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Foot Drop - Diagnosis and Treatment

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Foot Drop - Diagnosis and Treatment

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Foot drop or drop foot is a term used to describe the difficulty in elevating the front part of the foot. Read this article to learn more about foot drop.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At July 21, 2022
Reviewed AtFebruary 20, 2023

What Is a Foot Drop?

Foot drop is not a disease but is a symptom of underlying neurological, anatomical, and muscular problems. It is also known as drop foot and is used to describe the weakness or inability to lift the toes or foot upwards (dorsiflexion). If the patient has a drop foot, the front part of his foot will drag on the ground when he walks. People might lift their knees higher than normal to avoid dragging their toes while walking. They might also swing their legs in a wide arc.

Foot drop is usually temporary and can affect individuals at any age. If the patient suffers from permanent foot drops, he might need to wear braces on the ankle and foot to hold them in the normal position. Foot drop originates from the paralysis or weakness of the muscles that help lift the foot. It might occur due to different etiological factors, and the treatment depends upon those factors.

What Are the Causes of Drop Foot?

A foot drop usually occurs when the specific muscles of the legs become weak. The muscles that become weak are listed below:

  • Tibialis anterior.

  • Extensor hallucis longus.

  • Extensor digitorum longus.

These muscles cause problems because their tendons insert into the bones of the foot and toes, resulting in foot weakness and difficulty in lifting and moving the toes in different directions. Several neurological and muscular causes are responsible for weakness in these muscles. The common causes of the foot drop are listed below:

  1. Neurological Causes - There is a continuous network of nerves that runs in the lower back and legs. Foot drop might occur when this network of veins gets pinched or damaged. One of the most common causes of foot drop is the irritation and compression of the nerve in the legs that control the lifting of the foot. This nerve is known as the peroneal nerve. It might get injured during the hip and knee replacement surgery, leading to foot drop. Radiculopathy of the spinal nerve or root compression can also cause foot drop. The common symptoms of radiculopathy include weakness, pain, numbness, and a tingling sensation in the muscles supplied by the affected nerve. Diabetics are more susceptible to neurological disorders associated with the nerve root.

  2. Muscular Disorders - Muscular disorders or common conditions that lead to progressive muscle weakness, including muscle dystrophy, are the common causes of foot drop. Muscle dystrophy is a hereditary condition that can weaken the foot muscles and cause foot drop along with other diseases like polio and Charcot-Marie-Tooth disease. Loss of function in the pretibial and hip flexor muscles is responsible for foot drop.

  3. Central Nervous System Disorders - In rare cases, a tumor, brain hemorrhage, and blood vessel blockage might cause a foot drop. These lesions might compress the brain's motor cortex area associated with leg function. Amyotrophic lateral sclerosis, multiple sclerosis, and stroke are common disorders that affect the brain.

What Are the Risk Factors for Foot Drop?

The nerve that controls the muscles that lift the foot is known as the peroneal nerve. It runs near the skin's surface on the side of the knee closest to the hand. The following activities can compress the nerve and increase the risk of foot drop:

  • People who cross their legs frequently are more likely to compress the peroneal nerve on the uppermost part of the leg.

  • People involved in activities or occupations that involve kneeling or squatting for prolonged periods might get foot drops.

  • Wearing leg casts made of plaster that surround the ankle and end below the knees can increase the pressure and compress the peroneal nerve.

What Are the Signs and Symptoms of Foot Drop?

Foot drop decreases the person’s ability to elevate the front part of the foot during the swing phase of the menstrual cycle. The swing phase of the walking cycle indicates that phase in which the front part of the foot lifts upward before the heel presses down the ground while taking the next step. The signs and symptoms of foot drop are listed below:

  1. The person might feel uncomfortable and drag his affected foot because he has a feeling that his footwear has become loose.

  2. The foot muscles become weak and result in frequent tripping.

  3. As the patient cannot lift the front part of his foot, he might fall, lose his balance, and stumble multiple times.

  4. People who have foot drop disorder resort to high steppage gait while walking. It means they exaggeratedly raise their thighs to prevent the toe from hitting or scraping the floor while walking.

  5. Sometimes, people might use the circumduction walking gait pattern. It means they swing the leg to remain straight and swing sideways in a semicircle to move forward and prevent tripping.

  6. The affected foot flops away from the body, making it difficult for the person to climb stairs.

  7. Numbness or loss of sensation might occur on the front or upper part of the leg.

  8. Some people might have difficulty on one foot and are unable to walk.

  9. People having foot drops due to auto-immune diseases might have reduced muscle mass and strength because of muscle weakening.

  10. The patient might lose his balance while standing without support and with his eyes closed. This phenomenon is known as Romberg’s sign.

  11. Pain in the legs might radiate to the lower back region.

What Tests Are Done to Diagnose Foot Drop?

It is challenging for doctors to diagnose foot drop because the condition has numerous potential causes with overlapping symptoms. Therefore, foot drop is diagnosed based on the physical examination, medical history, and some diagnostic tests. The diagnostic methods are described below:

  • Physical Examination - During a physical examination, the doctor usually checks for pain and numbness in the feet, toes, and legs. He also evaluates the response to several stimuli like gently pressing the calf or toes. The doctor might move the foot, thigh, and legs in different directions to check the muscles of the ankles, knees, legs, and hips.

  • Medical History - A medical history is a professional conversation between the doctor and the patient to know about his symptoms and general health. The doctor might review the following in the medical history:

    • The onset and duration of weakness and other symptoms.

    • Underlying medical conditions like diabetes or multiple sclerosis.

    • Decreased strength in different parts of the body.

  • Electrodynamic Testing - It is the first-line diagnostic test used to check the health of the nerves and muscles in the legs. The test includes nerve conduction study and electromyography.

    • Nerve Conduction Test - It involves the assessment of motor and sensory nerve conduction by attaching electrodes to the patient’s skin. This test helps to know whether the nerves in the legs are demyelinated or damaged.

    • Electromyography - In this test, small needles are inserted into the damaged muscles to test the electrical activity. The electrical signals generated by the needle are visible on the computer screen and analyzed by the doctor.

  • Medical Resonance Neurography - It is an advanced imaging technique used to detect neural abnormalities and is more effective than electrodynamic testing. This test is done when one or more of the following are present:

    • Inflammatory nervous disorders.

    • Hereditary nervous disorders.

    • Immune-mediated disorders.

    • Tumors of the nervous system.

    • Alteration in the nerve structure due to trauma.

  • Blood Test - The doctor might recommend the blood test to rule out anemia, infectious diseases, and other auto-immune disorders. It gives an idea about the general health of the body.

How Is Foot Drop Managed?

The management of foot drop depends upon the underlying condition that caused it. Either it resolves or decreases once the underlying medical condition subsides. Neurological and surgical treatment options can be used to treat foot drops.

If the foot drop occurs due to spinal causes, the treatment plan is listed below:

  1. Pain relievers.

  2. Physiotherapy.

  3. Fluoroscopically guided epidural steroid injections.

Spinal Stenosis - The foot drop that occurs due to the compression of spinal nerves present in the small bony opening is treated by the following measures:

  • Anti-inflammatory drugs like Ibuprofen and Aspirin.

  • Physiotherapy.

  • Modifications in lifestyle.

  • Epidural injections.

Spondylolisthesis - When one vertebra slips over the adjacent vertebra, the spinal nerve roots get compressed, resulting in foot drop. It can be treated with:

  1. Physiotherapy.

  2. Lumbar stabilization device.

  3. Epidural steroid injections.

Vertebral Fractures - Foot drops that occur due to vertebral fracture and nerve damage might be treated with medications and a lumbar brace. Some people might be treated with minimally invasive procedures like vertebroplasty or kyphoplasty. If the vertebra is severely fractured, a bone cement might be injected to stabilize and reform the fractured vertebra.

If the foot drop occurs due to peroneal neuropathy, the following treatment is usually done:

  • Foot and ankle brace help in walking and prevent tripping or falling.

  • Physiotherapy helps strengthen the muscles of the leg and foot.

What Lifestyle Changes Must Be Done for Drop Foot?

  • Keep the floor clean and dust-free.

  • Do not throw rugs.

  • Move the electrical cords far away from the walkway.

  • Always keep the stairways and rooms lit.

  • Stick fluorescent tapes on the top and bottom steps of stairways.

Conclusion:

Foot drop is a common condition that can affect both males and females. The person cannot lift the front part of his foot for several reasons. The most important reason is the irritation and pinching of the nerves that regulate foot movements. The most common problem a person has due to foot drop is difficulty walking. However, the patient need not worry as nonsurgical treatment options are available to manage the condition. Therefore, the patient must consult the doctor the earliest to know more about the treatment of foot drops.

Frequently Asked Questions

1.

What Are the Signs of Foot Drop?

The main sign of foot drop is the inability to lift the front part of the foot. Other signs are dragging or scraping the bottom of the toes while walking, losing feeling in the foot, and numbness in the lower leg and ankle.

2.

How Is Foot Drop Treated?

The treatment involves supporting the foot with ankle-foot orthotics and thin leg braces, which are shoe inserts. Gait improvement also benefits from exercise therapy that strengthens muscles and maintains joint motion.

3.

What Are the Causes of Foot Drop?

Injury to the peroneal nerve is the most frequent cause of foot drop. A branch of the sciatic nerve is the peroneal nerve.  Foot drops can be caused by illnesses that impact the body's muscles and nerves. It supplies sensation to the foot, lower leg, and toes.

4.

What Is the Duration of the Foot Drop?

Compared to damage to the peroneal nerve, a spinal-level nerve will recover more slowly from injury. Muscles may atrophy while the rehabilitation process is taking place. 

5.

What Is Foot Drop, and What Are the Muscles Affected?

The most common cause of a foot drop is the weakening of certain leg muscles. The muscles affected are the anterior tibialis, extensor digitorum longus, and extensor hallucis longus.

6.

Which Nerve Does Foot Drop Effect?

Injury to the peroneal nerve is the most common reason for foot drop. The peroneal nerve is a branch of the sciatic nerve.  

7.

How to Fix Foot Drop?

Foot drops can be fixed in different ways. They are by braces or splints, practicing different exercises, nerve stimulation, and surgery.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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