Foot drop, everyone is at risk

     DROP FOOT 

It would be very upsurb waken up not able to lift your foot. In other words, not able to dorsiflex. This mostly happen within a twinkle of an eye since our body is like a machine, in most cases, slight changes may cause circumstances of the like, mostly when there's muscle weakness.  When this happens, we may feel like remaining immobilized because of pain and some discomfortness. 

Are you going to remain in the house, just because you can't walk? The answer is No 

Lets go through this article to the end and you will know the kind of condition, the cause, and what to do the to treat the condition such as that.When you are not able to lift your foot, that means, normal gait with heel strike would be impossible. You would have to drag the toes on the floor or bend the knee with slight hip flexion, before you can walk. But this would be more difficult and even embarrassing. You may be having a condition called foot drop or drop  foot or colloquially called floppy foot. It is a condition that results in difficulty lifting the foot due to weakness in muscles involved in dorsiflexion.

Our muscles are tissues that help our body parts to move. They contract to cause movement. Before these muscles work, or contract, there is intact linkage between corresponding nerves which receive signals(motor signals) from the brain that supply them.
The muscles gain strength, power and endurance (muscle performance)  when there's effective conductivity of nerves that supply them. Muscle tone is maintained through ability of the muscle to contract or cause movement, thus, involved in constant physical activity.

Not able to lift your foot is a problem from the tibialis anterior muscle, and other muscles, Extensor Digitorium Longus(EDL)and Extensor Hallusus longus(EHL).

These muscles help the body clear the foot during swing phase and control plantarflexion of the foot on heel strike.
The muscles are supplied by the deep common peroneal nerve.
Weakness of these muscle may cause foot drop.

The weakness could be caused by #peroneal nerve lesion or either by condition that cause frequent wastage of these muscles such as muscular dystrophy, Polio, or amyotrophic lateral sclerosis.

1.1 ANATOMY OF THE COMMON PERONEAL NERVE...

Fibers from the dorsal branches of the ventral rami of L4-S1 are found in the peroneal nerve, which is paired with the tibial nerve to constitute the sciatic nerve. The sciatic nerve leaves the pelvic cavity at the greater sciatic foramen, just inferior to the piriformis muscle. It bifurcates to form the peroneal and tibial nerves either in the distal third of the thigh or at the midthigh level.

The peroneal nerve crosses laterally to curve over the posterior rim of the fibular neck to the anterior compartment of the lower leg, dividing into superficial and deep branches. The superficial branch travels between the two heads of the peronei and continues down the lower leg to lie between the peroneal tendon and the lateral edge of the gastrocnemius. It then branches to the ankle anterolaterally to supply sensation to the dorsum of the foot

The deep branch divides just after rounding the fibular neck. Its initial branch supplies the tibialis anterior, and the remaining branches supply the EDL, the EHL, and a small sensory patch at the first dorsal web space.

Foot drop may be caused by one of three ways:

#Nerve injury

#Brain or spinal disorders

#Muscle disorders

1.2#NERVE INJURY:

Nerve injury is one of the most probable cause of foot drop. The peroneal nerve can be injured or compressed and may result in weakness of muscles that help in dorsiflexion of the foot. It's always susceptible to injury or trauma.

This is due to ;

1.It is part of the sciatic nerve, and its funiculi(stalks)are relatively isolated from those of the tibial nerve.

2.The funiculi of the peroneal nerve also are larger and have less protective connective tissue than those of the tibial nerve.

3.The peroneal nerve runs a more superficial course than the tibial nerve does, especially at the fibular neck, and this relatively exposed position makes it vulnerable to direct insult.

4.Its close adherence to the periosteum of the proximal fibula renders it susceptible to injury during surgical procedures in this area.

Most commonly, foot drop is caused by an injury to the peroneal nerve as earlier explained, and it is also known to be a branch of the sciatic nerve that wraps from the back of the knee  to the front of the shin. Because it is very superficial to the surface, it may be damaged easily.

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

#Sport injuries

#Diabetes

#Hip or knee replacement surgery

#Spending long hours sitting cross-legged or squatting

#Childbirth

#Time spent in a leg cast

#Injury to the nerve roots(L4-S1) in the spine may also cause foot drop.

Also;

1.3. Brain or spinal disorders.

That is,  neurological conditions can contribute to foot drop.
These include:

#Stroke

#Multiple sclerosis  (MS)

#Cerebral palsy

#Charcot-Marie-Tooth disease.

1.4. MUSCLE DISORDERS

Moreover, Muscle disorders can also cause the Conditions that cause the muscles to progressively weaken or deteriorate may cause foot drop. These include:

#Muscular dystrophy

#Amyotrophic lateral sclerosis  (Lou Gehrig's disease) and

#Polio

1.5. What are your signs and symptoms when you have foot drop??

Primarily, foot drop symptoms involve difficulty with or loss of dorsiflexion.
As one would imagine, the loss of dorsiflexion, or even marginal impairment of this function, can lead to a host of mobility issues for patients. For example, drop foot patients often report the foot slapping against the ground as it lands. Others notice the affected foot dragging during walking and therefore tries to swing their leg in a wide arc. Due to the diminished dorsiflexion associated with foot drop, sufferers may appear to have a limp or floppy foot when walking, and many find that their decreased stability makes changing directions difficult.

As a result of these foot drop symptoms, many individuals will eventually compensate with exaggerated movements to prevent foot dragging or foot slapping. This is known as steppage gait (or neuropathic gait), a gait abnormality characterized by over-lifting the knee and thigh. Lifting the thigh higher than normal allows drop foot sufferers to clear obstacles and ensure the foot isn’t being dragged along during activity. This high stepping gait may reduce foot dragging and foot slapping, however, over time, steppage gait may strain the muscles involved in these compensatory movements.

Additionally, it’s common for the toes of the affected foot to curl inward, and some individuals with drop foot report corns on the bottom of the foot.

Pain or numbness along the shin or the top of the foot may also be experienced by victims of foot drop.

#HOW IS IT TREATED? 

Doctors may perform a simple test by asking you to dorsiflex your foot to determine whether your condition is foot drop. You may also be asked to walk on the floor. Unable to dorsiflex  actively as well as dragging your toes or swing in a wide arc during walking would tell the doctor you might be suffering from drop foot or foot drop.

They may prescribe pain killer medications to those who experience pain.

Whatever the cause of your problem, the doctor would refer you to a physiotherapist for further assessment and treatment.

PHYSIOTHERAPY MANAGEMENT OF FOOT DROP.         

                           

Foot drop is caused by weakness in muscles that are involved in dorsiflexion. It can be bilateral .

A physical therapist would perform a simple test by asking you to dorsiflex your involved foot(feet) actively. Failure to dorsiflex your foot, means there's weakness in these dorsiflexors. He may further ask you to walk to determine the kind of gait that you may show, whether stepping gait, or dragging your toes during walking. This will reinforce his initial finding to be able to ascertain your condition is really foot drop.

Foot drop involve #muscle weakness, #muscle atrophy( due to reduced mobility ), and #stiffness of ankle and phalangeal joint(s) may occur.

The aim of the physiotherapist, would be to alleviate these impairments.

1.PASSIVE MOBILISATION: This would be useful in promoting ankle ROM to prevent ankle joint stiffness that may be accompanying foot drop. The physiotherapist moves the ankle joints within their full range as the patient is relaxed.

2.ISOMETRIC EXERCISES: You may be asked to dorsiflex against the resistance of the ptt to help build strength in the dorsiflexors. The rule, "don't let me move you " would be used here to achieve this aim during this exercise.

3.AFO(ANKLE FOOT ORTHOSIS):

This is a foot brace that would be worn to lift the foot to a position that the foot should be for normal gait. It will provide stability during ambulation.

4.ELECTRICAL STIMULATION :
In instances where pain may prevent ankle movement, the muscles are immobilized. This would cause atrophy and weakness when the immobilization is prolonged.
Faradic current or Trabert can be used to cause the weak muscles to contract. TENS can also be used to stimulate the nerve and also helps relief any pain present. In order to achieve maximum contraction during the use of Faradic current, you(pt) must concentrate on assisting the movement by contracting actively in the direction of what the equipment is producing or causing.

5. RESISTANCE EXERCISES :
[CONSTANT RESISTANCE &VARIABLE RESISTANCE EXERCISES:

Constant loads such as dumbbells, Sand bags etc can be rapped around the foot to create resistance  as you move the foot into dorsiflexion. This would also help build strength in the dorsiflexors. In a similar way you may be asked to dorsiflex against resistance provided by a Theraband rapped around you foot for the same purpose.

6.SOFT TISSUE MANIPULATION 
Massaging the foot will enhance muscular relaxation and reduce any swelling present as well as promoting blood circulation, which may be sluggished due to immobilization as a result of pain.

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