Drop foot

THE presser foot Drop foot/foot drop occurs when the muscles responsible for lifting the foot become weak, making it impossible to lift the foot. The condition is not a disease in itself, but is a symptom of a larger health problem that may result from muscle or nerve damage.

The background of the foot lift

The medical term for raising the foot is ankle dorsiflexion (dorso – upper, flexion – bending), or bending the ankle upwards. The movement is caused by the contraction of the anterior tibialis muscle (a muscle that extends the foot, originating on the outer knee and attaching on the inner ankle, and which raises the foot when contracted); the muscle is innervated by the peroneal nerve.

Symptoms of clubfoot

In the case of clubfoot, since the foot cannot be lifted, the sole does not move away from the ground, so some degree of shuffling is very common. Some people try to compensate for this by involuntarily raising their knees, i.e. raising their legs so high while walking that the toe does not even touch the ground when dropped.

Another characteristic symptom is that the sole of the foot "slams" into the ground when walking (hence the name of the condition), as without proper muscle and nerve control, the foot cannot be placed in a coordinated manner when taking a step.

It is also common for the upper part of the foot to become numb, and the numbness can even extend to the outer half of the lower leg (following the nerve-muscle pathway).

 

What can cause clubfoot?

Nerve injury

The muscles responsible for raising the foot are innervated by the L4 spinal nerve (originating at the 4th lumbar vertebra). The L4 then divides into several branches in the body, one of which is the aforementioned peroneal nerve, which innervates the main muscle responsible for raising the foot, the anterior tibialis.

Injury to any nerve starting at L4 can lead to a communication disorder between the nerves and the muscles responsible for leg raising.

Injury from nerve compression

If something presses on a nerve for an extended period of time, it can lead to nerve damage, death, and communication problems, and these effects can manifest as clubfoot and other walking and movement problems.

Such pressure injuries can result from poor positioning in a wheelchair, where the frame puts pressure on the nerves in the knee and leg. Or from lying in a position for a long time where the environment can press on the nerves, such as after a fall or while recovering from a hospital stay or surgery.

In some cases, a herniated disc can become so severe that the discs themselves press on the spinal nerve roots exiting the spinal cord, such as L4, causing all the nerves arising from it to suffer disruption.

Central nervous system injury (brain, spinal cord)

The brain and spinal cord control the functioning of the entire body, they channel and process sensations, initiate and control movements. If these parts are damaged, the regulation of the extensive areas they control is disrupted, and damage to the nerves that provide both motor and sensory functions can manifest as a serious musculoskeletal disorder.

In the case of the most extensive injuries, the central nervous system is always affected in some way. Such an injury can be, for example,

• Stroke
• Traumatic brain and spinal cord injury
• Anoxic brain injury
• Multiple sclerosis
• Cerebral palsy

Muscle injury/diseases affecting the musculoskeletal system

Any condition or condition that leads to muscle weakness or regression can potentially lead to clubfoot. Examples include muscular dystrophy, polio and post-polio syndromes, and amyotrophic lateral sclerosis (ALS).

Treatment of clubfoot

The exact treatment for foot drop depends on what is causing the problem in each case, but there are some considerations that must be taken into account during the process.

• Identify and remove any objects that may be pressing on the nerve (such as the footrest of a wheelchair)
• You need to protect your feet and ankles.
• Freedom of movement of the ankle must be maintained.
• The muscles responsible for lifting the foot need to be strengthened.
• Walking safety must be increased and falls prevented

In practice

Foot/ankle immobilization is often necessary to prevent shuffling, which can easily lead to further ankle injuries or falls.

Electrical stimulation can help with numbness and therapy.

Physical development is essential. Developmental specialists help strengthen and stretch the foot, improve gait. A treatment plan should be developed that meets the patient's individual needs and lifestyle, using a combination of appropriate fixation devices and development techniques. 

Contact your ARNI trainer for a treatment plan!