Foot Drop

| Advanced Physiotherapy
Foot Drop

Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion.

The foot and ankle dorsiflexors include the tibialis anterior, the extensor hallucis longus (EHL), and the extensor digitorum longus (EDL). These muscles help the body clear the foot during swing phase and control plantarflexion of the foot on heel strike.

Symptoms Patient is unable to lift the frontal part of your foot, so patient drags the foot while walking . In some cases patient may feel numbness. Causes of foot drop:

1)Nerve injury

2)Brain or spinal disorders

3)Muscle disorders

Most commonly , foot drop is caused by an injury to the peroneal nerve. The peroneal nerve is a branch of the sciatic nerve that wraps from the back of the knee to the front of the shin. Peroneal nerve is damaged or compressed include:

1) sports injuries

2) diabetes

3) hip or knee replacement surgery

4) childbirth

5) long time spent in leg cast

Brain or spinal disorders which can cause this condition are

1) stroke

2) multiple sclerosis

3) cerebral palsy

4) charcot- marie- tooth disease.

Muscular issue which can cause foot drop can be:

1) muscular dystrophy

2) amyotrophic lateral scelorosis

3) polio


1) x ray, ultrasound, MRI, CT scan to look for any injury in the legs, spinal cord and brain.

2) blood test to check blood sugar levels

3) Nerve conduction test to examine how the nerves are functioning.

4) EMG a test in which electrodes are placed in the muscles of the legs to measure their electrical activity.

Management of foot drop

1) A simple and relatively inexpensive way to correct these issues is to wear a foot support brace that helps you lift the foot. These dorsiflexions assist AFOs come in many styles, ranging from posterior leaf spring . The dorsiflexion night splint is specifically designed to support the ankle and foot at a 90-degree ngle as you sleep. This foot and ankle brace is far less bulky than traditional night braces for foot drop and it features a breathable, open heel design that improves sleep quality.

2) electrical stimulation for foot drop: functional electric stimulation (FES) device to the peroneal nerve can stimulate contraction of the muscles that lift the front of the foot up, allowing you to walk more naturally.

3) Exercises and stretches : Foot physiotherapy exercises are not a quick fix. Drop foot exercises are most effective when a patient commits to doing them regularly and on a long-term basis.

For some, physical therapy to strengthen weak feet and ankle muscles can improve the symptoms of foot drop by enhancing your balance, broadening your range of motion and keeping your tissues limber.

Exercises are as follows:

1) Seated ball lift: Sit in a chair with your feet flat on the floor. Place a small ball (e.g., a tennis ball) on the floor in front of you. Grab the ball using both your feet and slowly extend your legs to lift it. Hold for a few seconds then lower back to the ground. Repeat 10 times.

2)Marble pickup: Sit in a chair with your feet flat on the floor. Put around 20 marbles in a bowl in a bowl on the floor in front of you, with an empty bowl next to it. Use the toes of your affected foot to transfer all the marbles to the empty bowl.

3)Toe-to-heel rocks: Rock your weight forward to rise onto your toes and hold the position for 5 seconds. Then rock your weight backward and lift your toes off the ground and hold for five seconds. Repeat 10 times. For more of a challenge, you can do this standing on one leg. You may want to do this exercise near a wall or with a chair or counter in front of you so you can hold on for added support.

4)Modified toe raises: If you’re not able to do the toe-to-heel rocks, give this one a try. In a seated position, slide your unaffected foot underneath the affected one. Use the lower foot to lift the front part of the affected foot, while keeping both heels on the ground. Repeat 10 times.

5)Towel Stretch: Sit on the floor with your legs extended in front of you. Loop a towel or resistance band around the arch of your foot. Pull the towel/band toward your body so you get a good stretch. Hold for 30 seconds then release. Repeat five times.

6)Ankle Eversion: Stand with your affected foot slightly in front of your other foot. Rotate your ankle/foot to lift the outer edge of your foot toward the sky, hold for a few seconds and then relax the foot back to the ground. As you do this exercise, focus on using your foot and ankle to twist the foot, rather than the leg. Repeat 10 times.

7)Ankle rotations: Sit in a chair with the back supported. Raise one leg in the air and slowly rotate your foot as far inward as you can and hold the position for a few seconds. Next slowly rotate your foot outward and hold. Repeat 10 times for each leg. To make this more challenging, you can add weighted bands to your ankle.

Tendon transfer for foot drop

In this procedure, a tendon and some attached muscle (often the posterior tibial tendon) is taken from one area of the foot and transferred to another area to replace tissue that is no longer functioning.After surgery, you will need to be off your feet for several weeks, including time in a cast and boot, followed by weeks of physical therapy and use of a night splint for several months.

Nerve transfer for foot drop treatment. Nerve transfers are another option for some. With this surgery, nerves with less important roles are transferred to the branch of the nerve used to flex the foot. Extensive therapy will be needed not only to train the transferred tendons to lift the foot but also to address the loss of the “donor” nerves.

Arthrodesis Another drop foot surgery option is one to fuse the ankle and foot joint so that they are well aligned, cause less pain and function better. fixating the ankle and foot this is not a perfect solution, but it does provide pain relief and improves the function of the foot/ankle for some with drop foot.

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