From the Guidelines
Ankle-foot orthoses (AFOs) should be used on selected patients with foot drop following proper assessment and with follow-up to verify effectiveness. Treatment for foot drop typically involves a combination of approaches tailored to the underlying cause, with the primary goal of improving gait and preventing tripping. According to the most recent guidelines 1, AFOs are recommended for patients with foot drop, as they hold the foot in a normal position.
Key Treatment Approaches
- Physical therapy is essential and focuses on strengthening leg muscles, stretching tight muscles, and improving range of motion through exercises like ankle dorsiflexion, toe raises, and ankle rotations.
- For temporary foot drop, nerve stimulation devices such as functional electrical stimulation (FES) units can activate the nerves controlling the lifting muscles during walking, as suggested by 1.
- In cases where foot drop is caused by compression, surgery may be necessary to release pressure on the affected nerve.
- For permanent foot drop, surgical procedures like tendon transfers can improve function by rerouting tendons from stronger muscles to compensate for the weak dorsiflexors.
Considerations
- The choice of treatment depends on whether the condition is temporary or permanent, the specific nerve affected (commonly the peroneal nerve), and the underlying cause, which could range from nerve injury to neurological conditions like multiple sclerosis or stroke.
- Orthotic devices, such as those used for foot drop, should be considered as part of a multidisciplinary team involvement, including physiotherapy, occupational therapy, and speech therapy as appropriate 1.
From the Research
Treatment Options for Drop Foot
- Ankle-foot orthosis (AFO) is a commonly prescribed treatment for drop foot, which prevents the foot from being dragged and provides a clearance between the foot and the ground during the swinging phase of gait 2.
- Functional electrical stimulation (FES) is another treatment option that stimulates active dorsiflexion and can be used as an alternative to AFO for gait dysfunction caused by foot drop 3.
- FES can augment pharmacologic intervention and significantly improve gait function, decrease the impact of multiple sclerosis on walking, and improve quality of life for people with multiple sclerosis 3.
- A systematic literature review of AFO and FES foot-drop treatments for persons with multiple sclerosis found that both treatments can help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity 4.
Types of Ankle-Foot Orthosis
- Commonly used types of AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO 2.
- New types of AFOs, such as AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, have been developed to compensate for the demerits of conventional AFOs 2.
- Articulated ankle foot orthoses are designed to resolve complications associated with drop-foot gait, such as foot-slap during loading response and toe-drag during swing 5.
Importance of Addressing Quality of Movement
- Functional electrical stimulation for foot drop in people with multiple sclerosis emphasizes the importance of addressing quality of movement, and physiotherapy combined with FES may further enhance the benefits of FES 6.
- Qualitative measures can broaden our understanding and improve treatment and adherence, and identify areas for further research 6.