Foot drop, a gait abnormality, manifests as the inability to lift the front part of the foot, often resulting from nerve injury, muscle weakness, or neurological disorders.
Article Index
Introduction
Examination & Diagnosis
Treatment & Exercise
Alternatives
Conclusion & References
Causes of Foot Drop
The most prevalent cause of foot drop is peroneal nerve injury, which can be induced by various conditions impacting the nerves and muscles within the body.
Among these conditions are:
Peripheral neuropathy, with diabetes being the most frequent cause, and Charcot-Marie-Tooth disease, a common inherited peripheral neuropathy.
Muscular dystrophy, a group of disorders characterized by muscle weakness and loss of muscle tissue.
Polio, a viral infection that can lead to muscle weakness and paralysis. As at 2022, endemic wild poliovirus type 1 remains in two countries: Pakistan and Afghanistan (WHO).
Even everyday habits like crossing the legs can damage the peroneal nerve, contributing to foot drop. Additionally, brain and spinal cord disorders are potential culprits in causing muscle weakness and paralysis, leading to foot drop.
Such disorders include:
Stroke
Amyotrophic lateral sclerosis (ALS)
Multiple sclerosis
This article delves deeply into the anatomy and biomechanics of foot drop, examining its signs, symptoms, and diagnostic methods. With a focus on manual therapy, specifically motion specific release (MSR) techniques, and functional exercises, the article highlights the promising treatment options available for those affected by foot drop.
Signs and Symptoms
Individuals suffering from foot drop may display a range of signs and symptoms that can significantly impact their daily life and mobility. The primary manifestations include:
Impaired dorsiflexion: Patients experience difficulty lifting the front part of the foot, leading to an inability to perform proper dorsiflexion.
Foot dragging: As a consequence of the inability to dorsiflex, patients often drag their affected foot while walking, increasing the risk of tripping or falling.
High-stepping gait: To compensate for the loss of dorsiflexion, individuals with foot drop may adopt a high-stepping gait, characterized by exaggerated lifting of the knee to prevent the foot from dragging.
Sensory disturbances: Patients may report numbness or tingling sensations on the top of the foot or the outer part of the shin due to damage to the sensory fibers within the common peroneal nerve.
Ankle weakness: Weakness in ankle dorsiflexion and eversion may be present, further complicating the patient's ability to walk and maintain balance.
Muscle atrophy: Prolonged nerve damage or disuse of the affected muscles may lead to muscle atrophy or wasting, exacerbating the weakness in the foot and ankle.
Pain: Depending on the underlying cause of foot drop, some individuals may experience pain in the affected leg, knee, or ankle.
These signs and symptoms may vary in severity, and the specific presentation often depends on the underlying cause of the foot drop. Early recognition and intervention are critical in managing this condition and improving overall patient outcomes.
Article Index
Anatomy, Biomechanics & Related Causes
The common peroneal nerve, a crucial branch of the sciatic nerve, plays a vital role in innervating the anterior and lateral compartments of the leg. It is responsible for several key functions, such as controlling dorsiflexion and eversion of the foot. The peroneal muscles, including the peroneus longus and peroneus brevis, are essential for various movements and actions:
Eversion: Turning the sole of the foot outward or laterally
Plantar flexion: Pointing the toes and foot downward, away from the body
Damage to the common peroneal nerve or the peroneal muscles can lead to foot drop. Several factors may contribute to this damage:
Direct trauma: Fractures or dislocations around the knee or ankle can injure the common peroneal nerve.
Compression: Prolonged pressure on the nerve, such as from a tight cast or crossing the legs, can cause nerve damage.
Inflammation: Conditions like vasculitis, which causes inflammation of blood vessels, can damage the peroneal nerve.
Tumors: Benign or malignant growths may compress or infiltrate the nerve, leading to foot drop.
Iatrogenic injury: Surgical procedures, particularly those involving the knee or ankle, can inadvertently damage the common peroneal nerve.
Diagnosis
A thorough diagnosis of foot drop is essential to identify the root cause and develop an appropriate treatment plan. The diagnostic process typically involves orthopedic, neurological, and vascular assessments, which can help determine the underlying factors contributing to the condition.
Orthopedic Testing:
Orthopedic examinations focus on evaluating joint and muscle function, as well as range of motion. These assessments can help determine if the foot drop is caused by musculoskeletal issues, such as muscle weakness, or if it stems from a neurological problem. In the context of foot drop, orthopedic testing may include evaluating ankle strength, flexibility, and stability. Click on the video to see our orthopedic examination of the ankle and foot.
Neurological Testing:
A comprehensive neurological examination can help pinpoint the location and extent of nerve damage, which is crucial for targeted treatment. This may involve testing for sensation, reflexes, and muscle strength in the affected limb. Identifying the specific nerve(s) involved in foot drop can guide the treatment approach and optimize the chances of successful recovery. Click on the video to see our Lower Limb Neurological Examination.
Vascular Testing:
Vascular assessments aim to evaluate blood flow to the affected leg to determine if a vascular issue, such as peripheral artery disease, is contributing to foot drop. Ensuring adequate blood supply to the nerves and muscles is essential for proper function, and addressing any vascular issues can be a critical component of the overall treatment plan. Click on the video to see our Peripheral Vascular Examination.
Functional Exercises and Treatment
Addressing foot drop effectively often entails a blend of functional exercises and manual therapy, aimed at tackling the root causes of the ailment.
Functional Exercises: In the featured video, registered massage therapist Miki Burton elucidates six potent exercises for alleviating foot drop, melding principles from anatomy, biomechanics, and neurology. Targeting pertinent muscles and neural pathways, these exercises are geared towards enhancing motor control and coordination for individuals afflicted with foot drop.
Manual Therapy: Manual therapy techniques like MSR (Motion Specific Release) can be employed on the muscles, nerves, and other structures implicated in foot drop, fostering mobility, encouraging nerve regeneration, and potentially hastening recovery. By zooming in on the affected tissues and addressing the larger kinetic chain encompassing the hips, spine, and upper body, MSR can bolster overall functionality and contribute to the therapeutic journey. Additionally, Dr. Abelson illustrates how engaging the broader kinetic chain can significantly augment foot drop treatment.
Best Foot Drop Exercises and Treatment
In this video, Miki Burton, showcases six effective exercises for treating Foot Drop. Then Dr. Brian Abelson demonstrates how to address the larger kinetic chain, including the hips, spine, and upper body, to further support the treatment of Foot Drop.
Combining manual therapy and functional exercises provides a comprehensive approach to treating foot drop, addressing both the immediate symptoms and the underlying causes of the condition to promote long-term recovery and improved quality of life.
Alternative Options
In some cases, despite a comprehensive approach involving manual therapy and functional exercises, foot drop may not improve significantly. If conservative treatments do not yield the desired results, it may be necessary to explore additional options to manage the condition and maintain mobility.
Ankle-Foot Orthosis (AFO): An AFO is a custom-made brace that supports the foot and ankle, assisting with dorsiflexion and providing stability during walking. This can help compensate for the lack of muscle function and reduce the risk of tripping or falling.
Functional Electrical Stimulation (FES): FES uses electrical impulses to stimulate the nerves and muscles responsible for lifting the foot. A small device sends signals to the affected muscles, promoting muscle contraction and improved foot function during walking.
Consultation with Specialists: If conservative treatments have not been effective, it is essential to consult with healthcare professionals such as neurologists, orthopedic surgeons, or physiatrists. These specialists can offer further evaluations and recommend alternative treatment options, which may include medications or surgical interventions if deemed necessary.
It is crucial to maintain open communication with your healthcare team throughout the treatment process, as they can help monitor your progress, reassess your condition, and adjust the treatment plan accordingly.
Conclusion
In conclusion, foot drop is a complex gait abnormality that can significantly impact an individual's quality of life. A thorough understanding of the anatomy and biomechanics of the condition, coupled with a comprehensive diagnostic approach, is essential in addressing the root cause of foot drop. Manual therapy and functional exercises can play a crucial role in the management and potential recovery of foot drop for many patients.
However, it is vital to recognize that in some cases, conservative treatments may not yield the desired results. In such instances, exploring alternative options, such as ankle-foot orthosis, functional electrical stimulation, or consulting with specialists, can help maintain mobility and improve overall function. Ultimately, a collaborative and multidisciplinary approach, with ongoing communication between the patient and healthcare team, is vital in managing foot drop and ensuring the best possible outcome for each individual.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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