different shoes

It is almost three and a half years since my stroke. Conventional wisdom about post-stroke recovery suggests that the first neurological adjustments and improvements after a brain injury are very rapid, and then tend to plateau off after the first six months. The importance of this “six month window” was often repeated to me by various medical practitioners, and I remember very clearly that one of my biggest fears in the weeks following my stroke was that, some point in the future, I was going to feel retrospectively guilty about not having done enough to maximise my recovery during that time. But every stroke is different, and looking back now, it seems to me that these arbitrary post-stroke “recovery windows” are really of most use to those involved in making ethical / financial decisions about resources and the provision of care. Telling someone who has just had a stroke that they have six months in which to complete the difficult work of neurological recovery to the best of their abilities is frankly not that helpful and can, as it did in me, heighten the general terror and desperation of what is already a pretty desperate time. Very little research exists into long-term post-stroke improvement, and, after the OTs and physios have done what they can, one is pretty much left to one’s own devices. But from my own entirely partial perspective I would say that, though the pace of recovery is certainly much slower long-term, one can still notice improvements two and even three years down the line. Though I am resigned to the fact that my damaged left leg is never going to enjoy running, and that my balance issues will probably always make riding a two-wheeled bicycle impossible, I still occasionally discover that I can do something now that I couldn’t say, six months or a year ago.

Footwear is incredibly important if you have a neurologically damaged leg and foot, and I have found that a really effective way of making improvements in my mobility is simply by changing shoes. A different pair of shoes can initially impede one’s mobility — the gait alters, the foot drags, the limb refuses to make the routine movements that it made just yesterday. But, although effectively heightening one’s own disabilites in this way can be both uncomfortable and annoying, walking in different shoes forces the damaged limb to adapt to different billateral rhythms and movements. The good limb also shows the bad how it has to deal with the minute alterations in weight and pressure forced upon it by its new environment. The good limb helps the bad one on its way.

I tend to walk around 4 miles a day, and until very recently, my choice of footwear was limited to sturdy boots with a lot of ankle support. I could certainly walk a little in flat shoes (with orthotics) but found it difficult and tiring. Often, after a mile or so in flats, my left leg would simply give up and revert to its dead, dropped state while the right one carried it hesitantly and judderingly along. Then, in February this year, I decided to try an experiment. I would alternate my footwear daily, completing my normal walking routes in several different pairs of shoes and boots, including flats. This wasn’t particularly easy, but I noticed that after just a couple of weeks that my left foot was adapting to the changes forced upon it more rapidly, and that I could walk further without problems in shoes I was unable to before. I also found that these continual changes and adaptations helped with other, non-walking activities, such as pointing my toes in order to put on a pair of socks or pants (a gesture I have found frustratingly impossible for the past three and a half years). Then I discovered that I was able to hop (albeit briefly and inelegantly) on my left leg for the first time since my stroke. I continued with the footwear changes: things continued to improve.

In March, I bought the pair of sandals that you see above (shamelessly copying Jen, who had recently acquired a pair). They are a great fit and very comfortable but when I first stuck my orthotics in and started to walk, my left foot flapped about, clown like, and after a mile or so I’d be limping and dragging the foot quite badly. But I gradually forced the unruly foot to adapt by including the sandals in my alternating-different-shoe routine. By April, they had become my go-to shoe, and since then, I’ve walked over 350 miles in them. Last week I encountered one of my good dog-walking buddies, an elderly gent, who I first met three years ago when I was still getting about with a leg brace. As we were passing the time of day, he remarked on how very much my walking seemed to have improved of late. I was aware of this, but it was nice to hear it. “I’ve just been wearing different shoes,” I said.

I am repeating this experience for those with brain injuries or other neurological impairments who have been told that their recovery period has a window, or that it is somehow at an end. I honestly don’t think that the work of neurological recovery or adaptation will ever be over for me. I will certainly keep forcing the parts of my body and brain that were damaged by the stroke to make whatever small improvements they can. I’ll keep on wearing different shoes.

Because I know you will ask, the sandals are made by Red or Dead, and are a style called “Jade”. The socks are a pair I knitted from Rowan Fine Art sock yarn, and are holding up remarkably well to their daily mileage.