A foot drop, also known as drop foot, is a condition whereby the front part of the foot is unable to lift leading one to drag the toes while moving.  Foot drop disorder is caused by a defect of the common peroneal nerve (a small and terminal branch of the sciatic nerve composing posterior divisions). Peroneal nerve controls the backward flexing movement and contraction of the foot occurring at the ankle when the toe is drawn back toward the shin through a process known as dorsiflexion. This disruption of dorsiflexion during gait-stance (motion of the foot leaving the ground to when it touches the ground) leads to foot drop.

Indications for Foot Drop Repair

There are various factors that may lead to the need for foot drop repair. These include:

Muscle disorder: This is when certain muscles are weakened by conditions leading to foot drop. These conditions include poliomyelitis and muscular dystrophy that affect the equilibrium in the base of support during swing time of the gait motion.

Nerve injury: This is the injury of the peroneal nerve hence leading to foot drop. The peroneal nerve can be compressed or damaged easily because of its location, which is near the surface. The damage can be caused by:

• Patellar dislocation where the lateral shaft of patella dislocates from trochlea groove of the femoral condyle
• Injury of the knee or hip leading to replacement surgery
• Staying positioned in one place while cross legging, or having a leg cast which causes numbness
• Difficulty in childbirth which causes lumbosacral nerve roots to be injured
• Diabetes
• Sport injury

Neurological disorders: These occur at the spine or brain. The neurological conditions causing the foot drop include cerebral palsy, and stroke.

Other factors include:

• Fracture of the fibula and tibial plateau
• Pressure applied on fibula head during treatment such as use of a tourniquet
• Charcot-Marie-Tooth disease

Treatment Techniques

Bracing or Splinting

Lightweight braces or solid ankle orthoses are used to regain the gait-stance phase, prevent or restore deformity and reduce weight bearing pain as the toes are put in plantar grade (mid-range).  A splinting device can be used on the lower or upper limb to stabilize and protect the spinal fractures.

Exercise/ Physical therapy

Physiotherapy is done to build up muscles, enhance active dorsiflexion and speed up the recovery time. Physiotherapy improves the gait stance which may be causing foot drop in the ankle and knee by sustaining the range motion. Patients who have had trauma in their knee or ankle physiotherapy prevent stiffness and muscle contraction.

Nerve Stimulation

Electro-stimulation is done to revitalize the muscle and nerve which lifts the foot, thus improving the recovery time of foot drop.

Surgery

Repairing of the common peroneal nerve is done to loosen up the damaged nerve when the braces are not effective anymore.  The tibialis posterior (a muscle located in the deep posterior compartment of the lower part of the leg), together with anterior tibialis and peroneus longus tendon is transferred so that they can be fixed on the defected muscle area. This procedure is known as bridle tendon transfer. This improves gait stance and steadiness on the ankle and foot.

This procedure tends to make the ankle feel stiff and therefore the Achilles tendon is stretched to assist in bringing the ankle and foot up by making an incision at the Achilles tendon where the Achilles are rigid.

Possible Complications of Foot Drop Repair

There are few risks involved in a foot drop repair procedure including:

• Infection of the tendon transferred
• Tearing off of the tendon during transfer
• Infection of the wound

Post-Op Guidelines

After the foot drop repair surgery, there is swelling, therefore the foot and ankle are positioned in a split to hold and protect the new tendon from getting injured or displaced. For the next 2 weeks post-surgery, the foot stays elevated and pressure on it is avoided.

The surtures are removed 2 weeks post-surgery, a cast is applied, which lasts for up to 6 weeks, then physiotherapy commences after the cast is removed. Also, after the cast is removed, a special boot is provided to help support the foot. The aim of the surgery is to enable the patient to walk without the assistance of the brace.

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