Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Foot drop


Published on

  • Dating for everyone is here: ♥♥♥ ♥♥♥
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating direct: ❤❤❤ ❤❤❤
    Are you sure you want to  Yes  No
    Your message goes here

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
  32. 32. 32