Foot drop

What is it?

Foot drop refers to weakness of the ankle dorsiflexor muscles, mainly the tibialis anterior muscle, which causes difficulty or an inability to lift the foot. This makes walking and moving around more difficult. It is not a disease in itself, but rather a symptom.

 

What causes foot drop?

This condition can affect a wide range of people, as it can result from several different mechanisms. Here are a few examples:

Compression of the deep fibular nerve, which originates from the sciatic nerve and is located on the anterolateral side of the leg. This compression may be caused by an external object, such as a hockey shin guard, a fibula fracture, or pressure on the side of the leg, for example when lying on one side on a hard surface, which compresses the structures around the fibula.

A neurological condition that affects nerve conduction in one or more extremities, such as a stroke, severe traumatic brain injury, cerebral palsy, spinal cord injury, multiple sclerosis, etc.

A herniated disc in the lumbar region causing compression of the L5 nerve root, which is responsible for innervating the tibialis anterior muscle.

Peripheral neuropathy: a metabolic condition that affects the speed and capacity of nerve conduction, such as diabetes, alcoholism, etc. Certain chemotherapy treatments can also cause these symptoms. This results in sensory and/or motor impairments that mainly affect the extremities, such as the feet and hands.

 

What are the symptoms?

• Difficulty or inability to lift the foot due to significant weakness of the tibialis anterior muscle.
• A tendency to trip or catch the toes while walking, increasing the risk of falls during movement.
• Altered walking pattern: compensatory limp, increased hip movement, and the foot slapping the ground.
• Difficulty or inability to walk on the heels.
• Feeling of muscle weakness in the ankle.
• Possible sensory issues such as numbness, tingling, pins and needles, loss of sensation, etc.
• Possible pain and radiating symptoms in the leg and foot.
• In more severe or chronic cases: muscle atrophy at the front or side of the leg.

 

How is it diagnosed?

If you believe you may have foot drop, it is recommended that you consult your physiotherapist or physician promptly to receive the appropriate follow-up. Foot drop itself is not dangerous, but it can be present in cases of serious conditions that require quick medical care.

Depending on your symptoms, your physician may prescribe an EMG test, or electromyography, which evaluates nerve conduction speed; an X-ray if a fibula or spinal fracture is suspected; an MRI, or magnetic resonance imaging, if nerve compression is suspected; or blood tests if there is a risk of a metabolic condition.

 

What is the treatment?

Treatment varies greatly depending on the cause of foot drop. Once more serious causes have been ruled out, such as neurological involvement, fracture, tumor, peripheral neuropathy of metabolic origin, etc., you may be referred to physiotherapy for rehabilitation.

The focus of physiotherapy interventions will be to strengthen the ankle dorsiflexor muscles through mobility and strengthening exercises for the leg and foot, as well as the use of neuromuscular electrical stimulation, an electrotherapy device, to stimulate contraction of the weakest muscle fibers. Gait retraining will also be done to help ensure safe movement and reduce the risk of falls.

In cases of nerve compression caused by a herniated disc, the physiotherapist will mainly treat the lumbar region in order to decompress the affected nerve root, which will help restore nerve conduction.

If sensory issues are present, it will also be important to begin sensory retraining to address the problem.

Finally, if the condition causes significant difficulty walking or increases the risk of falls, the physician may prescribe an ankle-foot orthosis to keep the ankle in a neutral position. Gait retraining will then be carried out in physiotherapy. This intervention is compensatory in nature. Wearing the orthosis may be temporary, until the muscle recovers enough strength, or permanent if the recovery potential is more limited.

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