Rehabilitation interventions for foot drop in neuromuscular disease

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases

Rehabilitation interventions for foot drop in neuromuscular disease

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases

Impaired transmission in the corticospinal tract and gait disability in spinal cord injured persons

Rehabilitation following spinal cord injury is likely to depend on recovery of corticospinal systems. Here we investigate whether transmission in the corticospinal tract may explain foot drop (inability to dorsiflex ankle) in persons with spinal cord lesion. The study was performed in 24 persons with incomplete spinal cord lesion (C1 to L1) and 15 healthy controls. Coherence in the 10- to 20-Hz frequency band between paired tibialis anterior muscle (TA) electromyographic recordings obtained in the swing phase of walking, which was taken as a measure of motor unit synchronization. It was significantly correlated with the degree of foot drop, as measured by toe elevation and ankle angle excursion in the first part of swing. Transcranial magnetic stimulation was used to elicit motor-evoked potentials (MEPs) in the TA. The amplitude of the MEPs at rest and their latency during contraction were correlated to the degree of foot drop. Spinal cord injured participants who exhibited a large foot drop had little or no MEP at rest in the TA muscle and had little or no coherence in the same muscle during walking. Gait speed was correlated to foot drop, and was the lowest in participants with no MEP at rest. The data confirm that transmission in the corticospinal tract is of importance for lifting the foot during the swing phase of human gait

A sock for foot-drop: A preliminary study on two chronic stroke patients

Background: Foot-drop is a common motor impairment of chronic stroke patients, which may be addressed with an ankle foot orthosis. Although there is reasonable evidence of effectiveness for ankle foot orthoses, user compliance is sometimes poor. This study investigated a new alternative to the ankle foot orthosis, the dorsiflex sock. Case description and methods: The dorsiflex sock was evaluated using an A-B single case experimental design. Two community-dwelling, chronic stroke patients with foot-drop participated in this study. Measures were selected to span the International Classification of Function, Disability and Health domains and user views on the dorsiflex sock were also collected. Findings and outcomes: The dorsiflex sock was not effective in improving participants’ walking symmetry, speed or energy expenditure. Participant 1 showed improvement in the distance he could walk in 6 min when using the dorsiflex sock, but this was in keeping with a general improvement trend over the course of this study. However, both participants viewed the dorsiflex sock positively and reported a positive effect on their walking. Conclusion: Despite positive user perceptions, the study found no clear evidence that dorsiflex sock is effective in improving foot-drop. Clinical relevance Although the dorsiflex sock offers an attractive alternative to an ankle foot orthosis, the case studies found no clear evidence of its efficacy. Clinicians should view this device with caution until further research becomes availabl

Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop

Objective:  To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop. Material and Methods:  This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief  on a Visual Analogue Scale (VAS) after 1 month and then after 6 months. Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery,  power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ≥ 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40). Conclusion:  Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits

Bilateral foot drop linked to rapid intentional weight loss and long distance walking.

There are many causes of acute onset foot drop ranging from deep fibular nerve or sciatic nerve injury caused by trauma or a compressive mass such as a neuroma, to spinal cord disorders like disc herniation causing L4-5 radiculopathy, and various muscular dystrophies affecting the tibialis anterior muscle responsible for foot dorsiflexion and eversion. Even brain disorders like MS, stroke or ALS can result in foot drop. We present a case of bilateral foot drop as a complication of rapid 70 lb weight loss which was described in literature previously as “slimmer’s palsy”

Cerebral Infarction Producing Sudden Isolated Foot Drop

Foot drop usually results from lesions affecting the peripheral neural pathway related to dorsiflexor muscles, especially the peroneal nerve. Although a central nervous system lesion is suspected when there is a lack of clinical evidence for a lower motor neuron lesion, such cases are extremely rare. We describe a patient with sudden isolated foot drop caused by a small acute cortical infarction in the high convexity of the precentral gyrus. This report indicates that a cortical infarction may have to be considered as a potential cause of foot drop

In Patients Post-stroke, Is Implantable Peroneal Nerve E-stim More Effective Than Transcutaneous E-stim In Improving Foot Clearance?

A cerebrovascular accident (CVA) more commonly known as a stroke, is a life changing event resulting in impairments that decrease the quality of life.1 Over 795,000 people each year suffer from a stroke and are affected by resulting impairments and disabilities, of these impairments 20% of those affected by a stroke will acquire foot drop.2 Foot drop is due to paralysis or weakness of the ankle dorsiflexor muscles3,4 and therefore describes the inability to actively raise the toes up required to clear the ground during swing phase, resulting in the toes to drag. Foot drop not only causes abnormal gait patterns and compensations, but increases the risk of falls, increases energy expenditure, and potential orthopedic issues up the chain.5-8 Literature has shown the use of ankle foot orthoses (AFOs), transcutaneous functional electrical stimulation (FES), and implantable FES to be effective interventions used to decrease the severity of foot drop in patients post CVA. 8,9 Implantable FES offers an alternative to the transcutaneous e-stim by allowing patients to have a more permanent device to address their foot drop impairment that is more convenient and eliminates the need for daily application. Furthermore, there has been no research in the comparison of transcutaneous FES to implantable FES and their effectiveness on foot clearance during gait for individuals post CVA