FOOT DROP

What’s a Foot Drop?

Also known as Drop Foot, the clinical term “Foot Drop” usually refers to a feeling of weakness in patient while lifting their foot or toes in an upward direction (Liu et al., 2013). This abnormal gait activity causes the dropping of the foot and toes. This condition usually occurs due to the weakness of muscle in the ankle and toes dorsiflexion or paralysis in the anterior part of the lower leg. The muscles of the ankle and foot include anterior tibialis, the extensor hallucis longus, and the extensor digitorum longus. This condition ultimately causes the involuntary dragging of the toes of the affected foot while attempting to walk.

Patients with foot drop usually perform high steppage or slapping gait to compensate for the dragging. Here, the patient lifts their leg higher than normal on the affected side to prevent the foot from dragging along the ground. Depending on the extent of the muscle weakness or paralysis, this condition may have a temporary nature or permanent and can affect one or both feet. People with foot drops may suffer from muscle weakness and “tingling” feelings in the leg (Gil-Castillo, Alnajjar, Koutsou, Torricelli, & Moreno, 2020).

Usually not considered a disease, Foot Drop represents a symptom of an underlying major problem. This problem can occur due to some hidden neurological, muscular, or anatomical problems. One of the most characterized features of foot drop includes steppage gait. Patients with foot drop conditions suffer while lifting their foot from the ankle which results in dragging the front of their foot on the ground. Unlike other neurological conditions, in Drop Foot, the patient usually raises their foot high enough to prevent the slapping and dragging of their toe in the ground. Patients may show some other symptoms such as the characteristics of tiptoe walking on the opposite leg, the excessive raising of the thigh, a wide outward leg swing, etc. Depending on the severity of the condition, the duration of symptoms may vary from patient to patient.

The first signs of Drop Foot may include dragging the foot on the ground while walking, frequent tripping, a feeling of weakness or fatigue in the foot or ankle, as well as difficulty in ascending stairs or inclines. The symptoms may have presented subtle at first but typically turned more pronounced over time. There’s various causes for foot drop, including nerve injuries such as compression of the sciatic nerve, peripheral neuropathy, or spinal cord injuries. Medical conditions such as stroke, multiple sclerosis, or muscular dystrophy can also lead to foot drop. It’s important to seek medical evaluation if you notice these signs, as proper treatment will depend on the underlying cause. The doctor may order tests such as magnetic resonance imaging or electromyography to aid in diagnosis and determine the best therapeutic approach.

A wide range of neurological to a muscular disorders may cause foot drop. Neurological causes of foot drop may include radiculopathy, neuropathy, lumbosacral plexopathy, peripheral nerve injury, multiple sclerosis, amyotrophic lateral sclerosis (ALS), stroke, Alzheimer’s disease, Parkinson’s disease, cerebral palsy, etc. Muscular cause of foot drop includes muscular dystrophy, weakness, or paralysis of the pretibial, peroneal, or hip flexor muscles. Habitual crossing of the legs also causes foot drop in some patients. Patients can easily resolve their problems by discontinuing their habits.

Several risk factors of foot drop may include the habitual crossing of the legs along with the prolonged kneeling and wearing a leg cast. Foot drop differs from the flail foot in several ways. Foot drops usually characterized by severe foot weakness, bending the foot downward with some degree of weakness while flail foot includes no ankle and/or foot movements in any direction. A flail foot requires a medical emergency and indicates a more serious condition, such as cauda equina syndrome or stroke (Carolus et al., 2019).

A recent study estimates almost 17% of US residents develop familiarity with foot drop that may arise for several reasons (Aldemir & Duygun, 2017). Lumber degenerative disc disease also causes foot drop in almost 8.1% of people by affecting the respected nerve. The initial diagnosis of foot drop includes performing a routine physical examination by a medical professional such as a physiatrist, neurosurgeon, or health specialists.

A neurosurgeon performs a simple test to observe the mobility of the patient on a scale of 0 to 5. This helps to determine the deformity of the patient and tests muscle sensation and strength. The lowest point in the scale (0) denotes complete paralysis and the highest point (5) denotes complete motility of the affected foot.

The physician may perform some other imaging tests to confirm the underlying etiology for this diagnosis. These tests may include X-rays, CT scans, MRIs, MRN, or EMGs to assess the surrounding areas of damaged nerves and damaged nerve, respectively. Physicians found an association between a common yoga kneeling exercise, the “Varjrasana” with foot drop.

Treatment for foot drop depends upon the underlying cause.  The Treatment options for successful recovery include the following (York & Chakrabarty, 2019):

1. Braces or splints:
   A brace on the ankle or foot will help to hold the foot in a normal position and improve walking.
2. Exercises: Regular exercises helps to strengthen the lower leg muscles and support the ankle and foot to maintain the normal range of motion.
3. Orthotics:
   This lightweight device on the ankle and lower leg helps patients keep straight.
4. Electrical nerve stimulation: The physician places electrodes on the lower leg and connects to a small pack on the patient’s hip, which sends impulses to the electrodes and activates the nerves to improve foot drop.
5.  And in extreme cases – surgical intervention. Neurosurgeons transfer a tendon from the other leg to the muscle in the affected leg that helps to make the foot up. Sometimes, neurosurgeon recommend surgery to fuse the foot and ankle joint to stabilize it.

The prognosis of foot drop usually depends upon the cause of the foot drop. Several cases such as peripheral compressive neuropathy require up to 3 months for a full recovery. In case of any emergency, please contact with our neurosurgeon.

References

Aldemir, C., & Duygun, F. (2017). New and unusual causes of foot drop. Medicine Science | International Medical Journal, (January), 1. https://doi.org/10.5455/medscience.2017.06.8602

Carolus, A. E., Becker, M., Cuny, J., Smektala, R., Schmieder, K., & Brenke, C. (2019). The interdisciplinary management of foot drop. Deutsches Arzteblatt International, 116(20), 347–354. https://doi.org/10.3238/arztebl.2019.0347

Gil-Castillo, J., Alnajjar, F., Koutsou, A., Torricelli, D., & Moreno, J. C. (2020). Advances in neuroprosthetic management of foot drop: A review. Journal of NeuroEngineering and Rehabilitation, 17(1), 1–19. https://doi.org/10.1186/s12984-020-00668-4

Liu, K., Zhu, W., Shi, J., Jia, L., Shi, G., Wang, Y., & Liu, N. (2013). Foot drop caused by lumbar degenerative disease: Clinical features, prognostic factors of surgical outcome and clinical stage. PLoS ONE, 8(11), 1–6. https://doi.org/10.1371/journal.pone.0080375

York, G., & Chakrabarty, S. (2019). A survey on foot drop and functional electrical stimulation. International Journal of Intelligent Robotics and Applications, 3(1), 4–10. https://doi.org/10.1007/s41315-019-00088-1

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