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    Old 04-04-2005, 09:58 PM   #1
    mkf
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    foot drop ?

    What is foot drop?

     
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    Old 04-04-2005, 10:12 PM   #2
    veggigoddess
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    Re: foot drop ?

    I searched on-line and here's what I got.

    Foot drop is a deceptively simple name for a potentially complex problem. Foot drop can be associated with a variety of conditions such as dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. The causes of foot drop may be divided into 3 general categories: (1) neurologic, (2) muscular, and (3) anatomic. These causes may overlap. Treatment is variable and is directed at the specific cause.Problem: Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion. The foot and ankle dorsiflexors include the tibialis anterior, extensor hallucis longus, and extensor digitorum longus. These muscles help the body clear the foot during swing phase and control plantar flexion of the foot on heel strike. Weakness in this group of muscles results in an equinovarus deformity. This is sometimes referred to as steppage gait, because the patient tends to walk with an exaggerated flexion of the hip and knee to prevent the toes from catching on the ground during swing phase. During gait, the force of heel strike exceeds body weight, and the direction of the ground reaction vector passes behind the ankle and knee center (see Image 1). This causes the foot to plantar flex, and if uncontrolled, to slap the ground. Ordinarily, eccentric lengthening of the anterior tibialis, which controls plantar flexion, absorbs the shock of heel strike. Injury to the dorsiflexors, or to any
    point along the neural pathways that supply them, can result in foot drop.


    Frequency: Peroneal neuropathy caused by compression at the fibular head is the most common compressive neuropathy in the lower extremity. Foot drop is its most notable symptom. All age groups are affected equally, but it is more common in males (male-to-female ratio 2.8:1). Ninety percent of peroneal lesions are unilateral, and they can affect the right or left side with equal frequency.

    A foot drop of particular concern to orthopedic surgeons is a peroneal nerve palsy seen after total knee arthroplasty or proximal tibial osteotomy. Foot drop has an estimated prevalence of 0.3-4% after total knee arthroplasty and a 3-13% occurrence rate after proximal tibial osteotomy. Ischemia, mechanical irritation, traction, crush injury, and laceration can cause intraoperative injury to the peroneal nerve. Correction of a severe valgus or flexion deformity also has been suggested to stretch the peroneal nerve and lead to palsy. Postoperative causes of peroneal nerve palsy include hematoma or constrictive dressings.

    In a study by Cohen et al, the relative risk of palsy was 2.8 times greater for patients who had received epidural anesthesia for total knee arthroplasty than for those who received general or spinal anesthesia. One postulation is that epidural anesthesia likely decreased proprioception and sensation, continuing to some extent postoperatively, allowing the limb to rest in an unprotected state susceptible to local compression. In addition, intraoperative neurological damage may not have been readily apparent in the immediate postoperative period due to ongoing effects of epidural anesthesia. In this same study, the relative risk of palsy was 6.5 times greater in patients who had a prior lumbar laminectomy.

    A series of patients who developed foot drop following primary hip arthroplasty were carefully examined and found to have spinal stenosis. Up to 70% of patients undergoing hip arthroplasty have electromyographic evidence of nerve injury, but they rarely have clinical symptoms. Patients with preexisting spinal stenosis are believed to be at increased risk for foot drop following hip arthroplasty due to this proximal compromise. This is the double-crush phenomenon described in more detail in the Pathophysiology section.

     
    Old 04-05-2005, 04:42 AM   #3
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    Re: foot drop ?

    Wow! Thanks for the research - I appreciate it.

     
    Old 04-06-2005, 02:47 AM   #4
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    Re: foot drop ?

    You're so welcome!

     
    Old 04-06-2005, 03:05 AM   #5
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    Re: foot drop ?

    Foot drop needs to be addressed by a spine specialist before it becomes permanent!

     
    Old 04-23-2005, 07:10 AM   #6
    reeree778
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    Re: foot drop ?

    i agree, i have had 5 back surgeries and after the last one i develop foot drop. my last disc ruptured around the holidays and my surgeon was on vacation and the hospital sent me home with pain meds and said to wait to see him, well the nerves was being so compress that i now have this foot drop, i hate very much. i have to wear this foot brace. that does not fit into my shoes very well and the first one i had 2weeks cracked and i now have this one. but anyway i know i could be more limited, i was in a wheel chair for a while, and i'm glad that i was able to put that away. with the pain and the brace i am reminded every day of how lucky i am. on the other hand i hate this

     
    Old 04-25-2005, 02:23 PM   #7
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    Re: foot drop ?

    [QUOTE=veggigoddess]I searched on-line and here's what I got.

    Frequency: Peroneal neuropathy caused by compression at the fibular head is the most common compressive neuropathy in the lower extremity. Foot drop is its most notable symptom.

    [/QUOTE]

    This is what I got 2 years ago...the peroneal nerve is the outside calf region and is superficial (vs. deep).

    Although surgeries cause this, mine started when I weeded my beds for 4 hours (that's what I get for squatting). Lasted 2 months.

    Foot drop, regardless of the origin nerve, results in the inability to flex your foot. Had to wear a brace, do certain exercises, and wear extremely high heels to client meetings to keep from falling on my face!

    Neurologist is the appropriate dr for this...they can conduct the basic reflex tests, and the EMG/Nerve Conductivity. That's how we found out mine was superficial (which is obviously preferable to deep).

    Good luck!
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