1. FOOT DROP

2.  DROPING OF FOREFOOT DUE TO
WEAKNESS
 DAMAGE TO COMMON PERONEAL
NERVE
 PARALYSIS 0F MUSCLES IN ANTERIOR
PORTION OF LOWER LEG
 INABILITY TO DORSIFLEX ANKLE AND TOES
 UNILATERAL OR BILATERAL
 TEMPORARY OR PERMANENT

3. ANATOMY
 SCIATIC NERVE BIFURCATES INTO TIBIAL
AND PERONEAL NERVE
 PERONEAL NERVE CROSSES LATERALLY
OVER FIBULAR NECK
 DIVIDES INTO SUPERFICIAL AND DEEP
BRANCHES

5.  SUPERFICIAL BRANCH TRAVELS BETWEEN
TWO HEADS OF PERONEI AND SUPPLIES
LATERAL COMPARTMENT
 DEEP BRANCH SUPPLIES ANTERIOR
COMPARTMENT

7. MUSCLES
 DORSIFLEXORS
TIBIALIS ANTERIOR
EXTENSOR HALLUCIS LONGUS
EXTENSOR DIGITORUM LONGUS
PERONEUS TERTIUS
 EVERTORS
PERONEUS LONGUS
PERONEUS BREVIS

9. MOREVULNERABLE TO INJURY
 Funiculi of the peroneal nerve - larger and less
connective tissue
 Fewer autonomic fibers, so in any injury,
motor and sensory fibers bear the brunt of the
trauma.
 More superficial course, especially at the
fibular neck
 Adheres closely to the periosteum of the
proximal fibula

10. CAUSES
 NEUROLOGICAL
NM DISEASE
PERONEAL NERVE INJURY
SCIATIC NERVE INJURY
LUMBAR SACRAL PLEXUS INJURY
SPINAL CORD LESIONS
CAUDA EQUINA SYNDROME
BRAIN – STROKE,TIA
GENETIC

11.  RUPTURE OF TIBIALIS ANTERIOR
 FRACTURE OF FIBULA
 COMPARTMENT SYNDROME
 DIABETES
 ALCOHOL ABUSE

12. SYMPTOMS
 Difficulty in lifting the foot.
 Dragging the foot on the floor as one walks.
 Slapping the foot down with each step.
 Raising thigh while walking(stepping gait)
 Pain , weakness or numbness in the foot.

13. GAIT CYCLE
 Swing phase (SW):The period of time when
the foot is not in contact with the ground. In
those cases where the foot never leaves the
ground (foot drag) - phase when all
portions of the foot are in forward motion.
 Initial contact (IC): when the foot initially
makes contact with the ground; represents
beginning of the stance phase - foot strike.
 Terminal contact (TC): when the foot leaves
the ground - end of the stance phase or
beginning of the swing phase - foot off. .

14. FOOT DROP
 Drop foot SW: Greater flexion at the knee
to accommodate the inability to dorsiflex -
stair climbing movement.
 Drop foot IC: Instead of normal heel-toe foot
strike, foot may either slap the ground or the
entire foot may be planted on the ground all at
once.
 Drop footTC: Terminal contact is quite
different - inability to support their body weight
– walker can be used

15. DIAGNOSIS
 PHYSICAL EXAMINATION
 TRAUMA – no lab investigations

16. INVESTIGATIONS
FBS
ESR
CRP
B.UREA
S CREATININE
ELECTROPHORESIS.

17. IMAGING
 Plain films
posttraumatic - tibia/fibula and ankle-any bony
injury.
anatomic dysfunction (eg, Charcot joint)
 Ultrasonography
If bleeding is suspected in a patient with a hip or
knee prosthesis
 Magnetic Resonance Neurography
tumor or a compressive mass lesion to the
peroneal nerve

18. Electromyelogram
◦ This study can confirm the type of
neuropathy, establish the site of the lesion,
estimate extent of injury, and provide a
prognosis.
◦ Sequential studies are useful to monitor
recovery of acute lesions.

19. TRAETMENT
 Depends on the underlying cause.
 If cause is successfully treated foot drop
may improve or even disappear.
 Medical treatment - painful paresthesia
sympathetic block
amitriptyline
nortriptyline
pregabalin
Laproscopic synovectomy

20. SPECIFIC TREATMENT
 Braces or splint-a brace on the ankle and
foot or splint that fits into the shoe can
help to hold the foot in the normal
position

21. Physical therapy
 exercises that strengthen the leg
muscles
 maintain the range of motion in knee and
ankle
 improve gait problems associated with
foot drop.

22.  Nerve stimulation
stimulating the nerve (peroneal nerve)
improves foot drop especially if it caused
by a stroke.

23. SURGICAL REPAIR
 Foot drop due to direct trauma to the
dorsiflexors generally requires surgical
repair.
 When nerve insult is the cause - restore
the nerve continuity - nerve grafting or
repair.

24.  If there is no significant neuronal recovery
at one year - tendon transfer maybe
considered.
 Bridal procedure
 Neurotendinous transpositon

25. BRIDALS PROCEDURE
 Tendon to bone attachment - posterior
tibial tendon is attatched to the second
cuneiform bone.
 Tendon to tendon attachment

26. Neurotendinoustransposition
 Lateral head of gastronemius is transposed to
the tendons of the anterior muscle group with
simultaneous transposition of the proximal end
of deep peroneal nerve.
 The nerve is sutured to the motor nerve of the
gartronemius
 Active voluntary dorsiflexion of foot

27.  AFTER TENDON TRANSFER
CAST AND NON WEIGHT BEARING
AMBULATION FOR SIX WEEKS
 PHYSIOTHERAPY
TO CORRECT GAIT ABNORMALITIES
 CHRONIC AND CONTRACTURE CASES
ACHILLES TENDON LENGTHENING

28.  In patients whom foot drop is due to
neurologic and anatomic factors (polio,
charcot joint ) - arthodesis
 Subtalar stabilising procedure or triple
arthodesis can be done.

29. COMPLICATIONS
 Surgical procedure- wound infection may
occur.
 Nerve graft failure
 In tendon transfer procedures- recurrent
deformity
 In arthrodeses or fusion procedures-
 pseudoarthrosis, delayed
union, or nonunion.

30. THANKYOU