Foot Drop & frequency of symptoms

These are probably more stupid questions. I've looked through most of the archives and visited other sites for answers, but I can't seem to find what I'm looking for.
Is "foot drop" something that happens all the time or at least frequently or do people have it and experience it occasionally?
And...are there MS related conditions that you can have daily while others relapse or resurface during an episode? I'm sorry if I'm not using the correct terms. For example, can a person have issues with pain/numbness regularly while only experiencing incontinence issues during a relapse with many more symptoms?
I'm just trying to put all the pieces together.
Linda

[Quixotic1]

Foot Drop can be caused by different mechanisms.  

Foot-drop I

It is usually caused by damage to the muscle that lifts the foot up.  The muscle is called the Anterior Tibialis.  to locate this muscle , sit in a chair with your foot flat on the floor.  Locate the muscle that runs just along the outside of the shin on that leg.  Keep your fingers on it.  Now, keeping your heel on the floor, lift your foot up.  You will feel the muscle contract to pull the forefoot up.  that is the Tibialis Anterior.

If the nerve to that muscle is damaged it will show up as being unable to bring the toe up or to do it very weakly.

Now, why is this important?  Being able to lift the toes up is crucial to being able to walk smoothly and safely.  As we stride forward we pull up the toes to clear the ground as the foot swings forward.  If we can't pull them up enough, then they will drag against the ground and often cause us to stub them on the ground and trip us up.  We can compensate by lifting the knee much higher to pull the foot up so that it clears the ground even though the toes can't pull up.  This is called an absolute foot-drop.

If we can pull up the toes just a little we can usually walk on even ground, but will trip over the slightest irregularity.  Area rugs are killers as are cracks in sidewalks or any other small rise in the ground.

This type of Foot-Drop is present as long as the nerve is damaged. The damage can arise up in the central nervous system, as in MS, and is usually a spinal lesion.  As we know MS lesions sometimes heal and if this happens, the foot-drop can resolve.  The damage can also happen to the peripheral nerve, the Tibialis anterior.  This would be a peripheral neuropathy.  Peripheral nerves can also sometimes heal.  If healing occurs the Foot-Drop will disappear.


Foot-Drop II

The second type of foot-drop is caused by spasticity and not by a weakness of the tibialis anterior.  If a person has "extensor spasticity" they will have the tendency to have their foot pull downwards via the contraction of the calf which has a higher tone in it.  When these people do the test trying to lift their foot while the heel is on the ground, they will often be able to do it.  However, during the act of walking the spasticity of the calf will pull the foot downward even though the person is trying to raise the foot to clear the ground during the stride forward.  So, they trip anyway.  This is called a "functional" foot-drop.  I have this second probem.  When I am sitting I can easily bend my ankle up to bring up my foot.  But when I walk the toe drags the ground.  I also cannot lift the leg higher to compensate for this as I also have hip flexor weakness.

Many of us have observed that spasticity can vary thoughtout the day or day-to-day.  I find that I have almost no spasticity after a long rest and my first 100ft or so of walking I may have a perfectly normal stride.  But, the muscles fatigue quickly and soon I am dragging my foot.

Treatment

The treatment for both types of foot-drop is a brace called an AFO - Ankle Foot Orthotic - which holds the foot in the same position as if you were just standing on the ground.  the foot is at right angles to the lower leg.

Another part of the treatment is to frequently stretch the Achilles' tendon so that it does not shorten permanently either from the persistent droop of the foot or from the pull of spasticity.

There is also an electrical biomechanical device that can be programmed to the person's calf that will deliver a signal to make the tibilais anteroir contract (pulling up the foot) at the right moment as we walk, to treat the foot drop with using a brace.  There are several of these.  A few are called the Walkaid, the ODSF - Odstock Foot Drop Stimulator, and the Ness H200 or Bioness.

I looked into one of these at one time.  It would have been $6000 out of pocket and I had to pass.

Well, this was the blurb I have ben wanting to write up on Foot Drop.

Any questions?

Quix

[Sailorsong]

Linda

Yes any and all Sx can come and go all of the time. I have been dealing with this since 1989 and it was only earlier this year that any of my doctors have noticed my foot drop for the first time but it has been happening for years. At times it will only happen part of the day while other day it will happen for days on end, and still other days I won't have any foot drop at all. I happen to wear slippers most of the time and when the foot drop is happening my right slipper will keep sliding off of my foot while I am walking  when I have foot drop going on.

I also have some Sx that are there always namely my leg/foot numbness and pain. While my vision will go from 20/20 to 20/40 over the course of months and then end up back at 20/20.

I hope this helps with your question.

Dennis

[tonyad]

  Hello and Welcome to the Forum :)

    PLEASE take Note when I say...Ther are NEVER Stupid Questions my Friend!
if you are thinking it or wondering about it , well then chances are someone else is too :)

    As Dennis had mentioned your sx can come and go and they can also come and just 'Hang Around" for a long while or Just never leave!  That's the umpredictability of this Disease, making it so hard to understand.

    Please also note that Everyone's MS is unique to them. So your MS is Your's.  Now of course there are always common denominators in all of us but the course it runs for you may be quite different to everyone else.  I hope that make some sort of sense  :0

    Foot drop, a disorder of the distal aspect of a lower extremity, like most foot ailments, has little to do with the
intrinsic function of the foot. This neurological disturbance, like most common to the foot, is caused by nerves
proximal to it's location. This impairment is a malfunction of either a peripheral nerve or a part of the central
nervous system.  

http://www.mult-sclerosis.org/footdrop.html

http://www.ninds.nih.gov/disorders/foot_drop/foot_drop.htm
  So from what I am understanding through reading these articles specifically the 2nd one is that if it neurological it will probably stay......

     Have you talked to your Neuro about this?  I hope you can get some answers soon. Remember you can always come here and ask Anything you like!  Or just "Rant..Lol

Take Care,
~Tonya    

[RedFlame]

Hi Linda,

You have already received great advice and information.  I just wanted to say hi and let you know that many of us deal with foot drop in varying degrees.  I also wanted to thank you for bringing it up as it is something I have been studying myself

I hope that you will be able to talk with your doctor soon.  People with foot drop will use some type of orthotic device that holds your foot in the proper position.  There is also specific physical therapy for foot drop.

Like Tonya and Dennis said-----you can talk about anything here.

Red

[sllowe]

Hi GracieBee,

Thanks for joining us!

The Relapsing/Remitting title of MS really can be confusing. On 1st mention, one would tend think, oh good, I'm going to get better and then only have to deal with problems during relapses! Yippee

Sadly, it very much not the case, though I do know others who are symptom free and only experience this during relapses.

Pardon me if you have already posted a bit about yourself - but were you dx'd? Or, currently in limbo w/not answers....

Nice to meet you, hope we can help out,
-Shell

[GracieBee]

Thank you to each and every one of you that responded to my questions. This group has been very helpful!
I am posting separately about my visit with the neuro doc today.

Linda

[Quixotic1]

Foot Drop can be caused by different mechanisms.  

Foot-drop I

It is usually caused by damage to the muscle that lifts the foot up.  The muscle is called the Anterior Tibialis.  to locate this muscle , sit in a chair with your foot flat on the floor.  Locate the muscle that runs just along the outside of the shin on that leg.  Keep your fingers on it.  Now, keeping your heel on the floor, lift your foot up.  You will feel the muscle contract to pull the forefoot up.  that is the Tibialis Anterior.

If the nerve to that muscle is damaged it will show up as being unable to bring the toe up or to do it very weakly.

Now, why is this important?  Being able to lift the toes up is crucial to being able to walk smoothly and safely.  As we stride forward we pull up the toes to clear the ground as the foot swings forward.  If we can't pull them up enough, then they will drag against the ground and often cause us to stub them on the ground and trip us up.  We can compensate by lifting the knee much higher to pull the foot up so that it clears the ground even though the toes can't pull up.  This is called an absolute foot-drop.

If we can pull up the toes just a little we can usually walk on even ground, but will trip over the slightest irregularity.  Area rugs are killers as are cracks in sidewalks or any other small rise in the ground.

This type of Foot-Drop is present as long as the nerve is damaged. The damage can arise up in the central nervous system, as in MS, and is usually a spinal lesion.  As we know MS lesions sometimes heal and if this happens, the foot-drop can resolve.  The damage can also happen to the peripheral nerve, the Tibialis anterior.  This would be a peripheral neuropathy.  Peripheral nerves can also sometimes heal.  If healing occurs the Foot-Drop will disappear.


Foot-Drop II

The second type of foot-drop is caused by spasticity and not by a weakness of the tibialis anterior.  If a person has "extensor spasticity" they will have the tendency to have their foot pull downwards via the contraction of the calf which has a higher tone in it.  When these people do the test trying to lift their foot while the heel is on the ground, they will often be able to do it.  However, during the act of walking the spasticity of the calf will pull the foot downward even though the person is trying to raise the foot to clear the ground during the stride forward.  So, they trip anyway.  This is called a "functional" foot-drop.  I have this second probem.  When I am sitting I can easily bend my ankle up to bring up my foot.  But when I walk the toe drags the ground.  I also cannot lift the leg higher to compensate for this as I also have hip flexor weakness.

Many of us have observed that spasticity can vary thoughtout the day or day-to-day.  I find that I have almost no spasticity after a long rest and my first 100ft or so of walking I may have a perfectly normal stride.  But, the muscles fatigue quickly and soon I am dragging my foot.

Treatment

The treatment for both types of foot-drop is a brace called an AFO - Ankle Foot Orthotic - which holds the foot in the same position as if you were just standing on the ground.  the foot is at right angles to the lower leg.

Another part of the treatment is to frequently stretch the Achilles' tendon so that it does not shorten permanently either from the persistent droop of the foot or from the pull of spasticity.

There is also an electrical biomechanical device that can be programmed to the person's calf that will deliver a signal to make the tibilais anteroir contract (pulling up the foot) at the right moment as we walk, to treat the foot drop with using a brace.  There are several of these.  A few are called the Walkaid, the ODSF - Odstock Foot Drop Stimulator, and the Ness H200 or Bioness.

I looked into one of these at one time.  It would have been $6000 out of pocket and I had to pass.

Well, this was the blurb I have ben wanting to write up on Foot Drop.

Any questions?

Quix

[twist330]

Reading your very understandable info has made me realise that I possibly have two issue going on with my foot which I had not understood before.

1. When I walk, I turn my right foot out (like a ballet dancer) I know why I do this - if I walk with my foot straight. I get very strong tingling sensation that that within a few steps has turn my whole leg to jelly and I can't walk at all, so I go to turning my foot out. I guess that in this position I do not have to walk through my foot so much as if it were straight.

2.  Is what I think you have described as foot drop II. On uneven ground (and when I have lost concentration of where I am stepping) I end up tripping over my right foot.
            A recent example of this was on Holiday (A cruise). On one day we walked round the ruins of Pompeii, very uneven under foot.I went very slowly, very carefully. It was a long day, and apart from the odd stumble I was OK, but tired. Now if I was at home after a long day like that, I would not plan anything for the next day so as I could recover. But our ship arrived in corsica the next morning there was a traditional farmers market which couldn't have been more than 400yards from the boat so off we went my husband slightly in front. I was tired and not concentrating on the floor only in which direction my hubby was walking.

Who put the crack in the pavement,? Who showed it to my right foot and not me? It was a stunning fall that lauch me forward to land on my left knee and hands, infront of an audience of 2 corican police officers who spoke no english. My husband hadn't even realised he was still walking on! anyway grazed and brusied I managed to convey to them an ambulance was not required. Hubby was very confused as to why I was sat on the floor chatting up the police officers!

Thanks Quix I now understand possibly whats happening and why it only happens some of the time some of the time. I'm not so sure about the turn out foot issue.

[Sailorsong]

Quix,

Yet another great post from you. Very easy to understand and gives a person a great insight into what is going on in their body. After reading your post I have come to the conclusion that I have the second type of foot drop going on and now know what I should be talking to my Neuro about.

I do have one question though. When are you going to write a book about all of this? Maybe if all these S.T.U.P.I.D. doctors read it they would understand who to treat patients and treat their illnesses.

Dennis

[Sailorsong]

Oops that should have been

they would understand how to treat patients and treat their illnesses.

Dennis