Foot drop is a gait disorder in which the dropping of the forefoot occurs due to weakness, irritation or damage to the common fibular nerve including sciatic nerve, or paralysis of the muscles in the lower anterior portion of the foot. Usually a symptom of a larger problem, not the disease itself. Foot drop is characterized by an inability or impaired ability to lift a toe or raise the foot from ankle (dorsiflexion). Foot drop can be temporary or permanent, depending on the level of muscle weakness or paralysis and can occur on one or both legs. In walking, the bent leg slightly bent at the knee to prevent the foot dragging the ground.
Foot drop can be caused by nerve damage only or by muscle or spinal cord trauma, abnormal anatomy, poison, or disease. Toxins include organophosphate compounds that have been used as pesticides and as chemical agents in warfare. Toxins can cause further damage to the body such as a neurodegenerative disorder called delayed induced organophosphate polineuropathy. This disorder causes loss of motor function and sensory nerve pathways. In this case, leg loss can be a result of paralysis due to neurological dysfunction. Diseases that can cause leg loss include trauma to posterolateral fibular neck, stroke, amyotrophic lateral sclerosis, muscular dystrophy, poliomyelitis, Charcot Marie Tooth disease, multiple sclerosis, cerebral palsy, hereditary spastic paraplegia, Guillain-Barrà © Å ©, distal myopathy Welander, and Friedreich's ataxia. This can also occur as a result of hip replacement surgery or ligament knee reconstruction surgery.
Video Foot drop
Signs and symptoms
Foot drop marked with step step. While walking, people suffering from conditions drag their toes on the ground or bend their knees to lift their feet higher than normal to avoid dragging. This serves to lift the foot high enough so that the foot is not dragged and prevent slapping. To accommodate the big toe, the patient can use the tiptoe to characterize walking on the opposite leg, raising the thigh in excess, as if walking upwards, while letting the big toe down. Other actions such as swinging the wide legs out (to avoid raising the thighs excessively or to veer in the opposite direction of the affected limb) may also show a decrease in the foot.
Patients with painful pain disorders (dysesthesia) from the sole of the foot may have the same walking style but do not have foot fall. Because of the tremendous pain caused by even the slightest pressure on the feet, the patient walked as if walking barefoot on hot sand.
Maps Foot drop
Pathophysiology
The cause of leg loss, as for all causes of neurological lesions, should be approached using a focused approach to localization before etiology is considered. Often, foot fall is the result of a neurological disorder; rarely suffer from muscle diseases or malfunction. Sources for neurological disorders may be central (spinal or cerebral) or peripheral (a nerve that connects from the spinal cord to the muscle or end-site sensory receptors).
Rare legs are the result of pathology involving the muscles or bones that make up the lower legs. The anterior tibialis is the muscle that lifts the foot. Although the anterior tibialis plays a major role in dorsiflexion, aided by tertiary fibularis, extensor digitorum longus, and extensor smoothus longus. If the drop-foot is caused by a neurological disorder, all of these muscles can be affected because they are all innervated by the deep fibular (peroneal) nerve, which branches off the sciatic nerve. The sciatic nerve exits the lumbar plexus with its roots emerging from the fifth lumbar nerve chamber.
Occasionally, flexibility in the muscles opposed to the anterior tibial, gastrocnemius and soleus, is present in the presence of decreased legs, making pathology much more complex than a drop of foot. The height of the isolated foot is usually a soft condition. There are gradations of weakness that can be seen with the fall of the foot, as follows:
- 0 = complete paralysis,
- 1 = flicker contraction,
- 2 = contraction with gravity removed alone,
- 3 = contraction against gravity only,
- 4 = contraction against gravity and some obstacles, and
- 5 = contraction against strong resistance (normal strength).
Foot drop is different from foot slap , which is a footstroke that sounds to the floor with every step that occurs when the first foot touches the floor at every step, though often simultaneously.
Treated systematically, the location of the lesions that allow causes drop foot included (go from peripheral to center):
- Neuromuscular disease;
- Peroneal nerves (common, that is, often) - chemical, mechanical, disease;
- Sciatic nerve - direct, iatrogenic trauma;
- The lumbosacral plexus;
- nerve root L5 (common, especially in relation to back pain radiating down the leg);
- Cauda equina syndrome, caused by a collision of the nerve roots within the distal spinal canal to the end of the spinal cord;
- Spinal cable (rarely causes foot drops apart) - poliomyelitis, tumor;
- Brain (not common, but often ignored) - stroke, TIA, tumor;
- Genetic (as in Charcot-Marie-Tooth Disease and hereditary neuropathy with responsibility for suppressing palsion);
- Non-organic causes.
If the L5 nerve root is involved, the most common cause is a herniated disk. Other causes of foot drop are diabetes (due to common peripheral neuropathy), trauma, motor neurone disease (MND), adverse reactions to drugs or alcohol, and multiple sclerosis.
Gait cycle
Drop foot and foot drop is an interchangeable term that describes an abnormal neuromuscular disorder that affects the ability of the patient to raise their legs at the ankle. Dropping of the leg is further characterized by the inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle in or out. Therefore, the normal gait cycle is affected by the drop-foot syndrome.
The normal gait cycle is as follows:
- Swing phase (SW): The period of time when the foot is not in contact with the ground. In cases where the foot never leaves the ground (drag feet), it can be defined as a phase when all parts of the foot move forward.
- Initial Contact (IC): A point in the gait cycle when the foot is initially in contact with the ground; this is the beginning of the attitude phase. It is recommended that a heel strike is not a term used in clinical gait analysis because in many cases the initial contact is not done with the heel. Suggestion: Must use a foot strike.
- Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this is the end of the stance phase or the beginning of the swing phase. Also referred to as the foot. Toe-offs should not be used in situations where the toes are not the last part of the foot to leave the ground.
The cycle of decreasing the walking style requires a more exaggerated phase.
- Drop SW feet: If the legs are moving are the affected legs, there will be greater flexion in the knee to accommodate the inability to dorsoflection. This increase in knee flexion will lead to climbing ladder movements.
- Drop leg IC: The initial contact of a moving leg will not have a normal heel-foot foot strike. Instead, the foot can slap the ground or the entire foot can be planted on the ground at once.
- Drop leg TC: The terminal contact observed in patients with drop foot is very different. Because patients tend to have weakness in affected legs, they may not have the ability to support their weight. Often, a tool or a stick will be used to assist in this aspect.
Drop Foot is the inability to dorsiflex, evert, or reverse the foot. So when looking at the Gait cycle, part of the gait cycle involving most of the dorsiflexion action is the Heel Contact foot on the 10% Gait Cycle, and the entire swing phase, or 60-100% of the Gait Cycle. This is also known as Gait Abnormalities.
Diagnosis
Initial diagnosis is often performed during routine physical examination. Such diagnosis can be confirmed by professional medical personnel such as physiotherapists, neurologists, orthopedic surgeons or neurosurgeons. A person with a foot fall will have difficulty walking on his heel because he will not be able to lift the front of the foot (foot and toe) from the ground. Therefore, a simple test asking the patient to dorsofleksi can determine the diagnosis of the problem. It is measured on a 0-5 scale that observes mobility. The lowest point, 0, will determine the total paralysis and the highest point, 5, will determine the complete mobility.
There are other tests that may help determine the underlying etiology for this diagnosis. Such tests may include MRI, MRN, or EMG to assess the surrounding area from damaged nerves and damaged nerves themselves. The nerves that communicate with the leg muscles are peroneal nerves. This nerve innervates the anterior muscle of the foot used during the ankle dorsi flexion. The muscles used in plantar flexion are innervated by the tibial nerve and often develop shortness in the presence of a drop of foot. The muscles that keep the ankle from supination (like from ankle sprain) are also innervated by the peroneal nerve, and it is not uncommon to find weaknesses in this area as well. Paraesthesia in the lower legs, especially on the upper legs and ankles, can also accompany a drop of foot, though not in all cases.
The common kneeling yoga practice, Varjrasana, with the name "yoga foot drop," is linked to the foot.
Treatment
The underlying disorder should be treated. For example, if a spinal herniation in the lower back affects the nerves leading to the leg and causes symptoms of leg loss, disc herniation should be treated. If leg loss is the result of peripheral nerve injury, windows for recovery of 18 months to 2 years are often recommended. If it is clear that no restoration of nerve function is occurring, surgical interventions to repair or transplant the nerves may be considered, although the outcome of this type of intervention is mixed.
Non-surgical treatment for spinal stenosis includes an appropriate exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory drugs such as ibuprofen or aspirin. If necessary, decompression operations that minimize damage to normal structures can be used to treat spinal stenosis.
The non-surgical treatment for this condition is very similar to the non-surgical method described above for spinal stenosis. Spinal fusion surgery may be necessary to treat this condition, with many patients improving their function and experiencing less pain.
Nearly half of all vertebral fractures occur without significant back pain. If pain medication, progressive activity, or brace or support does not help with fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be an option.
The ankles can be stabilized by mild orthosis, available in mold plastics as well as soft materials that use elastic properties to prevent foot fall. In addition, the shoes can be equipped with traditional spring wire to prevent the fall of the foot when walking. Regular exercise is usually determined.
Functional electrical stimulation (FES) is a technique that uses electric currents to activate nerves that infect extremities affected by paralysis due to spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is mainly used to restore functionality to people with disabilities. Sometimes referred to as Neuromuscular electrical stimulation (NMES) The latest treatments include peroneal nerve stimulation, which lifts the leg as you move. Many stroke patients and multiple sclerosis with decreased feet have managed to do so. Often, individuals with drop feet prefer to use compensation techniques such as footsteps or hip hiking as opposed to a brace or splint.
Treatment for some can be as easy as the bottom of the foot "L" foot-shaped (orthose-foot orthoses). Another method uses cuffs placed around the patient's ankles, and springs and hooks at the top are mounted under the shoelaces. Hooks connect to the ankles and lift shoes when the patient is walking.
See also
- Yoga at foot height
- Walking feet
- Polymyositis
- inclusion body myositis
References
- Mayo Clinic. (November 5, 2010). Foot Drop. Retrieved from [1]
- James W Pritchett, MD. (23 Jun 2009). Foot Drop. Retrieved from [2]
- Health Costs and Utilization Projects. (2011). [3]
External links
- Foot Drop article from Emedicine.com by James W Pritchett, MD, FACS; Margaret A Porembski, MD.
- ^ Saladin, Kenneth. Anatomy & amp; Physiology: A Unity of Form & amp; Function. Issue 7 New York: McGraw-Hill Education, 2015. Print.
- ^ Balali-Mood, Mahdi. "Neurotoxic disorders of organophosphorus compounds and their management." Arch Iran Med. 2008 Jan; 11 (1): 65-89. Jokanovic, Milan, Melita Kosanovic, Dejan Brkic, and Predrag Vukomanovic. "Organophosphate induces Delayed Polineuropathy in Man: An Overview." Clinical Neurology and Neurosurgery 113.1 (2011): 7-10. Web.
Source of the article : Wikipedia
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