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Foot drop is a condition that can occur due to the weakening or paralysis of certain foot muscles. It causes the patient to drag their toes while walking and raise their knee higher than usual to prevent tripping. This condition can affect one or both feet and is not a disease, but rather a symptom of a deeper anatomical, muscular, or neurological issue.
Although foot drop can be a permanent condition, it is sometimes temporary. Patients with this condition may require the use of ankle and foot braces to support and stabilize their affected foot, with the type of brace used depending on the severity of the condition.
It is crucial to identify the underlying cause of foot drop in order to determine the best treatment. Physical therapy may be recommended to strengthen the affected muscles and improve mobility. In some cases, surgery may be required to correct the underlying issue causing foot drop. Proper treatment and management can improve a patient’s ability to walk and reduce the risk of falls or other injuries.
Symptoms
Foot drop can lead to difficulties in walking due to the inability to lift the front of the foot. This requires the affected person to raise their leg higher than usual when taking a step to prevent dragging their toes or tripping. The foot may produce a slapping sound when it hits the ground, a condition referred to as a steppage gait. Furthermore, the condition may affect one or both feet, depending on the root cause. Seek medical attention if you notice any weakness in your foot, or if your toes drag on the ground while you walk.
Causes
Foot drop is a condition that occurs when the muscles responsible for lifting the front part of the foot are weakened or paralyzed. Some potential causes of foot drop include:
- Lumbar radiculopathy: Radiculopathy is caused by an inflamed or compressed nerve root where the nerves connect to the spinal column. When a nerve is pinched in the lower back, it’s called lumbar radiculopathy. The legs and feet are served by nerves that originate in the lumbar spine, which is made up of the L1 to L5 vertebrae. Foot drop can be caused by conditions that affect the spinal cord or brain, such as stroke, amyotrophic lateral sclerosis (ALS), or multiple sclerosis.
- Peroneal nerve injury: Foot drop is most commonly caused by compression of the nerve in the leg that controls the muscles involved in raising the foot. An extreme knee injury can lead to nerve compression and foot drop. Foot drop can also result from damage to the common peroneal nerve, which can be caused by various factors. These nerve injuries often occur due to severe damage to the knee, leg, or ankle. Additionally, foot drop can occur due to nerve damage sustained during hip or knee replacement surgery.
- Muscle or nerve disorders: Foot drop can also be caused by various neurologic disorders, such as muscular dystrophy, an inherited disease that causes progressive muscle weakness. Other conditions that can contribute to foot drop include polio and Charcot-Marie-Tooth disease.
Risk factors
The muscles responsible for elevating the foot are controlled by the peroneal nerve, which is situated close to the skin’s surface on the side of the knee nearest to the hand. Activities that put pressure on the peroneal nerve can increase the possibility of foot drop, and there are certain factors that can elevate this risk.
Examples of these factors include:
- Leg crossing: Frequent leg crossing can lead to compression of the peroneal nerve in the leg that is on top, causing symptoms such as numbness, tingling, weakness, and foot drop. To prevent this, it’s recommended to avoid crossing the legs for long periods of time and to change positions often.
- Prolonged kneeling: Jobs that involve prolonged bending or kneeling, such as gardening, construction, or plumbing, can put pressure on the peroneal nerve and cause foot drop, a condition in which the foot cannot be lifted properly due to weakness or paralysis of the muscles. To reduce the risk of foot drop, it’s important to use proper kneeling techniques, take frequent breaks, and wear supportive footwear.
- Leg cast: Plaster casts that cover the ankle and extend to just below the knee can cause compression of the peroneal nerve, leading to symptoms such as pain, swelling, and numbness in the foot and ankle. To prevent this, the cast should be applied properly by a trained professional, and regular checks should be done to ensure that there is no excessive pressure or constriction.
Diagnosis
The following will assist the healthcare provider diagnose foot drop.
- Physical examination: Physical examinations are typically used to identify foot drop. The healthcare provider will observe the patient walking and look for any weakening in the leg muscles. The doctor may also feel the top of the patient’s foot and toes for numbness.
- Imaging tests: The pressure of a tumor on a nerve can occasionally cause foot drop. A tumor or cyst pressing on the nerve in the knee or spine, or an expansion of bone in the spinal canal, are two possible causes. These abnormalities can sometimes be discovered with the assistance of imaging tests.
- X-rays: A soft tissue tumor or a bone lesion that may be the source of the symptoms can be seen with simple X-rays, which emit very little radiation.
- Ultrasound: This method can detect cysts, tumors, and swelling on the nerve caused by compression. It uses sound waves to create images of internal structures.
- Computed tomography (CT) scan: This creates cross-sectional pictures of the body’s structures by combining X-ray images captured from numerous angles.
- Magnetic resonance imaging (MRI): This examination produces highly detailed pictures of the bones and soft tissues using radio waves and a powerful magnetic field. MRI is very helpful for identifying soft tissue abnormalities that can be compressing a nerve.
- Blood test: particular blood tests, like a blood sugar test, to look for diabetes and diabetes-related neuropathy.
- Nerve tests: The electrical activity of the muscles and nerves is measured using nerve conduction studies and electromyography (EMG). These tests can be unpleasant, but they are helpful in locating the damage along the affected nerve.
Treatment
Foot drop treatment is dependent on the underlying cause. If the cause of foot drop is treatable and is effectively managed, there is a possibility that the condition may improve or even resolve completely. However, in cases where the cause is untreatable, foot drop may become a permanent condition.
Possible treatments for foot drop include:
- Physical therapy: Physical or occupational can help the patient keep their knee and ankle range of motion while also strengthening their leg muscles. These exercises may help with gait issues brought on by foot drop. To avoid stiffness in the calf and heel, stretching exercises are very crucial.
- Braces or splints: The equipment can help hold the foot in a normal position by wearing a splint that fits inside their shoe or an ankle and foot brace.
- Nerve stimulation: Foot drop can occasionally be improved by stimulating the nerve that elevates the foot.
- Surgery: Nerve surgery might be beneficial depending on the cause and if the foot drop is relatively recent. If foot drop has persisted for a while, the healthcare provider may advise surgery to improve function by moving a functioning tendon to another area of the foot.
In the case of persistent foot drop, the healthcare provider may advise fusing the bones of the ankle or foot, or the patient may undergo tendon surgery, in which a tendon from one leg is transferred to the problematic leg’s muscle to aid in pulling the foot up.
