What is Foot Drop?

Foot drop isn’t actually a condition, but rather a symptom of another health disorder affecting the muscles and nerves in the body. Some of the most common conditions causing this condition include:

• Peripheral neuropathy that causes the nerves in the body to misfire or fail
• Muscular dystrophy causing loss of muscle tissue and weakness
• Other neurological diseases that cause muscles to stop functioning
• Stroke, a brain disorder that occurs when the blood flow to the brain is cut
• Traumatic conditions, such as compartment syndrome, which restricts the flow of blood after an injury

The most common cause of foot drop is related to damage to the peroneal nerve, which runs on the outside of the lower leg just below the knee and innervates the lower leg, foot and toes. There are a number of diseases that attack nerve fibers, including diabetes, which occurs in 1 in 10 Americans. 

People who experience foot drop may try to compensate by changing how they walk. They may try to lift their leg higher so the foot doesn’t drag on the ground. This can take much more energy than walking with a normal gait and can cause problems in the back and hips. Poor balance can lead to a fall, so these patients must be aware at all times of their surroundings and remove or avoid any hazards that can lead to tripping or injury

Fortunately, there are treatments available to correct foot drop. Dr. Davis says, “Our goal is for you to have a much more normal gait.”

Dr. Davis says, “Typically, we start with bracing.” The orthopaedic bracing, known as an ankle-foot orthosis, is a splint or brace made out of plastic and carbon fiber that holds your foot in a neutral position. This allows you to walk normally with your foot in the right position. The bracing, which straps onto the lower leg of the affected foot, can be worn under pants and hidden from sight. 

However, Dr. Davis says there are other treatments available for patients that suffer from long-term foot drop. She notes that the non-invasive bracing is the go-to initial treatment, however, “When patients become sick of the brace because they’re tired of wearing it all the time, we start to think about surgical options.”

Treatment for foot drop depends on the underlying condition. Sometimes if that condition is treated, the foot drop may resolve itself. However, if this is a longer-term condition that can’t be resolved, surgery may be an option. The goal of foot drop surgery is to improve your ability to flex the foot and walk with a more normal gait.

Dr. Davis says “There are tendon transfers that can be done that will basically function like the other muscles did to lift your foot up.” A tendon transfer requires removing a working tendon from another part of the body to try to replace the malfunctioning tendon that causes the foot drop. 

The procedure is called a posterior tibial tendon transfer. Surgeons can use a variety of methods to conduct this procedure, which typically takes about two hours. During the procedure, the patient undergoes anesthesia, while the surgical team carefully removes the tendon and replaces it with the transferred tendon. 

Recovery from this procedure typically requires that your ankle be immobilized in a splint. In some cases, the tendon transfer can be done as a less-invasive outpatient procedure allowing the patient to go home on the same day as the surgery. Each patient is different, so work with your clinical provider to come up with the best treatment plan for your unique situation.

The typical recovery time from tendon replacement is a stepped down process that gradually allows the patient to become more weight-bearing over time. Typically, after surgery, elevation and non-weight-bearing activities happen for the first two weeks. At that time the stitches are removed but the foot and ankle are in a cast for another six weeks or so. After six weeks, the cast is removed and the patient can begin to walk with a special boot. Once the strength of the limb is improved, the boot can be removed and the patient can begin to walk normally without the brace.

If you see signs of foot drop at home, don’t wait; see your doctor. The goal is to begin treatment immediately so that this doesn’t become a permanent condition. Some of the symptoms you may experience include:

• Curled toes
• Having feet or toes that drag or slap on the ground when you try to walk
• Lower leg or foot numbness
• Trouble walking and lifting your foot
• You may notice adjusting your gait higher to accommodate the drooping foot
• Weak foot or leg muscles

Your doctor will examine the leg and foot along with taking a detailed health history. You may have additional testing of the nerves and muscles as well as imaging tests to be sure there isn’t a mass blocking your nerves. 

One concern is that foot drop can lead to a fall, which could be very dangerous. If you notice any signs of foot drop or have trouble with daily activities such as walking, playing sports, or dressing, contact the team at Orlando Orthopaedic Center. There are treatments available and we can help.