FOOT DROP

Foot drop is a muscular weakness or paralysis which makes it difficult to lift the front part of your foot and toes. This can cause you to drag your foot on the ground making it difficult to walk. Foot drop is a sign of an underlying problem rather than a condition itself. It can be muscular, caused by nerve damage in the leg, or the result of a brain or spinal injury or a neurological condition such as Multiple Sclerosis or Parkinson's.

Foot drop usually only affects one foot, but both feet can be affected depending on the cause. It can be temporary or permanent.

Nerve Injury. 

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. Because it sits very close to the surface, it may be damaged easily.

An injury to the peroneal nerve may also be associated with pain or numbness along the shin or the top of the foot.

Some common ways the peroneal nerve is damaged or compressed include:

  • Sports Injuries

  • Diabetes

  • Hip or knee replacement surgery

  • Childbirth

Injury to the nerve roots in the spine may also cause Foot Drop and conditions such as Charcot-Marie-Tooth disease are also known to be a common cause of peripheral nerve damage and muscle weakness leading to Foot Drop.

Muscle Weakness

Muscular dystrophy is a group of inherited genetic conditions that cause gradual muscle weakness and can sometimes lead to Foot Drop. Foot Drop can also be linked to other muscle wasting conditions, such as Spinal Muscular Atrophy or Motor Neurone Disease.

Brain and spinal cord disorders

Foot Drop can also be caused by conditions that affect the brain or spinal cord, such as:

  • Stroke

  • Cerebral Palsy

  • Multiple Sclerosis

Diagnosing Foot Drop

Foot drop is often diagnosed during a physical examination. Your GP and/or Orthopaedic Ankle and Foot Consultant will look at the way you walk and examine your leg muscles.

In some cases, imaging tests, such as an X-ray, ultrasound scan or computerised tomography (CT) scan, may be required.

Nerve conduction tests may be recommended to help locate where the affected nerve is damaged.

Electromyography, where electrodes are inserted into the muscle fibres to record the muscles' electrical activity, may also be carried out at the same time.

Managing Foot Drop

If you have Foot Drop, you'll find it difficult to lift the front part of your foot off the ground. This means you'll have a tendency to scuff your toes along the ground, increasing your risk of falls. To prevent this, you may lift your foot higher than usual when walking.

Recovery depends on the cause of Foot Drop and how long you've had it. In some cases it can be permanent.

Making small changes in your home, such as removing clutter and using non-slip rugs and mats, can help prevent falls. There are also measures you can take to help stabilise your foot and improve your walking ability.

These measures include:

  • Physiotherapy – to strengthen your foot, ankle and lower leg muscles

  • Wearing an ankle-foot orthosis – to hold your foot in a normal position

  • Electrical nerve stimulation – in certain cases it can help lift the foot

  • Surgery – an operation to fuse the ankle or foot bones may be possible in severe or long-term cases

These treatments are discussed in more detail below:

Physiotherapy

Physiotherapy for Foot Drop will aim to reduce the impact of reduced active movement at the ankle and improve the efficiency of your walking.

A Physiotherapist will put together an individual treatment plan based on your needs and goals, however treatment could include:

  • Exercises to reduce tightness in muscles in the leg.

  • Exercises to maximise and strengthen the muscle activity in the ankle/leg.

  • Mobilisation to the foot to improve the ability to access movement.

  • Provision of orthotics (see below section on orthotics) to help maintain the foot in the correct position when walking and reduce the effort of walking.

  • Balance exercises to improve balance reactions and reduce risk of falling.

  • Use of Functional Electrical Stimulation (See section below) if appropriate.

Benefits of Physiotherapy:

  • Improved mobility

  • Reduced risk of falls

  • Improved confidence

  • Improved muscle strength

  • Reduced muscle stiffness

Ankle-Foot Orthosis

An ankle-foot orthosis (AFO) is worn on the lower part of the leg to help control the ankle and foot. It holds your foot and ankle in a straightened position to improve your walking.

If your GP/Consultant thinks an AFO will help, they'll refer you for an assessment with an orthotist (a specialist who measures and prescribes orthoses).

Wearing a close-fitting sock between your skin and the AFO will ensure comfort and help prevent rubbing. Your footwear should be fitted around the orthosis.

Lace-up shoes or those with Velcro fastenings are recommended for use with AFOs because they're easy to adjust. Shoes with a removable inlay are also useful because they provide extra room. High-heeled shoes should be avoided.

It's important to break your orthosis in slowly. Once broken in, wear it as much as possible while walking because it will help you walk more efficiently and keep you stable.

Electrical Nerve Stimulation

In some cases, an electrical stimulation device can be used to improve walking ability. It can help you walk faster, with less effort and more confidence.

Two self-adhesive electrode patches are placed on the skin. One is placed close to the nerve supplying the muscle and the other over the centre of the muscle. Leads connect the electrodes to a battery-operated stimulator.  The stimulator produces electrical impulses that stimulate the nerves to contract (shorten) the affected muscles and help improve walking. 

If your GP or consultant thinks you'll benefit from using an electrical stimulation device, you'll be referred to an orthopaedic foot and ankle consultant for an assessment. You may then be referred to a specialist unit to try the device and assess its suitability.

The National Institute for Health and Care Excellence (NICE) advises that electrical stimulation can be used to treat people with foot drop caused by damage to the brain or spinal cord, provided:

  • the person understands what's involved and agrees to the treatment

  • the results of the procedure are closely monitored

Read the NICE guidance about Functional electrical stimulation for drop foot of central neurological origin.

Surgery

Surgery may be an option in severe or long-term cases of foot drop that have caused permanent movement loss from muscle paralysis.

The procedure usually involves transferring a tendon from the stronger leg muscles to the muscle that should be pulling your ankle upwards.

Another type of surgery involves fusing the foot or ankle bones to help stabilise the ankle.

Speak to your GP or orthopaedic foot and ankle consultant if you're thinking about having surgery for foot drop. They'll be able to give you more information about the available procedures and any associated pros and cons.