Foot Drop

General

Foot drop is a term that refers to a weakening of the muscles that allow for flexing of the ankle and toes.

This condition causes the individual to drag the front of the foot while walking. To compensate for this dragging, the patient will bend the knee to lift the foot higher than in a normal stride (high steppage gait).

Foot drop typically affects the muscles responsible for moving the ankle and foot upward, specifically the anterior tibialis, extensor halluces longus, and extensor digitorum longus.

A quick test for foot drop is to try to walk on the heels. If this is difficult, foot drop may be present.

While foot drop is a neuromuscular disorder that affects the nerves and muscles, it is not actually a disease. It is a symptom of another underlying medical problem, possibly a condition in the lower back.

Characteristics of Foot Drop

Foot drop may seem straightforward, but it is actually a uniquely complex symptom. Here are several variations in how foot drop may present:

    • Foot drop may resolve on its own in a few weeks even without treatment, or it may require surgery for treatment. For example, if a lumbar herniated disc is causing the foot drop symptoms and the disc resolves, then the foot drop may get better as well. Conversely, if the lower back condition persists, the foot drop may persist as well.
    • Foot drop may occur without any symptoms of foot pain or leg pain. It may be the only symptom that something is wrong, or it may occur with pain and/or neurological symptoms such as tingling or burning.
  • Foot drop may be accompanied by a loss of balance or lack of balance, making it difficult to walk without assistance.
  • Foot drop may occur in only one or in both feet (bilateral).

The most common symptom of foot drop, high steppage gait, is often characterized by raising the thigh up in an exaggerated fashion while walking, as if climbing the stairs.

High steppage gait is associated with one of the following:

  • Dragging of the foot and toes
  • Scraping of the toes across the ground
  • Uncontrolled slapping of the toes against the ground

The affected muscles are usually used to keep the foot off the ground during the swing-through portion of walking. When these are weak, they cannot keep the foot up and foot will scrape across the ground if the foot is not picked up high.

Other foot drop symptoms may include one or a combination of the following:

    • An exaggerated, swinging hip motion. With foot drop, the hip may swing out in an effort to counteract the toes from catching the ground.
    • Limp foot. The affected foot my flop away from the body.
    • Tingling, numbness, and slight pain in the foot. These symptoms can range from a slight tingling sensation to a complete lack of feeling in the foot. This symptom can make everyday activities such as walking or driving a car difficult. This kind of foot pain may be linked to lower back pain.
  • Difficulty engaging in activities requiring the use of the front of the foot. For example, climbing the stairs may become difficult with foot drop.
  • Muscle atrophy in the leg. Muscle atrophy refers to a muscle decreasing in mass and weakening. As the anterior tibialis, extensor halluces longus, and the extensor digitorum longus muscles are most affected by foot drop, atrophy may occur and make it harder to exert force with the leg and foot.
  • Foot drop may be experienced in one or both feet. If the foot drop is caused by a low back condition, it is typically experienced in one foot.

Foot drop is a condition that can be either temporary or permanent, depending on the underlying cause and treatment.

As there are various symptoms of foot drop, there are many different foot drop causes that merit understanding and evaluation when seeking treatment.

Foot drop is a symptom or result of another underlying problem. Generally speaking, foot drop causes fall into one or a combination of three categories:

  • Muscle damage
  • Skeletal or anatomical abnormalities affecting the foot
  • Nerve damage

Specific conditions and diseases that may lead to foot drop may include:

  • A lower back condition (see below for more detail)
  • A stroke or tumor
  • Parkinson’s disease
  • Diabetes
  • Motor neuron disease
  • Multiple sclerosis
  • Adverse reactions to drugs or alcohol
  • An injury to the foot or lower leg

The above list includes the most common causes of foot drop, but other possible sources of injury also occur. For example, it is possible for the peroneal nerve to become damaged during some types of hip replacement surgery, or as part of a dislocated knee injury.

Treatment for foot drop will vary depending on the cause. Typical treatments for foot drop include one or some combination of the following approaches:

Foot Drop Braces and Splints (Orthoses)
Orthoses, such as a drop foot brace or splint, are often the first line treatment by providing stabilization of the ankle and the foot. An Ankle-Foot-Orthosis (AFO) can be used to keep the dropped foot off the ground while walking if the patient has the functional use of their muscles. This creates a more even and more normal gait.

A brace for foot drop is used to keep the ankle at 90 degrees and prevents the foot from dropping toward the ground. The drop foot brace makes it easier for the patient to walk and more difficult to trip. The most common type of foot drop brace is made of polypropylene and is inserted into a shoe.

Physical Therapy as a Foot Drop Treatment
In many cases, specific exercises may be advised to help the affected muscles.

In situations where foot drop has caused a significant gait disturbance, physical therapy may be necessary. Specialized physical therapy for foot drop may include gait training, which teaches the patient how to walk correctly again.

Non-Surgical Foot Drop Treatments and Surgery
If a lower back condition is causing the dropped foot, specific non-surgical foot drop treatments many be the correct course of action.

    • Herniated disc. If a bulging or herniated disc is causing the foot drop, nonsurgical treatments such as physical therapy and fluoroscopically guided epidural steroid injections may be appropriate. In some cases, the disc may need to be surgically removed to take the pressure off the nerve.
    • Spinal Stenosis. Treatment might include an exercise program developed by a physical therapist, activity modification, epidural injections or anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery might be performed.
    • Spondylolisthesis. Non-surgical treatments are similar to the non-surgical treatments for spinal stenosis. Spinal fusion surgery may be required to treat this condition.
  • Vertebral Fractures. Nearly half of all vertebral fracturesoccur without any significant back pain. If pain medication, progressive activity or a brace or support does not help with the fracture, two minimally invasive proced ures may provide relief:
    • Vertebroplasty
    • Kyphoplasty
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