As an Orthopaedic Spine Specialist, I regularly see patients who suffer from Foot Drop or drop foot, which is the inability to lift the front part of their foot. In a mild case, this can be simply irritating to the patient or in a severe case, this can cause the patient to drastically alter their gait in order to walk. Regardless of its severity, it is caused by a nerve injury which needs to be addressed immediately before the problem becomes a permanent one. In this article, I will discuss the causes of foot drop and how it is treated.
When foot drop strikes, it can happen in one or both feet and can occur at any age. It is not a condition in and of itself, but rather a symptom of an underlying problem. It happens because a branch of the peroneal nerve (which runs from the front of the shin to the back of the knee) is injured. As a result, the muscles responsible for lifting the foot become weakened or paralyzed.
This injury to the nerve branch can be caused by a disease, like diabetes, which is known to affect the nerves in the body. Compression of the nerve roots of the spine, due to structural changes in the spine, nerve pressure from childbirth, or from a sports trauma, can also be culprits. Hip or knee replacement surgery, squatting, kneeling or sitting with your legs crossed or even a large amount of weight loss can cause this condition. Sometimes a disorder of the nerves, brain or muscles can be responsible, such as multiple sclerosis, stroke, cerebral palsy or Lou Gehrig’s Disease.
Foot drop is obvious and easy to recognize. Uncovering the underlying cause and making a diagnosis requires more investigation. I watch the patient walk and conduct a thorough physical examination. I ask questions about their general health and condition. I may order x-rays to reveal an easily discernable problem; however an MRI is usually the preferred diagnostic test. I may also order an EMG, which is a specialized test for nerve damage, to help me pinpoint the exact location of the affected nerve.
Treatment depends on the underlying disease or condition. For patients who have diseases that are neuropathic (nerve-related) in origin, and where there is no mechanical compression of the nerves, I can order a light brace or orthotics to assist the patient with walking. Physical Therapy can also help the patient to strengthen muscles that are used in ambulation. The Physical Therapist can also use electrical stimulation to treat the injured nerve.
A non-surgical procedure that can be performed as a next step in treatment is an Epidural Steroid Injection. Epidural injections allow me (or our Interventional Pain Management Specialists) to inject steroid medication near the affected nerve root in the spine, helping to reduce inflammation. We do this under Fluoroscopy (a specialized x-ray) which allows us to more accurately place the medication. Epidural injections may help the drop foot to resolve temporarily or completely.
Most other conservative treatments will be ordered by a patient’s Primary Care Physician which will address their primary diagnosis. For example, if the foot drop is related to diabetes, the PCP will assist the patient with a treatment plan to better control blood sugar levels, through medication, diet and exercise. If the diabetes is well-controlled quickly, the foot drop may resolve as well, as the nerve inflammation will decrease as blood sugar levels are better regulated.
Patients who have mechanical issues causing foot drop can be a different story. Nerve compression caused by a herniated spinal disc, bone spurs, bone tumors or other structural problems AND where foot drop is present, should be addressed as soon as possible to avoid permanent nerve damage. If epidural injections are not helpful in quickly resolving foot drop, surgical intervention is usually the next treatment recommended.
We do our best to determine whether surgery will be helpful in resolving foot drop before making our recommendation to proceed. In some cases, there will be nothing that we can do to help the patient. If we determine that the nerve damage and foot drop is likely permanent, we will not offer surgery as a treatment option.
Today’s minimally-invasive surgical techniques and improved instrumentation allow me to perform many spine surgeries as outpatient procedures. Patients are able to go home and recover extremely well in the comfort of their own homes. Whether inpatient or outpatient spine surgery is needed, I can address the mechanical issues that are causing the foot drop and fix them so that they never recur.
Mark W. McFarland, DO is a Board-certified and Fellowship-trained Orthopaedic Spine Specialist with Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. McFarland or OSC, please go to www.osc-ortho.com or call us at 757-596-1900 for an appointment.