What is Foot Drop Definition Its Causes Symptoms Physical Therapy for Foot Drop Exercises With Long Term Outlook

What is Foot Drop?

Foot drop is a paralysis or weakness of muscles that causes difficulty in lifting the forefoot. This leads to an abnormal walking pattern, with the forefoot dragging along the ground. People with foot drop often compensate by lifting the knee higher while walking.
Foot drop is not a medical condition. Instead, it is a symptom of an underlying problem. Conditions that cause nerve damage, systemic muscular weakness or injury to the spine can all cause foot drop.

Foot Drop Symptoms

A person with foot drop finds it difficult or impossible to lift up the front of their foot. This causes the foot to drag along the ground during a normal gait pattern.
To stop the foot hitting the ground, people with foot drop develop an abnormal gait. Common abnormalities include lifting the hip, to provide more clearance, and swinging the leg out to the side.

Foot Drop Causes

Any condition that causes muscular weakness or nerve damage can potentially cause foot drop. Drop foot may also be a symptom of a neurological disease such as multiple sclerosis, or conditions such as cerebral palsy and a stroke.

Muscular Weakness

The muscles of the lower leg that pull the ankle and foot up are called dorsiflexors. If these muscles are weak or inhibited, they cannot provide the required force to lift the foot up fully, leading to foot drop. This weakness can be caused by conditions such as spinal muscular atrophy, motor neuron disease and muscular dystrophy.

Nerve Damage

Each muscle is controlled, or innervated, by a nerve that tells the muscle when to contract or relax. The dorsiflexors are innervated by the peroneal nerve. If this nerve, or any leading to it, become trapped or damaged, electrical signals telling the muscles to contract may not get through. This can result in drop foot.

Damage to the nerves that control the ankle dorsiflexors can occur through a traumatic accident, injury during surgery or as a result of conditions affecting the nerves. Nerve damage from diabetes can also cause foot drop.
Treatments and Management

The most effective treatments for foot drop depend on the underlying cause.

Some people with foot drop find that a brace helps them to walk more normally. Others find a brace uncomfortable or think that a brace is unsightly with certain types of clothing. For many patients with foot drop, the long-term goal is to avoid using an AFO. While this may be possible, it is important that a brace is used until the patient’s healthcare professional indicates it is no longer required.

Physical Therapy and Foot Drop Exercises

Physical therapy can potentially lead to a partial or full recovery from foot drop. The long-term outcome depends on the underlying cause and how quickly the person receives treatment. A patient with some ability to move the foot when first visiting a physical therapist is more likely to achieve greater improvement.

A physical therapist will create an individual program for each patient. This program may contain a variety of types of exercises, including:

• Strengthening Exercises. If the muscles of the leg and foot become stronger, a person with drop foot may find it easier to walk normally. Strengthening exercises also prevent or delay muscles from becoming progressively weaker.

• Stretching Exercises. It’s important that a person with foot drop actively stretches to maintain muscle length. This helps prevent restricted range of motion in the ankle and knee.

• Gait Training. If a patient has developed an abnormal gait pattern, a physical therapist can re-train him or her to use a safer pattern. Gait training is also important after surgery.

• Balance Exercises. Some patients with foot drop find it difficult to walk on uneven surfaces. A physical therapist may re-teach the patient how to walk on surfaces such as sand or bumpy ground.

Physical therapy for foot drop is an ongoing process. The patient’s physical therapist will provide a progression of exercises to stimulate increased strength and function

Home Exercises

A patient with foot drop will typically have one or two sessions with a physical therapist each week. These sessions alone usually aren’t enough to achieve significant improvement. For this reason, a physical therapist will create a home exercise program. Following this program is vital for managing and improving foot drop.

Foot Drop Exercises

A physical therapist may prescribe a range of exercises to maintain joint motion, increase muscle strength and improve ankle stability. Some of the most common exercises include:

• Calf Stretch. The patient sits with legs out in-front. Placing a towel around the toes of the foot, the patient gently pulls the forefoot towards the body. This provides a stretch to the calf muscles and prevents a loss of joint mobility.

• Toe Curls. Start by placing a rolled up towel on the floor. While sitting, the patient curls the toes of the affected foot to scrunch up the towel.

• Straight Leg Raises. The patient lies on the floor with upper body propped up on elbows and one leg bent. He or she then contracts the quadriceps (upper thigh muscles) of the straight leg and slowly lifts the leg off the floor until it is at the height of the bent knee. This exercise strengthens the thigh muscles and can improve stability. If the exercise becomes too easy, ankle weights should be added.

• Isometric Ankle Exercises. Isometric exercises involve contracting a muscle without movement. An exercise band is secured to the bottom of a door and wrapped around the patient’s upper foot. The patient then contracts the muscles that lift the forefoot up while sitting on the floor.

• Swimming Pool Exercises. Exercising in a pool provides support for the body, allowing for an aerobic workout without the risk of falling. Walking in water also helps to strengthen the muscles used in a normal gait.

Caring for Foot Drop at Home

Foot drop can be temporary or permanent, and may affect one or both feet. A person with foot drop may need to make lifestyle adjustments for increased safety and management of the problem.

Emotional Support

Foot drop can be emotionally distressing. There may be activities or daily tasks that become much more difficult for the patient. For this reason, the support of medical professionals, family, and friends in the patient’s home is an important part of coping with foot drop.

Pain Management

Foot drop may be painful depending on the underlying condition. It is important to manage the pain to prevent it from getting progressively worse. The patient should discuss pain management options with his or her doctor.

Safety

A person with foot drop has an increased risk of falling over. This risk can be reduced by being careful when walking and by using a brace. Some people with foot drop also find it useful to use a walking stick. A stick can be especially useful when walking in crowded areas.

It’s important to remove any potentially dangerous obstacles from the home. Other family members should be aware of items or clutter that could be dangerous and move them off the floor whenever possible. Rugs, in particular, can be a slipping hazard. It is also a good idea to remove any electrical cords that are close to walkways.

Every case of foot drop needs to be evaluated individually to judge the safety of certain activities. Many people with foot drop stay active, although walking can become tiring more quickly. The level of safe activity depends on the severity of foot drop and the underlying condition.

Outlook

The outlook for a person with foot drop varies. The long-term development depends on the underlying cause and how long the person has had foot drop before getting treatment. In some cases, foot drop is permanent.
The outcome of physical therapy often depends on the speed with which treatment began. The person’s dedication to performing exercises at home is also a major factor. With the right program, physical therapy can sometimes achieve excellent results.

Newer treatments such as FES have helped many people with foot drop to improve their gait. Surgery can also be an effective treatment in some cases, especially if a compressed nerve is causing the problem. For permanent foot drop, surgery to fuse the ankle can be useful to provide extra stability.

Foot drop doesn’t always get worse with age, although there are situations where this is the case. The progression of foot drop ultimately depends on the underlying cause and treatment.

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