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What is footdrop?

BY: Isaac Yeboah

By Dorothy Akua Adjabu

Walking is a basic activity of daily living for most individuals but having a Footdrop makes this simple activity quite a challenge.

Footdrop refers to the inability of an individual to lift his/her foot and toes appropriately when walking.

It is not a disease itself, but to a certain extent a symptom that develops as a result of various problems in the muscles or nerves.

Footdrop typically affects the muscles responsible for moving the ankle and foot upwards.

It is caused by weakness or paralysis of the muscles responsible for moving the ankle and foot upward and it is also accompanied by weakness in the entire lower limb.

An individual with footdrop usually has difficulty lifting the front part of the foot and tends to scuff his toes along the ground.

The individual compensates by lifting his foot higher than normal whenever he walks to prevent this- the movement is similar to climbing the stairs.

Children with footdrop often drag their toes along the floor when walking and fall whenever they attempt to run.

Footdrop is often associated to damage or disease of the brain or spinal cord, even though it may also be a consequence from injury to the nerves in the lower limb.

The normal gait cycle or walking stride involve the pull of the toes from the ground at the beginning of a stride and controlling the foot after the heel touches the floor near the end of the stride — to avoid the person from tripping on them.

In the individual with the footdrop, the toes of the footdrop down and strike the floor first and they are also unable to control the movement of the ankle joint.

The gait the individual develops is referred to as the Steppage or Marching gait.  

Presentation

Individuals with footdrop may have the following presentation:

• Inability to point toes upwards or towards the body.

• Pain in the affected lower limb.

• Weakness in the affected lower limb.

• Tingling sensation and numbness (on the shin or top of the foot) – the individual may have slight tingling sensation to a complete lack of feeling in the foot, this may make activities of daily living like walking or driving a car very complicated.

• Inability to walk normally in the heel-to-toe fashion.

• High-stepping walk (called steppage gait).

• Dragging of the foot and toes.

• Scraping of the toes across the ground

• Uncontrolled slapping of the toes against the ground.

• An exaggerated, swinging hip motion. The hip may constantly swing out in an endeavour to prevent the toes from catching the ground.

• Limp foot – The foot usually flops away from the body.

• Tingling, numbness and slight pain in the foot. Ranging from a slight tingling sensation to a complete lack of feeling in the foot, these foot drop symptoms may make everyday activities like walking and driving a car very difficult.

• Difficulty with activities that involve the use of the front aspect of the foot- this may make stair-climbing become quite a challenge.

• Muscle atrophy in the leg – this refers to a reduction in muscle size accompanied with muscle  weakness in the affected lower limb.                                                                                                                                        

Causes

Footdrop should be seen as a symptom of an underlying condition. Footdrop occurs as a result of:

• Muscle damage.

• Skeletal/bony abnormalities affecting the foot.

• Nerve damage.

These may be caused by the following;

• A lower back condition.

• A stroke or tumour.

• Parkinson’s disease.

• Diabetes.

• Multiple sclerosis.

• Adverse reactions to drugs or alcohol.

• An injury to the foot or lower leg.

Diagnosis

A comprehensive clinical exam which includes a physical examination, for example a basic muscle test may be executed to see whether the individual can pull the foot upwards towards the body to test for foot strength.

If there is difficulty then a gait analysis may be conducted to incite footdrop for example walking on ramps or climbing the stairs.

Another swift way to test for footdrop is for the individual to try to walk on the heels. If this proves difficult, footdrop may be present.

Imaging tests like an MRI may also be conducted.  
To be continued...

The writer is a senior physiotherapist at the 37 military hospital. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.


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