Some scholars have pointed out that the formation of foot drop and foot inversion is caused by dysmenorrhea of the yin and yang meridians, that is, the spleen, liver, and kidney have more than three qis, and the stomach, gallbladder, and bladder have no sufficient yang and meridians. The formation of the turn, the focus during treatment is to regulate the foot Sanyang Meridian Qi. After the acute phase of stroke, the muscle strength of the lower limbs begins to recover, and the muscle tone changes from low to hyperactive or has entered the convulsive period. It is more responsible for chronic diseases, such as poor blood flow, choroidal blockage, tendon and vein failure, and foot Shaoyang. The gallbladder meridian points, which have the effects of filling the essence and replenishing the marrow, relieving the muscles and promoting blood circulation, have a good effect on treating foot drop and foot inversion.
2. Physical factor therapy
Nerve function electrical stimulation: Currently, the main operation procedure of functional electrical stimulation for foot varus and foot drop is to let the patient lie down or sit down. The treatment electrode is placed on the anterior tibialis anterior and calf muscle of the patient's calf or muscle. At the starting point, adjust the position of the electrode and the intensity of the current based on the patient's response. During the treatment, the patient's ankle joint will produce dorsiflexion and valgus movements, thereby correcting the original varus and sagging. After the treatment, the patient can feel significant labor-saving and walking speed during walking.
Wax therapy, thermomagnetic: For the high tension of the calf triceps, wax or thermomagnetic therapy can improve local blood circulation, accelerate metabolism, and provide adequate blood supply for spasm muscles, thereby improving A state of muscle spasm, which relieves sagging feet and varus.
3. Walking training
Encourage the patient to get out of bed and stand early. When standing out of bed, you should step by step according to your own situation. You can stand on the bed first, keep your heels in contact with the ground as much as possible while doing squats and walking exercises, and gradually increase the walking time.
4. Maintain footwork position
When the patient can only lie in bed, neither the supine position nor the lateral position can leave the foot suspended. You need to place a cushion on the foot, flex the affected hip and knee when lying down, and place your foot on the cushion and make it firm. When lying sideways, the affected foot should be cushioned. Cloth shoe therapy can be taken during sleep, that is, the affected cloth shoes are fixed vertically on the patient's bed rails, and the affected foot is put into the shoes every night for 2-3 hours before going to bed for massage.
5. Rehabilitation training
Mainly passive activities, from the ankle joint to the toes, joints between the toes. Each joint needs to be fully moved in all directions to fully expand the joint capsule and the tendons around the joint. The technique is gentle, the force is gradually increased from small, 2 times/day, 30 minutes/time. After the joints are fully passively moved, the patient is given language stimulation to allow the patient to perform joint flexion and joint extension movements of the foot. Training must be carried out step by step. Use a soothing massage to relax the muscles with high tonicity, and massage and knead those with low tonicity. For those who cannot be active on the bed, perform passive movements of the affected limbs and joints through the patient's mind Active training with confidence. Reshape the behavioral pattern of the affected foot plus basic functional training. In short, a gentle external force will be applied to the toes before the contracture occurs. Joints are fully stretched and squeezed to stimulate sensation and movement to prevent foot drop and promote functional recovery.
6. Botox treatment
Botulinum toxin is a neurotoxin containing polymer protein produced by botulinum. It is currently known as the most toxic biotoxin among natural toxins and synthetic poisons. It mainly inhibits the release of acetylcholine from nerve endings, causing muscle relaxation and paralysis. Therefore, the local application of botulinum toxin injection in spasm muscles can effectively alleviate spasms and correct foot drop and varus. However, its efficacy is maintained for up to three months, and multiple injections can cause resistance or induce muscle weakness.
The main mechanism of wearing an ankle and foot orthosis (AFO) to treat sagging and the varus foot is to brake the ankle joint and keep it in a neutral or slightly dorsiflexed state for a long time. Because the ankle plantar flexion is restricted, it can prevent the upper end of the calf from leaning forward when landing, so it helps the knee to straighten and stabilize. It has a certain meaning when the quadriceps muscle is weak.