Foot drop is a condition characterized by the inability to perform dorsiflexion of the ankle, which means the inability to lift the foot toward the knee—opposite of pressing a brake or gas pedal. This condition usually results from nerve damage due to lumbar disc herniation, injury to the peroneal nerve passing through the knee, or neurological disorders affecting nerves.
Patients tend to drag their feet when walking since they cannot fully lift them off the ground. Foot drop leads to significant functional impairment, affecting daily activities. Identifying and treating the underlying cause of foot drop is crucial.
What is Foot Drop?
Foot drop is the inability to lift the foot and/or toes upward. It typically affects one foot and causes gait disturbances.
Causes of Foot Drop
1. Peroneal Nerve Injury (Peroneal Nerve Palsy)
The most common cause of foot drop is damage to the peroneal nerve, which runs along the outside of the knee. This nerve controls the muscles responsible for dorsiflexion (lifting the foot and toes toward the knee), and damage to it can make it challenging to lift the ankle. Compression of the peroneal nerve in the peroneal tunnel, trauma to the nerve due to impact in the tunnel, or prolonged leg flexion can lead to peroneal nerve injury.
2. Lumbar Herniated Disc and Nerve Compression
Herniation or nerve compression in the spine can affect the nerves going to the legs, causing foot drop. Particularly issues at L4 and L5 (mostly L4) levels, such as a herniated disc, can compress nerve roots, leading to foot drop.
3. Crural Compartment Syndrome
Crural compartment syndrome occurs when the muscle groups in the leg (between the ankle and knee) become excessively swollen, compressing nerves and blood vessels. Increased pressure on the muscles and nerves in this syndrome can hinder adequate blood flow, leading to nerve damage. The deep peroneal nerve, which controls the muscles lifting the foot and toes, may be particularly affected. Untreated crural compartment syndrome can result in permanent nerve and muscle damage, causing serious complications like foot drop.
4. Muscle and Tendon Problems
Muscle diseases like muscular dystrophy or polio, as well as issues or tears in the ankle tendons, can lead to foot drop.
5. Brain or Spinal Cord Injuries
Strokes, brain trauma, or spinal cord injuries can affect the nervous system, impairing control over the foot muscles and potentially resulting in foot drop.
6. Neurological Disorders
Neurological conditions like multiple sclerosis (MS) and Charcot-Marie-Tooth disease can impair the nervous system, leading to foot drop by disrupting signals from the nerves to the muscles.
7. Trauma and Fractures
Fractures around the knee can lead to nerve damage, resulting in foot drop. Additionally, nerve damage during surgical procedures may contribute to this condition.
Symptoms of Foot Drop
Foot drop is characterized by the inability to lift the ankle upward, leading to gait difficulties and significant challenges in daily life.
1. Inability to Lift the Foot
The most noticeable symptom is the inability to perform dorsiflexion (lifting the foot up), causing the foot to drag when walking, commonly referred to as "foot drag."
2. Walking Difficulty
People with foot drop cannot adequately lift their feet while walking, so they must lift their legs higher than usual, a gait referred to as "steppage gait" or "high-step gait."
3. Weakness in the Leg
Due to peroneal nerve damage, the muscles responsible for lifting the ankle and toes weaken.
4. Sensory Loss and Numbness
Numbness and tingling, particularly on the upper outer part of the foot, indicate nerve damage. This sensory loss can negatively affect balance and walking.
5. Muscle Atrophy
In cases of prolonged nerve damage, muscle weakness and eventual atrophy (thinning) may develop.
Treatment for Foot Drop
The treatment approach for foot drop is determined based on the underlying cause and includes both surgical and non-surgical options.
1. Non-Surgical Treatment Options
Physical Therapy and Rehabilitation: Exercises aimed at strengthening the ankle and toe muscles can help improve mobility in foot drop.
Orthotic Devices: Ankle-foot orthoses (AFO) that stabilize the ankle and keep the foot in an elevated position can reduce the risk of falls during daily activities.
Electrical Stimulation (Neuromuscular Stimulation): Electrical devices that stimulate the muscles can facilitate the foot lift movement by promoting nerve function.
2. Surgical Treatment Options
In surgical treatment for foot drop, if nerve damage is recent, surgery to repair the nerve is performed; if the damage is chronic and nerve recovery is unlikely, tendon transfer surgery is recommended.
Nerve Repair or Transfer: In cases of acute injury, nerve repair or nerve transfer from other areas can correct nerve damage causing foot drop.
Tendon Transfer: In chronic foot drop cases, tendon functions of muscles responsible for lifting the ankle and toes are restored by transferring healthy tendons.
Bridle Procedure- Foot Drop Tendon Transfer
As an orthopedic surgeon, I, Dr. Utku Erdem Özer, perform the Bridle procedure for tendon transfer surgery in patients with foot drop where nerve recovery is not possible.
In the Bridle procedure, the tibialis posterior tendon is released, brought from the back of the leg to the front, passed through the tibialis anterior tendon, and then attached to the middle cuneiform bone in the foot. Additionally, the peroneus longus tendon on the outer side of the foot is connected to the tibialis posterior tendon where it crosses the tibialis anterior tendon. If the Achilles tendon is short, it is also lengthened.
Above, you can see the photo of my patient with foot drop after completing the tendon transfer surgery using the Bridle procedure.
Recovery Process After the Bridle Procedure
During surgery, the ankle is stabilized in a splint to maintain foot position and protect the newly transferred tendons. For the first 10-14 days, the foot must be kept elevated and weight-bearing should be avoided. The foot remains in a cast for approximately six weeks, and during this period, the patient typically refrains from putting weight on it or does so in a controlled manner.
Once the cast is removed, the patient can walk in a special boot. Physical therapy continues for 8-12 weeks to help the tendon adapt to its new position. A night splint is used for three months post-surgery.
As the swelling subsides, a custom-molded supportive shoe insert can be used in a regular shoe, allowing the patient to discontinue the walking boot. With the increase in strength and mobility through physical therapy, the support is eventually phased out. The goal of the surgery is for the patient to walk with a regular shoe without requiring any support.
Drop Foot Syndrome Frequently Asked Questions
What does foot drop syndrome mean?
Drop foot syndrome in particular is the inability to lift the foot above the ankle. This occurs due to nerve damage or muscle weakness and affects walking.
Has anyone had foot drop and recovered?
Yes, foot drop syndrome can be cured with appropriate treatment and rehabilitation programs . Physical therapy , nerve conduction studies and sometimes surgical treatment can be effective in this process.
How do we know if we have foot drop?
This disease manifests itself with symptoms such as dragging the foot on the ground while walking, bending the knees excessively, and high-stepping gait .
Which muscle is affected in foot drop?
The tibialis anterior muscle is most commonly affected in drop foot. This muscle is responsible for ankle dorsiflexion .
Conclusion
Drop foot syndrome is a condition that seriously affects a person's walking function. It can develop due to various reasons such as peroneal nerve damage, herniated disc, diabetic neuropathy.
It is possible to improve this condition with physical therapy, neurotherapy and, if necessary, surgical treatment. Starting treatment early and implementing an appropriate rehabilitation program increases the chance of recovery.
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