When I was first discharged from inpatient hospitalization to the DayRehab outpatient program, the physical therapists had me fitted for an ankle-foot orthotic (AFO). The AFO is a common partial solution to leg weakness and improper gait — essentially, it is a device built to prevent what’s called foot drop (keeping your foot at a constant ninety degrees with the rest of your leg) and makes up for ankle weakness or potential twisting.
gaining your footing
I was instructed to wear it at all times, which essentially restricted me to wearing gym shoes every single day no matter where I went. This posed a number of superficial and aesthetic issues for me, a young girl to whom fashion was an important means of self-expression.
Generally, I’m not the type of person who ever wears gym shoes outside of a gym. And I like to wear skirts. I’m short, so I don’t own many skirts that go past the knees. So the entire question of wearing an AFO indefinitely was something my ego would not stand for.
In 2004 (my injury was in ’03), while living in Italy, I discovered a solution to my inability to wear skirts: legwarmers. I was overjoyed! (More on that later.) But I was still stuck in gym shoes day after day, which admittedly helped me to gain speed and strength in my walking for the year I lived there without a car (having to walk virtually everywhere).
About three years after my hospitalization, I began to wean myself off the AFO. A friend of mine commented, “Isn’t it more important to follow medical advice and wear the brace than to be able to wear the shoes you want?”
I’d faced a similar conundrum before. After my hospitalization, my parents had wanted me to take a full year off of university before going back. But after one semester of living at home doing nothing but the tedium of repetitious fine motor retraining, I felt like I was getting dumber. I craved the academic environment, which was all I knew at that point, missed society, missed exams, even.
So I fought to go back early. My father resisted, trying to get my physicians to back him up. But clearly, I had a psychological need to return to my life.
And I did.
Now, medically speaking, it may not have been the most conducive thing to my recovery; in fact, I’m sure I could have recovered a lot more quickly had I stayed home to concentrate on my rehab, since my personality was such that I quickly prioritized my schoolwork ahead of my physical therapy.
But I had a session with a neuropsychologist once who told me she believed going back to school was exactly the right thing for me to do at that time, despite its medical implications.
Our psychological needs are valid. Of course, depending on what they are, some needs are more feasible than others.
So knowing my own body and feeling my own sense of balance, I self-prescribed a reduction in AFO use. Therapists will be loath to recommend or encourage this, but I retain you ought to use your own discretion. Generally, removing an AFO when it’s heavily needed will result in instability and/or falling, but I knew my body. I had had scarce, if any, falls, and after having been a dancer and athlete for most of my teenage life, I was kinesthetically aware of my sense of balance. Additionally, my trainer did warn me that a lot of people’s muscles atrophy from too much dependence on braces and things of the like.
Early last year, I went back to DayRehab for some OT and PT. The physical therapist responded with the expected dismay at my lack of AFO use, and she called in the orthotics specialist to come examine my gait to potentially give me a prognosis for future injury due to not using it.
Fortunately, he didn’t see anything wrong or pathological about my anomalous gait, and didn’t prescribe me a return to the AFO (or a new one).
I’ll still use it if I anticipate trying to run or jump, for safety, but I wanted to point out something to those of you with “medically discouraged psychological needs”: compensate for what you’re doing by counteracting whatever disadvantage you’re putting yourself in.
Example: I could have rigorously fit my therapy in with my school schedule when I went back so soon, or prioritized my therapy over my academics (not the smartest — but probably the best for medical improvement).
Or, in the case of the missing AFO, you can work on regularly strengthening the muscles that the AFO is made to assist: the ankle evertors, calves, hamstrings, quads. Develop those muscles and counteract that dependence so that when the therapist tut-tuts you, you can defy them with your newfound independence.
I’m not saying that this is a solution for everybody, so please use your own discretion. I can’t tell you what your body is capable of, and obviously safety measures should be taken.
This is, after all, how you break free from the shackles of injury and slowly take control of your own healing and return to self-sufficiency.
To our healing,