foot drop

1. FOOT
DROP

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

3. CAUSES
• 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)

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

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

6. MUSCLES
• DORSIFLEXORS
TIBIALIS ANTERIOR
EXTENSOR HALLUCIS
LONGUS EXTENSOR
DIGITORUM LONGUS
PERONEUS TERTIUS
• EVERTORS
PERONEUS
LONGUS

7. • INVERSION of foot :Tibialis anterior,tibialis posterior
• Planter flexion of foot:Gastronemius,soleus

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. FOOT DROP
• 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

11. IMAGING
• 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 Neurography
Tumor or a compressive mass lesion to the
peroneal nerve

12. ELECTROMYELOGRAM
• 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.

13. 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

14. SPECIFIC TREATMENT
• 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

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

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

17. SURGICAL REPAIR
• 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.
• Neurotendinous transpositon

18. NEUROTENDINOUS TRANSPOSITION
• 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. • 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.

20. 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.

21. THANK YOU