Causes:
Foot drop is not a disease, but a symptom of a separate muscular, neurological, or anatomical disorder. Treatment depends on the cause.
People who suffer from foot drop have muscle weakness or paralysis that makes it difficult to lift the front part of the foot. The condition can even mean that the toes drag along the floor when walking. To compensate, people often develop an unusual gait, lifting the knee high at each step, or swinging the leg around.
Disorders that can cause foot drop include
Nerve injury: Usually damage to the peroneal nerve (a branch of the sciatic nerve) that wraps around from the back of the knee to the shin. The peroneal nerve runs close to the surface of the leg so is vulnerable to damage. Injury to the nerve might result from hip or knee surgery, diabetes, a sports injury, excessive time spent in a crossed-leg or squatting position, or it may be that the nerve root in the spine gets damaged.
Brain or spinal disorder: Stroke, cerebral palsy, Parkinson’s disease, and multiple sclerosis are neurological conditions that can cause foot drop.
Muscle disorder: Some conditions such as Lou Gehrig’s disease, polio, or muscular dystrophy can result in muscle deterioration or weakness, leading to foot drop.
Symptoms:
- Dragging of the front part of the foot along the ground when walking. To walk without dragging the foot, you may lift the thigh high with each step, in an action similar to climbing a stair, often called ‘steppage gait’. Or you may swing your hip to bring the leg out to the side and so avoid the toes catching on the ground.
- The foot may slap on the ground with each step.
- The foot may be limp.
- There may be numbness, tingling or slight pain in the toes and the skin on top of the affected foot.
Diagnosis:
A quick test for foot drop that you can perform yourself is to try walking on your heels. Difficulty doing this because your front foot cannot be lifted off the ground suggests foot drop.
After taking a complete medical history and discussing your current symptoms, your doctor would physically examine your foot. He or she would watch you walk and would also check for muscle weakness along the leg. Any areas of numbness would be noted. Your lower back should be assessed for nerve compression or other conditions.
Depending on the suspected underlying cause of your foot drop, diagnostic imaging tests may be performed. These might include X-rays, ultrasound, CT (computerized tomography), and MRI (magnetic resonance imaging). Nerve conduction tests can help pinpoint the location of any neural damage.
Treatment:
Successful treatment depends on the primary source of the condition. In many cases foot drop can be improved and sometimes eliminated, but sometimes the condition cannot be successfully treated and the foot drop will remain. Bear in mind that nerves regenerate at a rate of about 1mm a month, so recovery from nerve damage will take time and depend on the location of the injury.
Brace or splint: The use of a lightweight leg brace on the ankle and foot is the most common treatment. The brace fits inside the shoe and holds the foot in a fixed position, enabling a more normal walking gait.
Ankle-foot orthosis (AFO): These are often used. They hold the foot at a 90-degree angle, helping the toes to clear the floor when swinging the foot forwards. They also provide stability to the ankle while standing. They are usually constructed of polypropylene or other, softer elasticized material, and are inserted into a shoe.
Surgery: In some cases, a surgical procedure to repair the peroneal nerve might be suitable, or to transfer a nerve branch from a less important leg muscle and connect it to the muscle that raises the foot. Sometimes the transfer of a tendon from a stronger muscle to the weak area can help improve stability and walking. If the foot drop condition is permanent, another surgical option is to fuse the ankle-foot joint. This obviously results in loss of flexibility in the ankle, but can provide greater stability.
Vitamin therapy: B6 or a nerve medication can be administered to promote healing of the damaged nerve in the hope that foot drop symptoms will decrease or disappear.
Physical therapy: Exercises can be performed to increase strength in the foot and leg muscles. Sometimes neuromuscular electrical stimulation (NMES) can be given to the peroneal nerve. A switch (which can be implanted or external) on the affected leg is activated when the foot lifts off the ground, and turns off when the heel hits the ground. An alternative device, the WalkAide, comes in the form of a battery-operated cuff worn on the leg. Electrical impulses stimulate the leg muscles to raise the foot at the correct point in the step cycle.
Exercises:
These exercises will help to strengthen the muscles responsible for lifting the front part of your foot. Only perform them if you have obtained your doctor’s permission.
- Toe Grab: Sit in a chair. With your bare feet, try to grab a ball or small towel with your toes. Lift the ball or towel up to knee height (or as high as you can) then lower it. Repeat 10 times for 1 set. Do 2 sets.
- Toe Curl: Sit in a chair. Hold on to the sides of the chair to minimize thigh strain. Raise both legs, knees straight, until they are parallel with the floor. Draw your toes towards your body and hold for 5 seconds. Uncurl your toes. Repeat 10 times for 1 set. Do 2 sets.
- Toe Flex: Sit on the floor with your legs straight out in front of you. Supporting yourself with your hands, lift one leg slightly off the ground. Bend your foot towards your body and hold for 5 seconds. Bend your foot away from your body and hold for 5 seconds. Repeat exercise with the opposite leg. Do the exercise 10 times for each leg.
- Foot Stretch: Sit on the floor with your legs straight out in front of you. Loop a towel or exercise band around the balls of your feet and hold on to the ends of the towel with your hands. Gently pull your toes and feet towards you. Hold the stretch for 5 seconds. Repeat 10 times.
- Calf Raise: Stand up straight. Rise up onto your toes as high as you can then lower your heels to the ground. Repeat 20 times for 1 set. Build up to 2 sets.
- Cycling: Use a real bicycle, a stationary bicycle or just lie on the floor with your legs in the air and make cycling motions.
