FOOT DROP

PRESENTED BY:Sunil Kumar Daha

Introduction

• Inability of the dorsiflexion foot weakness or paralysis of the muscles that lift the foot

• A symptom

• Can result if there is injury to • the dorsiflexors or • any point along the neural pathways that supply them

Muscles of Anterior Compartment of Leg

• Dorsiflexors of foot at ankle:Tibialis anteriorExtensor digitorum longusExtensor hallucis longusFibularis tertius

• Innervation to all these musclesDeep peroneal nerve

Sciatic nerve: Origin L4 to S3

Contd…• Sciatic nerve leaves the

pelvic cavity at the greater sciatic foramen, just inferior to the piriformis muscle.

• At distal third or mid-thigh level,

it bifurcates to :Tibial nerveCommon peroneal nerve

Peroneal nerve in Popliteal fossa

• Runs downward through popliteal fossa following medial border of biceps

femoris muscle

• Leaves fossa by crossing superficially, the lateral head of gastrocnemius muscle

In the leg

• Passes behind the head of fibula and winds laterally

around neck of bone

• Pierce peronous longus muscle and divides into:

Superficial peroneal nerveDeep peroneal nerve

Common and superficial peroneal nerves, branches, and cutaneous innervation

Deep peroneal nerve, branches, and cutaneous innervation

CentralBrain

Ex- Multiple Sclerosis

Spinal CordEx- Disc prolapse

Peripheral

NerveEx- Common peroneal nerve injury

MuscleEx- Muscle atrophy

Causes

• L4-L5 disc herniation, spinal stenosis• Lumbosacral Plexus injury

Due to pelvic fracture

• Sciatic nerve injuryHip dislocation

• Injury to the kneeKnee dislocation

Motor neuron disorderPolio and amyotrophic lateral sclerosis

Neurodegenerative disorder of the brainMultiple sclerosis, stroke, cerebral palsy

Causes

• External compression– During anesthesia, coma, sleep, bed rest– Plaster cast, braces– Habitual leg crossing– Sitting cross legged– Prolonged squating, kneeling

Direct trauma– Blunt injuries, lacerations– Fracture of fibula– Adduction injuries and dislocations of knee– Surgery and arthroscopy in popliteal fossa and knee

Causes

• Traction injuries– Acute ankle injuries

• Masses – Ganglia, Baker’s cyst, callus, fibular tumors, osteoma, hematomas

Tumors– Nerve sheath tumors– Nerve sheath ganglia– Lipomas

Entrapment – In the fibular tunnel– Anterior (tibial) compartment syndrome

Causes

• Vascular– Vasculitis, local vascular disease

• DM: susceptibility to compression, ischemic damage• Leprosy• Idiopathic

Causes

Presentation

• Direct injury to dorsiflexors

• Compartment syndromes

• Anterior compartment syndrome – Nerve involved: deep peroneal nerve

• Deep posterior compartment syndrome– Nerve involved: posterior tibial nerve

• Chronic compartment syndrome

• Neurologic defects

Clinical Features• Inability to point toes toward the body

(dorsi flexion)

• Tingling, numbness & slight pain in the foot

• Loss of function of foot

• High-stepping gait (called Steppage gait or Foot Drop Gait)

• An exaggerated, swinging hip motion

Diagnosis• History • Clinical exam, including neurological exams• Electromyogram• Nerve conduction test• Imaging studies, such as X-rays or high-

resolution MRI (magnetic resonance imaging)

Treatment• Non-surgical

Orthotics, including braces or foot splint

Physicotherapy including gait training

• Surgical therapyDecompression surgeryNerve suturesNerve graftingNerve transfer Tendon transfer

The End