2. Inability to raise the front part of foot due to
weakness or paralysis of tibialis anterior
muscle that lift the foot
Foot drop occur due to peroneal nerve injury
Can happen to unilateral or bilateral foot
2
4. Origin : upper two thirds of lateral surface of
tibia and adjacent interosseous membarane
Insertion: medial surface of medial cuneiform
and the base of 1st metatarsal bone
Nerve supply : receive twigs from deep
peroneal nerve and recurrent genicular nerve
Action: dorsiflexion of foot at ankle joint and
invertor of the foot at midtarsal and subtalar
joint
4
5. Testing the function of Tibialis Anterior :
patient is asked to dorsiflex the foot against
the resistance of therapist’s hand placed
across the dorsum of the foot
Injury to deep peroneal nerve leads to
paralysis of dordiflexors
5
6. Origin: medial part of anteromedial surface of
the middle two forth of fibula and adjacent
interosseos membrane
Insertion: base of terminal phalanx of great
toe
Nerve supply: Deep peroneal nerve
Action: dorsiflexion of foot at ankle and
dorsiflexion of great toe
Testing Functional : patient attempts to
dorsiflex the great toe against resistance
6
7. Origin: upper three fourth of anteromedial
surface of fibula, adjacent interosseous
membrane and anterior intermuscular septum
Insertion: EDL is divided into four tendon on
the dorsum of foot
Nerve supply: deep peroneal nerve
Action: produce dorsiflexion of ankle joint
and dorsiflexion of lateral four toes
Testing functional: patient is asked to do
dorsiflexion of the toes against resistance
7
9. Sciatic nerve the thickest and largest nerve in the
body
It’s start in lower back and runs through the
buttock and lower limb with root value of L4 until
S3
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 nerves which are
tibial and peroneal nerve
Those 2 nerves innervate different parts of the
lower leg
9
10. Begin from L4, L5, SI, and S2 nerve roots
Common peroneal nerve travels anterior,
around the fibular neck
Common peroneal nerve divides into
superficial and deep peroneal nerve
Deep peroneal nerve : innervation of tibialis
anterior muscle that is responsible for
dorsiflexion of the ankle
10
11. I. Traumatic:
Tendon injuries to dorsiflexors of foot
Neurogenic
A)At or below the level of common peroneal nerve
Direct injuries: incised and penetrating injuries
Fracture and dislocations:
Fracture of lateral condyle of tibia
Fracture/ dislocation of head/neck of fibula
Dislocation of knee
compound fracture of upper 1/3rd of tibia
11
13. Iatrogenic :
High tibial skeletal traction
Tight plaster around knee
High tibial osteotomy
Total knee replacement
B) Above the level of common peroneal nerve
Fracture of shaft of femur
Posterior dislocation of hip
Deep intra muscular injection
PIVD
Spina bifida
If any cerebral tumors and space occupying
lesions of
CNS
13
14. II. Infective:
Leprosy
Poliomyelitis
Guillain-Barré Syndrome
Syphilis
III. Metabolic:
Diabetes mellitus
Beri beri
Alcoholic neuritis
IV. Exogenous toxin:
Lead
Arsenic
Mercury
14
15. Established compartment syndrome
-foot drop is late finding
-irreversible muscle and nerve ischemia occur
in patient if fasciotomy is not performed
15
16. Inability to lift the front part of the foot
Abnormal gait which drag the front of foot on
the ground during walking (stepping gait)
An exaggerated, swinging hip motion
Tingling, numbness & slight pain in the foot
Difficulty in performing certain activities that
require the use of the front of the foot
Muscle atrophy in the leg
Limp foot
16
17. 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
17
18. Low lesion : incomplete 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
18
19. Gait of foot drop gait is high stepping gait
The patients lift the knee high and slaps the
foot to the ground on advancing to the
involved side
19
20. Occur during routine examination where
patient find it’s difficult to walk on their heel
Plain X-ray
Magnetic Resonance Imaging (MRI)
Electromyography (EMG) and nerve
conduction study
SD curve
Tinel sign
20
21. Conservative management: Its aim is to
prevention of deformity and improvement of gait
Proper positioning of foot splints
Passive movements of the joints
Electrical stimulation of the muscles
Ankle foot orthosis:
Provide toe dorsiflexion during swing phase
Medial and lateral stability at ankle during stance
phase
Push off stimulation during the late stance phase
21
22. Traumatic conditions:
Secondary to tibialis anterior and peroneal
tendon injuries→→tendon repair
Secondary to sciatic or common peroneal nerve
injury→→manage according to the principle of
treatment of peripheral nerve
Infective conditions: control the infection and
wait for recovery or regeneration
Other conditions like PIVD(L4-L5) and spinal
tumors treat the underlying cause
22
23. For surgical correction following points should
be taken into consideration
Mobility of joints
Soft tissue and muscle contractures
Availability of muscles and tendon for
transfer
Bony changes
Age of the patient
23
24. When joints are mobile and muscles and
tendons are available for transfer , tendon
transfer surgeries are performed
When joints are stiff with muscle and soft
tissue contractures and bony
changes(equinovarus deformity) bony
operations can be performed
24
25. It is indicated when dynamic muscle
imbalance results in a deformity that
interferes with the ambulation or function of
extremities
Types of tendon transfer surgeries
1. Anterior transfer of tibialis posterior
2. Split transfer to tibialis posterior tendon
3. Two tailed transfer of tibialis posterior
25
26. Lengthening of tendo achilles:
Open lengthening of tendo calcaneus
Percutaneous lengthening of tendo calcaneus
Semiopen sliding tenotomy of tendo
calcaneus
26
27. Lambrinudi arthrodesis:
The wedge of bone is removed from the
plantar distal part of the talus so that the
talus remains equines at the ankle joint and
while remainder of the foot is repositioned to
the desired degree of plantar flexion
Triple arthrodesis :
It is a fusion of the subtalar , calcaneocubiod
and talonavicular joints
27
29. Campbells posterior bone block operation:
Posterior arthrodesis permits lengthening of
the tendo calcaneus and ankylosis of both
the ankle and sub talar joint
Ankle arthrodesis:
It is recommended for severe paralytic
equinovarus deformities in adults when
muscles suitable for tendon transfer are not
available
29
