A couple of questions about foot drop and their answers

 

 

Two of the readers of my blog asked me about foot drop. Their questions are given below. My response to them follows.

QUESTION

lu Hi there,
Really need some advice/information. About 5-6 weeks ago i started noticing that my left foot felt funny, tingling and numb, and i was also experiencing some problems walking but i couldn’t quite pinpoint it and thought it would go away. I started to realise that i couldn’t dorsiflex my left foot, it felt numb and tingly on the top of my foot and to half way up the shin. After spending a few days trying to exercise my foot i regained some minimal dorsiflexion (about half capacity compared to my normal right leg) I have no pain and minimal discomfort (the bones on the top of my foot and around my ankle are starting to ache as i constantly try and flex my muscles/toes to improve action). I have been told by my GP that i have drop foot, which i’d already suspected, but i can’t get an appointment for another 7 weeks with an orthapaedic consultant and i am starting to really stress myself out reading so much on the internet that it might be ALS/MS or some serious underlying condition. I’m mid-twenties, female and was totally free of health issues until this incident. I don’t know whether I should push my doctor for an earlier referral – i have no other symptoms and can get about but walking is becoming tiring and upsetting. The condition has not deteriorated but nor has it improved much – I was praying that it was simply a transient problem but after 6 weeks i’m not so sure. I haven’t suffered any discernible trauma or injury (except i remember carrying a heavy bag and wearing heels for a few hours which made my foot hurt prior to these symptoms). Please if you can offer any info/assurances that it is common to have something like this out of the blue, it would be much appreciated.

 

Dear Lu,
thank you for writing in to me. You say you are in your mid-twenties so first let me reassure you. More than likely you do not have anything serious such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Let us first discuss ALS since that is a scary disease indeed. ALS does at times start off with an innocuous foot drop but you are not in the right age group for it. Usually ALS is a disease which strikes people in their fifth or sixth decade of life. Familial ALS begins at a younger age but here the history is of multiple family members having ALS at a young age.

Now let us come to MS. MS can have myriad clinical presentations. While it can present with foot drop it is usually not a common presentation. More common presentation of MS in a young lady like you is an attack of optic neuritis (sudden loss/blurring of vision in one eye along with pain) or an incomplete transverse myelitis (TM). Patients with TM depending upon the level of involvement of the spinal cord (usually it is in the cervical cord) may present with weakness in the legs, numbness, loss of bladder control, problems with gait and balance.

So most likely you have a foot drop due to either peroneal nerve palsy or sciatic nerve palsy. Now you deny any trauma. At times the cause of peroneal nerve palsy can be “subtle” such as repeated crossing and uncrossing of the legs (in thin persons), falling asleep with the outer aspect of the knee (near the head of the fibula) pressing against something hard such as a bed railing and so forth or something pressing on the sciatic nerve (as it exits the pelvis) or at the level of the fibular head (peroneal nerve) . Rapid changes in body weight may make a person predisposed to compression palsies of various peripheral nerves. This is especially common in people who have marginal diets, alcoholic and diabetics.

My advice to you though would be to follow up with you GP. He/ she shall be the best person to guide the workup forward. I hope I have been able to offer you some useful advice.

Personal Regards,

Nitin Sethi, MD

QUESTION

Dear Dr Sethi,

Two months ago I had THR with a spinal block. Upon the spinal wearing off my right foot and leg from the knee down remained numb and I was left with foot drop.

Physical Therapy and a NEMS stimulator are not helping. The pins and needles feeling is lessening but still have tingling in my toes, top of my foot in certain positions. I have to constantly wear an AFO to walk or drive but it is very uncomfortable. The Surgeon thought my foot would come back by now but no improvement. If anything it seems worse.

What could have caused this? I was fine prior to the surgery. Is there any hope of my foot coming back? What can I do? I do not wear a brace at night and have tried Nuerontin to no avail.

Thank you, Lynee

Dear Lynne,
thank you for writing in. Foot drop can occur as a complication of total hip replacement surgery. The cause of the foot drop is usually pressure/ stretching of the fibers of the sciatic nerve. This can occur during the surgery itself or may occur due to the way the hip/limb was positioned during the surgical procedure. If the injury is a simple neurapraxia (pressure on the nerve), the nerve usually recovers fully in due course of time. Since two months have passed since your total hip replacement surgery and your foot drop persists it would be advisable that a nerve conduction study (NCV) be carried out. A good nerve conduction and electomyography (EMG) study shall give useful prognostic information namely to what extent is the nerve damaged and is the nerve regenerating? Also nowdays a high quality MRI scan can actually image the sciatic nerve itself.
The best person to guide you forward shall be your orthopedic surgeon and primary care physician. I wish you my very best.

Personal Regards,

Nitin Sethi, MD

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3 thoughts on “A couple of questions about foot drop and their answers

  1. I am 26 years old, and have just developed foot-drop after an apparent nerve injury. I saw the apparently uncomfortable and / or motion-hindering AFO braces available (at incredible costs) and decided this was a problem I could solve myself for much less than the $700-900 prices I was seeing. It just involves spending about 10 minutes modifying a shoe a bit and I’d be amazed if you could manage to make it cost more than $20 in materials.

    My muscle that lifts the front of my foot is 100% unresponsive, but I have no other injury. For someone with already weakened muscles having more ankle support with a standard AFO might be better, for anyone else though, I’d suggest at least trying out something like this.

    1. same here i have some movement to lift toes but hurts my bak. but like you i dont feel any sacroilliac nerve pain thats supposed to accompany it!

  2. Kind: Attaintion:- Dr Nitin Sethi,

    Dear Sir,

    I am Amit from district Meerut, India, On 13th of april I met in a road accident, and my hips was dislocated, after treatment doctor told me that my nerve got injured, reasult foot drops, nimbness in lower part of leg, and knee/ankle weakness, I am taking the treatment from a Neuro physician, I am taking the pills Met.Neurobeion & multi vitamins..

    But there is no any improvement, I am a working person and facing lot of problems, kindly rely to me what I have to do, and where I can get the proper treatment.

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