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Foot drop

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Foot drop

  1. 1. Name: Rahila Najihah AliMatrix Number : DPH/0102/11Batch : July/11Date: 19th June 20131Foot Drop
  2. 2. Definition2 Inability to raise the front part of foot due toweakness or paralysis of tibialis anterior musclethat lift the foot Foot drop occur due to peroneal nerve injury Can happen to one foot or both feet
  3. 3. Muscle and Nerve3oDorsiflexor Muscle-Tibialis anterior-Extensor hallucis longus-Extensor digitorumlongusPeroneal Nerve
  4. 4. Tibialis Anterior4 Origin : upper two thirds of lateral surface of tibiaand adjacent interosseous membarane Insertion: medial surface of medial cuneiform andthe base of 1st metatarsal bone Nerve supply : receive twigs from deep peronealnerve and recurrent genicular nerve Action: dorsiflexion of foot at ankle joint andinvertor of the foot at midtarsal and subtalar joint
  5. 5. 5 Testing the function of Tibialis Anterior : patient isasked to dorsiflex the foot against the resistanceof therapist’s hand placed across the dorsum ofthe foot Injury to deep peroneal nerve leads to paralysisof dordiflexors
  6. 6. Extensor Hallucis Longus6 Origin: medial part of anteromedial surface of themiddle two forth of fibula and adjacentinterosseos membrane Insertion: base of terminal phalanx of great toe Nerve supply: Deep peroneal nerve Action: dorsiflexion of foot at ankle anddorsiflexion of great toe Testing Functional : patient attempts to dorsiflexthe great toe against resistance
  7. 7. Extensor Digitorum Longus(EDL)7 Origin: upper three fourth of anteromedial surfaceof fibula, adjacent interosseous membrane andanterior intermuscular septum Insertion: EDL is divided into four tendon on thedorsum of foot Nerve supply: deep peroneal nerve Action: produce dorsiflexion of ankle joint anddorsiflexion of lateral four toes Testing functional: patient is asked to dodorsiflexion of the toes against ressistance
  8. 8. Sciatic Nerve8 Sciatic nerve the thickest and largest nerve in thebody It’s start in lower back and runs through thebuttock and lower limb with root value of L4 untilS3 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 aretibial and peroneal nerve Those 2 nerve innervate different parts of thelower leg
  9. 9. Peroneal Nerve9 Begin from L4, L5, SI, and S2 nerve roots andjoint the tibial nerve to form the sciatic nerve Common peroneal nerve travels anterior, aroundthe fibular neck Common peroneal nerve divide into superficialand deep peroneal nerve Deep peroneal nerve : innervation of tibialisanterior muscle that responsible to thedorsiflexion of the ankle
  10. 10. Causes of Foot Drop10 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. 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. 12 Established compartment syndrome-foot drop is late finding-irreversible muscle and nerve ischemia occur inpatient if fasciotomy is not performed
  13. 13. LEVEL OF LESION IN SCIATISNERVE INJURY13 High lesion (above the knee)-both tibial and common peroneal nerve areparalaysed Low lesion (below knee)-spared : peroneus longus and brevisType 1 : anterior tibial nerve injurylost : Tibialist anterior, extensor hallucis longus,extensor digitorum longus and peroneus tertiusType 2 : musculocutaneus nerve injuryspared : all above muscle innervated by anterior tibialnervelost : peroneus longus and brevissensation : over outer leg and foot
  14. 14. Symptom of Foot Drop14 Inability to lift the front part of the foot Abnormal gait which drag the front of foot on theground during walking (steppage gait) An exaggerated, swinging hip motion Tingling, numbness & slight pain in the foot Difficulty performing certain activities that requirethe use of the front of the foot Muscle atrophy in the leg Limp foot
  15. 15. Clinical features of Type 1 footdrop15 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. 16. Clinical features of type 2 footdrop16 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. 17. Gait of Foot Drop17 Gait of foot drop gait is high stepping gait The patients lift the knee high and slaps the footto the ground on advancing to the involved side
  18. 18. Diagnosis18 Occur during routine examination where patientfind it’s difficult to walk on their heel Plain X-ray Magnetic Resonance Imaging (MRI) Electromyography (EMG) and nerve conductionstudy SD curve Tinel sign
  19. 19. Treatment of early foot drop19 Conservative treatment : shows high incidence ofrecovery Splintage – splint knee in 20° of flexion and anklein 90° for night time In day time, walking is allowed by using ‘foot-dropappliance’ Varieties of foot drop appliances:i) dynamic-spring shoeii) static- back stop shoe
  20. 20. 20 Ankle foot orthotics (AFO)-support the foot with light-weight leg braces andshoe inserts Exercises-strengthen the muscle, help to maintain range ofmotion (ROM) and improve gait Electrical Functional Stimulations-electrically stimulate the peroneal nerve duringfootfall
  21. 21. 21 Surgery – done if conservative management fails Repairs or decompresses a damaged nerve thatfuses the foot and ankle joint or transfers tendonsfrom stronger leg muscles Choices of surgeryi) tendon transfers – for mobile foot dropii) tendo-archilles lengthening - in fixed equinusiii) subtalar stabilizer procedur – for fixed varusiv)triple arthrodes – for fixed varus at the subtalarjoint
  22. 22. Physiotherapy- Exercise22 When problem stems from weak muscles Proper physical therapy exercises can strengthenankle muscle and improve symptoms
  23. 23. 23 Toe curls exercise Place a small towel and curl it toward you byusing only your toes. You can increase theresistance by putting the weight at the end of thetowel Relax and repeat this exercide for 5 times
  24. 24. 24 Marble picked up exercise Place 20 marbles on the floor. Pick up one at atime with your toes and put each marble in abowl.
  25. 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. 26 Foot stretch Patient sit with the knee straight and towel aroundthe affected foot Gently pull a towel until comfortable stretch at thecalf muscle is felt Hold for 10 second and do for 10 times
  27. 27. 27
  28. 28. 28 Isometric dorsiflexion
  29. 29. 29 Toes band exercise Put the rubber band around the toes Do the abduction of the toes by against therubber band Hold for 5 sec for 10 times
  30. 30. Electrical stimulation30 Electrical stimulation to the nerves controls thedorsiflexor muscles. It was first proposed as a treatment for foot dropin 1961 They send electronic pulses to fire the nerveresponse for the front of your foot to lift. Its programmed to each individual separately It provides normal range of motion to the foot andankle during walking Stroke and multiple sclerosis had success with it
  31. 31. Reference31 Neeta V Kulkarni, 2006, Clinical Anatomy forStudents Problem Solving Approach,New Delhi,Jaypee Brothers Jules M.Rothstein, 2005, The RehabilitationSpecialist’s Handbook, 3rd edition, Thailand, F. A.Davis Company Chris Kirtley, 2006, Clinical Gait Analysis Theoryand Practice, Sydney, Churchill LivingstoneElsevier Susan B. O’Sullivant & Thomas J. Schmitz, 2007,Physical Rehabilitation, 5th edition, Philadelphia,F. A. Davis Company
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