Treatment of Foot Drop
Ankle-foot orthoses (AFOs) are the first-line treatment for foot drop, as they are the most effective method for compensating for motor impairments, improving mobility and normalizing ankle and knee kinematics. 1
Primary Treatment Options
Ankle-Foot Orthoses (AFOs)
- AFOs should be prescribed as the initial intervention for most patients with foot drop 1, 2
- They work by maintaining the foot in a neutral position during the swing phase of gait, preventing toe dragging 1
- AFOs improve multiple gait parameters including velocity, stride length, and energy cost of walking 1
- They normalize both ankle and knee kinematics and kinetics during ambulation 1
- AFOs are helpful devices that enable patients to walk better and more safely regardless of the underlying cause 2
Functional Electrical Stimulation (FES)
- FES is an equally effective alternative to AFOs and can be considered as an equivalent first-line option 1
- Both AFOs and FES demonstrate equal effectiveness in improving gait speed 1
- FES electrically stimulates the peroneal nerve to activate ankle dorsiflexors during the swing phase 1
- Can be delivered via surface electrodes placed over the common peroneal nerve 1
- Implantable nerve stimulators are available for more severe or chronic cases 1
- FES has the advantage of providing active muscle contraction, which may help maintain muscle mass compared to passive orthoses 1
Surgical Treatment Considerations
When to Consider Surgery
- Surgical intervention should be considered when there is a realistic chance of nerve recovery and a clinically suspected compressive neuropathy 3
- Any patient with subjectively disturbing foot drop and suspected peroneal nerve compression at the fibular head should be informed about surgical decompression, which carries little risk 3
- Surgical options vary based on etiology and include: 4, 5
- Neurolysis of the nerve
- End-to-end nerve repair
- Autogenous nerve graft procedures
- Nerve transfers
- Direct neuromuscular neurotization
- Tendon transfers
Permanent Foot Drop
- For permanent foot drop where nerve recovery is not expected, muscle-transfer surgery can benefit selected patients 3
- In proximal sciatic nerve lesions, nerve transfers and one-stage nerve repair with concomitant tendon transfer are valuable treatment methods 4
Adjunctive Therapies
Physical Therapy and Rehabilitation
- 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
Emerging Therapies
- Virtual reality may be beneficial for gait improvement when combined with other therapies 1
- Treadmill training (with or without body weight support) may be reasonable for recovery of walking function 1
- Rhythmic auditory cueing shows some promise but effectiveness remains uncertain 1
Special Considerations
Spastic Foot Drop
- For spastic foot drop, botulinum toxin injections should be evaluated as a treatment option 3
Activity Modification
- Common nonsurgical interventions include activity modification and electrical nerve stimulation 5
- For patients with foot drop caused by habitual leg crossing, most improve when they stop this habit 2