Contents

Search

foot drop

Etiology: - peripheral nerve injury - stroke - neuropathy - peroneal neuropathy caused by compression at the fibular head is the most common compressive neuropathy in the lower extremity - foot drop is its most notable symptom - 90% are unilateral - peroneal nerve palsy after total knee arthroplasty (0.3-4% of cases) or proximal tibial osteotomy (3-13% of cases) - postoperative causes of peroneal nerve palsy include hematomas & constrictive dressings - dorsiflexor injuries - compartment syndrome - drug toxicity - diabetes mellitus - Charcot foot - vitamin B12 deficiency - thiamine deficiency [4] - uremia Pathology: 1) weakness in muscles of dorsiflexion - tibialis anterior - extensor hallucis longus (EHL) - extensor digitorum longus 2) spasticity of muscles of plantar flexion - gastrocnemius Clinical manifestations: - steppage gait* * video of steppage gait in patient with bilateral foot drop [3] Laboratory: - glucose in serum/plasma - urea nitrogen in serum/plasma - creatinine in serum/plasma - hemoglobin A1c in erythrocytes - erythrocyte sedimentation rate (ESR) - C-reactive protein in serum/plasma - serum protein electrophoresis/immunofixation electrophoresis - vitamin B12 in serum/plasma Radiology: - X-ray of the tibia, fibula, & ankle - ultrasound if bleeding is suspected in a patient with a hip or knee prosthesis - magnetic resonance neurography - electromyography - MRI of brain if stroke is suspected Management: - correct underlying pathology - avoid leg crossing if due to peroneal neuropathy - surgery - orthotics - nerve stimulation - erythropoietin* in 3 doses of 5000 U/kg over 1 week after nerve injury * erythropoietin has neuroprotective &, possibly, neurotrophic properties

Related

high-step gait; steppage gait

General

gait ataxia

References

  1. Brummel-Smith, K, Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  3. Pritchett JW, Panchbhavi VK (video) Foot Drop. Medscape. Aug 3, 2017 http://emedicine.medscape.com/article/1234607-overview
  4. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022