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Despite the condition suggesting otherwise the root cause of drop foot doesn’t reside within the foot but stems from either neurological conditions (brain injuries) or damage to the peroneal nerve (which sits behind the knee and is a branch of the sciatic nerve).
The peroneal nerve runs from behind the lateral side of the knee and runs down the fibula to the foot. It consists of two branches in the deep and superficial and is responsible for providing feeling (sensation) to the front and side parts of the leg and the foot. They also work to enable dorsi flexion (lifting the toes and ankle upwards).
There are a number of conditions that can cause drop foot syndrome, either temporarily or permanently, including:
If we take a slightly more detailed look at some of the main causes of the condition.
One of the main sources of problems associated with drop foot is where there is damage to the peroneal nerve. As this is located behind the knee and runs alongside the fibula any knee injury can result in damage, which is why some people may not link the two conditions.
If you were to break or fracture your leg then you may run the risk of the damaged bone compromising the nerve, another reason why immobilisation and immediate medical attention should be sought in order to prevent further damage being caused.
Likewise a bad sprain or twist of the knee joint can impact on the nerve adversely. Following a sprain there will be an inherent weakness in the joint and an increase in the likelihood of it happening again, which is why it is important to work on strengthening exercises and even to utilise a knee support for greater protection to avoid further sprains which could cause further damage to the peroneal nerve.
A group of generative conditions, muscular dystrophy leads to the gradual weakness of a muscle. It can affect any muscle in the body and in serious cases can compromise breathing which could be life threatening.
From a drop foot perspective the muscles in the leg become weaker so that the patient no longer has the strength to lift their leg / feet when walking and is something more common in elderly patients.
Not all cases of drop foot relate to peroneal nerve damage but can result from trauma to the brain such as a stroke (or even trauma associated with the spinal code which can occur as a result of an accident). A stroke can be extremely serious (requiring immediate medical attention) and occurs where the brain is affected by a compromised blood supply.
The biggest sign of drop foot is your inability to lift your foot when walking and follow the normal gait cycle.
The below video shows the gait of a healthy individual and any deviation from this is a cause for concern.
The condition itself is not painful but the repercussions from failing to manage it could be. If you feel that you are having difficulty lifting your feet when mobile or find yourself catching your toe when walking then this is something you should seek to address.
Trips and falls are common with drop foot sufferers which can lead to further complications from bruising to broken bones and even head injuries, another reason why diagnosis and treatment is important to minimise the risk to yourself. It is worth noting that trips and falls are just as common at home as they are outside due to the number of obstacles which may be in your path from room to room.
A doctor or clinician should be able to diagnose the appearance of drop foot through a physical examination. Your gait will be analysed and if you walk more like the below video than the video above then this is a clear sign of the condition. Your leg muscles will also be assessed to check whether there is any degradation (muscular dystrophy).
If the initial examination is not conclusive there are a number of other tests which can be undertaken, either through analysis of the peroneal nerve via an x-ray or ultrasound scan or even performing a nerve conduction test to check the response of each nerve, which in turn will identify the main source of the problem.
Complete recovery will depend on the root cause of the condition.
If the root cause is a knee injury then there is a greater chance of regaining movement (control) in the foot compared to if the condition follows a brain injury which is more neurologically based. A doctor or clinician will be able to work with you on identifying the best treatment options available to you and typically a combination of some or all of these may offer the best possible results.
One of the main causes of drop is muscle weakness, therefore a physiotherapist can work with you on strengthening the knee and the foot to help build up muscle which in turn will give you greater control when active.
Knee exercises can work to offer greater control of the foot by strengthening the thighs, hamstrings and calf’s.
The following exercises are designed for Achilles tendonitis but can equally be applied for the management of drop foot by working on strengthening the muscles and ligaments in the foot region through extended range of motion actions.
Speak with your physiotherapy before starting any exercise programme (to make sure it is suitable for you) but there is a wealth of information online on the best exercises for the management of drop foot.
This can help in some, but not all, cases of drop foot syndrome and can assist users in walking more confidently and with less effort. Electrodes are placed next to the relevant nerves and over the muscle, either externally or implanted under the skin. These will then be connected via leads to a small portable, battery operated stimulator. Triggered by a sensor worn in the shoe, an electrical impulse will stimulate the nerves to contract the muscles and lift the foot up each time it is lifted off the ground. In the case of implanted electrodes, the electrodes can be activated with radio-frequency.
The electrical stimulation device can be a temporary measure or one that’s used over a number of years. For treatment of this kind, a referral can be made through a GP or consultant.
This is a special brace or foot support worn on the lower part of the leg and ankle to stabilise and control the ankle. AFOs can significantly improve walking ability by offering stability and enhancing confidence.
There are two types of AFO.
The first is effectively an ‘L’ shaped rigid plastic device (like the Prolite AFO) which sits under the foot and on the back of the calf. It can be worn with shoes and effectively stops your foot from dropping by keeping it at a right angle at all times. One of the limitations noted is that if you are wearing shorts then the device will be visible and is not particularly discreet.
An alternative is something like the Foot-Up which works on the same principle by connecting your ankle and foot so that it can’t drop. There is a standard version and a shoeless version. The standard version works using an ankle wrap which is then connected to an inlay that sits under the laces of your shoe which prevents it from dropping. The shoeless version substitutes the inlay for the laces with another wrap which fits around the foot and is connected to the ankle, again preventing the foot from dropping beyond 90 degrees.
It is normally advisable to try the different options available on the market to find the right option for you as whilst a Prolite might be perfect for one person the Foot-Up may be more suited to someone else. It is the same with most supports in that whilst they are designed to undertake a specific function it is personal preference as to which one you feel most comfortable with.
For those with drop foot syndrome as a result of permanent paralysis, surgery may be an option. This could involve the removal of a tendon from the stronger leg to the weakened muscle, which will help the sufferer to lift their foot up more easily. Very occasionally, it may be necessary to completely fuse the affected ankle joint.
In the majority of cases drop foot cannot be prevented, especially where the root cause is a neurological condition. If this is the reason for the condition then it is important to work on the exercises provided by your physiotherapy to help offer you a greater control over your mobility and at the same time using an AFO.
If there is a family history of muscle degenerative conditions then you may want to look at the same type of exercises as those currently suffering from drop foot to build up the muscles in a bid to counteract the degradation.
It is also important to understand the early signs of the condition setting in so that you are able to address it quickly.
If you have any questions regarding drop foot or any other foot problems then we would recommend speaking with your doctor or clinician.