Most people are used to swinging their legs forward when they take a stride … whether they’re walking or running.
What this does is create a heel strike where your heel then becomes a fulcrum and your foot slaps down onto the pavement with each step. Not only is a heel strike unhealthy for your knees, the slapping can bruise the metatarsal heads and make your feet feel like they’re on fire.

Quick Self-Tests to Tell if You have Trigger Points in Your Tibialis Anterior:
Follow the instructions below to test whether you have myofascial trigger points in the "Shin Splint, Foot Slap, Foot Drop" muscle.

Test 1: Tibialis Anterior Stretch Test
While standing or sitting in a chair, bring your leg back behind you and place the top of the great toe on the floor, ...
Leaving the toe in the same spot, bring the knee forward as far as is comfortably possible, stretching the top of your foot and ankle.

A Passing result is when the ankle can flex backward 40 degrees or more, which you can eyeball by checking if your foot and shin are approximately in line with one another, as shown by the red line in the drawing above. A Failing result occurs when the ankle cannot stretch far enough to form a straight line with the shin.

TEST 2: Heel Down Squat
Stand with your feet shoulder-width apart and your feet pointing forward.
Squat down as low as you can go without lifting your heels off the ground.
A Passing result is if you can squat all the way down without raising your heels.
A Failing result is when your heels lift off the ground before you attain a full squat ... or you cannot attain a full squat.
This test indicates difficulty with the Tibialis Anterior due to tight antagonistic muscles of the calf (namely the Soleus muscle).

TEST 3: Palpation
As always, the best assessment of trigger points and myofascial dysfunction in a muscle is to examine it with our own hands. Feel and press into the muscle tissue in the front of the lower leg and along the shin, covering the entire Tibialis Anterior. Check for tender spots and taut bands of muscle tissue, indicating that you have trigger points in these areas. This is also a nice form of warm up before performing the self-care steps.

LOADING RESPONSE (Sagittal plane)
Orientation of ground reaction force vector (GRFV) in sagittal plane

Normal GRF is located

    posterior to ankle joint
    posterior to knee joint
    anterior to hip joint 

What effect will this have
on joint motion and muscle activation?, images online

During loading response, ground reaction force produces

    a plantar flexion moment at the ankle joint
    a flexion moment at the knee
    a flexion moment at the hip

The body controls these moments with

    eccentric activity in the ankle dorsiflexors
    eccentric activity in the knee extensors
    isometric activity in the hip extensors 

Causes of Foot Slap. INDEX
http://www.letsrun.com/forum/flat_read.php?thread=1189510

The most common reason for a foot slap is a weak tibialis anterior muscle (your calf's antagonist.)
Why the unilateral nature of the slap? It may be that driving with your right foot on the pedals ... or if it's your dominant foot ... are reason enough.

If the slap is singular to your (brand of shoe) it's likely to be the depth of the heel cup.
Compare it to other models/brands you wear and see if there's a negative heel position (with regard to the arch and forefoot) causing the TA to be exerted more in the (brand of shoes) than others. ...

- Blog -: Treatment suggestions for Foot Slap. INDEX
http://www.letsrun.com/forum/flat_read.php?thread=1189510
1-21-2006 from various contributors.

LINK 2: https://www.chirunning.com/blog/a-cure-for-foot-slapping/
by Danny

LINK 3: https://www.sharecare.com/health/
walking-biomechanics/what-do-slapping-feet-walking
by Keith Chittenden , NASM Elite Trainer

LINK 4: https://myemail.constantcontact.com/Get-Ready-to-Run-II--The--Shin-Splints
--Foot-Slap--Foot-Drop--Muscle.html?soid=1101121545271&aid=hP3wRQbm2S0
by Your Friends at The Pressure Positive Co.

LINK 5: https://ouhsc.edu/bserdac/dthompso/web/gait/kinetics/footslap.htm
Last updated 5-15-98 --- Dave Thompson PT

To strengthen the TA, walk on your heels with your toes flexed upward as far as you can.
Do two or three sets of this walking 20-30 meters each day.

strengthen your TA by sitting in a high chair with a weight tied to your foot ...
when pulling the weight up by pointing your foot up, you are contracting the TA as wells as other dorsiflexion muscles

A Cure for Foot Slapping.
In the ChiRunning and ChiWalking techniques, the foot strikes under your center of mass in a midfoot strike.
This eliminates a heel strike and shortens your support time. The legs are always swinging to the rear, which noticeably reduces the amount of impact to the knees. When many people first try the midfoot strike they tend to focus more on the landing than on what the rest of their body is doing. The way to get rid of the slapping is to work on your pelvic rotation, ....

As your foot hits the ground under you, your leg begins its rearward swing.
Your leg then extends out behind you and when your foot returns to its original support position, it’s underneath you again … not landing out in front of you. As long as your foot never lands in front of your body, the slapping will go away.

Here’s the trick.
Every time your leg swings out the back, let your hip swing back with it.
This will force your hips and pelvis to rotate in the direction your rear leg is swinging, creating a healthy twisting motion along your spine. Your stride will open up behind you, as it should, and you’ll experience a new sense of smoothness in your gait because your legs will no longer be swinging forward which causes foot slapping.

Walking Biomechanics.
The muscles located in your lower leg which controls the rate the foot comes in contact with the ground are the tibialis anterior muscles (shin muscles). These muscles are responsible for slowly lowering the foot to the ground when your heel makes its initial contact to the ground during normal walking. To reduce the slapping of your foot to the ground try to strengthen the tibialis muscles.

One good exercise is toe rises with an elastic band.
Loop the band around all your toes and mid foot and then secure the band against the ground with your other foot.
Keeping the band snug against the ground, try to raise your toes/top part of your foot towards your head and bring it down slowly.
Try 2 sets of 15 reps with a moderate weighted band.

... Simple Self-Care Remedies.

Compression.
... Compression allows the taut band to loosen and blood flow to increase when you release the compression.

... roll (your shin) on top of a foam roller ...
When you find a tender point, press into it with enough pressure to feel the tenderness but not cause you to withdraw from the pain. Hold for 10 seconds while completing at least two full breaths in and out. Continue searching for more tender areas until you have covered the entire Tibialis Anterior.

It is also important to address the tight calf muscles that are antagonists to the Anterior Tibialis.
Roll over the back and sides of the calf and when you find a tender spot, press into the muscle to pain tolerance ("good pain" - not pain that is sharp or makes you want to withdraw). Hold for 10 seconds while completing at least two full breaths in and out. Then continue searching for more tender spots until the entire calf musculature is covered.

Range of Motion Exercise / Foot Pedal.
To take your calf muscles and Tibialis Anterior through its full range of motion, alternate rolling the foot back and forth, flexing the toes back as far as you can (dorsiflexion) and then pressing the toes back down and lifting the heel off the floor as far as possible. Do the same on the other foot but opposite timing so that one heel is up while the other heel is down. Repeat 30 repetitions per foot after finishing your self-care compression.

What is slapping feet while walking?
Foot slap is often referred to as drop foot or foot drop.
There could be some differences but for the most part they have similar implications.
The first thing to do is see your Doctor to be checked for any signs of nerve damage.
In many cases "foot drop" is associated with paralysis with muscles in the lower leg.
Although this is probably not the case most of the time, still have it checked.

The sound of the foot slapping comes from the inability of the anterior tibialis to control the forefoot, after the heel strikes when walking. This muscle is on the front of the tibia (the large bone in the lower leg) and is commonly the culprit when it comes to shin splints.

Foot slap can be controlled by incorporating an appropriate flexibility and strenghtening program.
First, as usual, get an assessment from an NASM Certified Personal Trainer in order to determine where the muscular imbalance may be originating. Most of the time, there is noticable flattening of the foot and/or the foot is turning out, during the overhead squat assessment.

Answer: Treatment for Foot Slap. INDEX
https://www.sharecare.com/health/
walking-biomechanics/what-slapping-feet-when-walking
Kyle Stull , NASM Expert

1. Use self massage on the calf complex.
   Either with a foam roll or enlist the help of a massage therapist.
   These muscles are restricting proper motion as well as affecting the anterior tibialis from a neurological perspective.

2. Next, use static stretching on the calfs.
   This can be done with a typical wall stretch, leaning forward to stretch the calves.

3. Follow this up with "toe taps".
   Simply point the toe down, then pull all the way up.
   The goal is to get the top of your foot as close as possilbe to the front of the lower leg.
   Begin with just the weight of your foot, then you can add resistance with a band if necessary.

4. Once this is complete perform "towel scrunches".
   Place a towel on the ground, and pull it towards you with your toes.

5. Last, integrate in single leg balance work. Perform this by simply standing on one leg for 30-45 seconds.

If possible perform the exercises barefoot.

Motion: Foot Slap Gait. INDEX
https://makeagif.com/gif/43-foot-slap-gait-heel-strike-
abnormalities-normal-and-abnormal-gait-series-bTyaux
Video --- March 27, 2016

Personal: Stroke damage benefits from New connections. INDEX

During a 1 week hospital stay in early November, 2018, I acquired a right leg foot-slap motion difficulty.
I had gone to the Emergency Department seeking a remedy for a severe lower back and right leg crippling pain. This was, eventually diagnosed as a lumbar sacral pinched nerve and was remedied by an epidural nerve block injection. The foot-slap change was directly noticed on my first leaving the hospital when I was walking for the first time on a hard paved surface. This would become a particular indicator of the ailment. Walking in bare feet or in socks on a carpet, at home, did not result in the gait symptom.

Some decades earlier, an uncle living in Detroit, Michigan state, USA had acquired a similar gait malfunction which had been identified to me later as a "foot drop" disability. To my knowledge and from my exposure to him, he was never advised to utilize any exercise regimes or attend any physiotherapy sessions to improve or correct it. Neither was it connected to any possibility of a stroke or advised as such. He was simply informed that it was an "aging disability" and he acquired some form of shoe brace to cope with it. It presented as the front of the foot not raising normally during walking to enable a clean sliding forward over ground, floor or other terrain. With the front part of the foot falling without awareness or control, a usual mishap would be for the toe part of the foot to drag against the ground and present an unbalancing effect which precluded a likely trip and possible fall. My own current disability was quite different though in the same physiological area.

For me, when I went to walk on a hard surface, each subsequent placement of my RIGHT foot down on the surface to continue a stride forward resulted in the FRONT part of the foot uncontrollably falling down on the ground to produce both a noticeable SLAP sound, and there being a significant shock pulse to by right leg ... similar in effect to if I had struck a solid object with the toes of that foot or stomped down on the surface intentionally. Besides the embarrassment and frustration of the sound, the repeated shocks to the leg quickly developed a fatigue in the leg, and generally to my whole body. It was the same leg which had been fully disabled by PAIN and Total weakness resulting from the spine difficulties. Remedying the spine injury with an epidural nerve block resulted in NO change to this walking problem.

I had never, in my 74 years plus had any disability or injury problem with this leg.
The CHANGE in movement dynamics had been immediate so it did suggest to me that a stroke could be the source of the change.
I suggested this to my General Practitioner with the hope that some testing or specialist might be able to evaluate this option and determine if recovery could be geared to such a realization, or, definitively excluded with confidence. My doctor did not seem to acknowledge this as a possibility and made NO effort to refer me to an appropriate specialist.

On my release from the hospital, the supervising physician advised that I go to a Physiotherapist for treatment.
Eventually, I determined how the referral procedure worked, the usual dynamic of where to go and who to see for an assessment, and, how flexible the choice of physiotherapist was, and, how costly the treatments were likely to be. I could choose other than the hospital physiotherapy department specialist, and, the cost would be covered by my provincial healthcare service. These institutional options seemed to be unaware to the medical personnel I had been in contact with and so my choices were revealed by my asking enough questions of persons who could provide the answers, including the eventual physiotherapist who was suggested to me by my General Practitioner ... who had recently begun to work from the same clinic as the General Practitioner.

Initially, the physiotherapist assessed my movement difficulties and corrected my confusion between what was a foot-drop and a foot-slap condition. He also confidently outlined the muscle and tendon dynamics to me, that differed from the description and exercise suggestions I had found online. I was given an exercise regimen designed to strengthen the applicable muscles and restore a normal gait. At the time, early 2019, I was continuing to cope with a number of yet-to-be-diagnosed significant intestinal and lung problems together with significant prescription drug (instigated by the hospital doctors) side effects. These "distractions" and energy absorbers, together with the reality of the complications of my first and general epidural nerve block (which felt after the first week until the end of the mandatory 3 month minimum duration before reactivation surgery) as if it were going to give out at any time. The result was that doing the exercises, which would seem to require minimum time and effort, could not be done without over-exercise side effects.

A visit back to the physiotherapist resulted in a modification to the exercise regimen and an improved detailing and understanding of just how much movement would be enough, for rebuilding, or too much, for possible added injury. After a number of weeks, no benefits were arising from these and these with the other health challenges were not being done on as regular a basis as I understood was expected. During all of this time, 4 months or more, it had been necessary for me to support myself with a cane (actually a walking pole I had was much better) during any ventures away from home. Fatigue frustrated such movements as the foot-slap movements did not improve any and the leg jarring and complicated supported movements drained energy away quickly. Negotiating down a flight of stairs, walking half a block, or walking around a store would leave me physically drained. It had become necessary for me to use a restricted municipal transit service for disabled persons. This was a GREAT help, both financially (taxi was the only alternative, at up to 10 times the cost), energy wise, and time demand ... until I GREATLY improved and CHOSE not to use it longer.

A touch of insight came to me one day while I was labouring my way to the 3-blocks away bus stop.
I was having to stop frequently along the way, at least once every short half-block, to regain my energy.
In an almost automatic manner, I began to consciously focus intently on the movement of my Right foot.
What follows is difficult to put into words as it involves actions and perceptions which we seldom describe.
At the same time as I was intently consciously concentrating, I accessed a sense state I use to access Spiritual Guidance. This is a state I would hope others develop as an extension of their repetitive efforts to achieve inner peace, harmony, and openness during the activity of prayer, meditation, accessing Spiritual Guidance, or, some may describe as receiving intuition, insight, or, an epiphany. Essentially, it is a routine which quiets the consciousness of the Ego and SuperEgo and opens our awareness to the Reptilian Structure and and its ability to connect with the Personal Spirit.

I found that by intently focusing on the movement of my Right foot as if to direct the selection of the nerves and muscles required to move the foot in a continuous gliding manner, my foot took the next step without any slap or awkwardness. Initially, this process took a LOT of energy --- I estimate 35 times as much energy as just taking the step. This was more a case of INTERNAL energy than it was of physical energy, although the result was to tire me both mentally and physically. If I let my focus ease or my awareness fall away from the specific muscle selection routine, the older, and now disturbed "broken" movement immediately took over. As I practiced and reflected upon this new development over the following weeks, the following clarified what had happened and was happening ... at least for me.

• I had experienced a STROKE and this had resulted in a neurological break in my Right foot walking movement string of impulses. This learned and robot-like series of automated muscle stimulations and relaxations had LOST one or more STEPS in the sequence.

• This was NOT a Physical injury that could be neurologically knit back together by an exercise strengthening routine. That would have required integrity of the NEURAL sequence and would build upon a MUSCLE injury being repaired.

• My routine of using FOCUS and REPTILIAN STRUCTURE communication was enabling me to assist my Reptilian Structure in the making of an ALTERNATIVE neural pathway and sequence for Right foot walking. This was NOT a modification of or correction of the injured pathway. It was a NEW pathway. In the early use of this "routine" my right leg calf muscles became tired and sore quite quickly. Somehow these muscles were being involved in the walking motion which I had been completely unaware of during my previous decades of walking, and running.

• I was having to REPLACE a Go-To automated walking routine which I had developed, reinforced, and repeated millions of times in my 7 plus decades with a new PATHWAY which was still novel and an exception. It would continue, for a number of weeks, to be IMMEDIATELY active and applied whenever I used my FOCUS and INTERNAL Energy to select it, and, it would disappear just as quickly as if it never were .. whenever I lost my Focus and Internal Concentration by distraction, fatigue, external necessity (being aware of the surroundings and others so as to avoid accidents and injuries).

• Initially, it seemed to take 35 times MORE Energy to activate and progress through the new movement routine as to simply use the older automated broken pattern.

• The more often I CHOSE to use the Alternative neural pathway in my daily movements, the easier and more dependably my Reptilian Structure would integrate and use it for walking and running. I would be best to remain aware of the Change-of-Response HABIT Selection dynamics in which ... under the stress or urgency, panic, fear, or surprise ... our Reptilian Structure chooses the most reinforced automated action to REACT with rather than the more recent, more beneficial and relevant, Movement sequence.

This tendency for us to fall back onto attitudes, reactions (learned or trauma induced automatic actions), and beliefs is most simply demonstrated if we move from one residence to another and must discard our kitchen garbage in a different manner. Perhaps because of the changes in the Structure of the kitchens, or, our Choice to make a change in What we place our garbage into ... we will make MISTAKES of old habits ... under the stress or urgency, panic, fear, or surprise. In the older location, we may have routinely discarded our kitchen garbage into a container under the kitchen sink. We may have done this one or more times daily for a decade. We move to our new location and there is no space for or garbage container under the sink. Or, we choose to purchase a new kind of container which we place at the end of the kitchen counter. The new NORMAL is to discard over the end of the counter. But, occasionally, when we are rushed and distracted, we prepare to throw the garbage under the sink ... only, hopefully, to catch our throw in time to redirect it to the newer and now BEST location ... at the end of the counter.

The message and REALITY here is that if YOU or someone you know, experiences a SUDDEN loss of physical ability, it may be best and possible to make an effort to make an Alternative Neural Pathway for yourself as I did for myself. At least if you do, you will understand WHY such may be necessary, and, WHY you may experience some of the frustrations involved in making such a replacement routine.