Three Questions with Meghann Koppele Duffy

Foot Drop, Feet, & Other Important Sh!t

• Meghann • Episode 6

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What if foot drop isn’t just a neurological thing? In this week’s episode of Three Questions w/ Meghann Koppele Duffy, we explore the hidden culprits of foot drop besides the common neurological conditions.  You’ll hear about the importance of sensory input, proprioception, and full-body integration when addressing foot drop in both, athletes and the general population.  This episode will challenge you to look beyond the surface and unlock effective strategies for the whole body when it comes to foot drop and other foot issues.

Resources mentioned:
Episode 5: Hypermobility Part 2... Now What?
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Meghann Koppele Duffy: Welcome to Three Questions, where critical thinking is king and my opinions and research are only here to support your learning and understanding. Well, hello. I am Meghann, your host of 3 Questions, and I am so excited you clicked on Episode 6 to talk about foot drop. Now, I was a little concerned doing this episode because I didn't want you guys not to click on this episode because you thought like, I don't work with clients with neurological conditions.

I don't need to worry about foot drop. So foot drop, if you're not sure what it is, is something we often see with people with neurological conditions. However, you can have foot drop if you've had a major back injury. Or I see foot drop a lot, although it's called something different in dancers. So just for somewhere on the same page, let's look at this episode and determine foot drop as the inability to dorsiflex or lift your foot, whether it's from neurological weakness to the peripheral muscles, the central nervous system, damage to your spinal cord from a low back injury.

Or what I experienced a major injury in the ankle that was set incorrectly. And now I have limited joint range that makes dorsiflexion and plantar flexion of my ankle problematic. Okay. So, now that we've got that out of the way, let's talk about the questions I have for you. Can you feel your feet? Now that might be like a stupid question, but what are you doing with your feet right now?

Take notice. What are they touching, what is the pressure underneath them, and what parts of the foot do you feel? Let me explain. Right now, I am sitting on my chair with my right leg bent and the right bottom of my foot is kind of underneath my left leg. Whereas, my left foot is on the floor, but she's not flat.

I am up on the ball of my foot, pressing down in the ball of my foot. Now, I realized that I was really pressing down in the ball of my foot, so I just relaxed my heel. But my heel does not touch the ground because of an injury I had in college. Let's get this out of the way. I always like to be clear. I always laugh when like people like.

Talk about their high school glory days with like rose colored glasses. Uh, just so we're clear, I am not a great athlete. Never was. Average at best at movement and sports. I often would make the team, but like, you know, maybe because the coach liked me and I was funny, I don't know. But I was good enough. I remember in middle school I really wanted to make the softball team, but I wasn't as good as the other girls, you know.

I didn't have great hand eye coordination, but nobody wanted to be catcher. And I was like, I'll be catcher. You get to kind of touch the ball at every pitch. You kind of are a little bit of the manager on the field. And I liked that power. So number one, my grandfather was a catcher. So I was like, perfect.

I'll be like pop pop. And number two, it was my ability to make the team. So I only share that story just so you don't think on this phenomenal athlete that this comes natural. My husband, on the other hand, is a genetic freak. Dude is, it's crazy to me. Two quick stories about Brian. And he freaking hates that I talk about him, but whatever.

When we were dating, I was moving out of Hoboken and coming down the shore. It was very windy, so we attached my mattress to the top of my jeep. And it was super, super windy. Did I mention it was windy? We're going over that bridge, kind of leaving Jersey City. I'm sorry, I'm assuming everybody knows New Jersey.

It's this long ass bridge that it's like windy normally. And you might know if you've ever flown into Newark Airport. Shit gets windy there. But anyway, I thought the Jeep was gonna go, fall over. So we pull over, and Brian goes, Okay, let me attach the mattress better. So, we roll down the windows, and he kind of attaches the mattress to the top.

And then we both realize, Oh shit, we cannot open the car doors now because we've literally roped them shut. Now if you've never seen a picture of my husband, he is 6'6", I don't know how much he weighs cause I have no idea, but I know when he played football, he was 320.. He's a big ass white boy. This dude literally looked, took one leg in through the window, then his body, then his other leg and got in the car.

And I looked at him and I was like, you're like a fucking ninja. I couldn't believe it. I'm five, three, pretty agile. And I couldn't do that. Second quick Brian stories. We were at the gym working out. We were doing kind of split lunges or jump lunges, whatever you want to call them. And I'm thinking, God, he's so fricking loud.

And then I realized, oh, the noise stopped, but he was still doing the exercise. It was me landing like an elephant, not him. Okay. So why I bring this up foot to hip connection, ability of your foot to respond to the ground. is critical. Now, what I think determines athletes from normal people. So Brian is an athlete.

I am a normal person. A lot of things come natural to Brian. He can naturally know where his body is in space better. But something we don't talk about for athletes is their visual acuity and ability to know where something is in space visually and propriocept their body based off that position. I have an obsession with Bo Jackson.

And if you don't know, you should Google him. Watch every documentary. He is amazing. And his visual acuity to me is what made him so amazing. Now, coupled out with sheer fricking power and force is what made him so remarkable. I see this now in Patrick Mahomes too, his ability to see the whole field and to see when he's not looking.

So that being said, when we are talking about the feet, Your client's history matters. Were they an athlete? If they were, you need to treat them neurologically, then you would treat someone like me, who plays amateur sports. Okay, yeah, I play tennis now at 42. I think I'm 42. Better than when I was in my teens and 20s.

But I am still not that great of a tennis player. I can go around and hit the ball and keep up, but I'm not that good. So, real quick, we need to separate athletes from general population here. Most of my clients that I work with foot drop and foot issues are general population. But I bring this up because I want to talk about dancers or any sport where there's excessive ankle mobility out of need.

Gymnastics, uh, swimming, how the foot is in the water could also be affected. Okay, so let's talk general population first. People who don't have as good of sensory integration. Can they feel their feet? Remember I asked you this before. What do they feel? Check their calluses. Do they have a bunion? What is going on on their feet?

If they have a bunion, put the sensory input at the bunion. If they have a callus, put the sensory information, the towel, the neboso insole, whatever you're using for sensory input, put it at that place. I just worked with a professional dancer the other day, and I, all I did was literally touch her bunion and give it sensory information, and her whole body shifted.

She tries to avoid sensory information at the bunion because she doesn't want to make it worse, but that's where her foot is trying to connect to the ground. Okay. Be honest about where your feet are connecting to the ground and giving sensory input. Also, with your clients, the bottom of our foot is designed for feel.

Okay, the skin, the sensory receptors. It, it, it's, it's perfect to really map out our body and foot. But depending on how that person lived or injuries, they might have shitty sensory information. They might have kind of loosed. Lost their sensation in the foot like someone would lose their ability to hear very well.

So, some clients have better sensory information on the top of their foot or the side. This is why you see me working with some clients with shoes and some clients without. I want to identify where they're actually getting sensory information from and utilizing that. I'm not gonna force them to try to get sensory information from a place where I want them to have sensory information.

Well, the foot is designed to give sensory intel. Great! The ears are designed to hear. What are you going to yell at a deaf person? Get out of here. Alright? Now, getting people to feel their feet is crucial. But identifying what they feel the most. Is it scratchies? Is it pressure? Is it deep pressure? Is it light pressure?

Don't go rolling out the bottom of your foot with a freaking lacrosse ball. If you have to release the plantar fascia and muscles of your feet. We have a much bigger problem and you're putting a tiny bandaid on a huge gunshot wound. We want, I don't want to say stiffness, but we want responsiveness in the foot.

Um, some people call it a rigid foot, but I don't like to say that because when people think rigid, they think not mobile. I really need to push off and use power from my foot. So stop mashing out your feet. If your feet are tight, that's how your brain is trying to stabilize them. So figure it out from there.

Question two. What does you, your head, or your client's head do when they try to move their foot? Okay. Let's start with the general population and neuro clients first. Often time when they cannot move their foot, they are going to couple foot movement with something else. So there's like a million different gait patterns and people love to Love to name them, but strengthening your glute med is not going to fix a Trendelenburg gait.

The reason the person has a Trendelenburg gait is not because of a weak glute med. It's because of lack of sensory info coming from the foot, the inability to process it, and the inability of the rest of the body to respond. That creates a compensatory pattern that makes the client lean or shift their femur in a way that they have a mechanical disadvantage to the glute med.

If you're not using your glute med, it's gonna get weak. So fixing muscles based off a gait pattern is again, band aid on gunshot wounds. I like to get that bullet out. So what I want you to do instead, whatever the client does when they lift their foot, if they march, if they circumduct their leg. Do they tilt their head?

What are they doing when they move their foot? Whatever they're doing, I want you to couple and uncouple it. I spoke about this in episode 5 about hypermobility. But let me explain again because I don't want to assume that you like the sound of my voice and listen to every episode. So, if a client's circumducting or swinging their leg when they're trying to lift their foot, their brain is often going to confuse, in the brain map, foot movement, hip circumduction, and often lateral flexion and pelvic movement around the opposite femur.

Uh, that's kind of what you have to do to circumduct your leg. So I'm going to ask my client, okay, lift your foot, swing your leg and bend your hip, whatever they're doing. I'm going to cue them to do what they're doing. And clients always say, I can't do that. And I want to be like, yeah, just did it like 45 times, but it didn't feel like they did it because they're mapping it differently.

So couple the joints that they want to use once they get that. Maybe three to five times. Say, okay, now I'd like you to lift your foot without circumducting the leg. Without tilting the head. And see what happens. Two things will happen. They will think you are a magician and a genius and saved their life.

Okay? It wasn't magic. It was brain science. Creating a new movement pattern. Now, it's not going to hold, unless you're specific about the sensory input you used. So, if I'm now saying, okay, let's do just head tilt because it's easier. Tilt your head as you lift your foot. Because you know, people tend to lean.

Now, lift your foot without tilting your head. How do they know they're not tilting their head? Are they thinking about not spilling a martini in their head, using a vestibular base cue? Are they touching their head and their shoulder and trying to differentiate two joints with their fingers? I call those two point differentiation proprioceptive cues.

So whatever cue you gave to help them move the foot without the head is the cue you need to do for repetition. Okay, so you're gonna either have a winner and you go with it or they're gonna physically not be able to move their foot at all. That's gonna be frustrating, but that's information. That's going to indicate their cerebellum has no other movement options based off that sensory input.

And we've got to get to work creating new patterns so that we can integrate foot change. Do we always want the first one to happen? Sure, it makes our lives easier. But the second option doesn't mean it's impossible. We just have to dig in and show the brain that other joints are available. Often not standing.

So all my PTs and OTs who are so great with functional exercises and movements, get them down to the ground. Change the dynamic completely. Try to just get them to isolate their hip. And all my Pilates and personal trainers that might be spending too much time with hip isolation, isolate the damn hip and then integrate it into a functional exercise.

Right? Don't just stay there. Okay? Number three question. Goes with question two. Are you addressing the entire body when you're working with foot drop? Now I rushed to question three because I kind of want to tie all these questions together. I'd like to make a point and tie a bow around this. This question's really important to me.

Because I once was asked to teach a lecture and a course at a very, at PT students. They were seeing the great results I get with neuro clients and wanted me to teach my strategies. But the head physical therapist, who is the best physical therapist for, um, MS and Neurological Clinicians in New York City, said to me point blank, I mean, but I, I can't recommend all this because I see you're giving a shoulder exercise to improve foot drop.

Shoulder has nothing to do with the foot. And right then and there, I knew I had two options. To agree with an old way of thinking, and get a job, or to stand up for myself. And it was one of the first times in my career, and this was all early on, where I said, I completely disagree with you. The entire body is connected, fashionably and muscularly.

You can slice a body however you want. You can cut a fascial line or a muscle however you want. So to say that the foot is not related to the shoulder is to me so outdated and the reason why traditional physical therapy falls short. Now, anybody who's a physical therapist that just got their undies in a bunch, I want you to think right now.

Are you the problem? Probably not. If you're listening to this podcast, you're an outside the box thinker. You're, we're on the same team. I love you. Thank you for being here. And if you're not, if you're trying to be like, Oh, this bitch knows nothing. Get the hell off my podcast. Okay. Take a lap. Don't be pissed because you get shitty results and I get good results.

Sorry. It's the truth. Okay. Saying that the shoulder and inability to stabilize does not affect the foot. It's so short sighted, it pisses me off, and it's the reason why a lot of people with neurological conditions are more disabled than they should. I cannot count on three hands the amount of clients I've gotten off of Zoom and wanted to cry and scream.

You can hear it in my voice, because they shouldn't be disabled. Nobody paid attention, and they just gave them random exercises. Okay, I'm going to get off my soapbox. Remember, if you're listening to this podcast, we're on the same team. Even if you do things different than me, I still applaud you. You're trying to figure out what works.

Okay? So, going back to this PT, I clearly said to him, like, Hey, why I was doing an upper body exercise, and it wasn't as articulate as I just was now, if I even was articulate, um, because this was probably, this was probably eight years ago, and I was nervous. And I said, listen, the reason why I'm doing an upper body exercise is a lot of my clients their shoulder girdle is really locked up and their upper quadrant doesn't stabilize.

And that's going to affect the lat. Okay, and you know, like right, you know, the lat connects the arm. It's the only muscle that connects the upper to lower body. That's kind of what I said at the time. I mean, now I kind of feel like we're all one muscle and fascial sac, although there are parts. I'm not, I'm still a biomechanics nerd.

Love muscles. I love to separate things, but I love to put them together. And, again, the lat, through the thoracolumbar fascia, the ilium wraps around and comes, touches your scapula and your humeral head. Okay, so, to me, the lat is such an important muscle because it connects the lower quadrant to the upper.

So, inability to fully utilize your lat and stabilize the lat is going to affect your glute. So we're all talking about glute amnesia, which is not a frickin thing. I mean, it is a thing, but it's not a diagnosis. It's bad sensory input. No foot to hip connection. If you're not using your glutes, you don't need them.

You're using something else. But you're not going to get your glutes strong. You're not going to be able to use them. And if your glutes aren't active, and your hip cuff can't activate, how the hell are you going to mobilize your foot? The foot doesn't move in isolation and you cannot get good mobility without stability up the chain.

So if you're not using a full body approach when working with foot drop or foot injuries, I really want to empower you to try. So the next time you give a client a foot exercise, I want you to notice what is happening up the chain. Take a step back. Look at the entire elephant. Don't just look up the elephant's ass.

Stop looking at the foot. Look at the whole body. Notice their tails. Are they moving their tongue? Are they making a face? Is their shoulder shifting? Is their head shifting? All these things matter. Now, I know I talked a lot about a lot in this episode, I promise I will do a part two on the foot to kind of hone in a little bit, but I had to get all these thoughts out because I want you guys to come up with solutions.

I know you can. Going back to the athletes in general population. Athletes often need less queuing. So for example. Remember I said, what was the sensory input you used so they didn't know their head, where their head is? That's what you need for general population. Um, athletes. Athletes are any person who does movement professionally, whether it's a dancer, a football player, a tennis player, soccer player, whatever.

Um, that is all important. So like, with, when I'm working with Brian. All I need to do is either touch a part of his body that's moving and shouldn't because it's not stabilizing or sometimes just tell him and he integrates that change. I'll tell you when it doesn't integrate when I interfere with my yapping, my touching and my micromanaging.

He hates demoing for my courses and I hate demoing on him because we have two very different learning styles. Me talking when he's trying to move is annoying. I get that. I don't like people talking when I'm trying to work. I can't concentrate. So, if you're working with a high level athlete, integrate the change, say less, let them come to their own solutions about the situation, and when you have a big ah ha, they're often gonna know.

Now, keep in mind, if they're post injury or in a pain pattern, their brain map there is going to be very smudgy. So again, we might have to approach things different. Keep in mind, I never make absolutes. I am the biggest gray area person when it comes to movement. So if you say, Meghann said this, you're not listening.

Meghann said this in this particular instance. Give athletes time. Tell them what to do. Step away. Let them figure it out. Let them get frustrated. When they have questions, they will ask. If you're working with general population, people like me, don't say anything. Tell them what to do. Don't give them the sensory cue.

Step away. But if they do not correct after the second or third rep, their cerebellum is struggling, help them. Because if you let me get frustrated, I'm going to quit. I hate to admit that about myself, but when I'm frustrated in a movement, I stop doing it. Athletes often stay in, dig their heels in, and figure it out.

Which is why they are exceptional at what they do. Cool? So, I threw so much at you today in this episode. Okay? It might have seemed chaotic and all over the place, but I'm chaotic and all over the place. Welcome to 3 Questions. If you're new, don't worry, you'll get my style, we'll grow together, I might get better at this, I might not though, so, you know, it is what it is.

But, when you're working with foot drop or any foot injuries, can your clients or you feel the feet? What are they feeling? What feels best? Where do they put most of the pressure? Where are their shoes worn? Where are their holes in their shoes? What do they connect with? If you're a Pilates teacher, when they do footwork, do not put them in perfect foot position.

Wherever their feet land on the foot bar tells you exactly where you should start to get their hips active. Then you can do all the fun foot positions. Athletes, coaches, if your athlete sets up in a weird stance, what if you just shut the hell up? Let them be in their weird stance. Let them get their hips and body to respond to that weird stance.

And then I promise you can change their stance. One more quick story. It's my favorite story about my dad. I am the female version of my father. It's actually terrifying. When we were little, we went to this place in Florida. I think it was called the Doral. It was like a tennis and golf resort with friends.

Arthur Ashe was the tennis pro at the time. And my dad did a lesson with Arthur Ashe, where they basically videoed you and broke down your stroke. And Arthur Ashe said to my dad, no notes. Not because my dad was a good tennis player. Arthur Ashe says, It is frustrating and upsetting watching you play because everything you do is wrong, yet, you're getting the ball over the net and you're a decent enough player.

Arthur Ashe recognized any critiques he gave to my dad's game would probably unravel the whole situation. He knew this guy wasn't going pro. He knew this guy's never going to be a great tennis player. But he stepped back and said, You're basically the worst tennis player ever seen, but you're getting over the net, keep doing what you're doing, no notes.

And I think that's the most, that's the best advice that anybody has ever given me as a movement coach, is stop assuming you know better than the client. Let them do what they need to do. Set up goals and figure out how to help them get there based off what they actually want to do. What does your client's body do when they move their feet?

So what was my dad's body doing when he was making hand eye coordination with the ball? Well, it wasn't what Arthur Ashe wanted, but it was good enough that my dad could get the ball over the net. So, start in the weirdness, and use the weirdness to make things biomechanically better, to help reduce pain, and to get the foot to move better.

And last but certainly not least, please, when you're working with foot injuries, when you're working with foot drop, especially for people with neurological conditions, if you are not addressing the whole body, you are setting this client up to fail long term. They need integration of their whole body.

This is why fatigue is a big problem. Help them look at the entire elephant, identify sensory gaps, and use that information to improve the foot. So, I hope you enjoyed this episode, which was sort of about foot drop, and I look forward to getting into foot drop for neurological conditions in another episode to give you a little bit more detail and some cool shit to look at.

But for now, if you have any questions about your feet or your client's foot drop, you know where to find me. Have, and have, a wonderful day. I almost made it through without making a gaffe. A gaffe, a snafu. Well, that's a really shitty way to end an episode. So I don't edit anything out. I'm going to say goodbye.

Have a great rest of your day and keep your feet active and moving. Thanks guys.