Good Foot to Heaven, Bad Foot to Hell

December 2, 2010 by  
Filed under Rehab and Recovery

There comes a time in life when the knees and legs lose some of their reliability.  Typically this occurs late in life as bones, muscles, and body start to weaken.  Stairs become a nuisance that just doesn’t go away.  They eventually grow into one of the biggest single obstacles in life.  Eventually, stairs are removed from the daily routine by casting aside the two story house in favor of a patio home or retirement village.

For most of us, the anxiety that accompanies a trip on the stairs is something that has never entered our mind.  Most people go through life without ever considering limitations in mobility.  Those of us that are fully healthy never even think about placing a call to a restaurant or theater to see if the place is handicap accessible.  Before traumatic brain injury, Jessica never gave a second thought to conquering any flight of stairs.

Upon discharge from the hospital, it was recommended that she avoid going up or down any flight of stairs.  This was strictly a safety concern.  When walking on a hard surface, Jess’ right leg did not advance on its own.  A strap had to be wrapped around the thigh so that a helper could pull the leg forward for the next step.  Level surfaces were all she could do… the dragging and pulling of the bad foot created serious friction on any type of carpet.

Going up stairs is infinitely harder than walking on a level surface.  While this makes complete sense to anyone who considers it, the actual act of assisting a handicapped person up or down stairs introduces a whole new meaning to the word “frustration”.  Obviously, stairs are a big challenge for someone who has trouble walking.  The two parts of this endeavor that are the most frustrating are:

  • Difficulty in raising the good foot straight up and then straight forward to clear the next step.
  • The “bad” foot’s tendency to extend out at the ankle, making it difficult to get the toe over the front lip of a step while going up.

 

A stroke patient who wishes to relearn the art of stair climbing requires two adult spotters.  The primary spotter’s job is to help advance the leg and maintain balance.  The secondary spotter is in charge of maneuvering the foot so that the bad toe clears the lip of the next stair each time. As the patient gains strength, the phrase “Good foot to heaven, bad foot to hell” describes the best way to get up or down stairs.

 

Good Foot to Heaven

When one leg is weaker than the other, the good leg must take the lead in going up the stairs. The weaker leg’s dead weight prevents the knee to lift the bad foot up to the next step. Even if the bad foot was flexible enough to be placed on the next step, the leg doesn’t have the strength to push the entire body up there. Upon reaching the staircase summit, a quiet inner celebration commences for the walker as well as the spotter. The light streaming in the upstairs window makes it look like heaven at the top of the stairs. The feeling of accomplishment of tackling those 13 stairs feels like heaven.

 

Bad Foot to Hell

Going down the stairs is even scarier than going up… looking down at the crash point of your potential fall an intimidating scene for someone with minimal control of their legs.  When going down the stairs, it is necessary to lead with the bad foot.  The good leg is needed to control the descent down each individual stair.

 

Making Progress

Each time Jessica does the stairs, she gains a little bit of confidence and strength.  Her right knee and ankle lack the flexibility to clear the lip of the next step, so her body compensates by turning to the right.  Instead of raising her leg straight up, she opens up at the hip and swings her leg up to the next step.

Two short weeks were all that was needed to see some improvement.  After fourteen days of practice, she can get up the stairs with the help of a single adult spotter.  Her bad foot still needs some direction, but each day it gets closer to making it up to the next step independently.  Going down stairs is tough due to the stubborn right knee and ankle.  Imagine bending your leg just a little and stiffening it from hip to toe with a cast.  In order to walk down stairs, one needs to lean back to lift the foot off the ground.  An immediate change of course into a forward lean is needed to keep you center of gravity over the advancing leg.

The real challenge is finding the courage to lean forward enough to walk.  Too much forward lean leads to a painful ending at the base of the stairs.  Jessica is slowly improving her ascent and descent, but this task that used to be second-nature for her remains a daunting one.  Walking up and down stairs is just one of many challenges that fill her typical day.  Jessica is determined to continue working at this challenge and strengthen her body and her mind in order to regain as much independence as possible.  Someday in the future, stairs will no longer be something worthy of writing about.  The metaphor of heaven and hell one that we hope to eventually put in our rearview mirror.

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Comments

One Response to “Good Foot to Heaven, Bad Foot to Hell”
  1. gary lewinski says:

    I am post stroke-6 years ago-just recently been going up stairs on my deck with affected foot first-I have foot drop. Been doing pretty good.is this good exercise for my affected Side? Thanks

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