From the Research
Flail foot is primarily caused by damage to the peroneal nerve, which can result from various factors including traumatic injuries, compression, diabetes-related neuropathy, and systemic conditions. The most common causes of flail foot include:
- Traumatic injuries such as fractures or dislocations around the knee or fibular head
- Compression from prolonged pressure, like leg crossing or tight casts
- Diabetes-related neuropathy
- Systemic conditions like Guillain-Barré syndrome or multiple sclerosis
- Direct nerve injuries during surgery, particularly knee operations Less commonly, tumors or cysts compressing the nerve pathway, vitamin deficiencies (particularly B vitamins), and certain medications with neurotoxic side effects may cause this condition 1, 2. The peroneal nerve is particularly vulnerable to injury due to its superficial location as it wraps around the fibular head. When damaged, patients lose the ability to lift their foot, resulting in a characteristic foot drop where the toes drag during walking, often requiring compensatory movements like high-stepping to avoid tripping. According to a study published in 2021, peripheral neuropathy in the lower limbs of individuals with spinal cord injury or disease is a significant concern, with a length-dependent polyneuropathy diagnosed in 0.77% of all admissions 3. Treatment depends on identifying and addressing the underlying cause, potentially including physical therapy, bracing, and in some cases, surgical intervention, as seen in a study from 2018 where limited surgeries combined with external fixation played an important role in recovering the stability of foot and ankle, with better clinical results and less complications 4. In real-life clinical practice, a meticulous neurological evaluation and targeted diagnostic testing are necessary to ascertain the site of the lesion and establish the degree of damage, as highlighted in a 2008 study 1. Overall, the management of flail foot should prioritize the identification and treatment of the underlying cause, with a focus on improving patient outcomes and quality of life.