2. • Foot remains in plantar flexion
due to the weakness of the
dorsiflexors and evertors of the
foot.
• Due to common peroneal nerve
palsy
3. COMMON PERONEAL NERVE
• Division of the sciatic nerve
• Composed of L4 L5 S1 and S2
• It deviates laterally in the
popliteal fossa
• Arches around the posterior
aspect of the fibular head
• Encircles the fibular neck
• Divides into the superficial and
deep peroneal nerves
4. SUPERFICIAL PERONEAL NERVE
• Passes between peroneus longus and extensor digitorum longus
muscles
• MOTOR BRANCHES:
1. PERONEUS LONGUS
2. PERONEUS BREVIS
• SENSORY BRANCHES
1. skin on the anterior and lateral aspects of the lower leg
2. dorsum of the foot.
5.
6. DEEP PERONEAL NERVE
• It passes obliquely beneath the extensor digitorum longus.
• MOTOR BRANCHES :
1. TIBIALIS ANTERIOR
2. EXTENSOR DIGITORUM LONGUS
3. EXTENSOR HALLUCIS LONGUS
4. PERONEUS TERTIUS
5. EXTENSOR DIGITORUM BREVIS
6. FIRST DORSAL INTEROSSEI
• SENSORY SUPPLY : 1st WEB SPACE
9. CAUSES OF FOOT DROP
TRAUMATIC
• Tendon injuries to the dorsiflexors of the foot
• NEUROGENIC :
At or below the level of common peroneal nerve
1. DIRECT INJURIES : incised and penetrating injuries.
2. FRACTURES AND DISLOCATIONS:
Lateral condyle of tibia
Head or neck of the fibula
Knee dislocation
Compound fracture of upper 1/3rd of tibia
10. 3. IATROGENIC:
• High tibial skeletal traction
• Tight plaster around knee
• High tibial osteotomy
• Total knee replacement
11. • Above the level of common peroneal nerve
Fracture shaft of femur
Posterior dislocation of the hip
PIVD
Spina bifida
13. CLINICAL FEATURES
• Loss of dorsiflexion of foot
• HIGH STEPPING GAIT
• Loss of sensation over the lateral
aspect of the leg and dorsum of
the foot.
14. HIGH STEPPING GAIT
• Ankle dorsiflexors act during the
swing phase of the gait cycle
• During walking the foot slap in
the ground on heel strike and
then drops in the swing phase.
• To prevent this the patient flexes
the hip and knee excessively in
order to clear the ground.
16. Management of Foot Drop
Traumatic Condition
Secondary to
common peroneal
nerve injury
Secondary to sciatic
nerve injury
Secondary to
extensor and
peroneal tendon
injuries
Tendon repair
Infective Conditions
Control the Infection
Other conditions like
PIVD and spinal
tumours
Treat the underlying
cause
Management according to
the principle of treatment of
peripheral nerve injuries
Inoperability or inadequate
or no response to nerve
repair
Wait for recovery or regeneration
SURGICAL CORRECTION OF FOOT DROP
Joints mobile,
tendons and
muscles available
for transfer
Tendon transfer
surgeries
Joints stiff and soft
tissue contractures
with bony changes
Bony procedures
(Arthrodesis)
17. MANAGEMENT OF FOOT DROP
• CONSERVATIVE MANAGEMENT:Aim is prevention of the deformity
and improvement of gait.
Proper positioning of foot splints
Passive movements of the joints
Electrical stimulation of the muscles
18. ANKLE FOOT ORTHOSIS
• Function
Provide toe dorsiflexion during the swing phase
Medial and lateral stability at the ankle during stance
Push off stimulation during the late stance phase
Substitute for wide plantar flexion during stance.
19.
20. SURGICAL CORRECTION OF FOOT DROP
• Mobility of the joints
• Soft tissue and muscle contractures
• Availability of the muscles and tendons for transfer
• Bony changes
23. OBER’S TECHNIQUE
• 1st incision: medial longitudinal
7.5cms long
tibialis posterior tendon is released from its attachment to the navicular.
• 2nd incision: longitudinal medial incision
10cm long
centered over the musculotendinous junction of tibialis posterior.
Withdraw the tendon from the proximal wound.
• 3rd incision: over the base of the 3rd metatarsal.
• Tibialis posterior tendon is drawn from the second incision into the third incision.
• Its distal end is anchored to the base of the third metatarsal.
24.
25. KAUFER’S TECHNIQUE
• Dissect the plantar portion of
tibialis posterior tendon from its
insertion.
• Half tendon is freed distally.
• Another incision is made 2cm
proximal to the lateral malleolus
and extending it upto base of 5th
metatarsal.
• The T.posterior tendon is passed
through a tunnel made under the
tibia and is sutured to the P.brevis
tendon.
26. SRINIVASAN’S TECHNIQUE
• Patient in supine position,knee in extension,passive dorsiflexion of
the ankle is done.
• Tendon of tibialis posterior is exposed by a short transverse incision at
the navicular tuberosity.
• The tendon is divided close to its insertion site.
• A curved incision is made on the medial aspect of the lower third of
leg.
• Tibialis posterior muscle and tendon are identified and it is withdrawn
through this incision.
27. • The tendon is split longitudinally to give two slips.
• Two small curvilinear incisions are made over the dorsum of the foot
proximal to the summit of the tarsal bones.
• Through the medial incision EDL is identified and isolated
• Through the lateral incision EHL is identified and isolated
• Each slip of the tibialis posterior tendon are pulled through each of
the curvilinear incision.
• With the foot in dorsiflexion the two tails of the T.posterior tendon
are laced and fixed to the EHL and EDL tendons with non absorbable
sutures.
28.
29. Post operative
• Immobilize the limb in below knee POP cast with ankle in dorsiflexion
of 70 degrees for 3 weeks.
31. WHITE TECHNIQUE
• Tendon achilles is released from
its insertion on the calcaneum.
• Divide the posteromedial 2/3rd
of the tendon near the insertion.
• Divide the medial 2/3rd of the
tendon 5 to 8cm proximal to the
distal division.
• Forceful dorsiflexion is done to
lengthen the tendon.
32. PERCUTANEOUS LENGTHENING
• Patient in prone position,knee in
extension,dorsiflex the ankle to
tense the tendocalcaneus.
• 3 partial tenotomies are done.
1. At the insertion of the tendon
through one half of the tendon
2. Proximal and medially just below
the musculotendinous junction.
3. Laterally half of the width of the
tendon midway between the 2
medial cuts.
• Dorsiflex the ankle to desired
angle.
33. POSTOPERATIVE
• LONG LEG CAST applied for 3 weeks followed by SHORT LEG CAST for
3 weeks.
• Later AFO is given with ankle in neutral dorsiflexion.
