Peroneal nerve palsy

1. FOOT DROP
BY PHILANS C. ANKRAH

3. Once upon a time…
72 YEAR OLD, UNCLE WILLIE WOKE UP THIS MORNING WITH WEAKNESS IN HIS LEFT
LEG. HE NOTED DIFFICULTY IN LIFTING UP HIS LEFT FOOT FROM THE FLOOR. THE
PATIENT HAS RECENTLY BOUGHT A COMPUTER AND HAS BEEN BROWSING THE WEB,
SITTING WITH HIS LEGS CROSSED FOR PROLONGED PERIODS. WHAT COULD
THE PROBLEM BE…?

4. OBJECTIVES
By the end of this presentation students should be able to:
 Define foot drop
 Identify some causes and risk factors of foot drop
 Identify ways foot drop is tested for and diagnosed
 State the roles played by physiotherapists and occupational therapists in the management
of foot drop

5. What is foot drop?
Stein et al. (2010) defined foot drop as a motor deficiency caused by partial or
total paralysis of the muscles innervated by the deep peroneal nerve.
Foot drop is not a disease but a symptom of an underlying problem often caused
by an injury to the deep peroneal nerve.
Individuals with foot drop are unable to dorsiflex their ankle, walk on their heel or
walk with the normal heel-toe pattern.

6. BRIEF ANATOMY
The human foot and ankle are strong and complex mechanical structures
containing exactly 26 bones, 33 joints (20 of which are actively articulated),
and held together by muscles, tendons and ligaments (Forester, 2002).
The foot and ankle receive innervation from branches of the sciatic nerve
which has both sensory and motor branches.

7. BRIEF ANATOMY
Ankle dorsiflexors include:
1. Tibialis anterior
2. Extensor hallucis longus
3. Extensor digitorum longus and
4. Peroneus tertius
These are innervated by the deep peroneal nerve branch of the sciatic nerve

10. FEATURES
1. Foot drop is not a disease.
2. Foot drop can either be temporal or
permanent.
3. It can happen unilaterally or bilaterally.
4. Patient is unable to dorsiflex, invert nor evert
5. Steppage gait
6. Foot drop can affect anyone, including
children

12. Causes
1. Muscle damage
2. Nerve damage
3. Skeletal or anatomical abnormalities
affecting the foot
4. Diabetes
5. Brain and spinal cord disorders
6. Overgrowth of bone in the spinal
canal Or Tumor/cyst pressing on the
nerve in the knee or spine.
7. Misplaced intramuscular gluteal
injections and repeated injections
leading to fibrosis can injure the
sciatic nerve

13. Risk factors
1. Crossing your legs
2. Prolonged kneeling
3. Wearing a leg cast.
4. Wrongly placed injections
5. Pre-existing conditions

14. TESTS AND DIAGNOSES
(physical exam)
• STORY CONTINUES…
After being examined by a Physiotherapist, it was observed that Uncle Willie had
difficulty walking on his heels. The physiotherapist observed that Uncle Willie was
unable to dorsiflex when asked to, he also observed numbness on his shin and on
the top of his foot and toes.
• What do we learn from these observations?

15. TEST AND DIAGNOSES
(other tests)
• Foot drop can also be tested for using the Nerve test. Electromyography(EMG) and nerve
conduction studies measure electrical activity n the muscles and nerves
• X-rays
• Ultrasound
• Computerized tomography (CT scan)
• Magnetic resonance imaging (MRI)

16. MANAGEMENT
Treatment depends on the specific cause of foot drop and the severity. It could be
1. Conservative/ Non-surgical
2. Surgical

17.  SURGICAL MANAGEMENT
In cases with permanent loss of movement, surgery that fuses the foot and ankle
joint or that transfers tendons from stronger leg muscles is occasionally performed.

18.  CONSERVATIVE MANAGEMENT
PHYSIOTHERAPY MANAGEMENT
OCCUPATIONAL THERAPY

19.  PHYSIOTHERAPY
1. Electrotherapy: Peroneal nerve stimulation using trabert, Transcutaenous
Electrical Nerve Stimulation (TENS), interferential therapy, etc
2. Strengthening exercises for ankle dorsiflexors
3. Range of motion and stretching exercises for ankle joint(s) to prevent the
development of stiffness in the heel.

20.  OCCUPATIONAL THERAPY
1. Prescribe an appropriate ankle-foot orthoses or device to help reduce the
deformity.
2. Give expert advice on safe/ disability-friendly environment a patient
should take note of
3. Work hand-in-hand with the physiotherapist to help rehabilitate the foot-
drop patient

22. REFERENCES
• Forester ND, Parry D, Kessel D, et al. (2002). Ischaemic sciatic neuropathy: an
important complication of embolization of a type II endoleak. European Journal of
Vascular and Endovascular Surgery; 17(6): 507-16
• Stein RB, Everaert DG, Thompson AK, Chong SL, Whittaker M, Robertson J, et al.
(2010). Long-term therapeutic and orthotic effects of a foot drop stimulator on
walking performance in progressive and nonprogressive neurological disorders.
Neurorehabilitation and Neural Repair; 24(2), 152-167.
• Tak SR, Dar GN, Halwai MA, et al. (2008). Post-injection nerve injuries in Kashmir:
a menace overlooked. Journal of Research in Medical Sciences; 13:244–247