What are the treatment options for isolated foot drop?

Treatment Options for Isolated Foot Drop

For patients with isolated foot drop, an ankle-foot orthosis (AFO) is recommended as the primary treatment option to compensate for foot drop and improve mobility and gait parameters. 1

First-Line Treatment Options

• Ankle-foot orthoses (AFOs) are the most effective method for compensating for motor impairments causing foot drop, improving mobility and normalizing ankle and knee kinematics and kinetics 1
• Functional Electrical Stimulation (FES) is a reasonable alternative to AFOs for foot drop management and can be considered as an equivalent first-line option 1
• Both AFOs and FES are equally effective in improving gait speed, making either option suitable depending on patient characteristics 1

Mechanism and Benefits of AFOs

• AFOs help by maintaining the foot in a neutral position during the swing phase of gait, preventing the toes from dragging on the ground 1
• They improve:
  • Gait parameters (velocity and stride length) 1
  • Energy cost of walking 1
  • Stability and safety during ambulation 2
  • Paretic ankle and knee kinematics 1

Functional Electrical Stimulation Details

• FES works by electrically stimulating the peroneal nerve to activate ankle dorsiflexors during the swing phase of gait 1
• Can be delivered through:
  • Surface electrodes placed over the common peroneal nerve 1
  • Implantable nerve stimulators for more severe or chronic cases 1
• Benefits include active muscle contraction which may help maintain muscle mass compared to passive orthoses 1

Additional Treatment Approaches

• Physical therapy with intensive, repetitive mobility-task training is recommended for all individuals with gait limitations 1
• Circuit training in group therapy settings is a reasonable approach to improve walking function 1
• Cardiovascular exercise and strengthening interventions should be incorporated to improve gait capacity 1
• Robotic-assisted movement training may be considered in combination with conventional therapy 1

Treatment Selection Considerations

• Severity of foot drop - more severe cases may benefit from custom-molded AFOs or implantable FES 1, 3
• Cause of foot drop - treatment should address the underlying etiology when possible:
  • Common peroneal nerve injury (most common cause) 4, 5
  • L4/L5 radiculopathy 4, 5
  • Sciatic nerve injury 4
  • Central nervous system disorders 4
• Patient's functional goals and activity level - more active patients may benefit from dynamic AFOs or FES 3

Emerging and Adjunctive Therapies

• Virtual reality may be beneficial for gait improvement in combination with other therapies 1
• Rhythmic auditory cueing shows some promise but effectiveness remains uncertain 1
• Treadmill training (with or without body weight support) may be reasonable for recovery of walking function 1
• Surgical options may be considered in select cases:
  • Nerve decompression for compressive neuropathies 4, 6
  • Nerve repair or grafting for traumatic injuries 4
  • Tendon transfers for permanent foot drop 4, 6

Important Considerations and Caveats

• AFOs improve static stability and decrease the probability of trips/stumbles, but may potentially impair the compensatory stepping response if a trip does occur 2
• The optimal design of AFOs should allow for assistance-as-needed support rather than rigid immobilization when possible 3
• Regular reassessment is necessary as recovery may occur depending on the underlying cause 5
• Treatment should be initiated promptly to prevent complications such as falls, injuries, and development of compensatory gait patterns 4, 5