What is Foot Drop?
If lifting the front part of your foot causes problems, you might be experiencing foot drop, which is characterized by a weakness or paralysis of affected muscles. While the name seems simple enough, the condition can actually turn into a wealth of serious complications associated with medical issues you may not have known existed, such as peripheral nerve injuries, stroke, and diabetes. It is also quite common to see the above causes overlap with one another.

Foot drop becomes quite noticeable when one begins to drag the toe of their shoe across the ground as they walk. While the sight is disturbing to foot drop victims, the condition will eventually cause significant impairment to the way they walk. While foot drop is not a disease, it is a sign that something else is taking place regarding the muscles in the foot. An underlying problem is the cause.

Foot drop is often associated with a host of other diseases and medical conditions, such as dorsiflexor injuries, neuropathies, and drug toxicities. Additional causes of foot drop include compressed nerve roots, muscle disorders, brain tumors, and multiple sclerosis. Depending on the source of a foot drop problem, the condition may remain temporary or permanent. The cause of the condition will also help doctors decide upon the best course of action for treatment. A typical mode of treatment includes an orthotic brace worn on the ankle and foot, which aims to keep the foot in its normal position.

When it comes to the foot and ankle dorsiflexors, it is the tibialis anterior, extensor hallucis longus, and extensor digitorum longus that suffers the significant weakness associated with foot drop. These particular muscles are known to aid the body when the foot is in its "swing phase." They also help maintain plantar flexion of the foot on heel strike. As this group of muscles suffers weakness, deformities may arise, which is often referred to as "steppage gait," as the patient makes a habit of walking with strained flexion of the hip and knee to prevent the toes from skimming the ground during the swing phase.

Surgical Treatment Options

A patient with foot drop typically faces medical or surgical therapy to treat their condition. Surgical treatment options include the operative care of foot drop caused by trauma to the dorsiflexors. Surgery concentrates on restoring the continuity of affected nerves through direct repair or removal of trauma-causing obstacles in the foot and ankle region.

When foot drop is caused by lumbar disc herniation, some patients undergo a discectomy, which helps to relieve decreased blood flow. Nerve root compression- related foot drop cases may benefit from early decompression, especially in elderly individuals. Additional surgical foot drop procedures include nerve grafting, nerve repair, and as a last resort – tendon transfers.

Medical Treatment Options

When surgery is not feasible, medical therapy is the best solution for treatment. A patient may receive an ankle foot orthosis (AFO), which provides toe dorsiflexion during the swing phase. Medial and/or lateral stability at the ankle is also delivered through the use of an ankle foot orthosis. This type of treatment is successful only when the foot is able to achieve a plantigrade position when standing. A contracture of the foot disturbs this mode of treatment. The most common AFOs for foot drop are made from polypropylene and easily fits inside of footwear. There are also shoe-clasp orthosis options, which directly connect to the heel counter of a shoe.

Peroneal nerve stimulation is sometimes considered for foot drop patients, where the stimulation of nerves are used to correct an active gait, and can be customized to fit individual needs. A short burst of electrical stimulation is applied to the nerves located between the popliteal fossa and fibular head. A switch placed in the heel of affected limbs acts as a control for the electricity, which is activated when the foot lifts and stops to make contact with the ground. The ultimate aim is to create dorsiflexion and eversion during the swing phase of gait. Some nerve stimulation devices are external, while others are implants with radio frequency activation.