A stroke is a sudden and unexpected trauma where the blood flow and oxygen supply to certain parts of the
brain has been interrupted by a blood clot or burst artery, which can severely damage a person’s brain cells, causing
them to die. This means that certain areas of the brain don’t work as they usually would.
The effects of a stroke on each person can vary greatly depending on which parts of the brain have been affected, and to what extent. A
stroke tends to significantly impact a person’s motor function, mobility and independence, and affect stroke survivors' ability to
move, walk, balance, or even feel temperature or touch in their legs or feet, with one side normally affected more than the other.
As such, recovering from a stroke is something that our podiatry team takes very seriously, working very closely alongside patients at all
stages or their recovery, to support them regaining, maintaining and improving their movement, gait and overall comfort on their feet, and
preventing further complications.
How Are The Feet Impacted By A Stroke?
While the way the feet are affected will depend on which areas of the brain have been affected, there are some key ways that feet are
impacted:
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Muscle weakness or paralysis: Many stroke survivors struggle with foot and leg weakness or paralysis, which can mean that
you may be more likely to slip, trip or fall, or struggle to stand or walk at all. Weakness on one side of the body is known medically as
hemiparesis, which means ‘half-weakness, and paralysis on one side of the body is called hemiplegia or ‘half-paralysis.
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Fatigue: After a stroke, many people have fatigue or tiredness that does not get better with rest, and you may find that
using your legs and feet may become very tiring. This means that although you may be able to walk safely at the start of a shopping trip,
you become tired and more likely to trip towards the end. Many stroke survivors find that they also lose cardiovascular fitness, because
they become less active after a stroke.
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Pain: Some stroke survivors have spasticity or muscle tightness (which we’ve outlined below), which can lead to pain.
Others may have painful or unusual sensations like tingling, or feeling cold or burning in their feet, which can be due to damage to their
nervous system.
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Spasticity: The muscles in some stroke survivors have increased muscle tone, and very tight muscles, which can lead to some
stiffness and tiredness in the muscles of the unaffected side, as you may be using them differently by trying to make up for weakness in
your affected limbs.
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Contractures: Sometimes, spasticity can lead to a permanent shortening of your muscles, known as a contracture, which can
lead to muscles and joints in your legs and feet becoming fixed in position, and unable to fully bend or straighten.
- Changes in sensation: A stroke can affect your sensation in various ways:
Common Feet Issues And Symptoms For Stroke Survivors
The conditions and symptoms our podiatrists often see in the lower limbs in those who are recovering from a stroke include:
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Foot drop: those with foot drop have difficulty raising the front
part of their foot because of weakness or paralysis in the muscle that normally lifts it. This can make it hard to clear the ground while
walking, and patients often drag or scuff their foot along the ground. Foot drop can also make stroke patients unsteady when standing, as
it can cause poor positioning of the ankle and knee.
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Spastic equinovarus foot deformity: this causes the foot to turn inward and to the side, making it difficult for a patient
to walk, and in some cases can lead to arthritis over time.
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Changes to walking movements: as many stroke survivors struggle with poor balance, they tend to compensate by adjusting the
way they walk. Steppage gait involves bending the hip and knee excessively to lift the foot higher, and circumduction gait
involves keeping the leg straight and swinging to the side in a semicircle to move the foot forward, resulting in slower walking, fatigue,
pain, and a higher chance of falls.
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Ankle instability: this most commonly occurs as a result of low muscle tone which leads to weakness and flexibility, or
alternatively from high muscle tone that causes stiffness and spasticity.
- Balance and coordination problems, as well as jerky or uncontrolled movements
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Toe walking: toe walking is seen from muscle contracture affecting the Achilles tendon that makes bringing the heel in
contact with the ground difficult or uncomfortable.
- Hip dysplasia: hip dysplasia may occur as a result of muscle imbalances that move the hip joint out of alignment.
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Claw toes: muscle contracture can also affect the toes, leaving them in a clawed position that can make it difficult to fit
shoes comfortably, and may risk the development of corns, calluses and blisters on the toes.
Treatment For Feet In Stroke Survivors
The treatments we recommend to help optimise foot function and for stroke patients will depend entirely on the specific way you have been
affected, your symptoms, your concerns and your goals. All of these are covered during your initial assessment with us, where we complete a
thorough clinical exam and get to know your history. From there, we’ll discuss our findings, the possible treatments, and how they
work. This may include:
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Physical therapy: physical therapy can involve a stretching, strengthening, balance and gait training program that is
targeted at each person’s unique symptoms and circumstances, working to optimise the strength and movement in their feet and legs.
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Custom foot orthotics: orthotics are custom-prescribed shoe inserts that
work to accommodate the existing structure of a rigid foot and its deformities, offloading high-pressure areas and adding stability and
comfort to the feet. Alternatively, they can be used as a functional device to support the feet, reduce pain and discomfort, and promote
better foot function and gait in a way that responds to the direct needs of a person’s foot characteristics.
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EXO-UP brace: the EXO-UP brace is an innovative brace for foot drop and ankle
weakness that is prescribed and designed following a 3D scan of the foot and ankle. It keeps the foot from catching on the ground,
thereby reducing the risk of falls, while also promoting a better gait pattern, and improving walking speed, balance, posture, safety and
confidence.
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EXO-L brace: the EXO-L brace is also a custom prescribed brace, but is
designed specifically for weak and unstable ankles, and is proven to prevent most ankle sprains.
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Ankle foot orthoses: we offer a range of ankle foot orthotic options to improve the quality of life of stroke survivors and
help with symptoms like foot drop and muscle weakness. This includes the slimline leaf spring AFO that is incredibly comfortable to wear and
provides a fantastic fit in shoes, and the Richie Brace - Dynamic Assist model that gives greater control of the heel while giving patients
with foot drop back the ability to walk without fear of falling.
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MLS laser: MLS laser is a proven, painless and safe treatment that is shown to help with reduced muscle tone and muscular
contractions, as well as helping improve the ability to detect sensations around the feet. Learn more about the MLS
laser here.
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Mobilisation: foot mobilisation involves the hands-on manipulation of stiff or dysfunctional joints in order to improve
joint alignment, release tension and help your feet and legs function more efficiently.
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Skin and nail care: regular skin and nail care appointments can help
with any corns, calluses and nail problems that are produced as a result of the effects of a stroke on the feet
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Footwear modifications and recommendations: we’re proud to be able to offer a range of footwear modifications that
enable your current shoes to best support the way your feet are affected. An example may be adding a rocker bottom sole to help move the
foot efficiently through the step with the help of the rocking motion of the shoe. You can see our full list of modifications here.
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Referrals: strokes can change and affect people in a very wide range of ways. As such, it’s important to work with a
team of health professionals that are skilled in helping in a wide range of ways. We have a strong network of health professionals we can
refer you to when we identify further needs - like seeing an occupational therapist for greater mobility inside your home, for performing
tasks like walking up and down the stairs.
Podiatrist support is an integral part of stroke recovery. The brain cannot regenerate any cells lost during the
stroke, but podiatry techniques can help the brain to reorganise existing cells to compensate for the loss. This
is known as neuroplasticity, meaning that the brain is able to be remoulded. This can help stroke patients to attain new
skills, and improve and regain skills they had before.
Treating stroke-related foot issues starts with an appointment with our podiatry team. We’ll take the time to get to know you, and
complete a detailed assessment to understand how your stroke has affected your movement, function, and mobility. We’ll then discuss
your goals, your previous levels of activity, and create a tailored programme to support an optimal recovery.
We’ll look at all the options to optimise your quality of life throughout the different stages of your recovery, including the use of
our range of treatments and aids. We’ll discuss all of the options carefully with you, ensuring you understand exactly what the plan
is, and will make changes to the plan as you progress and regain function. Your podiatrist also stays with you throughout your rehab -
regardless of how short or long that is.
