Foot Drop Causes, Symptoms, Treatment Guide
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Foot drop is a condition characterized by the inability to lift the front part of the foot. It can be caused by injury to nerves like the peroneal nerve or from neurological conditions such as stroke or multiple sclerosis. Symptoms include difficulty lifting the foot and dragging of the toes 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 functional walking patterns.
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Foot Drop Causes, Symptoms, Treatment Guide
- 1. FOOT DROP ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com PRESENTED BY DR ROHIT BHASKAR PHYSICAL THERAPIST 1
- 2. • Drop Foot • The inability to lift the front part of the foot. • Paralysis of 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. • Temporary or permanent ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com 2
- 3. CAUSES ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Injury to the peroneal nerve. • sports injuries • diabetes • hip or knee 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) 3
- 4. • Neurological conditions that can contribute to foot drop include: • stroke • multiple sclerosis (MS) • cerebral palsy • Charcot-Marie-Tooth 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 ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com 4
- 5. • Rupture of Anterior Tibialis • Fracture of fibula • Compartment Syndrome • Diabetes • Alcohol Abuse ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com 5
- 6. VULNERABILITY OF PERONEAL NERVE ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • 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 6
- 7. MUSCLES ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • DORSIFLEXORS > TIBIALIS ANTERIOR ➢ EXTENSOR HALLUCIS LONGUS EXTENSOR ➢ DIGITORUM LONGUS > PERONEUS TERTIUS • EVERTORS ➢ PERONEUS LONGUS ➢ PERONEUS BREVIS 7
- 8. SYMPTOMS ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • 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. 8
- 9. GAIT CYCLE ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Swing phase (SW): The period of time when the foot is not in contact with the ground. In those 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; represents beginning of the stance phase - foot strike. • Terminal contact (TC): when the foot leaves the ground - end of the stance phase or beginning of the swing phase - foot off. 9
- 10. FOOT DROP ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • 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: Terminal contact is quite different - inability to support their body weight – walker can be used 10
- 11. IMAGING ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • X-Ray • Post-Traumatic - tibia/fibula and ankle - any bony injury. • Anatomic dysfunction (eg. Charcot joint) • Ultrasonography • If bleeding is suspected in a patient with a hip or knee prosthesis • Magnetic Resonance Imaging • Tumor or a compressive mass lesion to the peroneal nerve 11
- 12. ELECTROMYELOGRAM ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • This study 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. 12
- 13. TREATMENT ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • 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 13
- 14. SPECIFIC TREATMENT ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • 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 14
- 15. PHYSICAL THERAPY ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Exercises that strengthen the leg muscles • Maintain the range of motion in knee and ankle • Improve gait problems associated with foot drop. 15
- 16. NERVE STIMULATION ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com Stimulating the nerve (peroneal nerve) improves foot drop especially if it caused by a stroke. 16
- 17. SURGICAL REPAIR ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Foot drop due to direct trauma to the dorsiflexors generally requires surgical repair. • When nerve insult is the cause - restore the nerve continuity - nerve grafting or repair. • If there is no significant neuronal recovery at one year - tendon transfer maybe considered. • Bridal procedure • Neurotendinous transpositon 17
- 18. BRIDALS PROCEDURE ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Tendon to bone attachment - posterior tibial tendon is attatched to the second cuneiform bone. • Tendon to tendon attachment 18
- 19. NEUROTENDINOUS TRANSPOSITION ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com • Lateral head of gastronemius is transposed to the tendons of the anterior muscle group with simultaneous transposition of the proximal end of deep peroneal nerve. • The nerve is sutured to the motor nerve of the gartronemius • Active voluntary dorsiflexion of foot 19
- 20. • AFTER TENDON TRANSFER • Cast and Non-Weight Bearing ambulation for 6 weeks • PHYSIOTHERAPY • To correct gait abnormalities • CHRONIC AND CONTRACTURE CASES • Achilles tendon lengthening • In patients whom foot drop is due to neurologic and anatomic factors (polio, charcot joint ) - Arthodesis • Subtalar Stabilising procedure or Triple Arthodesis can be done. ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com 20
- 21. COMPLICATIONS • Surgical procedure- wound infection may occur. • Nerve graft failure • In tendon transfer procedures- recurrent deformity • In arthrodeses or fusion procedures- pseudoarthrosis, delayed union, or nonunion. ©2021 Dr Rohit Bhaskar PT https://www.pt-pedia.com 21