Foot Drop or Drop Foot !!!

Foot Drop or Drop Foot is a medical term used when you are not able to lift the foot up. There are many underlying causes that make it difficult to lift the front part of the foot, which results in dragging the foot on the ground. 

Foot Drop isn't a disease, rather a sign of an underlying neurological, muscular or anatomical pattern.

Foot Drop symptoms are very common and may happen to one foot or both feet, it can strike at any age. It can be temporary or permanent. 

CAUSE

The main cause is a weakness or paralysis in the muscle which is responsible to lift the foot up.

this can be caused by a number of underlying problems.

1. PERIPHERAL NERVE PROBLEM or NEUROPATHY

Nerve Supplying to the muscles can get compressed, either in the knee, hip or pelvic region. Compression can be caused by tight muscle, bulged disc or reduced foramina in the spine. 

Peroneal Nerve, which is a branch of Sciatic Nerve wrap around the back of the knee to the front of the shin, since it sits very close to the surface, it can easily be damaged.
Sports Injuries are the commonest contact injury site. 

Spending long hours sitting cross-legged or Squatting. 

The nerve in the leg can also be injured or damaged during hip replacement or knee replacement surgery.

Tight leg cast following a fracture. 

Diabetes, Neuropathy can also damage the Nerve.

An inherited condition, such as Charcot-Marie-tooth disease, can lead to foot drop.

2. MUSCLE WEAKNESS.

Muscular Dystrophy is a group of inherited conditions that cause gradual muscle weakness and can sometimes lead to foot drop. 

Other Muscle wasting conditions like Spinal Muscular atrophy or Motor Neurone Disease.

Amyotrophic lateral sclerosis

Polio. 

3. BRAIN / SPINAL CORD DISORDERS. 

Stroke, Cerebral Palsy, and Multiple Sclerosis. 

DIAGNOSIS

1. History and Physical Examination :

Physical Therapy or Physician can observe the walking gait pattern and correlate to the condition. 

The patient usually drags the feet or use a circumduction gait pattern while walking. 

Muscular atrophy around the shin or entire leg can be observed or to be checked on palpation. 

Neurological History.

Based on history, imaging tests, such as X-Ray, Ultrasound Scan or CT may be required.

Neural Tissue Testing - Clinical Neurodynamic Test can be performed to confirm the neuropathy sign and symptoms of Pins and Needles, paraesthesia, Tingling, and Numbness. 

Nerve Conduction Test may be recommended to help locate where the affected nerve is damaged. 

Electromyography, where electrodes are inserted into the muscle fibers to record their electrical activity may also be carried out at the same time.

TREATMENT

The risk of falling is high because of the altered movement pattern which is developed due to foot drop. 

in such a scenario, little modification in your walking pattern is a must.

You may lift your foot higher than usual.

Making small changes in your home, such as removing clutter and using non-slip rugs and mats can help prevent falls. 

To stabilize the foot and improve your walking ability it is recommended to wear a splint, famously known as FOOT DROP SPLINT.

TREATMENT for foot drop will depend

on the cause.

Early treatment may improve the chances 

of Recovery...

Treatment Includes -

LIGHTWEIGHT BRACES.

SHOE INSERTS.

PHYSICAL THERAPY.

SURGERY.

Light Weight Braces

The commonest treatment used to support the Legs, to prevent contracture of Tendo-Achilles or to prevent tightness in Calf muscles. 

this is basically given to support and stabilize the foot.

If Splint is not available, use of RIGID STRAPPING TAPE serves the purpose of ankle stabilization. 

Physical therapy

once root cause of the condition is confirmed, Physical therapist may rehabilitate with

If Neuropathy is a cause 

For NERVE

Stimulate the Nerve with HPE Functional Dry Needling Protocol i.e - stimulating the nerve root or trunk or point of its origin to increase the blood and nerve circulation to the nerve to help improve the conduction velocity of the affected nerve. 

Functional Dry Needling Involves the insertion of thin filament needles on the superficial nerve or deep nerve. Such Nerve Stimulation increases the efficiency of the nerve and helps restore the symptoms.

2 - 3 session with Functional Dry Needling will help in restoring the symptoms. 

Electrical Stimulation with Dry Needling on the Anterior and Lateral Shin Muscle like peroneus group of muscles and tibialis anterior to strengthen.

Clinical Neurodynamics is the Nerve Stretching technique developed by Dr. Michael Shacklock to increase the peripheral sensation by sliding and tensioning the affected nerve. 

Stretching the Nerve help to get oxygenated blood circulation, removes deoxygenated blood circulation in the affected nerve and helps to maintain its length. (if compression is the cause)

For MUSCLE

Myofascial Release to inhibit the Calf Muscles (antagonist) which will help to relax them to facilitate the dorsiflexion movement (agonist). and to prevent contracture, if already formed to break it.

Strengthening Exercises for the Anterior and lateral group of shin muscle with the help of theraband in nonfunctional position, later progress to functional position and weight-bearing exercises.

Initial Basic Rehabilitation Exercises for Foot Drop

1. Towel Stretch. Sit on the floor with both legs straight out in front of you. ...
2. Toe to Heel Rocks. Stand in front of a table, chair, wall, or another sturdy object you can hold onto for support. ...
3. Marble Pickup. ...
4. Ankle Dorsiflexion. ...
5. Plantar Flexion. ...
6. Ball Lift.

HPE Functional Kinesio taping to activate the sensory joint mechanoreceptors to facilitate the movement. It is a technique where tapes help to give a sensory proprioceptive sense to the cortex to initiate the movement.

Functional KT tape can also help to facilitate the agonist muscle and inhibit the antagonist muscle.

Surgery

Surgery may be an option in severe or long term cases of foot drop that have caused permanent movement loss from muscle paralysis.

The procedure involves transferring a tendon from the stronger leg muscle to the muscle that should be pulling your ankle upwards

Ankle Fusion Surgery

Consult with an Orthopaedic surgeon or ankle specialist.


It is recommended to look for sign and symptoms of the condition and consult a physical therapist, early recovery is possible if early intervention is performed. 

Website link - www.hpeindia.in
Mail us - swapnil.physio@gmail.com