1. Name: Rahila Najihah Ali
Matrix Number : DPH/0102/11
Batch : July/11
Date: 19th June 2013
1
Foot Drop

2. Definition
2
 Inability to raise the front part of foot due to
weakness or paralysis of tibialis anterior muscle
that lift the foot
 Foot drop occur due to peroneal nerve injury
 Can happen to one foot or both feet

3. Muscle and Nerve
3
oDorsiflexor Muscle
-Tibialis anterior
-Extensor hallucis longus
-Extensor digitorum
longus
Peroneal Nerve

4. Tibialis Anterior
4
 Origin : upper two thirds of lateral surface of tibia
and adjacent interosseous membarane
 Insertion: medial surface of medial cuneiform and
the base of 1st metatarsal bone
 Nerve supply : receive twigs from deep peroneal
nerve and recurrent genicular nerve
 Action: dorsiflexion of foot at ankle joint and
invertor of the foot at midtarsal and subtalar joint

5. 5
 Testing the function of Tibialis Anterior : patient is
asked to dorsiflex the foot against the resistance
of therapist’s hand placed across the dorsum of
the foot
 Injury to deep peroneal nerve leads to paralysis
of dordiflexors

6. Extensor Hallucis Longus
6
 Origin: medial part of anteromedial surface of the
middle two forth of fibula and adjacent
interosseos membrane
 Insertion: base of terminal phalanx of great toe
 Nerve supply: Deep peroneal nerve
 Action: dorsiflexion of foot at ankle and
dorsiflexion of great toe
 Testing Functional : patient attempts to dorsiflex
the great toe against resistance

7. Extensor Digitorum Longus
(EDL)
7
 Origin: upper three fourth of anteromedial surface
of fibula, adjacent interosseous membrane and
anterior intermuscular septum
 Insertion: EDL is divided into four tendon on the
dorsum of foot
 Nerve supply: deep peroneal nerve
 Action: produce dorsiflexion of ankle joint and
dorsiflexion of lateral four toes
 Testing functional: patient is asked to do
dorsiflexion of the toes against ressistance

8. Sciatic Nerve
8
 Sciatic nerve the thickest and largest nerve in the
body
 It’s start in lower back and runs through the
buttock and lower limb with root value of L4 until
S3
 It’s supply biceps, semitendinosus,
semimembranosus and adductor magnus muscle
 In lower thigh, just above the back of the knee,
sciatic nerve divides into two nerve which are
tibial and peroneal nerve
 Those 2 nerve innervate different parts of the
lower leg

9. Peroneal Nerve
9
 Begin from L4, L5, SI, and S2 nerve roots and
joint the tibial nerve to form the sciatic nerve
 Common peroneal nerve travels anterior, around
the fibular neck
 Common peroneal nerve divide into superficial
and deep peroneal nerve
 Deep peroneal nerve : innervation of tibialis
anterior muscle that responsible to the
dorsiflexion of the ankle

10. Causes of Foot Drop
10
 L4-L5 disc herniation
-the herniated disc compressing the L5 nerve root
 Lumbosacral Plexus injuru
- due to pelvic fracture
 Sciatic nerve injury
-hip dislocation
 Injury to the knee
-knee dislocation

11. 11
 Neurodegenerative disorder of the brain
-multiple sclerosis, stroke, cerebral palsy
 Motor neuron disorder
-polio and amyotrophic lateral sclerosis
 Injury to the nerve roots
-spinal stenosis
 Peripheral nerve disorder
-acquire peripheral neuropathy
 Damage to the peroneal nerve
-muscular dystrophy

12. 12
 Established compartment syndrome
-foot drop is late finding
-irreversible muscle and nerve ischemia occur in
patient if fasciotomy is not performed

13. LEVEL OF LESION IN SCIATIS
NERVE INJURY
13
 High lesion (above the knee)
-both tibial and common peroneal nerve are
paralaysed
 Low lesion (below knee)
-spared : peroneus longus and brevis
Type 1 : anterior tibial nerve injury
lost : Tibialist anterior, extensor hallucis longus,
extensor digitorum longus and peroneus tertius
Type 2 : musculocutaneus nerve injury
spared : all above muscle innervated by anterior tibial
nerve
lost : peroneus longus and brevis
sensation : over outer leg and foot

14. Symptom of Foot Drop
14
 Inability to lift the front part of the foot
 Abnormal gait which drag the front of foot on the
ground during walking (steppage gait)
 An exaggerated, swinging hip motion
 Tingling, numbness & slight pain in the foot
 Difficulty performing certain activities that require
the use of the front of the foot
 Muscle atrophy in the leg
 Limp foot

15. Clinical features of Type 1 foot
drop
15
 High lesion : total foot drop
 Unable to do dorsiflexion and inversion of foot
 Able to do eversion
 Front of leg is wasted
 Sensation lost over dorsal web space of the leg

16. Clinical features of type 2 foot
drop
16
 Low lesion : incomplete of foot drop
 Unable to do eversion
 Able to do dorsiflexion and inversion of the foot
 Wasting of outer half of leg
 Sensation lost over outer leg and foot

17. Gait of Foot Drop
17
 Gait of foot drop gait is high stepping gait
 The patients lift the knee high and slaps the foot
to the ground on advancing to the involved side

18. Diagnosis
18
 Occur during routine examination where patient
find it’s difficult to walk on their heel
 Plain X-ray
 Magnetic Resonance Imaging (MRI)
 Electromyography (EMG) and nerve conduction
study
 SD curve
 Tinel sign

19. Treatment of early foot drop
19
 Conservative treatment : shows high incidence of
recovery
 Splintage – splint knee in 20° of flexion and ankle
in 90° for night time
 In day time, walking is allowed by using ‘foot-drop
appliance’
 Varieties of foot drop appliances:
i) dynamic-spring shoe
ii) static- back stop shoe

20. 20
 Ankle foot orthotics (AFO)
-support the foot with light-weight leg braces and
shoe inserts
 Exercises
-strengthen the muscle, help to maintain range of
motion (ROM) and improve gait
 Electrical Functional Stimulations
-electrically stimulate the peroneal nerve during
footfall

21. 21
 Surgery – done if conservative management fails
 Repairs or decompresses a damaged nerve that
fuses the foot and ankle joint or transfers tendons
from stronger leg muscles
 Choices of surgery
i) tendon transfers – for mobile foot drop
ii) tendo-archilles lengthening - in fixed equinus
iii) subtalar stabilizer procedur – for fixed varus
iv)triple arthrodes – for fixed varus at the subtalar
joint

22. Physiotherapy- Exercise
22
 When problem stems from weak muscles
 Proper physical therapy exercises can strengthen
ankle muscle and improve symptoms

23. 23
 Toe curls exercise
 Place a small towel and curl it toward you by
using only your toes. You can increase the
resistance by putting the weight at the end of the
towel
 Relax and repeat this exercide for 5 times

24. 24
 Marble picked up exercise
 Place 20 marbles on the floor. Pick up one at a
time with your toes and put each marble in a
bowl.

25. 25
 Toe-to-heel plantar flexion
 Ask patient to standing at edge of table
 Do dorsi flexion and plantarflexion
 Hold for 10 second for 10 times

26. 26
 Foot stretch
 Patient sit with the knee straight and towel around
the affected foot
 Gently pull a towel until comfortable stretch at the
calf muscle is felt
 Hold for 10 second and do for 10 times

27. 27

28. 28
 Isometric dorsiflexion

29. 29
 Toes band exercise
 Put the rubber band around the toes
 Do the abduction of the toes by against the
rubber band
 Hold for 5 sec for 10 times

30. Electrical stimulation
30
 Electrical stimulation to the nerves controls the
dorsiflexor muscles.
 It was first proposed as a treatment for foot drop
in 1961
 They send electronic pulses to fire the nerve
response for the front of your foot to lift.
 It's programmed to each individual separately
 It provides normal range of motion to the foot and
ankle during walking
 Stroke and multiple sclerosis had success with it

31. Reference
31
 Neeta V Kulkarni, 2006, Clinical Anatomy for
Students Problem Solving Approach,New Delhi,
Jaypee Brothers
 Jules M.Rothstein, 2005, The Rehabilitation
Specialist’s Handbook, 3rd edition, Thailand, F. A.
Davis Company
 Chris Kirtley, 2006, Clinical Gait Analysis Theory
and Practice, Sydney, Churchill Livingstone
Elsevier
 Susan B. O’Sullivant & Thomas J. Schmitz, 2007,
Physical Rehabilitation, 5th edition, Philadelphia,
F. A. Davis Company

32. 32