Tuesday, March 10, 2009

Revisiting Foot Drop:

Foot drop is a common and distressing problem that can lead to falls and injury.

Causes:
1. Most frequent cause is a (common) peroneal neuropathy at the neck of the fibula,
2. Anterior horn cell disease,
3. Lumbar plexopathies,
4. L5 radiculopathy and
5. Partial sciatic neuropathy.
6. Habitual leg crossing may well be the most frequent cause and most patients improve when they stop this habit.

Even when the nerve lesion is clearly at the fibular neck there are a variety of causes that may not be immediately obvious. A meticulous neurological evaluation goes a long way to ascertain the site of the lesion.

Basic investigations:
1. Nerve conduction and electromyographic studies are useful adjuncts in localising the site of injury, establishing the degree of damage and predicting the degree of recovery.
2. Imaging is important in establishing the cause of foot drop if it is at the level of the spine, along the course of the sciatic nerve or in the popliteal fossa;
Imaging tools are: ultrasonography, CT and MR imaging.

Foot drop of any cause must be immediately prescribed with an ankle foot orthosis is a helpful device that enables them to walk better and more safely (helps not to lose the muscle stretch reflex).

Reference:

Stewart JD; Pract Neurol. 2008 Jun;8(3):158-69.

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