Q's for the walkers

[loreo]

I’m a C5-6-7ish walking quad. My right side functions very well, pretty much normal accept for some loss of strength. My left side is wonky. No hamstrings, no glutes, weak quads (though gaining strength now), weak and inconsistent hip flexor, over-developed plantarflexion due to spasm, little/no dorsiflexion (with my knee bent I can raise my foot, but not when standing – I think because of overpowering plantarflexion). I use an afo to deal with the foot drop and combat the plantarflexion.


Question 1: Have you folks noticed that Baclofen affects how well your hip flexors work? I think I see a pattern and wonder if you folks have the same experience. I take baclofen to reduce leg spasm (esp. plantarflexion). It helps my gastroc relax which then doesn’t randomly point my toes to throw me off balance. However, my hip flexor sucks when I take Baclofen. When I don’t take it, my hip flexor seems to respond better. (I think this is the pattern – I’m still testing it out) It makes sense that Baclofen would relax all muscles, but does relax = less function/weakness?


Question 2: Related to the above, I’m considering botox for my gastroc for more isolated spasm reduction. Has anyone done this? To what affect? My doc says it’s worth trying but may affect my ability to keep my knee locked.


Question 3: Do those of you with drop foot/plantarflexion issues/afo’s walk with your heel striking before the rest of your foot or the other way around?


Thanks for any info.

[marycsm77]

Question 3: Do those of you with drop foot/plantarflexion issues/afo’s walk with your heel striking before the rest of your foot or the other way around?


Thanks for any info.[/QUOTE]

I have foot drop, although not completely. I also cannot lift the ball of my foot off the floor when bearing weight but can to a degree when sitting. i just got my AFO and now when i walk my heal hits the ground first as it should. Before I was walking on the ball of my foot. Does this address?

mary

[Bonnette]

My issue is MS, but I have the exact mobility issues you describe. I'm not on meds, but as to foot drop/heel strike, I have profound plantar flexion - unless I wear my AFO, the heel of my foot always strikes last and it's impossible to lift the ball of my foot, or the toes.

[kelrod]

I’m a C5-6-7ish walking quad. My right side functions very well, pretty much normal accept for some loss of strength. My left side is wonky. No hamstrings, no glutes, weak quads (though gaining strength now), weak and inconsistent hip flexor, over-developed plantarflexion due to spasm, little/no dorsiflexion (with my knee bent I can raise my foot, but not when standing – I think because of overpowering plantarflexion). I use an afo to deal with the foot drop and combat the plantarflexion.


Question 1: Have you folks noticed that Baclofen affects how well your hip flexors work? I think I see a pattern and wonder if you folks have the same experience. I take baclofen to reduce leg spasm (esp. plantarflexion). It helps my gastroc relax which then doesn’t randomly point my toes to throw me off balance. However, my hip flexor sucks when I take Baclofen. When I don’t take it, my hip flexor seems to respond better. (I think this is the pattern – I’m still testing it out) It makes sense that Baclofen would relax all muscles, but does relax = less function/weakness?


Question 2: Related to the above, I’m considering botox for my gastroc for more isolated spasm reduction. Has anyone done this? To what affect? My doc says it’s worth trying but may affect my ability to keep my knee locked.


Question 3: Do those of you with drop foot/plantarflexion issues/afo’s walk with your heel striking before the rest of your foot or the other way around?


Thanks for any info.

Q.1 : I take baclofen daily (90 Mg.) and if I reduce the amount, I suffer from night time extensor spasams. I wish I could stop.

Q.2 : I am 4.8 years post and tried botox injections in my quad to relax the muscle and reduce tone in hopes of activating my dorsiflexors. After several injections over a 30-45 day period it did not work for me.

Q.3 : Over a 3 year period I had difficulty with heel striking; but it was a result of poor mechanics and bad habits. By landing on your front toes or the ball of your foot it can and will create knee problems such as tendinitis. I use the bioness L-300 device and it pretty much reinforces heel strike. The other foot I've had issues with as mentioned previously. Longer steps, proper weight transfer and balance control helped me achieve heel strike consistenlty.

[jerkens]

I’m a C5-6-7ish walking quad. My right side functions very well, pretty much normal accept for some loss of strength. My left side is wonky. No hamstrings, no glutes, weak quads (though gaining strength now), weak and inconsistent hip flexor, over-developed plantarflexion due to spasm, little/no dorsiflexion (with my knee bent I can raise my foot, but not when standing – I think because of overpowering plantarflexion). I use an afo to deal with the foot drop and combat the plantarflexion.


Question 1: Have you folks noticed that Baclofen affects how well your hip flexors work? I think I see a pattern and wonder if you folks have the same experience. I take baclofen to reduce leg spasm (esp. plantarflexion). It helps my gastroc relax which then doesn’t randomly point my toes to throw me off balance. However, my hip flexor sucks when I take Baclofen. When I don’t take it, my hip flexor seems to respond better. (I think this is the pattern – I’m still testing it out) It makes sense that Baclofen would relax all muscles, but does relax = less function/weakness?


Question 2: Related to the above, I’m considering botox for my gastroc for more isolated spasm reduction. Has anyone done this? To what affect? My doc says it’s worth trying but may affect my ability to keep my knee locked.


Question 3: Do those of you with drop foot/plantarflexion issues/afo’s walk with your heel striking before the rest of your foot or the other way around?


Thanks for any info.

ur weak side sounds alot like mine but i have 0 hip flexors... as having dorsi flexion when knee is bent, i think that is something to do with a reflex.. i can get some dorsi when my quads are stretched out over a ledge. i have plat flexion tone as well.. real bad case of it.. but it helps me stabelize with tone.. so careful with knocking it completely

question 1 - baclofen is a central nervous inhibitor so yes, when u take baclofen, not only are ur weak muscles getting weaker but ur bowels and bladder can weaken too (if that makes sense) everything.. even ur thoughts get cloudy

question 2 - try lidocaine first... this is the same stufff ur dentist numbs ur mouth before surgery or w/e...it lasts for about 3 hours and is very short acting.

question 3 - foot drop, in my case means by big toes are dragging when i walk.. which friggin hurt when i crunch my toes.. AFO should get a heel strike.. may not be a pretty one but should be.. have u tried the bioness ness l300? or a matrix max?

[betheny]

All the anti-spasmodics made my muscles weak. I chose spasms, however they don't throw me from my chair or anything like that. Heel hits first w/ afo. W/o afo, I hike my hip and drag my toes, as you mentioned, a painful process.

Good luck!

[november]

Yep everyone is correct. My physiatrist said baclofen used for below the injury can effect arms/hands/etc causing weakness.
Can you reduce the amount you take or try another med?

[marycsm77]

Q.1 : I take baclofen daily (90 Mg.) and if I reduce the amount, I suffer from night time extensor spasams. I wish I could stop.

Q.2 : I am 4.8 years post and tried botox injections in my quad to relax the muscle and reduce tone in hopes of activating my dorsiflexors. After several injections over a 30-45 day period it did not work for me.

Q.3 : Over a 3 year period I had difficulty with heel striking; but it was a result of poor mechanics and bad habits. By landing on your front toes or the ball of your foot it can and will create knee problems such as tendinitis. I use the bioness L-300 device and it pretty much reinforces heel strike. The other foot I've had issues with as mentioned previously. Longer steps, proper weight transfer and balance control helped me achieve heel strike consistenlty.

Kelrod,
How was it determined that your difficulty with heel striking was from poor mechanics and bad habits? Also isnt the Bionesss L-300 basically e-stim to you ant tib. Just wondering, I just got an AFO and while it has improved my gait it also causes some problems with pain, my foot gets numb, Im not sure if it need more "tweaking" or what.
thanks
mary

[PeanutsLucy]

My son is L1 -

1.) He hated Baclofen. Used neurontin for a long time, off it now. His muscles are flaccid below the level of injury.

2.) Good luck with the botox. Hope it helps.

3.) His foot drop is extreme. He wears AFOs on both feet. Walks heel-toe with them. Without them, it's more of a slide/drag movement and he can't go very far. Plus, blood pools in his legs if he stands and doesn't have compression socks & braces on.

[PeanutsLucy]

P.S.
Love the Susie Derkins avatar. Calvin & Hobbes is still my favorite comic strip of all time.

[loreo]

Re: Baclofen. Thanks for clarifying. I guess I'll have to decide on spasm & active hip flexor vs. relaxed and no hip flexor. I actually take very little baclofen so there's not much to cut out: 10 mg in morning and 10 mg at night which doesn't really impact walking. I was taking 5-10 mg during the day before I walked so my muscles weren't so tight/spastic. It made for a nice smooth walk, except my hip flexor wasn't firing.

Re: AFO. Even with the AFO the ball of my foot strikes first. Swinging my leg through causes plantarflexion spasm - I then step on the ball so I'm balanced and I can use my weight to push down and force the spasm to subside. Maybe it is a technique issue. I'll work on this - see if, even when in spasm, I can force my heal to strike first

Re: Bioness. I have the Walkaide now which is essentially the same thing. I'm in training mode - which is cyclical e-stim to activate dorsiflexion. Does the Bioness have no problem dealing with your plantarflexion spasms (or maybe you don't have plantarflexion spasm)?

[loreo]

try lidocaine first... this is the same stufff ur dentist numbs ur mouth before surgery or w/e...it lasts for about 3 hours and is very short acting.

I'll ask my doc about this. It sounds like a good idea in theory. I'm not sure if a few hours will give my calf muscles and hamstrings enough time to lengthen/stretch to allow my dorsiflexors to activate, but it's worth a try.

Calvin & Hobbes is still my favorite comic strip of all time.

Me too! Thanks.

[arndog]

I'm having trouble understanding how you can wear a rigid AFO and not have a heel strike first. Maybe you are wearing a floppy AFO that doesn't fixate your ankle.

Mine is super rigid and I have a velcro strap at the ankle to push the heel into the AFO. I have total flaccidity below the knee so I don't have to deal with spasticity. Here is what I use. Also, I think the best thing to help gait is using forearm crutches. Yes, I can hobble around the house holding on to counters and walls, but if I want to go far, forearm crutches are the way to go.

[loreo]

I'm having trouble understanding how you can wear a rigid AFO and not have a heel strike first. Maybe you are wearing a floppy AFO that doesn't fixate your ankle.

Mine is super rigid and I have a velcro strap at the ankle to push the heel into the AFO. I have total flaccidity below the knee so I don't have to deal with spasticity. Here is what I use. Also, I think the best thing to help gait is using forearm crutches. Yes, I can hobble around the house holding on to counters and walls, but if I want to go far, forearm crutches are the way to go.

My AFO is exactly like yours. I think the difference is in muscle tone. Your calf is flaccid so your foot moves smoothly and you can strike with your heel first (I'm jealous). My calf spasms so my toes push down - the ankle strap holds the afo on as the spasm pushes hard against the strap. With my toes pushing down, I haven't been able to get my heel to strike first, at best my foot lands flat, but usually I put pressure on the ball first cut the spasm.

Maybe a better way to describe it is my toes point and almost curl under. If i put pressure on my heel when I strike, it does nothing to stop that. When i put pressure on the ball of my foot, the curling relaxes, calf muscles ease and it's safe to put my whole body weight on that leg as I take a step with the other foot.

I use a walker. Here is a fuzzy video. I've taken baclofen so the issue is not as pronounced - it looks like my foot comes down flat - but without baclofen (so my hip flexors work better) the toe point & curl/ball strike is more pronounced.

[Bonnette]

Loreo, I note on the video that your left leg makes a circle in the air before your foot strikes...this is the same compensation that I've been making for years, and it really makes for trouble with walking as time goes by, causing loss of hip flexor, hamstring and quad strength.

I didn't realize this until my recent visit to a specialist in a larger city. It turns out that gait training would have helped me to preserve whatever function I could with the AFO, so if you haven't had gait training, it might be something you want to look into.

Also, I know what you mean about the tone, because I have it, too...it makes the toes point strongly. Mine is plantar flexion eversion tone, meaning that the foot is skewed as it points down...from the video, it looks like you might have this, also.

The orthotist can correct for eversion in the upper part of the AFO...has this been done for yours? Arndog is correct, if the AFO is functioning as it should for you, your heel should strike first, regardless of tone. You might want to return to the original orthotist and see if your AFO can be tweaked, or even get an opinion from another orthotist. I ended up having to get a new AFO with the spring in a different place.