Foot drop

Foot drop explaination

1. FOOT DROP

2. Dro p Foot T he i nab i l it y t o l i ft t he f ront par t of t he foo t . Par a l y s i s of a n t e r i or musc l e s of l o w e r l eg I n a b i l i t y t o dors i f l e x a t t h e a n k l e s a n d t o e s Caus e s t he t oes t o d r a g alon g t he gro u nd wh i le walking. C a n h a p p e n t o one or b o t h feet a t t he sam e t i me. I t can s t r i ke a t an y ag e . T emporary or permanent

3. CAUSES Injur y t o t he pero n eal ner v e . spor t s injuries diabetes hip o r kn e e rep l ace m e n t s u r g ery spending long hours sitting cross-legged or squatting childbirth l ar g e amou n t of weigh t loss Injur y t o t he ner v e roo t s i n t he sp i ne ( L 5 )

4. Neurological conditions that can contribute to foot drop include: stroke mu l ti p l e sc l e ro s i s ( M S) c e r e br a l pa l sy C h a rco t - M a r i e - T o o t h d i s e a se Conditions that cause the muscles to progressively weake n or de t er i ora t e may ca u s e foot drop: muscu l a r d y s t ro p h y amyotrophic lateral sclerosis (Lou Gehrig’s disease) polio

5. R u p t ure of A n t er i or T i b i al i s Frac t ure of f i bula Co m par tme n t S y ndrome Diabetes Alcohol Abuse

6. VULNERABIL I TY O F PERON E AL NERVE Fun i c u l i of t h e pero n eal ner v e - large r a n d less connec t i v e t i ssue Fewer autonomic fibers, so in any injury, motor and sensory fibers bear the brunt of the trauma. More super f i c i a l cou r se , espec i al l y a t t he f i bular neck Adheres closely to the periosteum of the proximal fibula

7. MUSCLES DORSIFLEXORS TIBIAL I S A N TERIOR EXTE N SO R H A LL U CIS LONGUS EXTENSOR DIGITORU M LO NGUS PERONEUS TER T I U S EVERTORS PERONEUS LO NGUS PERONEUS BREV I S

8. SYMPTOMS D i f f i c u l t y i n l i ft i ng t he foo t . Dragg i ng t he f oot on t he f lo o r a s o n e walks. Slap p i ng t he f oot down w i t h each s t ep. Raising thigh while walking (high stepping gait) Pa i n, weaknes s or n umb n ess i n t he f oot .

9. G A I T CYCLE Sw i ng phas e ( S W ) : T he per i od of t i me when t he foot i s not i n con t ac t w i t h t he gro u nd. I n t hose cases wher e t he f oot ne v er lea v es t he ground ( foot drag ) - phase when all portions of the foot are in forward motion. In it i a l con t ac t ( I C ) : whe n t he f oot in i tia l l y makes con t ac t w i t h t he gro u nd; represen t s beg i n n in g of the stance phase - foot strike. T erm i nal con t ac t ( T C ) : whe n t he foot l ea v es t he ground - end of the stance phase or beginning of t he sw i ng p h as e - foot off. .

10. FO O T DROP Dro p foot S W : G rea t er f l ex i on a t t he knee t o acco m mo da t e t h e i n a b i li t y t o dors i flex - s t a i r cl i m b i ng mo v e m e n t . Dro p foot IC : Ins t ead o f n orm al hee l - t oe foot str i ke, foot may e i t h er s l a p t h e grou n d o r t h e en t i re foot may be planted on the ground all at once. Dro p foot TC: T erm i nal con t ac t i s qu i t e d i f f eren t - i n a b i li t y t o sup p ort t h e i r b o d y we i gh t – wal ke r c an be used

11. IMAGING X-Ray Pos t - T rauma t i c - t i b i a/f i bu l a a n d a n k l e - any bony injury. A na t om i c d y sf u nc t i on ( e g . Ch arco t jo i n t ) Ultrasonography I f b l eed i ng i s suspect e d i n a pa t i ent w i t h a h i p or knee p r os t hes i s Magne t i c Resona n ce Neurogr a p h y T umor or a comp ress i v e mass les i on t o t he peronea l ner v e

12. ELECTROMYELOGRAM T h i s s t udy can co n f i rm t h e t y pe of neurop a t hy , es t a b l i s h t h e s i t e of t h e les i on, e s t i m a t e ex t e n t of i n jur y , a n d pr o v i de a p rogn os i s. Sequential studies are useful to monitor recovery of acute lesions.

13. TREATMENT Depend s o n t he underl y i ng cause. If cause is successfully treated foot drop may i mpro v e or e v en d i sappear. Med i cal t rea t me n t - Pa i nful Parest hes i a Sympa t h e ti c b l ock Amitriptyline Nortriptyline Pregabalin Laproscopic Synovectomy

14. SPECIFI C TR E ATMENT Brace s or s p l i nt Brace on the ankle and foot or splint that fits into the sho e can h elp t o ho l d t he f oot i n t he normal pos i t ion

15. PHYSICAL THERAPY Exer c i se s t hat s t rengt hen t he le g musc les Maintain the range of motion in knee and ankle Improve gait problems associated with foot drop.

16. NERVE STIMULATION S t i mula t i n g t he ner v e ( pero n eal n er v e) i m p ro v es foot dro p espec i al l y i f i t ca u sed b y a s t roke.

17. SURGICA L REPAIR Foot dro p d u e t o d i rect t rauma t o t he dors i flexors general l y requ i res surg i cal repa i r. W hen ner v e i nsult i s t he ca u s e - res t ore t he ner v e continuity - nerve grafting or repair. I f t here i s no s i gni ficant neuron a l re c o v ery a t o n e y ear - t endon t ransfer ma y be cons i dered . Br i da l proced u re N eu r o t end i nous t ranspos i t on

18. BRID A LS PR O CEDURE Tendon to bone attachment - posterior tibial tendon is attatched to the second cuneiform bone. T endon t o t endon at t achme n t

19. NEUROTENDIN O US TRANSP O SITION 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. T he ner v e i s su t ured t o t he mo t or n erv e of t he gartronemius A ct i v e v olu n t ar y dors i flex i on of foot

20. A F T E R T E N DO N T R A N SFER Cast an d No n - W e i ght Bear i ng am b ula t i on for 6 weeks PHYSIOTHERAPY T o corre c t ga i t ab n orma l i ties CHRON I C A ND CON T R A C T U RE C A SES A chi l l es t endon leng t he n ing I n pa t i en t s who m foot dro p i s d u e t o neurol og i c and anat om i c fac t ors ( po l i o, charcot jo i nt ) - A r t hodes i s Subtalar Stabilising procedure or Triple Arthodesis can be done.

21. COMPLICATIONS Surg i cal p rocedur e - wound i nfect i on may oc c ur. Ner v e graft fa i l ure In tendon transfer procedures- recurrent deformity I n ar throdeses or fus i on proced u res - pseudoar t hros i s , de la y ed un i o n , or n o n un i on.

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