Current Concepts In Diagnosing And Treating Drop Foot

Start Page: 68

A Guide To Common Foot Drop Etiologies

• Hypothyroidism
• Lymphomas
(Hodgkin’s or non-Hodgkin’s)
• Guillain-Barré Syndrome
• HIV infection
• Cytomegalovirus infection
• Diabetes
• Megaloblastic anemia
• Intracranial tumors
• Brain lesions
• Tumors of the head and neck
• Trauma (direct injury)
• Antineoplastic drugs
• Spinal cord compression
• Direct peripheral
nerve invasion
• Autoimmunity
• Obesity or weight loss
• Idiopathic
• Local tumors such as ganglion or synovial cysts
• Nerve sheath tumors (schwannoma)
• Neurofibroma
• Bone tumors
• Postural (prolonged squatting, sitting or kneeling)
• Prolonged hospitalization
• Bed rest
• Internal surgery
(positioning on table)
• Ankle inversion/sprains
• Orthopedic (fibular fractures)
• Cast immobilization
• Tibial plateau repair/fracture
• Knee arthroplasty
• Hip surgery

75
Author(s): 
Nicholas Romansky, DPM, Kelly Scollon-Grieve, MD, and James G. McGinness, CPO

   Drop foot due to direct trauma to the dorsiflexors generally requires surgical repair. When nerve injury is the cause of drop foot, treatment focuses on restoring the nerve continuity by nerve grafting (transfer of functional fascicles, nerve repair or removal of the nerve insult). Many surgical techniques are available. These techniques typically involve modification of the Bridle procedure with and without the Achilles tendon lengthening to achieve adequate dorsiflexion. In patients with drop foot due to residual neurological or anatomical factors such as polio or upper motor neuron lesions or Charcot foot, arthrodesis may be the preferred surgical option.

In Conclusion

The podiatrist must determine a complete clinical diagnosis, including the performance of a comprehensive clinical neurologic exam. The podiatrist should involve other healthcare providers such as a physical medicine rehabilitation professional or interventional spine MD or DO. A team approach of individuals including an orthotist and prosthetist is absolutely imperative for successful outcomes and a maximally functioning patient. The single use of one treatment option is strongly discouraged as a combination of treatments in linear fashion should maximize the function of the patient.

   There are specific tests and modalities available. These include electrical stimulation guidance, MRI of the L-S spine to further delineate local or more proximal causes, electromyography, electromyography signal amplifiers, computed tomography scan, fluoroscopy and ultrasound. All of these modalities can aid in the diagnosis and treatment of drop foot.

   Dr. Romansky is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice at Healthmark Foot and Ankle Associates in Media and Phoenixville, Pa.

   Dr. Scollon-Grieve is in private practice at Premier Orthopaedic Sports and Spine Rehabilitation Division in Havertown, Pa.

   Mr. McGinness is affiliated with JG McGinness Prosthetics & Orthotics in Norristown, Pa.

References

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