Drop foot

What is drop foot?

  • Drop foot is the weakness of the dorsiflexion muscles in the foot
  • The extent of the deficit depends on three factors: location, severity and duration of the injury
  • The most common cause of the drop foot is peroneal nerve neuropathy a problem often related to compression at the neck of the fibula at knee level where the nerve is superficial with minor tissue support

What are the common causes of drop foot?

Peripheral:

  • common peroneal nerve damage
  • Superficial peroneal nerve damage
  • Deep peroneal nerve damage

Central:

  • L5 root radiculopathy
  • Sciatic nerve neuropathy
  • Anterior horn cell lesions
  • Cauda Equina Compression

Musculoskeletal:

  • Muscle dystrophy
  • hip arthroplasty that could result in sciatic nerve injury

Medical conditions:

  • DM
  • Vitamine B12 deficiency
  • chemotherapy
  • Alcohol misuse

What questions your doctor might ask you during the visit?

  • History of habitual or prolonged squatting or kneeling
  • History of knee brace or recent cast
  • Recent weight loss (Slimmer’s palsy)
  • Overstretching of peroneal leg, usually happens after ankle strain or prolonged leg or ankle stretch
  • History of DM
  • History of alcohol abuse
  • Recent surgeries

What laboratory work ups might be needed?

  • CBC for anemia
  • Vitamin B.12 level

What diagnostic work ups your doctor might request?

  • Electromyography
  • Nerve conduction
  • Lumbar MRI

How is drop foot managed?

  • Immediate neurologist referral if the problem is acute and bilateral
  • Surgeon or orthopedic referral in case of compartment syndrome
  • Education on avoidance from leg crossing, squatting and kneeling if the compression of the nerve at the knee is a potential cause
  • Physical therapy if needed
  • Recommend shoes with ankle support to prevent ankle sprain
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