Foot drop is a condition characterized by the inability to lift the front of the foot. It can be caused by injury or disease affecting the peroneal nerve or muscles in the lower leg. Symptoms include difficulty lifting the foot, dragging the toes, and slapping the foot down when walking. Treatment depends on the underlying cause but may include bracing, physical therapy, nerve stimulation, or tendon transfer surgery. The goal is to strengthen muscles and restore function to allow normal walking.

1. FOOT DROP

2. • Drop Foot
• T
he inability to lift the front part of the foot.
• Paralysisof anterior muscles of lower leg
• Inability to dorsiflex at the ankles and toes
• Causes the toes to drag along the ground while
walking.
• Can happen to one or both feet at the same time.
It can strike at any age.
• T
emporary or permanent

3. CAUSES
• Injury to the peroneal nerve.
• sportsinjuries
• diabetes
• hip orknee replacement surgery
• spending long hours sitting cross-legged or squatting
• childbirth
• large amount of weight loss
• Injury to the nerve roots in the spine (L5)

4. • Neurological conditions that can contribute to foot
drop include:
• stroke
• multiple sclerosis(MS)
• cerebral palsy
• Charcot-Marie-T
ooth disease
• Conditions that cause the muscles to progressively
weaken or deteriorate may cause foot drop:
• muscular dystrophy
• amyotrophic lateral sclerosis (Lou Gehrig’s disease)
• polio

5. • Rupture of Anterior Tibialis
• Fracture of fibula
• Compartment Syndrome
• Diabetes
• Alcohol Abuse

6. VULNERABILITYOF PERONEAL NERVE
• Funiculi of the peroneal nerve - larger and less
connective tissue
• Fewer autonomic fibers, so in any injury, motor and
sensory fibers bear the brunt of the trauma.
• More superficial course, especially at the fibular
neck
• Adheres closely to the periosteum of the proximal
fibula

7. MUSCLES
• DORSIFLEXORS
TIBIALISANTERIOR
EXTENSOR HALLUCIS LONGUS
EXTENSOR DIGITORUM LONGUS
PERONEUS TERTIUS
• EVERTORS
PERONEUS LONGUS
PERONEUS BREVIS

8. SYMPTOMS
• Difficulty in lifting the foot.
• Dragging the foot on the floor as one walks.
• Slapping the foot down with each step.
• Raising thigh while walking (high stepping gait)
• Pain, weakness or numbness in the foot.

9. GAITCYCLE
• Swing phase (SW): The period of time when the foot
isnot in contact with the ground. Inthose cases
where the foot never leaves the ground (foot drag)
- phase when all portions of the foot are in forward
motion.
• Initial contact (IC): when the foot initially makes
contact with the ground; representsbeginning of
the stance phase - foot strike.
• T
erminal contact (T
C): when the foot leaves the
ground -end of the stance phase or beginning of
the swing phase - foot off. .

12. FOOTDROP
• Drop foot SW: Greater flexion at the knee to
accommodate the inability to dorsiflex - stair
climbing movement.
• Drop foot IC: Instead of normal heel-toe foot strike,
foot may either slap the ground or the entire foot
may be planted on the ground all at once.
• Drop foot TC: T
erminal contact isquite different -
inability to support theirbody weight –walker can
be used

15. IMAGING
• X-Ray
Post-T
raumatic - tibia/fibula and ankle - any
bony injury.
Anatomic dysfunction (eg. Charcot joint)
• Ultrasonography
If bleeding issuspected in a patient with a hip
or knee prosthesis
• Magnetic Resonance Neurography
T
umor or a compressive mass lesion to the
peroneal nerve

16. ELECTROMYELOGRAM
• Thisstudy can confirm the type of neuropathy,
establish the site of the lesion, estimate extent of
injury
, and provide a prognosis.
• Sequential studies are useful to monitor recovery
of acute lesions.

17. TREATMENT
• Depends on the underlying cause.
• If cause is successfully treated foot drop may
improve or even disappear.
• Medical treatment - Painful Paresthesia
• Sympathetic block
• Amitriptyline
• Nortriptyline
• Pregabalin
• Laproscopic Synovectomy

18. SPECIFICTREATMENT
• Braces or splint
• Brace on the ankle and foot or splint that fits into the
shoe can help to hold the foot in the normal position

19. PHYSICAL THERAPY
• Exercises that strengthen the leg muscles
• Maintain the range of motion in knee and ankle
• Improve gait problems associated with foot drop.

20. NERVE STIMULATION
Stimulating the nerve (peroneal nerve) improves foot
drop especially if it caused by a stroke.

21. SURGICAL REPAIR
• Foot drop due to direct trauma to the dorsiflexors
generally requires surgical repair
.
• When nerve insult isthe cause - restore the nerve
continuity - nerve grafting or repair.
• If there isno significant neuronal recovery at one
year - tendon transfer maybe considered.
• Bridal procedure
• Neurotendinous transpositon

22. BRIDALSPROCEDURE
• Tendon to bone attachment - posterior tibial tendon is
attatched to the second cuneiform bone.
• T
endon to tendon attachment

23. NEUROTENDINOUS
TRANSPOSITION
• Lateral head of gastronemius istransposed to the
tendons of the anterior muscle group with simultaneous
transposition of the proximal end of deep peroneal
nerve.
• T
he nerve issutured to the motor nerve of the
gartronemius
• Active voluntary dorsiflexion of foot

24. • AFTER TENDON TRANSFER
Cast and Non-Weight Bearing ambulation for 6
weeks
• PHYSIOTHERAPY
T
o correct gait abnormalities
• CHRONIC AND CONTRACTURE CASES
Achilles tendon lengthening
• Inpatientswhom foot drop isdue to neurologic and
anatomic factors (polio, charcot joint ) - Arthodesis
• Subtalar Stabilising procedure or Triple Arthodesis can be
done.

25. COMPLICATIONS
• Surgical procedure-wound infection may occur.
• Nerve graft failure
• Intendon transferprocedures- recurrent deformity
• Inarthrodeses or fusion procedures-pseudoarthrosis,
delayed union,or nonunion.

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