Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke

Abstract

Purpose: To explore the nature and impact of foot and ankle impairments on mobility and balance in community-dwelling, chronic stroke survivors. Methods: A qualitative research design using face to face semi-structured, audio recorded interviews. Thirteen community-dwelling stroke survivors, all of whom had self-reported foot and ankle impairments, were interviewed (female n = 6, mean age = 67 years, SD = 12 years, mean time since stroke = 4 years, SD = 6 years, right stroke n = 7, left stroke n = 6). A framework analysis approach was used to analyse and interpret transcribed interviews. Results: Three themes emerged: (1) Impact. The influence of foot and ankle impairments on mobility and balance. (2) Standing out. How participants felt they “stood out” because of their impairments and wanted to be normal. (3) Help. The specific help and advice participants received in managing their problems. Conclusions: Foot and ankle impairments such as pain, altered somatosensory input and weakness significantly contribute to problems with community ambulation, balance and fear of falling in people with chronic stroke. Specific foot and ankle impairments may also negatively contribute to perceptions of physical appearance and self-esteem. Therapeutic management approaches within clinical practice appear to focus mostly on the gross performance of the lower limb with little emphasis on the specific assessment or treatment of the foot or ankle.

Implications for Rehabilitation

• Foot pain, sensory impairments and muscle weakness in the foot and ankle can impact on community ambulation, balance and fear of falling following stroke.

• Foot and ankle function post-stroke should be routinely assessed and monitored.

• Clinicians should be aware of the potentially distressing negative perceptions associated with altered gait patterns, footwear and orthotic use.

• Balance
• fear of falls
• foot and ankle
• mobility
• stroke

Acknowledgements

We are grateful to the participants for their time and their willingness to share their experiences, to Gwenda Pay and Leigh Boxall of the South West Stroke Research Network, and to Jane Grose for her guidance on data analysis.

Declaration of interest

The authors report no conflict of interest. This research was funded by a grant from the Dr. William Scholl Podiatric Research and Development Fund (Grant Ref: FAiMiS).