Foot drop is an abnormal walk (gait) which is caused by weakness, irritation or damage to the common fibular nerve including the sciatic nerve to drop downwards as you walk alone. Foot drop is characterized by an inability to dorsiflexion or inversion and eversion movement the foot at the ankle. Walking becomes challenge due to the patient’s inability to control the foot at the ankle. Patients with the foot drop usually exhibit an exaggerated or high stepping walk called steppage gait or foot drop gait.

Cause: Foot drop is usually caused by malfunction of a nerve in the lower leg. This nerve is called the common peroneal nerve.
• Trauma
• Hip replacement
• Knee surgery
• Sciatic nerve damage
• Diabetes
• Stroke
• Multiple sclerosis
• Cerebral Palsy
• Motor neuron disease
• Freidreich’s ataxia
• Brain tumour
• L5 root lesion
• Spinal cord injury
• Parkinson’s
• Heal injury
Risk Factors:
• Crossing legs.
• Prolonged kneeling.
• Wearing a leg cast.

Symptoms:
• The foot moves forward (swing phase).
• Weak ankle dorsiflexion and eversion.
• High stepping gait.
• Sensory loss between first and second toes,
• Dragging of the foot and toes.
• Scraping of the toes across the ground.
• Numbness in your lower leg and foot.
• Wasting of the anterior tibial and peroneal muscles.
• Pain in the foot.
• Muscle atrophy.

Diagnosis:
• X-ray
• Ultrasound
• CT Scan /MRI
• Electromyography
• Nerve conduction study
• Blood test
• Urine test
Physical examination-
• Gait analysis.
• Rhomberg’s test.
• Ankle reflex.

Treatment:-
i. Medication:
• Amitriptyline
• Nortriptyline
• Duloxextine
• Pregabalin
• Diclofenac

ii. Physiotherapy:
• AFO/Brace
• Calf muscle stretching exercise.
• Leg muscle stretching exercise.
• Balancing exercise.
• Proprioceptive exercise.
• Electrical nerve stimulation.
• Orthopedic shoe.
• Range of motion exercise.
• Use of night splint.
• Walk with an assistive device.

iii. Surgery:
• Decompression Surgery.
• Nerve sutures or grafting.
• Nerve or tendon transfer.
• Fusing the foot and ankle joint.

Advice:
• Keep all floors clear of cutler.
• Avoid the use of throw rugs.
• Relocate electrical cards away from walk ways.
• Make sure rooms and stairways are well lit.

Md.Ruhul Amin
BPT (DU)
Clinical Physiotherapist
Department of Physiotherapy
National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka.

TBT/SSR