Foot drop is a gait abnormality where the front part of the foot cannot be lifted, often due to nerve injury, muscle weakness, or neurological disorders. This condition can cause difficulty walking, resulting in dragging toes or an unsteady gait, which increases the risk of falls.
Treatment depends on the cause and severity.
Article Index
Introduction
Examination & Diagnosis
Treatment & Exercise
Alternatives
Conclusion & References
Causes of Foot Drop
The most common cause of foot drop is peroneal nerve injury, which can result from various conditions affecting the nerves and muscles. Peripheral neuropathy, often due to diabetes or inherited conditions like Charcot-Marie-Tooth disease, can lead to foot drop. Other causes include muscular dystrophy, a group of disorders that weaken muscles and lead to tissue loss, and polio, a viral infection that can cause muscle weakness and paralysis, with endemic wild poliovirus type 1 still present in Pakistan and Afghanistan as of 2022 (WHO).
Everyday habits, such as crossing the legs, can damage the peroneal nerve, contributing to foot drop. Additionally, brain and spinal cord disorders, including stroke, amyotrophic lateral sclerosis (ALS), and multiple sclerosis, can cause muscle weakness and paralysis leading to foot drop. This article explores the anatomy and biomechanics of foot drop, examining its signs, symptoms, and diagnostic methods. It also highlights promising treatment options, focusing on manual therapy, specifically motion specific release (MSR) techniques, and functional exercises for those affected by foot drop.
Signs and Symptoms
Individuals suffering from foot drop may exhibit a range of signs and symptoms that significantly impact daily life and mobility. The primary manifestations include:
Impaired dorsiflexion: Difficulty lifting the front part of the foot, leading to an inability to perform proper dorsiflexion.
Foot dragging: Patients often drag their affected foot while walking, increasing the risk of tripping or falling due to the inability to dorsiflex.
High-stepping gait: To compensate, individuals may adopt a high-stepping gait, characterized by exaggerated lifting of the knee to prevent the foot from dragging.
Sensory disturbances: Numbness or tingling sensations on the top of the foot or the outer part of the shin due to damage to the sensory fibers within the common peroneal nerve.
Ankle weakness: Weakness in ankle dorsiflexion and eversion, complicating the ability to walk and maintain balance.
Muscle atrophy: Prolonged nerve damage or disuse of the affected muscles may lead to muscle wasting, exacerbating weakness in the foot and ankle.
Pain: Depending on the underlying cause, some individuals may experience pain in the affected leg, knee, or ankle.
These signs and symptoms can vary in severity, depending on the underlying cause of foot drop. Early recognition and intervention are critical in managing this condition and improving overall patient outcomes..
Article Index
Anatomy, Biomechanics & Related Causes
The common peroneal nerve, a crucial branch of the sciatic nerve, plays a vital role in innervating the anterior and lateral compartments of the leg. It is responsible for several key functions, such as controlling dorsiflexion and eversion of the foot. The peroneal muscles, including the peroneus longus and peroneus brevis, are essential for various movements and actions:
Eversion: Turning the sole of the foot outward or laterally
Plantar flexion: Pointing the toes and foot downward, away from the body
Damage to the common peroneal nerve or the peroneal muscles can lead to foot drop. Several factors may contribute to this damage:
Direct trauma: Fractures or dislocations around the knee or ankle can injure the common peroneal nerve.
Compression: Prolonged pressure on the nerve, such as from a tight cast or crossing the legs, can cause nerve damage.
Inflammation: Conditions like vasculitis, which causes inflammation of blood vessels, can damage the peroneal nerve.
Tumors: Benign or malignant growths may compress or infiltrate the nerve, leading to foot drop.
Iatrogenic injury: Surgical procedures, particularly those involving the knee or ankle, can inadvertently damage the common peroneal nerve.
Diagnosis
A thorough diagnosis of foot drop is essential to identify the root cause and develop an appropriate treatment plan. The diagnostic process typically involves orthopedic, neurological, and vascular assessments, which can help determine the underlying factors contributing to the condition.
Orthopedic Testing:
Orthopedic examinations focus on evaluating joint and muscle function, as well as range of motion. These assessments can help determine if the foot drop is caused by musculoskeletal issues, such as muscle weakness, or if it stems from a neurological problem. In the context of foot drop, orthopedic testing may include evaluating ankle strength, flexibility, and stability. Click on the video to see our orthopedic examination of the ankle and foot.
Neurological Testing:
A comprehensive neurological examination can help pinpoint the location and extent of nerve damage, which is crucial for targeted treatment. This may involve testing for sensation, reflexes, and muscle strength in the affected limb. Identifying the specific nerve(s) involved in foot drop can guide the treatment approach and optimize the chances of successful recovery. Click on the video to see our Lower Limb Neurological Examination.
Vascular Testing:
Vascular assessments aim to evaluate blood flow to the affected leg to determine if a vascular issue, such as peripheral artery disease, is contributing to foot drop. Ensuring adequate blood supply to the nerves and muscles is essential for proper function, and addressing any vascular issues can be a critical component of the overall treatment plan. Click on the video to see our Peripheral Vascular Examination.
Functional Exercises and Treatment
Addressing foot drop effectively often entails a blend of functional exercises and manual therapy, aimed at tackling the root causes of the problem.
Best Foot Drop Exercises and Treatment
In this video, Miki Burton, showcases six effective exercises for treating Foot Drop. Then Dr. Brian Abelson demonstrates how to address the larger kinetic chain, including the hips, spine, and upper body, to further support the treatment of Foot Drop.
Combining manual therapy and functional exercises provides a comprehensive approach to treating foot drop, addressing both the immediate symptoms and the underlying causes of the condition to promote long-term recovery and improved quality of life.
Alternative Options
In some cases, despite a comprehensive approach involving manual therapy and functional exercises, foot drop may not improve significantly. If conservative treatments do not yield the desired results, it may be necessary to explore additional options to manage the condition and maintain mobility.
Ankle-Foot Orthosis (AFO): An AFO is a custom-made brace that supports the foot and ankle, assisting with dorsiflexion and providing stability during walking. This can help compensate for the lack of muscle function and reduce the risk of tripping or falling.
Functional Electrical Stimulation (FES): FES uses electrical impulses to stimulate the nerves and muscles responsible for lifting the foot. A small device sends signals to the affected muscles, promoting muscle contraction and improved foot function during walking.
Consultation with Specialists: If conservative treatments have not been effective, it is essential to consult with healthcare professionals such as neurologists, orthopedic surgeons, or physiatrists. These specialists can offer further evaluations and recommend alternative treatment options, which may include medications or surgical interventions if deemed necessary.
It is crucial to maintain open communication with your healthcare team throughout the treatment process, as they can help monitor your progress, reassess your condition, and adjust the treatment plan accordingly.
Conclusion
Foot drop, characterized by the inability to lift the front part of the foot, often stems from nerve injury, muscle weakness, or neurological disorders. This condition can significantly impact daily life, causing difficulty walking, dragging toes, and an unsteady gait, which increases the risk of falls.
Addressing foot drop requires a thorough understanding of its causes, symptoms, and available treatments. From manual therapy and functional exercises to orthotic devices and potential surgical interventions, a comprehensive approach tailored to the individual's needs is essential. Early recognition, consistent treatment, and regular assessment are key to improving mobility and enhancing the quality of life for those affected by foot drop.
References
Magee, D. J. (2014). Orthopedic Physical Assessment (6th ed.). Elsevier Saunders.
Umphred, D. A., Lazaro, R. T., Roller, M., & Burton, G. (2013). Neurological Rehabilitation (6th ed.). Elsevier Mosby.
Kesson, M., & Atkins, E. (2018). Orthopaedic Medicine: A Practical Approach (2nd ed.). Elsevier Butterworth-Heinemann.
Frontera, W. R., Silver, J. K., & Rizzo, T. D. (2015). Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation (3rd ed.). Elsevier Saunders.
Campbell, W. W. (2012). DeJong's The Neurologic Examination (7th ed.). Lippincott Williams & Wilkins.
O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). Physical Rehabilitation (6th ed.). F.A. Davis Company.
Hoppenfeld, S. (2016). Physical Examination of the Spine and Extremities. Pearson.
Hertling, D., & Kessler, R. M. (2006). Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods (4th ed.). Lippincott Williams & Wilkins.
Braddom, R. L., & Chan, L. (2015). Physical Medicine and Rehabilitation (4th ed.). Elsevier Saunders.
Magee, D. J., Zachazewski, J. E., & Quillen, W. S. (2016). Pathology and Intervention in Musculoskeletal Rehabilitation (2nd ed.). Elsevier Saunders.
Aminoff, M. J., & Greenberg, D. A. (2019). Clinical Neurology (10th ed.). McGraw-Hill Education.
Pomeroy, V. M., Evans, E., & Richards, J. D. (2007). Foot drop splints improve proximal as well as distal leg control during gait in Charcot-Marie-Tooth disease. Clinical Rehabilitation, 21(10), 932-941.
Singh, R., & Rohilla, R. K. (2016). Management of foot drop in CMT disease by dynamic foot splints: A case series. Journal of Orthopaedic Case Reports, 6(3), 87-91.
Allet, L., Armand, S., de Bie, R. A., Golay, A., Monnin, D., Aminian, K., ... & Pataky, Z. (2009). The gait and balance of patients with diabetes can be improved: A randomised controlled trial. Diabetologia, 52(3), 458-466.
Cho, H. Y., & Hwang, S. (2012). Effect of treadmill training based real-world video recording on balance and gait in chronic stroke patients: A randomized controlled trial. Gait & Posture, 35(4), 676-680.
Kluding, P. M., Dunning, K., O'Dell, M. W., Wu, S. S., Ginosian, J., Feld, J., & McBride, K. (2013). Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke, 44(6), 1660-1669.
Bulley, C., Mercer, T. H., Hooper, J. E., Cowan, P., Scott, S., & van der Linden, M. L. (2015). Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis. Disability and Rehabilitation: Assistive Technology, 10(6), 458-467.
Sabut, S. K., Sikdar, C., Mondal, R., Kumar, R., & Mahadevappa, M. (2011). Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke. Disability and Rehabilitation, 33(19-20), 1594-1603.
Tyson, S. F., & Kent, R. M. (2013). Effects of an ankle-foot orthosis on balance and walking after stroke: A systematic review and pooled meta-analysis. Archives of Physical Medicine and Rehabilitation, 94(7), 1377-1385.
Disclaimer:
The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.
This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.
By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.
DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
Protocols: Over 250 clinical procedures with detailed video productions.
Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.
Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.
Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.
Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.