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Focus on Foot Drop [ patient handoUT] Focus on Foot Drop dysesthesia of the feet—a disagreeable sense of TREATMENT touch that is caused by lesions of the nervous The type of treatment a patient receives system and often considered painful—may depends on the cause of foot drop. If the under- possess a similar gait pattern without having lying cause is effectively treated, foot drop can foot drop. improve or disappear. However, it can prove to be permanent if the underlying cause can- CAUSES not be successfully treated. Treatment options Foot drop is triggered when the muscles below specific to foot drop can include lightweight the knee that help lift the front of the foot are leg braces and shoe inserts; exercise therapy to weakened or paralyzed. Neurological, muscular improve muscle strength, preserve joint motion and anatomical problems are often underlying and enhance gait; electrical stimulation of the causes. Specific causes of foot drop may include peroneal nerve and surgery in cases of perma- multiple sclerosis, stroke and other neurode- nent movement loss. generative disorders of the brain that cause Ankle-foot orthoses (AFO), such as braces or muscular problems; polio, spinal muscular atro- splints, are often the first line of treatment for phy and other motor neuron disorders; injury patients with foot drop. To help hold the foot to the nerve roots; peripheral nerve disorders at 90 degrees (and keep it from dropping to the or acquired peripheral neuropathy; local com- ground), patients may benefit from a brace or pression or damage to the peroneal nerve as it splint that fits into the shoe. ften an indication of a neurological, passes across the fibular bone below the knee; A pair of shoes can also be fitted with spring- muscular or anatomical problem, and muscle disorders. loaded braces to prevent foot drop during gait. foot drop is characterized by the Injuries to muscles that move the ankle and A foot-up ankle support, where a cuff is placed inability to lift the front part of the toes can cause foot drop, as can nerve damage around the patient’s ankle and a hook is installed Ofoot. Patients diagnosed with foot drop possess in the lower spine or leg. under the shoelaces, would help to lift the shoe an abnormal gait and may drag the front of Temporary foot drop can occur as a result as the patient walks. the foot on the ground while walking. Though of pressure to the peroneal or fibular nerve Physical therapy is necessary in circumstances foot drop may be permanent in some cases just below the knee. Muscle disorders, such where foot drop has caused considerable gait where the fundamental cause can’t be treated, as the inherited disease muscular dystrophy; disturbance. In these situations, patients are certain treatment options, including physical and nerve disorders such as compartment taught how to walk all over again following a therapy, can help patients regain mobility syndrome may also contribute to foot drop. specialized physical therapy treatment plan. In and independence. Amyotrophic lateral sclerosis (ALS), multiple less-extreme circumstances, certain exercises are sclerosis and other central nervous system dis- recommended to assist affected muscles. CHARACTERISTICS orders that affect the spinal cord or brain may Nerve stimulation may be beneficial, espe- Foot drop (sometimes called drop foot) can cause this problem as well. cially to patients who have experienced foot affect either one (unilateral) or both (bilateral) drop as a result of stroke. Occasionally, stimu- feet. Patients with foot drop are not able to raise DIAGNOSIS lating the peroneal nerve will improve foot drop. the front of their foot because of weakness or A diagnosis of foot drop typically occurs during a The stimulator can either be implanted in the leg paralysis of the muscles involved in lifting the routine examination. Patients will find it difficult or strapped to the leg below the knee. foot. When walking, their toes scuff along the to walk on their heels as the peroneal nerve is Surgery may be the only way to improve walk- ground and they may raise their thigh to lift required to perform this action. ing difficulties when foot drop is permanent. their foot higher than usual to avoid the scuff- During the exam, patients should be equipped The operation can fuse ankle or foot bones, or ing. This results in a form of gait abnormality, to describe the problem they are experiencing, transfer tendons to stronger leg muscles. called “steppage gait,” which is associated with how it started and any other symptoms occur- No matter which type of foot drop treatment the loss of dorsiflexion. ring at the time. Sometimes further testing may patients require, they can expect to reclaim some A wide, outward leg swing often adapted to be recommended, such as magnetic resonance mobility and regain some self-sufficiency. n prevent extreme lifting of the thigh can also imaging (MRI), and electromyography (EMG) denote foot drop. However, patients who have and nerve conduction studies. Beth Puliti is a frequent contributor to ADVANCE. LEESER ADVANCE Y Disclaimer: This handout is a general guide only, intended for distribution to patients. If you have specific questions, for Physical Therapy & Rehab Medicine® be sure to discuss them with your healthcare provider. ©2011 MERION MAtters EFFER J www.advanceweb.com/PT.
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