Page 33 - IDF Journal 2023

Then, instead of the normal loop, a wide arc is seen on ‘foot roll-over’ with the range of plantar flexion reduced during weight transference.
During the third phase, usually there is
a normal ‘fold under’ of the leg which occurs in swing but in the patient, there is reduced knee extension and the ankle plantar-flexes as it comes into contact with the ground when it should be dorsiflexed ready for the next heel-strike.
Results
The key point is the heel-strike. Young people with trainers still achieve this. Older people with trainers lose their heel- strike. Again, postural change tips the person forward and due to the change
in their centre of gravity this will only get worse and lead to instability and falls – even without Parkinsonism.
Using a heel-raise in the shoe (for men) or shoes with a heel such as ‘old-fashioned’ men’s shoes or ‘court shoes’ for ladies immediately improves heel-strike. We also need to remember that the fore-part of the foot is the accelerator (observe
any athlete competing on a track event). The heel is the brake (observe any judo competitor resisting his opponent’s attempt to throw him).
With this in mind, we need to teach our patients to ‘walk back to happiness’ again with a normal heel-strike and a good walking action.
Essential to this is a correct arm action. People who have been through the Services once knew this. We are not looking for marching, but we are looking for ‘left leg forward, with right arm swing’. This can be augmented with a Nordic pole (or broom handle!) in the right arm but never with a walking stick which just pushes the person forward and down, looking at the ground, not the horizon.
The Parkinson patient initially finds it very hard to co-ordinate the action of the left arm and the right leg but can learn it in 20 minutes! The secret is to practise, practise, practise – indoors and then outdoors. Restoring the arm swing, pattern of walking and movement shows the Parkinson patient that they have never actually lost their skills. Those skills have to be re-learnt in order to turn the clock back when walking normally again really does bring back happiness.
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REFERENCES
1. ‘Walking Back to Happiness’. Popular 1962 hit sung by Helen Shapiro.
2. The measurement of Parkinsonian gait using polarised light goniometry. Rudy Capildeo, Beryl Flewitt and F Clifford Rose. Chapter 50, Research Progress in Parkinson’s Disease: Ed. F Clifford Rose and Rudy Capildeo, Pitman Medical Ltd, 1981.
Dr Rudy Capildeo FRCP
Consultant Neurologist
E: rcapildeo@gmail.com
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