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Effective Treatments for Drop Foot: Options and Solutions

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drop foot brace anderson podiatry center

Is the common peroneal nerve the solution for you?

In all diagnoses of drop foot, we must first define the signs, symptoms and causes. Drop foot is a disorder that most commonly creates problems while walking. A correlated symptom is difficulty pulling your foot up towards you off the ground while walking. Along with this, you may notice difficulty moving your foot sideways, away from the opposite foot. Everything combined creates the perfect storm for a nasty fall. When you can’t lift your foot off the ground, you are at high risk for injury since your foot is not able to clear uneven surfaces. The root cause? Simply put, your leg muscles that lift and raise your foot are weaker than normal.

Causes of Drop Foot

  • Brain and Spinal Cord – This may include stroke, multiple sclerosis, muscular dystrophy and amyotrophic lateral sclerosis.
  • Trauma – Any form of trauma to the leg that may damage the common peroneal nerve. This nerve is the primary nerve needed to stimulate the muscles that move your foot upwards.
  • Surgery – Knee and hip surgery may cause drop foot as a complication of the surgery.
  • Neuropathy – Diabetic and non-diabetic neuropathy may also cause drop foot.

Diagnosing Drop Foot

Physical Examination – Clinically, a physician may test your muscle strength by visually observing you walk with what is referred to as a “steppage gait”. This describes a gait pattern where you lift your knee up more on the side with drop foot symptoms, so that the foot clears the ground to avoid tripping on the foot. An EMG may also be ordered to test the common peroneal nerve that supplies the muscles used to lift your foot up.

Ultrasound and MRI – These forms of imaging may be useful to see if there is compression on the nerve.

Treatment

Drop foot, or foot drop, is a condition that can significantly impact mobility and quality of life. Since it results from nerve injuries, muscle disorders, or neurological conditions, it makes it challenging for individuals to walk normally. Addressing this condition involves a multifaceted approach tailored to the underlying cause and the severity of the symptoms.

Treatment options for drop foot vary based on the underlying cause and severity of the condition. Common treatments include:

      1. Bracing and Orthotics: Ankle-foot orthoses (AFOs) are commonly used to support the foot and ankle, improving walking ability and preventing the foot from dragging.
      2. Physical Therapy: Physical therapy can help strengthen the muscles in the foot and lower leg, improve range of motion, and enhance overall gait. Exercises often focus on improving flexibility, strength, and coordination.
      3. Electrical Stimulation: Functional electrical stimulation (FES) devices can be used to stimulate the nerves and muscles in the lower leg, promoting muscle contraction and aiding in lifting the foot.
      4. Medications: If the drop foot is caused by an underlying condition such as multiple sclerosis or nerve inflammation, medications to treat these conditions might be prescribed. Anti-inflammatory drugs and pain relievers may also be used to manage symptoms.
      5. Surgery: In severe cases, surgical intervention may be necessary. Procedures can include nerve decompression, tendon transfer, or fusion surgeries to improve foot positioning and function.
      6. Lifestyle Modifications: Adapting the environment, using assistive devices, and making changes to footwear can help manage symptoms and improve mobility.

Early diagnosis and a tailored treatment plan are crucial for managing drop foot effectively and improving quality of life.

Surgery

Bone and Tendon Surgery – There are surgical procedures that transfer fully functioning tendons and muscles to areas where the tendons and muscles are weakened from the drop foot condition. Another option is to fuse specific joints of the foot or ankle so the foot and ankle maintain a better position for walking.

infographic drop foot common peroneal nerve entrapment

Nerve Surgery – This is surgery on the common peroneal nerve, the source of the problem. Now, it’s important I emphasize the importance of the common peroneal nerve because the question truly is; “Is The Common Peroneal Nerve The Solution For You?” So often I see patients who go through trial and error, itching for a solution that seems impossible to find. If you have a drop foot, it’s important that you learn about the common peroneal nerve. For most patients, this is the source of the problem and therefore the solution to improving, or reversing drop foot. The common peroneal nerve is a branch of the sciatic nerve. It goes around the outside of the leg just below the knee joint. As it goes from behind the knee to the front of the leg, it goes through a nerve tunnel. If this nerve tunnel is tight or the nerve has been stretched, we remove the pressure in this area so the symptoms can be improved. Here are some examples:

Neuropathy

People who suffer from neuropathy will have burning, tingling, and numbness in their feet, toes and legs. For some, weakness may also occur resulting in drop foot. This situation can occur in patients with diabetic and non-diabetic neuropathy. Conventional medicine has not done a good job of training medical professionals about the peripheral nervous system in the lower extremity. Doctors have been slow to understand that neuropathy may be caused by nerve tunnels (like carpal tunnel in the hand) that become too tight. As a peripheral nerve surgeon, we have been trained to open nerve tunnels to relieve the pressure on the nerve, therefore reversing neuropathy symptoms. Weakness in patients with neuropathy can be from compression on the common personal nerve.

Hip and Knee Surgery

Patients who have undergone knee and hip replacement surgery are at risk of getting drop foot after surgery. This may occur from the sciatic nerve and the common peroneal nerve getting stretched. By surgically opening the common peroneal nerve tunnel to release pressure on the nerve, the drop foot can be reversed. The common recommendation to those who have this complication is to wait and see if it gets better over time, some waiting a whole year. The suggestion of a peripheral nerve surgeon would be to consider surgical decompression within the first 90 days if there is no improvement of the drop foot. Why? Because if there is no trending towards improvement, waiting longer will limit how much improvement of the drop foot can be achieved with surgery.

Trauma

There are situations where direct trauma to the common peroneal nerve can occur. Examples would be an impact to the nerve tunnel region, or severe knee joint trauma such as a knee dislocation. The same rule applies in these situations, as with patients with drop foot after knee and hip surgery. If no improvement in the first 90 days, surgical decompression must be considered.

So, if you are experiencing a drop foot, it’s important that you consider a peripheral nerve surgeon as part of the improvement process in your situation. Sitting back and waiting to see if it “gets better” can be one of the worst choices.

References

Drop foot from hip replacement surgery
Ng J, Marson BA, Broodryk A. Foot drop following closed reduction of a total hip replacement. BMJ Case Rep. 2016 Mar 22;2016:bcr2016215010. doi: 10.1136/bcr-2016-215010. PMID: 27005799; PMCID: PMC4823537.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823537/

Drop foot from knee replacement surgery
Carender CN, Bedard NA, An Q, Brown TS. Common Peroneal Nerve Injury and Recovery after Total Knee Arthroplasty: A Systematic Review. Arthroplast Today. 2020 Aug 22;6(4):662-667. doi: 10.1016/j.artd.2020.07.017. PMID: 32875016; PMCID: PMC7451888.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451888/

Jennifer’s drop foot eliminated in one day!

Domonique’s drop foot and weakness are gone after surgery.

Mike post drop foot surgery. How the surgery has helped his drop foot!

Sherrie’s Anderson Podiatry Center Experience with Dropfoot

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Sherrie’s experience with Anderson Podiatry was wonderful from the moment she placed her call to the second she was in the chair talking to Dr. Anderson. Sherrie was treated for a condition called drop toot, which is a general term for difficulty lifting the front part off the foot. It is caused by weakness of the muscles that lift the front part of the foot. Sherrie’s drop foot was in her left leg and caused by neuropathy, which made her ankle tilt forward and diluted her strength.

When strength is an issue, walking is obviously effected. You may not be able to push of the ground with your feet as well or lift your feet off the ground if you are experiencing drop foot. In fact, falls also become more probable which puts people’s safety at great risk.

Dr. Anderson performed surgery on three spots and untangled the nerves in her leg- and to Sherrie’s delight, the surgery corrected her problem! The best aspect of the outcome of Sherrie’s surgery is that her drop foot is gone; she can walk normally and has regained great strength and stability. Allowing her to live her life normally again without having to consider the risk of falling.

Sherrie would absolutely recommend her friends and family to Anderson Podiatry Center. She found that the Anderson Podiatry crew worked as a team to help each other, with the goal of putting patients first. Anderson Podiatry’s compassionate, friendly doctors are skilled at finding the root of foot, ankle, and lower leg problems.

Jacque/tarsal tunnel, drop foot, neuropathy, mortons foot

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Jacque’s experience at Anderson Podiatry was wonderful; she felt welcomed and safe, especially during the time of her surgery. According to Jacque, everyone was incredibly kind and she felt well taken care of as all of her questions were answered.

Jacque was treated for tarsal tunnel, and along with that she developed drop foot, neuropathy, mortons foot. The Anderson Podiatry team performed the surgery to release some of the nerves, and Jacque is now healing up very nicely.

Tarsal tunnel syndrome is described as ankle pain due to a compressed nerve. If you have muscle weakness, twitching, tingling, loss of balance, numbness, burning, prickling sensations, and/or nerve pain in your legs or feet, you might be experiencing neuropathy, or nerve damage. Neuropathy can have many causes, like diabetes, infections, injury,, and cancers, and can worsen over time.

The trained specialists at Anderson Podiatry Center know what it’s like to experience neuropathy: which is why we were the first doctors in the Rocky Mountain region to offer nerve decompression treatment that offers long-lasting relief. Our world-renowned podiatrists use the latest technology to reveal the exact stage of the neuropathy and determine the most appropriate actions to take. Our varied and affordable treatment options for neuropathy include, a non-invasive, conservative treatment package that includes diagnostic testing, MLS® Laser Therapy, Electrical Nerve Stimulation (ESTIM), and nutritional counseling, as well as revolutionary nerve decompression surgery

The best aspect of the surgery has been that the neuropathy is basically gone, she does not have the drop foot anymore. It is the best outcome she could imagine since she could feel that her leg and foot have not dropped since the surgery.

Jacque would absolutely recommend Anderson Podiatry to her friends and family, and in fact- she already has!

Understanding Your Mobility : The Mobility Triangle

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I’ve always been a visual learner, and I’ve always liked to teach. I have a passion for helping those with neuropathy, and challenging the status quo in regards to it. Putting all these together, I’ve come up with the concept of the mobility triangle. Why? Well, before I was trained in the treatment of neuropathy I was of the same belief as many in medicine that nothing could be done. However, I have learned that nerve function has a lot to do with your mobility.

During the past 14 years I’ve had the opportunity to extensively study about and receive training on restoring more normal nerve function by doing nerve decompression procedures. The potential benefits of these procedures outweighs anything I’d previously encountered as a doctor for patients suffering form neuropathy. Having nerves that function better can affect you in very significant ways. Before my exposure to these nerve procedures I was only able to help with foot pain itself, not in treating the underlying cause of the pain. Yes, pain does affect your mobility.  With pain in your feet or legs you don’t want to move around much, but eliminating foot pain doesn’t increase your mobility nearly as much as improving the nerves themselves.

So now for the triangle concept. The triangle is composed of three factors: numbness, strength, and pain. Remember, nerves that are not performing optimally affect all three.

  1. Numbness:

Without good sensation in your feet you are not going to want to ambulate as much. It’s difficult to feel the irregularities in the surfaces you walk on, and you’re more likely to fall. Walking on a mountain trail, for example, is an activity you may choose to avoid.

  1. Strength:

When strength is an issue, walking is obviously effected. You may not be able to push of the ground with your feet as well or lift your feet off the ground (drop foot). Falls become more probable. Again, no motivation to walk on that mountain trail, or even sidewalks for that matter.

  1. Pain:

Yes, pain! The burning, tingling, and nerve pain keep you from sleeping well, and often get worse with activity, so once again, no maintain trail for you.

Now let’s look at the mobility triangle with each of these three points. Simply stated, if any one of these three factors of pain, strength, or numbness is affected, it will tend to affect one or both other factors. Obviously to function well all three have to be working optimally.

For example, if you’re experiencing nerve pain you may become less active. This has a negative impact on your strength, making you even less active, and then your muscles become weak. You may even become diabetic, and your feet may eventually start to go numb. Or, you may have a lot of numbness, making it hard to walk and balance, and you become even weaker. This lack of activity can cause weight gain, which can lead to more arthritis in the knees hips and back. And so it goes. Each of these factors are important and have an impact on your general health in a big way.

It’s a simple concept. But I think it’s a good way for you to understand the importance of your nerves, and the role they play in the lower extremity and your general health.

Now for your next step. Imagine a way to reverse these problems. Imagine the potential to improve your mobility triangle. This is what you’re not being told.  What you are told is to take drugs, live with it, nothing can be done, and/or it’s probably your back.

Few in medicine, aside from us, are looking at the optimum function of your lower limb in terms of maximizing nerve function. However, medicine is in the midst of being challenged with this concept.

Some of the research we are doing will help in these efforts. That’s good news for you! So, keep learning and we’ll keep researching and working to give those with mobility issues more hope. Our goal is to make your lack of mobility a memory.

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9 Questions About How Hip Replacement Can Lead to Drop Foot and What You Can Do About It

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Many improvements have been made for patients who need hip replacement surgery. My experience with patients has been that most will say “If I knew it was going to help me this much I would have had it done earlier.” The concept of replacement of these joints has helped many to continue enjoying a more active and productive lifestyle. However, there is the potential risk of drop foot after having a hip replacement surgery.

1. What is drop foot?

In simple terms, this is the lack of strength to pull your foot up off the ground, or to pull away from the opposite foot

2. What is the problem with drop foot?

Essentially you have solved one problem, a hip joint that doesn’t hurt, and now have a new one: DROP FOOT!

3. How does this effect you?

With a mild amount of weakness, you may simply feel less stable when walking across uneven surfaces and feel more prone to twisting your ankle. With severe weakness you may find walking very unstable and therefore your activity is very limited. You may even need to wear a brace to keep your ankle in proper alignment. The net effect: You now have a foot and ankle that limits your activity instead of that old worn out hip joint.

4. How does hip surgery create the drop foot?

The common remarks among orthopedic surgeons is that the sciatic nerve may get stretched during the procedure. It is also common for patients to be told to wait, give it some time and maybe the nerve will repair.

5. Are there any newer thought processes regarding this complication?

Yes. We now believe that in many situations a nerve branch in the lower leg has been injured from this stretching, as this nerve is a branch of the sciatic nerve. It is also the primary nerve that sends signals to the leg muscles to pull the foot up and to the side. When the nerve is stretched along with the sciatic nerve it’s damaged and no longer works effectively. Therefore, weakness and drop foot.

6. What can you do?

First and foremost, don’t wait. Although we have had very good success helping people who have been in this situation for years, earlier treatment when the problem first appears can give the patient better recovery.

7. What do we do?

Our primary objective is to reverse the weakness! For many patients we are able to do this with surgery. The surgeries are primarily focused on one or two nerve tunnels in the lower extremity. By opening these tunnels, much like carpel tunnel surgery, nerve function and therefore strength can be restored.

8. What’s the good the bad and the ugly about these surgeries?

The good news is in most cases it can help. It’s a quick recovery as you can walk the next day. Some can appreciate improvement immediately. The bad and the ugly are it may not work. If it fails, we find that the effects of the surgery are neutral, there is no worsening of symptoms.

9. What’s your next step?

If you or someone you know suffers from drop foot after hip replacement please consider this option. You may be able to get back to more full activity without the worry of falling or twisting your ankle.

Be thankful that your hip is better and understand that the opportunity may be there to get your strength back!

hip replacement can lead to drop foot

Drop Foot: Why it’s Important to Seek Treatment Right Away

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I recently opened the paper on Sunday night and something in the sports section caught my eye. A star Notre Dame Football player, Jaylon Smith (soon to be playing professional football) has a drop foot. I researched more about his injury and subsequent reconstructive surgery to repair his knee. The discussion in the article was if he would ever fully regain his strength and return to football. I’m not sure if the discussion was about his injury, the surgery, or a combination of both, but in it they were contemplating whether Jaylon would ever return to normal.

In the interview Jaylon was being told to sit and wait. What?! The article specifically mentioned an injury to the common peroneal nerve. As a surgeon who operates on this nerve regularly this raised some serious concern.

I was concerned because I have seen many patients with a history of knee or hip surgery suffer from complications of drop foot. In Jaylon’s case it may have been from the knee injury. Doctors take a “wait and see” attitude towards this.   However, if there is not rapid trend toward improvement in the first 3 month I feel surgery should be considered.

Waiting could risk more long term permanent damage!Foot Drop: Causes, Symptoms, and Treatment

Drop foot is often considered to be from a sciatic nerve that gets stretched. Understand that the common peroneal nerve is a branch of the sciatic nerve that travels below the knee and sends impulses to the muscles that pull the foot up and to the side.  So, the basis of my concern is that the common peroneal nerve travels through an anatomical nerve tunnel just below the knee. This is an area where there is potential tightness or squeezing of the nerve which serves as an anchoring point, and when it is released (opened) it will reduce the stretching of the common peroneal nerve.

It’s been my experience when helping patients with drop foot after years of complications from knee or hip surgery that early intervention would have been better to maximize strength improvement.  I perform surgery on this nerve tunnel multiple times per month. It’s a 20 minute procedure with patients going home that day walking, and many have improvement within days. This challenges conventional wisdom that the nerves will take months to repair.

Thus, waiting could be detrimental to his career! So, even for people who aren’t professional athletes, waiting may not be the best plan.

This information I am sharing challenges what I would consider “traditional concepts.”  It has been thought that stretching of the sciatic nerve is the primary issue, but it has been my experience that by opening the anatomical tunnel that the common peroneal nerve travels through just below the knee the drop foot can be corrected.  As a surgeon, and the past President of the Colorado Podiatric Medical Association; Association of Extremity Nerve Surgeons, who does research associated with this nerve and its effects on the lower extremity I thought my opinion should be shared and considered.

If you experience drop foot from an injury, or knee or hip surgery please seriously consider this option!