Footdropkevinja 141118013605 Conversion Gate01 2

FOOT DROP
Dr. Kevin Joseph Ambadan

• Drop Foot
• The inability to lift the front part of the foot.
• Paralysis of anterior muscles of lower leg
• Inability to dorsiflex at the ankles and toes
• Causes the toes to drag along the ground while
walking.
• Can happen to one or both feet at the same time.
It can strike at any age.
• Temporary or permanent
CAUSES
• Injury to the peroneal nerve.
• sports injuries
• diabetes
• hip or knee replacement surgery
• spending long hours sitting cross-legged or squatting
• childbirth
• large amount of weight loss
• Injury to the nerve roots in the spine (L5)

• Neurological conditions that can contribute to foot
drop include:
• stroke
• multiple sclerosis (MS)
• cerebral palsy
• Charcot-Marie-Tooth disease
• Conditions that cause the muscles to progressively

weaken or deteriorate may cause foot drop:
• muscular dystrophy
• amyotrophic lateral sclerosis (Lou Gehrig’s disease)
• polio
• Rupture of Anterior Tibialis
• Fracture of fibula
• Compartment Syndrome
• Diabetes
• Alcohol Abuse
VULNERABILITY OF PERONEAL NERVE
• Funiculi of the peroneal nerve - larger and less

connective tissue
• Fewer autonomic fibers, so in any injury, motor and
sensory fibers bear the brunt of the trauma.
• More superficial course, especially at the fibular
neck
• Adheres closely to the periosteum of the proximal
fibula
MUSCLES
• DORSIFLEXORS
TIBIALIS ANTERIOR
EXTENSOR HALLUCIS LONGUS
EXTENSOR DIGITORUM LONGUS
PERONEUS TERTIUS
• EVERTORS
PERONEUS LONGUS
PERONEUS BREVIS
SYMPTOMS
• Difficulty in lifting the foot.
• Dragging the foot on the floor as one walks.
• Slapping the foot down with each step.
• Raising thigh while walking (high stepping gait)
• Pain, weakness or numbness in the foot.
GAIT CYCLE
• Swing phase (SW): The period of time when the foot

is not in contact with the ground. In those cases
where the foot never leaves the ground (foot drag)
- phase when all portions of the foot are in forward
motion.
• Initial contact (IC): when the foot initially makes

contact with the ground; represents beginning of
the stance phase - foot strike.
• Terminal contact (TC): when the foot leaves the

ground - end of the stance phase or beginning of
the swing phase - foot off. .
FOOT DROP
• Drop foot SW: Greater flexion at the knee to

accommodate the inability to dorsiflex - stair
climbing movement.
• Drop foot IC: Instead of normal heel-toe foot strike,

foot may either slap the ground or the entire foot
may be planted on the ground all at once.
• Drop foot TC: Terminal contact is quite different -

inability to support their body weight – walker can
be used
IMAGING
• X-Ray
Post-Traumatic - tibia/fibula and ankle - any
bony injury.
Anatomic dysfunction (eg. Charcot joint)
• Ultrasonography
If bleeding is suspected in a patient with a hip
or knee prosthesis
• Magnetic Resonance Neurography

Tumor or a compressive mass lesion to the
peroneal nerve
ELECTROMYELOGRAM
• This study can confirm the type of neuropathy,

establish the site of the lesion, estimate extent of
injury, and provide a prognosis.
• Sequential studies are useful to monitor recovery

of acute lesions.
TREATMENT
• Depends on the underlying cause.
• If cause is successfully treated foot drop may
improve or even disappear.
• Medical treatment - Painful Paresthesia
• Sympathetic block
• Amitriptyline
• Nortriptyline
• Pregabalin
• Laproscopic Synovectomy
SPECIFIC TREATMENT
• Braces or splint
• Brace on the ankle and foot or splint that fits into the
shoe can help to hold the foot in the normal position
PHYSICAL THERAPY
• Exercises that strengthen the leg muscles
• Maintain the range of motion in knee and ankle
• Improve gait problems associated with foot drop.

NERVE STIMULATION
Stimulating the nerve (peroneal nerve) improves foot
drop especially if it caused by a stroke.
SURGICAL REPAIR
• Foot drop due to direct trauma to the dorsiflexors
generally requires surgical repair.
• When nerve insult is the cause - restore the nerve
continuity - nerve grafting or repair.
• If there is no significant neuronal recovery at one

year - tendon transfer maybe considered.
• Bridal procedure
• Neurotendinous transpositon
BRIDALS PROCEDURE
• Tendon to bone attachment - posterior tibial tendon is

attatched to the second cuneiform bone.
• Tendon to tendon attachment

NEUROTENDINOUS TRANSPOSITION
• Lateral head of gastronemius is transposed to the
tendons of the anterior muscle group with simultaneous
transposition of the proximal end of deep peroneal
nerve.
• The nerve is sutured to the motor nerve of the

gartronemius
• Active voluntary dorsiflexion of foot

• AFTER TENDON TRANSFER
Cast and Non-Weight Bearing ambulation for 6
weeks
• PHYSIOTHERAPY
To correct gait abnormalities
• CHRONIC AND CONTRACTURE CASES

Achilles tendon lengthening
• In patients whom foot drop is due to neurologic and

anatomic factors (polio, charcot joint ) - Arthodesis
• Subtalar Stabilising procedure or Triple Arthodesis can be

done.
COMPLICATIONS
• Surgical procedure- wound infection may occur.

• Nerve graft failure
• In tendon transfer procedures- recurrent deformity
• In arthrodeses or fusion procedures- pseudoarthrosis,
delayed union, or nonunion.
THANK YOU

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FOOT DROP

Dr. Kevin Joseph Ambadan

• Injury to the nerve roots in the spine (L5)

• Conditions that cause the muscles to progressively

• Funiculi of the peroneal nerve - larger and less

• Swing phase (SW): The period of time when the foot

• Initial contact (IC): when the foot initially makes

• Terminal contact (TC): when the foot leaves the

• Drop foot SW: Greater flexion at the knee to

• Drop foot IC: Instead of normal heel-toe foot strike,

• Drop foot TC: Terminal contact is quite different -

• Magnetic Resonance Neurography

• This study can confirm the type of neuropathy,

• Sequential studies are useful to monitor recovery

• Exercises that strengthen the leg muscles

• Maintain the range of motion in knee and ankle

• Improve gait problems associated with foot drop.

• If there is no significant neuronal recovery at one

• Tendon to bone attachment - posterior tibial tendon is

• Tendon to tendon attachment

• The nerve is sutured to the motor nerve of the

• Active voluntary dorsiflexion of foot

• CHRONIC AND CONTRACTURE CASES

• In patients whom foot drop is due to neurologic and

• Subtalar Stabilising procedure or Triple Arthodesis can be

• Surgical procedure- wound infection may occur.

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