physio

Foot drop (also called drop foot) is a condition where a person has difficulty lifting the front part of the foot, causing it to drag or slap the ground while walking.
Key Symptoms
Inability or weakness in lifting the front of the foot (dorsiflexion)
Dragging the toes when walking
Steppage gait — lifting the knee higher than usual to avoid tripping
Numbness or tingling over the shin or top of the foot
Muscle wasting in the lower leg (if chronic)
Common Causes
Foot drop can result from issues at different levels of the nervous system:

1. Peripheral Nerve Causes Peroneal nerve injury (most common): at the fibular head, due to leg crossing, squatting, tight casts, or trauma Sciatic nerve injury (e.g., from hip surgery, injections, or trauma)
2. Spinal Causes L4–L5 nerve root compression (lumbar disc herniation) Spinal stenosis or trauma
3. Central (Brain) Causes Stroke Multiple sclerosis Cerebral palsy
4. Muscle Disorders Muscular dystrophy or other neuromuscular diseases (less common) Diagnosis A clinician may use: Physical exam: to assess muscle strength and gait Nerve conduction studies / EMG: to localize nerve injury Imaging: MRI of the lumbar spine, knee, or brain (depending on suspected cause) Blood tests: if systemic or metabolic cause suspected (e.g., diabetes) Treatment Depends on the underlying cause: Conservative Management Physical therapy: to strengthen muscles and improve gait Ankle-foot orthosis (AFO): brace to hold foot up during walking Stretching exercises: to prevent contractures Avoid nerve compression: e.g., avoid crossing legs, prolonged squatting Medical or Surgical Options Treat underlying cause: e.g., manage diabetes, relieve nerve compression Surgical decompression or nerve grafting (for persistent nerve injury) Tendon transfer surgery (in chronic cases with irreversible weakness) Prognosis Temporary foot drop (e.g., from nerve compression) often recovers in weeks to months. Chronic or severe nerve injury may result in long-term weakness requiring bracing or surgery.

Physiotherapy Treatment for Foot Drop
Goals of Physiotherapy
Improve muscle strength (especially ankle dorsiflexors)
Maintain joint mobility and prevent stiffness
Prevent muscle contractures and deformities
Improve walking (gait) pattern and balance
Facilitate nerve recovery and functional independence

1. Positioning and Support Avoid nerve compression: Do not cross legs or rest the leg on hard surfaces (protect peroneal nerve at the fibular head). Use of splint/orthosis Ankle-Foot Orthosis (AFO) – keeps ankle in neutral, prevents dragging and contracture, improves gait safety. Night splints may maintain dorsiflexion during rest.
   1. Strengthening Exercises 🔹 Active and Assisted Exercises (Once minimal muscle activity returns) Ankle dorsiflexion: Pull foot upward against gravity or manual resistance. Toe extension: Lift toes while keeping the heel on the ground. Resisted dorsiflexion: Use resistance band around the foot. Tibialis anterior re-education: Try to isolate dorsiflexion without inversion. 🔹 Passive Exercises (When muscles are very weak or flaccid) Therapist or patient moves ankle gently through its full range several times a day to prevent stiffness.
   2. Electrical Stimulation Faradic or functional electrical stimulation (FES): Stimulates peroneal nerve or tibialis anterior muscle to promote contraction. Can help maintain muscle tone, prevent atrophy, and retrain movement patterns. In modern setups, FES devices are used during walking to lift the foot in swing phase.
   3. Stretching and Range of Motion (ROM) Regular stretching of calf muscles (gastrocnemius, soleus) to prevent equinus deformity (foot pointing down). Gentle mobilization of ankle and foot joints.
   4. Gait Training Start with parallel bars for support. Focus on Heel strike and toe clearance. Avoid compensatory hip/knee hiking. Progress to walking with AFO or FES-assisted gait. Use mirror feedback or video gait analysis for correction.
   5. Proprioceptive and Balance Training Weight shifting and standing balance exercises. Wobble board, balance pad, or single-leg stance (as tolerated).
   6. Adjunct Therapies Massage therapy: to improve blood flow, reduce stiffness. Hydrotherapy: buoyancy reduces gravity load, allowing .
2. Home Exercise Program Encourage daily Active dorsiflexion and toe lifts (sitting/lying) Resistance band exercises Calf stretches Practice walking safely with assistive devices if needed
3. Prognosis Recovery depends on nerve injury severity. Mild nerve compression recovery within weeks to months. Severe or complete nerve damage may take longer physiotherapy helps maximize function and prevent complications.

written : Dayana k o https://physioji.com/