From the Guidelines
To assess a patient with foot drop, a comprehensive evaluation should include a thorough neurological examination, inspection of the skin, assessment of foot deformities, neurological assessment using a 10-g monofilament test, and vascular assessment, including pulses in the legs and feet, as recommended by the most recent guidelines 1. When evaluating a patient with foot drop, it is essential to consider the potential causes, such as common peroneal nerve compression, L5 radiculopathy, motor neuron disease, or peripheral neuropathy.
- A thorough neurological examination should focus on the lower extremities, testing ankle dorsiflexion strength using the Medical Research Council (MRC) scale, and evaluating for sensory deficits in the distribution of the common peroneal nerve (dorsum of foot and lateral leg).
- Assess deep tendon reflexes at the knee and ankle, and examine for muscle atrophy in the anterior compartment of the leg.
- Perform a comprehensive gait analysis, noting if the patient has a steppage gait (lifting the knee higher to prevent the toes from dragging).
- Inquire about the onset (sudden versus gradual), associated symptoms, and risk factors such as recent trauma, prolonged squatting, weight loss, or diabetes.
- Consider ordering electrodiagnostic studies (EMG/NCS) to localize the lesion and determine if it's axonal or demyelinating, as well as additional imaging, such as MRI of the lumbar spine if radiculopathy is suspected, or of the knee/fibular head if compression is likely.
- Laboratory tests should include glucose, vitamin B12, and inflammatory markers if systemic causes are suspected, as recommended by recent guidelines 1. This systematic approach will help differentiate between the potential underlying causes of foot drop and guide further management.
From the Research
Assessment of Foot Drop
To assess a patient with foot drop, a detailed history and physical examination are essential in understanding the underlying pathophysiology and capacity for spontaneous recovery 2. The evaluation should consider the timing, mechanism, and severity of neural injury resulting in foot drop, as these factors influence the selection of the most appropriate treatment options.
Key Components of Assessment
- A thorough medical history to identify potential underlying causes of foot drop, such as neurological injuries, muscular dysfunction, nerve compression, or vascular compromise 3
- Physical examination to assess the severity of foot drop, including evaluation of ankle joint dorsiflexion and gait abnormalities 4
- Assessment of the patient's functional abilities and potential for spontaneous recovery 2
Diagnostic Techniques
Various diagnostic techniques may be adopted to evaluate the severity of foot drop, including:
- Gait analysis to assess the patient's walking pattern and identify any abnormalities 5
- Electrophysiological tests to evaluate nerve function and identify potential nerve damage 3
- Imaging studies, such as MRI or CT scans, to rule out any underlying structural abnormalities 4
Multidisciplinary Approach
A multidisciplinary approach to care is essential for patients with foot drop, involving critical care physical therapists, neurologists, and other healthcare professionals 3. This approach ensures comprehensive management and rehabilitation strategies are implemented to address the patient's specific needs and promote optimal outcomes.