Feet in Stroke Patients

A stroke is caused by a sudden interruption to the blood supply to the brain. When the brain lacks sufficient blood flow for a certain time, the brain tissue becomes damaged and cell death can occur. This can result in neurological deficits like weakness in the body and limbs, the loss of or interruption in sensation and difficulty with walking, to name a few lower-limb related problems. 

A cerebrovascular accident (CVA) like a stroke can be classified into two processes:

1. Ischaemic (85%): this can be due to a clot forming in one of the blood vessels supplying the brain, or an embolus – a clot which travels from another site (usually the heart) to block off one of the arteries in the brain
2. Haemorrhagic (15%): this is caused by the rupture of one of the arteries in the brain – usually due to an aneurysm (an outpouching of an artery – causing a point of weakness)

There are several other types – including dissection (splitting) of the wall of one of the blood vessels to the brain, or trauma, and others – but they make up a very small percentage. A TIA (or transient ischaemic attack) has the same symptoms as a stroke, but the neurological deficit lasts for less than 24 hours – i.e. the person recovers completely within that time.

How Podiatrists Help People That Have Had Strokes

As a podiatrist, it is important to ascertain the cause of the stroke from the medical history. If vessel disease is the underlying pathology, there is reason to assume similar vascular manifestations are occurring in the lower extremity. Podiatrists also have a role in examining and treating the biomechanical complications that CVA victims often have.

Symptoms which may affect the foot and its biomechanics include muscle atrophy (wasting), paralysis (loss of nerve control and sensation) or paraesthesia (altered sensation). These symptoms can often lead to a secondary condition known as foot drop.

Foot Drop

Foot drop can be defined as a significant weakness at the foot and ankle that leads to the foot dropping towards the ground and having difficulties clearing the ground when walking. As a result, the patient will tend to change the way they walk to help them clear the ground and avoid tripping or dragging the feet. This may include excessively bending the hip and knee, circumducting the leg outwards to clear the ground, or other compensatory gait patterns.

Spastic Paralysis

After a stroke, you may be left with an abnormal increase in muscle tone that leads to spasticity where your muscle contractions become intense and involuntary. The result is stiffness in the feet and legs, painful or uncomfortable contractures, tired and achy muscles, and may lead to joint deformity over time. 

For the feet, this may lead to an equinovarus deformity where the foot contracts and twists inwards, making it difficult to walk as it will be the outside borders of the foot that will be coming in contact with the ground and not the bottom of the foot. This makes balancing difficult, combined with difficulty clearing the ground when swinging the leg through each step. Furthermore, high pressure on the outside of the foot can lead to severe calluses and even skin ulceration.

Helping Feet Affected By Stroke

Helping patients that have suffered from a stroke requires a careful multi-disciplinary approach. As podiatrists, we can help stroke patients with their walking, confidence on their feet, managing any complications that arise like calluses and ulcers, helping relieve their pain and improve their comfort. We do this using:

• Footwear – if your feet are severely affected after a stroke, you may benefit from specific custom footwear that has accommodating features like extra depth, width in the toe box, support, stability and more. If the feet are mildly affected, we can help you select the best off-the-shelf shoe to match your foot types and foot features
• Custom foot orthotics – we create custom orthotics especially for your foot and its characteristics using a 3D scan. These will address the specific problems and difficulties you’re facing, giving you correction and support where you will benefit most
• Custom AFO’s (ankle-foot orthoses) & braces – AFO’s are a slimline brace-like device that extends to the foot and ankle. We use these to help with problems like foot drop and to help you walk comfortably and confidently
• Education – we’ll inform you as much as possible about how to best manage your foot problems, what you can expect, the signs that you can look out for, and ways to help you stay active and comfortable on your feet