Drop Foot, also referred to as the Peroneal Nerve Injury, is a neuromuscular disorder that affects a person’s ability to lift his/her foot at the ankle joint. The peroneal nerve branches out from the sciatic nerve (located in the lower back) and is responsible for providing sensation to the frontal and top part of the feet besides the sides of the legs. It stimulates the muscles in the legs which help in lifting the ankle and toes in upward direction. This nerve passes through the outer part of the legs and hence can get easily injured. Drop Foot is considered to be a symptom of an underlying disease and it can greatly hamper a person’s ability to walk as well as increases the risk of tripping or falling down.
The symptom of foot drop, characterized by the inability to control the front half of the foot, causes the dragging of the toes while walking. Caused by a variety of conditions, physicians take the symptom of foot drop quite seriously and will want to quickly determine the cause and find if the symptoms will respond to treatment.
Causes
- Spinal injury
- Medical condition such as Amyotrophic Lateral Sclerosis (ALS)
- Multiple Sclerosis Parkinson’s Disease
- Herniated disc Fracture or dislocation in the knee or hip joint
- Hip replacement or knee surgery
- Nerve compression
- Diabetes
- Weak muscles due to prolonged immobilization of the leg
- Sitting in a cross legged position for too long
- Polio
- Sports injury
Symptoms
- The toes cannot be lifted upwards (dorsiflexion)
- Development of steppage gait – the person tends to lift the leg higher than normal while walking
- Pain, weakness or numbness in the upper part of the foot or shin
- Loss of foot functionality
- Limping
Diagnosis
- A detailed physical check of the affected foot
- Evaluation of the patient’s medical history
- Neurological tests to assess loss of sensation and function
- Observation of abnormality in gait X-ray and MRI Electromyography (EMG) to assess electrical conduction within the nerves and muscles
- CT scans
- Ultrasound to diagnose presence of cyst, tumor or any other abnormality that may put pressure on the nerves
Treatment
- Physical therapy to strengthen the leg muscles and improve gait
- Use of specifically designed foot brace or splints that can be customized to fit within the patient’s shoe
- Surgical decompression of the compressed nerve
- Surgical fusion of the ankle and foot joint
- Nerve grafting
- Tendons may be surgically transferred from healthy muscles to improve the condition
- Stimulation of the peroneal nerve may help improve the condition
- Stretching exercises may help to reduce stiffness in the foot
Treating Foot Drop
Treatments for foot drop in orthopedics fall into two categories: foot drop from degenerative changes to the spine causing compression of the sciatic nerve, and foot drop after a severe fracture or rare surgical complication that affects a branch of the sciatic nerve called the peroneal nerve.
Foot Drop from Spine Issues
Degenerative changes to the lower portion of the spine, called the lumbar spine, can cause nerve compression to the sciatic nerve causing radiating pain, numbness, tingling and potentially foot drop. While any radiating symptoms down one leg or both indicate the need to see a spine specialist, the presence of foot drop indicates a level of severity that requires quick medical intervention. Patients presenting with an acute foot drop should reach out to their physician immediately to inform them of their current symptoms.
Treating Foot Drop from Nerve Impingement
Evaluation of the location and extent of the compression will require the ordering of an MRI. Oral and injectable steroids may alleviate symptoms temporarily, permanently or in some cases not at all. Physicians often resolve nerve compression issues with oral, injectable or imaging-guided steroids in conjunction with physical therapies, stretching and strengthening the supporting structures of the back and abdomen. Patients who do not respond well to conservative treatments may find that to prevent permanent nerve damage their surgeon will recommend surgical intervention. In this case the procedure recommended varies dependent on the nature and severity of the degeneration.
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