Foot Drop

Posted by Nurse Linda in Life After Paralysis on December 01, 2021 # Health

individual using a wheelchair sitting on front of stairsFoot drop is a condition that is familiar to many people. It is an issue with the nerves where the toes and mid-foot have poor control for lifting the foot. It can occur in one foot, but it can appear on both feet, depending on the source of the issue.

Foot drop affects walking as the toes drag, making it easy to trip and stumble. To be able to walk, individuals must lift their thigh extra excessively to make sure their foot is high enough to make the step. When the foot is placed back on the ground, it can land flat or at an angle, creating more issues of muscle strains and bone fractures. The foot can also be pointed outward when standing. There can be pain in the calf, lower leg, ankle, and toes. Toes can be numb. Generally, the foot exhibits weakness.

Those who have mobility issues that prevent them from walking can have the consequences of foot drop. This can include difficulty positioning, skin breakdown, and shortening of the Achilles tendon or other anatomical issues.

Anyone with or without the disease can acquire a foot drop. Individuals with nervous system injury can have weak muscles and nerves, which can lead to the issue. People with no neurological issues who sit with their feet unsupported can develop it. An example is sitting in a recliner where the footrest does not extend to the back of the heel. If the footrest ends at the back of the ankle, over time, the weight of the foot can cause the foot to extend straight out from the leg instead of at a 90-degree angle. Individuals who have been ill and have been in bed for even a short time can get foot drop from not exercising the ankle joint. Even the weight of a sheet or blanket can weigh down a foot to the straight position. In other words, anyone can get foot drop. Foot drop can be temporary or permanent.

The National Institute of Neurological Disorders and Stroke (NIH) lists these issues as related to foot drop. I have added a few additional risks. If you have one of these issues, you may not develop foot drop, but you are at risk.

  • Neurodegenerative disorders that cause muscular issues such as Multiple Sclerosis (MS), Stroke, Cerebral Palsy (CP)
  • Motor neuron disorders like polio, spinal muscular atrophy, amyotrophic sclerosis (ALS)
  • Injury to nerve roots as in spinal stenosis or peripheral nerve disease (Charco Marie Tooth or peripheral neuropathy)
  • Spinal cord injury
  • Muscle dystrophy or myositis
  • Diabetes
  • Hip replacement surgery
  • Immobility

The peroneal nerve in the leg is a common cause of foot drop due to compression or damage. This nerve passes behind the knee extending around the shin. Crossing your legs, pressing the side of your leg against something, or sitting with your leg under your body can lead to peroneal compression. Squatting or kneeling can put pressure on the peroneal nerve. A cast that is too tight can constrict the nerve. Truckers sometimes have compression issues with the peroneal nerve if they rest it against the gearbox in the truck on the right side or against the door on the left side for long periods of time.

Diagnosing foot drop is fairly easy just by looking at the foot. Still, a complete physical assessment is conducted, including observation of gait and evaluating muscle strength and sensation, especially on the top of the foot, toes, and shin. You will be asked about a history of how long this has been occurring if you have engaged in any activity, injuries or postures that could compress the peroneal nerve.

Blood work may be done to look for underlying medical issues such as diabetes, infection, or alcohol abuse, which can affect your nerves.

Imaging studies will indicate the location of the injury. The source of the issue could be as high as in the spine or anywhere along the route of the leg nerves. These studies may include CT scans, MRI, ultrasound, or even an x-ray to assess the tissue and nerves that could be the source of the problem. An assessment of swelling of the nerves or swelling around the area of the nerves or compression due to soft tissue injury or tumor is made.

Nerve testing will provide information about how well your nerves are functioning or transmitting messages. This includes electromyography (EMG), which measures muscle function and nerve conduction studies (NCS), an assessment of nerve function. These assessments are conducted by application of a mild electric current either through a needle in your skin or by use of an electrical patch.

Treatments for foot drop will aim at the cause. Depending on your situation, you may use some of these options to improve your situation. Not all cases of foot drop can be cured depending on the cause, but there are many options that can help.

If foot drop is from a positioning issue without nerve damage or trauma, you will be instructed to stop that behavior. Do not let your legs press up against anything. Stop crossing your legs. Sometimes people feel their legs ‘go to sleep’ when crossed. This is the peroneal nerve telling you it is compressed. Support for your feet if you sit with your legs elevated. Look at how your body is positioned in bed to be sure the sheets are not tucked in too tightly, drawing your feet down when on your back. A blanket lifter will keep the sheets off your feet while still keeping them warm. Obtain ankle supports (usually heel protectors) when in bed.

Pain medication can be used to assist if the pain is an issue. If your pain is muscular, analgesics or nonsteroidal inflammatory (NSAIDS) will be ordered. If pain is from nerve issues, medications that particularly have an effect on nerve pain, such as antidepressants or anticonvulsants in low doses or gabapentin or pregabalin, are effective. Topical medications or those rubbed on the skin, such as capsaicin, might also be helpful.

An ankle-foot orthotic (AFO) will assist in keeping the toes in position for walking and positioning. These are plastic supports that fit along the back of the leg, down around the heel and along the bottom of the foot. A soft Velcro strap holds the splint around the calf while a supportive shoe holds it in place on the bottom of the foot. Some individuals find this cumbersome. There is a less rigid device that is a Velcro strap around the ankle that ties to your shoelaces allowing your shoe to support your foot. These pictures are the two orthotics randomly selected for you to see the devices.

Physical therapy will be ordered to improve your muscle strength and balance. Exercises will be provided that may include passive motion, isometric, stretching, use of elastic bands, and ankle weights. More strengthening further up the leg is also helpful.

Electrical stimulation is offered to some individuals. This is a small device that stimulates the peroneal nerve to hold the foot in an upright position. It keeps the foot at a 90-degree angle when walking. A therapist may also use e-stim to strengthen muscles and nerves as a treatment.

Surgery may be offered to release a compressed nerve or remove something pressing against the nerve. In some cases, nerves can be transferred from one area to another to recreate your function. Nerves recover at a rate of one inch per month. Therefore, if your injury is behind your knee, measure from there to your toes. How long this space is on your body in inches will be the number of months until the nerve has regenerated. If the issue is in your back, it will be longer as you will measure from the spot on your back to your toes. It takes a long time to regenerate a nerve.

Other surgical options that may assist in your recovery are tendon transfers, moving muscles for strength or fusing the ankle. Tendon lengthening can help if your Achilles tendon has shortened over time.

The good news about foot drop is that there is an abundance of treatments that can help you. It can be daunting, but there are options. Nurse Linda

Pediatric Consideration:

In young children, sometimes paraffin treatments are recommended to help a range of motion loosen joints. In this case, the therapist will instruct you on the correct procedure. Do not try this at home as done incorrectly or for the wrong condition. More damage can occur. In this treatment, a sock is placed on the foot for protection. Slightly warm paraffin is then applied to the sock. This gently loosens the ankle joint. Burning skin is a real complication, so be sure this is done only by an educated therapist or with extensive education yourself.

Provide your child with good positioning to avoid drop foot. Check equipment to ensure it is still appropriately working for your growing child. While you are looking, check the toes of shoes to make sure they still fit. Shoes too small do not create foot drop but are a common issue with children of all ages, so checking is important. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.