MS Foot Drop and the Road to Physiatry
When I first heard about MS “foot drop,” I assumed that the manifestation of this symptom would be a sudden and obvious inability to walk properly. I knew many people with MS who used canes and walked with significant stiffness or a “dragging” limb. I filed “foot drop” away for future reference and eased on down the road. Many years passed, and aside from some trouble walking due to balance issues, my feet and legs were fine. In fact, the lack of walking difficulty caused many a surprised or skeptical look when I said that I had MS.
In the spring of 2011, on the eight-year anniversary of my diagnosis, I took a family trip to Phoenix. We attended baseball games, toured the botanical garden, and even went dancing. A rookie choice of pink satin flip-flops on the dance floor led to a rolled ankle. Back home, I faithfully rested and iced. But daily severe muscle spasms began to affect my foot and calf, so painful that they could drop me to the floor and leave me there for up to a half hour. Summer arrived and I was worse, not better. It was my right leg, and driving became unbearable. Despite icing throughout the work day, the 20-minute drive home was excruciating. I over-used my cruise control and employed the breathing tricks learned for childbirth over a decade ago. I was frequently crying before I made it in the front door.
Something was very wrong and the neurologist, naturopath, and physical therapist couldn’t seem to put Judy back together again. I was discouraged, and some days devastated. Not only was it difficult to work and function as a parent, but I was unable to do my usual outdoor activities that lift my emotional and spiritual health. The neurologist mentioned possible “foot drop,” but was not certain. The PT was very doubtful that the problem was related to my MS. In August, depressed and desperate, I received my first ever IV Solu-Medrol treatment and a referral to a physiatrist.
The National MS Society describes a physiatrist as a physician with expertise in physical medication and rehabilitation, who may serve as the leader of a rehabilitation team. I had never heard of a physiatrist! My initial appointment and exam took an hour and a half. The doctor patiently assessed the smallest movements, as well as my standing, walking, flexing, and stretching. She had reviewed the other providers’ notes prior to my visit, and asked many additional questions to gain a detailed understanding of my symptom history.
I left her office that day with an official diagnosis of MS “foot drop.” She explained that the changes can start slowly and subtly. The muscles in my right calf had not been receiving the full message from my brain for a while. As a result, the muscles on my shin were working harder. Our bodies are very polite and tend to help without being asked … muscles compensate for each other. The muscles on the front of my leg had grown in size and strength, but were simply not designed to do this work. As a result, I had developed chronic shin splints and spasms.
We needed to give them a break. Hand controls for the car would save my leg muscles for the more useful and beneficial activity of walking. An ankle-foot orthosis, or AFO, brace would use kinetics to lift my toes for me as I walked. (I use the AFO, but there are also newer functional electrical stimulation, or FES, braces. Read about them here.) Hopefully with enough rest I would be able to modify my hikes and enjoy the outdoors again.
It all sounded too good to be true. Ironic, isn’t it? I had developed a new manifestation of my disease and it sounded too good to be true! I was truly relieved to have some answers and a plan. By October I had the brace and hand controls, and by November the daily pain was gone. It was an adjustment, but these tools have helped me regain much.
Just remember — foot drop may not arrive with a bedazzled cane and a boom … it may creep in quietly with shin splints and foot cramps, or masquerade as an ankle sprain. For any MS rehabilitation needs, I hope that my story might help others to find the yellow brick road that leads to a physiatrist sooner than I did!
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