From the Research
The appropriate workup for drop foot begins with a thorough neurological examination to determine the cause, followed by imaging and electrodiagnostic studies, as this approach allows for the identification of the underlying pathophysiology and guides the selection of the most appropriate treatment option 1. The initial evaluation should include a detailed history and physical examination to understand the etiologies of foot drop, which can be diverse 1. Key components of the workup include:
- MRI of the lumbar spine to rule out radiculopathy, particularly L5 nerve root compression
- Nerve conduction studies with electromyography to identify the location and severity of nerve damage 2 Treatment depends on the underlying cause but typically includes a combination of:
- Ankle-foot orthosis (AFO) to maintain proper foot position during walking
- Physical therapy focusing on strengthening exercises for the anterior tibialis and peroneal muscles
- Addressing the primary etiology, such as surgical decompression for compression neuropathies, corticosteroids for inflammatory causes, or strict glycemic control for diabetic neuropathy 3 For patients with refractory foot drop, tendon transfers, such as the modified Bridle procedure, may be considered to restore active ankle dorsiflexion 3. Additionally, functional electrical stimulation devices can help activate dorsiflexor muscles during the swing phase of gait in appropriate candidates, and smart protocols for physical therapy based on functional electrical stimulation may be beneficial in the early phase of recovery 4. It is essential to consider central causes of foot drop, although rare, as they can have a significant impact on treatment and outcomes 5. Early intervention is crucial for maximizing functional outcomes and preventing complications such as falls or abnormal gait patterns that can lead to secondary musculoskeletal issues.