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Foot Drop

Background & Etiology

Foot Drop (also called drop foot) is characterized by difficulty lifting the front of the foot (dorsiflexion), which may cause the foot to drag or slap along the ground when walking or moving. Foot Drop isn’t a disease; it is a sign of an underlying disorder of the foot that can be neurological, muscular or anatomical.

Foot Drop

This condition occurs as a result of weakness or paralysis of the muscles of the anterior portion of the lower leg. The anterior tibialis muscle plays a large role in dorsiflextion and deceleration of the foot when walking. The peroneal nerve, which branches from the sciatic nerve, innervates this muscle. Conditions causing foot drop can stem from the lumbar spine or knee and affect the leg down to the foot. This condition typically only affects one foot, however in some cases both feet can be affected.

Causes

Foot drop is caused by injuries to the muscles or damage to the nerves that serve the muscles of the leg. Damage to the peroneal or fibula nerve along the front of the shin may result in foot drop. Other common causes of foot drop include:

  • Peripheral Nerve damage from an injury
  • Muscle disorders, like muscular dystrophy, that cause weakness
  • Tear of the anterior tibialis tendon
  • Anterior Compartment syndrome
  • Nervous system disorders like amyotrophic lateral sclerosis or multiple sclerosis that affect the spinal cord and brain
  • Stroke causing hemiplegia or weakness of one side of the body

Symptoms

  • Difficulty lifting the front of the foot off the floor
  • Dragging the foot when ambulating
  • Slapping the foot on the floor with each step
  • Raising the leg while walking, as if trying to climb stairs (steppage gait)
  • Pain, weakness and numbness in the foot

Treatment

The cause of foot drop will play a large role in a how physicians and physical therapists decide to treat this condition. Focus should be on treating the underlying disorder that causes the foot drop, whether muscular, or neurological. This condition can be caused by a variety of disorders that vary in their severity. For some, rest, ice and physical therapy will be enough to relieve and improve the symptoms. However, a surgical procedure may also be necessary of there is nerve compression or a tendon rupture.

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Foot Drop include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the foot and ankle
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the foot and effected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, walking, stairs, gait training, or stepping) in daily use of the involved lower extremity.
  • Modalities that can include the use of EMS (electrical muscle stimulation) ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the foot and effected area.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Medical Interventions

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs) when inflammation is an underlying cause.
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology
  • The use of a brace to reduce the gait dysfunction due to weakness of the muscle

Prognosis

Depending on the cause of the foot drop, many people can recover full function following a course of conservative care that includes physical therapy, medication and possible use of an assistive brace. In cases where surgery is necessary physical therapy can play an important role in recovery, helping patients get back to the pre-injury level and function. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities.