common peroneal injury (foot drop) Flashcards
foot drop?
Foot drop is caused by disruption to the common peroneal nerve which controls active dorsiflexion of the ankle leading to a lack of heel strike during gait hence the term foot drop
nerve root of common peroneal nerve
The common peroneal nerve is the smaller and terminal branch of the sciatic nerve which is composed of the posterior divisions of L4, 5, S1, 2.
where it can be palpated?
palpated behind the head of the fibula and as it winds around the neck of the fibula.
which muscle will be affected ?
tibialis anterior
Mechanism of Injury / Pathological Process
Trauma or injury to the knee TKA[2] Neurological disorders i.e. stroke[3] Compression of the fibula head during surgery e.g. tourniquet[2] Fracture of the fibula Fracture to tibial plateau[4] Patellar dislocations (33% chance of nerve damage)[5] Ankle inversion injury[6]
Clinical Presentation
Foot and Ankle
When testing the foot and ankle a positive test for foot drop is NO active dorsiflexion in a non weight bearing position.
It is important to test passive ROM to ensure the ankle is not stiff.
See foot and ankle examination page for a full assessment of the foot and ankle.
Gait Assessment
Gait should be assessed in any clinical setting.
Foot drop gait can manifest in different ways varying from patient to patient.
Some patients may increase the amount of hip flexion they produce on the effected side therefore, clearing the floor more effectively:
Other patients may circumduct the hip and drag the forefoot along the floor:
Pain
Neurogenic pain can be experienced from damage to the common peroneal nerve.
This pain can be present over the lateral aspect of the knee as well as the dorsal part of the foot.
Sensory changes can also be experienced indicating nerve damage to the therapist.[9]
high steppage gait limp foot falls tripping numbness inability to hold foot wear
Diagnostic Procedures
Subjective History: emphasis on any knee trauma, recent spinal/peripheral limb surgery or family history of neurological disease
Assessment of ankle dorsiflexion
Neurological exam[9]
Gait assessment
Electromyography (EMG) / Nerve conduction studies[10][6]
Outcome Measures
Foot and ankle disability index
Functional gait analysis
Stanmore assessment of foot drop[11]
Hand dynamometry of the dorsiflexors in the foot using the Oxford scale
Management / Interventions
Splinting
One way to improve function while the foot drop resolves is the use of splinting.
A solid ankle-foot orthoses (AFO) or foot-up splint can be used to keep the foot in plantar-grade.
These work to increase the amount of dorsiflexion the foot is held in during gait and can prevent falls as the toes do not get caught on the floor.
Exercise
Physiotherapy interventions normally are focused on graded exercises to encourage active dorsiflexion and muscle recruitment. These exercises have been shown to prevent atrophy and speed up recovery but more research is needed.[2]
In neurologically impaired patients such as Charcot‐Marie‐Tooth disease improved with strengthening exercises to tibialis anterior, however, other neurological diseases like muscular dystrophy strength training was not found to be effective at reducing the foot drop. [12]
Preventing contractures and stiffness is also an important maintenance goal of physiotherapy as this is likely in neurological disease patients more so than after trauma to the knee.
Electro-stimulation of the affected muscle groups has also been shown to improve recovery times.[2]
Gait
Walking on a treadmill. Lifting your legs. Sitting down. Standing up. Stepping over objects.
BaLance
ROM
Stretching
strengthening exercises
steppage gait?
Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop or ankle equinus due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking.
