Over the years of working with so many great people to help them improve the control of their foot after stroke, I have found there is generally always one thing that we have to work on. And, it is something they have already worked on at some point in their journey of improvement. However, this particular area needs to be continually addressed until it can be maintained without specific work. And that area is….FLEXIBILITY!
Yes, stretching is generally the very first place a person has to start to focus on to get movement in the foot or to maximize the movement. Many times, stretching is an afterthought in the rehab process. A person may have been instructed at some point to stretch the foot and ankle, but the importance of this flexibility is not made clear and the stretches fall by the wayside.
The way I was trained, if you don’t have the available flexibility you are not going to be able to actively move the part in that range of motion. So, if a person wants to be able to fully lift the foot up, the foot needs to be able to move in that direction, easily. Notice I said easily. THat means that it should not take great effort to move the foot through that range. So, when I start to help someone, I look at that flexibility. And if there is not enough flexibility to easily move the foot the way that is needed, I instruct them on stretches. Sometimes I need to get my hands on the foot and ankle and get the joints loosened before the stretch can be beneficial. But, oftentimes, a person can use some tools and “set ups” to get the stretching that they need.
The next thing we tackle is changing some habits. If a person stretches out the part to get better foot lift, they are going to want to maintain that range. That is another thing I learned in my training- Maintain what you get.
So, I teach my clients to be sure the foot is up under them when they go to stand (that needs that ankle bending flexibility). Then, every time they stand up, they are maintaining that range and can then use their stretching to get more mobility. The great thing is that as a person starts to incorporate the range of motion that they gain into their everyday activities, the range of motion “starts to stick”.
I will also look at any foot brace the person has. I will see if it allows the ankle to bend in the most typical way possible and if it doesn’t, I will make a recommendation to change the brace. If a person is not using a brace and the foot is “drooping” with each step, I will consider a foot brace to help the foot lift. If the foot is drooping with every step=foot will get tight and you will probably not make gains in the range of motion and control toward lifting. So, in this case, I see the foot brace as a tool to help the foot get better. Once the stretching program and the plan to maintain it is in place, we can move on to increasing active control toward the foot lifting up.
Over the years, I have had occasions where I was surprised at how much improvement can come simply from stretching. I have had clients that, once they get good stretching and increase their range of motion, they are able to lift the foot well. The brain was sending the signal, the muscles were responding, the foot/ankle was just too stiff to be overcome. The stretching revealed the active movement!
If you are wanting to improve your foot lifting, start with really looking at how loose the foot is and get a stretching plan together if it looks like the stiffness is holding you back.
If you have a question about stroke recovery just send an email to Shannon@thrivestroke.com.