The Rollin' RN's

Developing Foot Drop? Quite Possibly Another Consequence of SCI


We present yet another frequently discussed topic in our spinal cord injury (SCI) Facebook groups…“foot drop” or “drop foot.” You will hear it called one or the other but either way, it’s a subject that wasn’t discussed in either of our rehabs, so here we are rollin’ in to break it down for you.

Why does foot drop occur?

Foot drop isn't a disease. Rather, foot drop is a sign of an underlying neurological, muscular, or anatomical problem. Foot drop is caused by a disruption at L4, L5, S1 levels, which may affect many of us. By far the most common cause of dropped foot is direct compression of the anterior tibial nerve. The tibial nerve, which branches off of the sciatic nerve, controls the muscles of the lower leg and foot. Most of us with an SCI have a “disruption” above the L4, L5, S1 level.


Causes

Foot drop is caused by weakness or paralysis of the muscles involved in lifting the front part of the foot. Causes of foot drop might include:

  • Brain and spinal cord disorders. Disorders that affect the spinal cord or brain such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, spinal cord injury, or stroke may cause foot drop.

  • Nerve injury. The most common cause of foot drop is compression or damage of a nerve in your leg that controls the muscles involved in lifting the foot. This can be the result of a sports injury, diabetes, childbirth, or even injury during hip or knee replacement surgery, all of which may cause foot drop.

  • Muscle or nerve disorders. Various forms of muscular dystrophy, an inherited disease that causes progressive muscle weakness, can contribute to foot drop. So can other disorders, such as polio or Charcot-Marie-Tooth disease.

As you can see, there are many reasons foot drop can occur but to keep this topic contained, we will focus mainly on injury of the spinal cord. Because most of us with an SCI can’t move our legs or feet, we are at risk to develop foot drop. The key is to be aware of this issue early on so you can take steps to prevent it.

Some suggestions to prevent foot drop:


  • Braces or splints. A brace on your ankle and foot called an Ankle Foot Orthosis (AFO) or a splint that fits into your shoe called an orthotic can help hold your foot in a normal position. Keep in mind that any kind of brace or splint may cause pressure leading to a pressure sore, so keep a close eye on your skin for any skin breakdown.

  • Shoes. Shoes will keep your feet in position during the day but make sure to let your feet breathe overnight.

  • Physical therapy. Exercises that strengthen your leg muscles and help you maintain the range of motion in your knee and ankle might improve gait problems associated with foot drop. Stretching exercises are particularly important to prevent stiffness in the heel. You can perform gentle exercises in your bed at night or during the day while sitting in your chair.



Treatment for foot drop:

  • Nerve stimulation. Sometimes stimulating the nerve that lifts the foot improves foot drop.

  • Surgery. Depending upon the cause, and if your foot drop is relatively new, nerve surgery might be helpful to relieve pressure on the nerve or to try to repair it. If foot drop is long-standing, your doctor might suggest surgery that fuses ankle and foot bones into the correct position or a procedure that transfers a working tendon and attached muscle to a different part of the foot.

Depending on the cause, foot drop may just be temporary, but it can also become permanent. Talking with your doctor and being ready to work with a physical therapist are two of the best steps you can take to treat foot drop.

It’s all good, so keep on rollin’.

Patty, BSN, RNC and Roberta, RN

The Rollin’ RNs ™

References:

Drop Foot (Foot Drop) and Steppage Gait (Footdrop Gait) https://www.spineuniverse.com/conditions/sciatica/drop-foot-foot-drop-steppage-gait-footdrop-gait

Drop Foot Injury: Complication of medical malpractice or spinal cord injury https://www.bensonbingham.com/drop-foot-injury/

Foot Drop https://www.mayoclinic.org/diseases-conditions/foot-drop/symptoms-causes/syc-20372628

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