Foot-Drop
● Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the deep fibular nerve (deep peroneal), including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg.
● It is usually a symptom of a greater problem, not a disease in itself.
● Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion).
● Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet.
● In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.
Causes of Foot-Drop
One being leprosy as a cause of foot-drop.
Local Causes
General Causes
Causes are seen along the course of the nerve.
At the spine:
• Spina bifida
• Tumors
• Disk prolapse, etc.
At the hip:
• Posterior dislocation of the hip (Fig. 25.24).
• Fractures around the hip.
• Fracture acetabulum.
At the gluteal region:
Deep intramuscular injections.
At the thigh:
• Fracture shaft femur.
• Penetrating injury and gunshot injury.
At the knee (Common causes):
• Forcible inversion of the knee.
• Dislocation of knee.
• Fracture lateral condyle of tibia.
• Lateral meniscal cysts and tumors.
• Dislocation of superior tibiofibular joint.
• Tight plaster casts around the knee.
• Poor padding during traction.
• Surgical damage during application of skeletal
traction.
• Direct injuries—gunshot injuries, incised and
penetrating injuries.
Injury to the peroneal nerve:
● Sports injuries.
● Diabetes .
● Hip / knee replacement surgery .
● Spending long hours sitting cross_ legged or squatting.
● Childbirth .
● Large amount of weight loss.
Clinical Features:
The resulting deformity following injury to the above nerves is foot-drop .
This could either be complete (in sciatic nerve or lateral popliteal nerve injury) or incomplete (injury to either superficial or deep peroneal nerve).
In high lesions, it is a total foot-drop and in low lesions, the foot-drop is usually incomplete.
In low type I, the patient cannot dorsiflex and invert the foot but eversion is possible, front of the leg is wasted.
In low type II, the patient cannot evert but
can dorsiflex and invert the foot. There is wasting
of the outer half of the leg.
In type I, injury sensation over the dorsal web space is lost.
In type II, injury it is lost over outer leg and foot.
The gait typical of foot-drop is a high stepping.
Symptoms:
Difficulty in lifting the foot.
Dragging the foot on the floor as one walks.
Slapping the foot down with each step.
Raising thigh while walking ( stepping gait).
Pain, weakness or numbness in the foot.
Brachial Plexus Injury
The brachial plexus is the network of nerves that sends signals from the spinal cord to the shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
Minor brachial plexus injuries, known as stingers or burners, are common in contact sports, such as football. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.
