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Examine the lower limbs
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What are the causes of foot drop? Injury to the common peroneal nerve, usually at the level of the fibula, as a result of trauma or compression.L5 root lesion if the inversion of the ankle is also weak. L5 root lesion is usually painful.Sciatic nerve lesion if there is weakness of the toe, plantar flexion and loss of ankle jerk (involvement of the tibial nerve).It could be part of a generalised neurological problem, such as peripheral neuropathy, motor neurone disease (ankle reflex will be brisk with no sensory signs) or cauda equina lesion.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The common peroneal nerve is relatively unprotected as it traverses the lateral aspect of the neck of the fibula and is easily compressed at this site (e.g., by fracture, tight plaster casts, or ganglia). Patients with such an injury present with foot drop, which is usually painless. Examination reveals weakness of ankle dorsiflexion, extensor hallucis longus, and eversion of the foot, but inversion and plantar flexion are normal and the ankle reflex is preserved.
Neuroanatomy overview
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The common peroneal nerve innervates the muscle of dorsiflexion, or extension of the foot. It is most commonly injured by athletic or automobile accidents related to trauma to the lateral aspect of the head of the fibula. Clinically, it is characterized by a foot drop.
Experiences of individuals with multiple sclerosis and stroke using transcutaneous foot drop electrical stimulators: a systematic review and meta-synthesis of qualitative studies
Published in Disability and Rehabilitation, 2023
Felicity Burns, Allyson Calder, Hemakumar Devan
Foot drop is a common clinical feature in people with neurological conditions, such as stroke, multiple sclerosis, and spinal cord injury [1]. The weakness or lack of motor control of the ankle joint dorsiflexor muscles (i.e., foot drop) alters lower limb biomechanics, which is particularly problematic during the swing phase of gait [1]. Spasticity of the antagonist muscle group (i.e., the ankle plantar flexors) can also contribute to foot drop, resulting in further deficits in gait parameters, such as walking speed and endurance [1,2]. Foot drop is also associated with an increase in number of trips and falls impacting on the individual’s safety [1,3]. Hence, effective equipment-based alternatives are trialled and used in clinical practice to counteract these deficits in gait parameters, and to foster independent mobility and safety.
A national survey on the management of foot drop secondary to lumbar degenerative disease in the United Kingdom
Published in British Journal of Neurosurgery, 2022
Fozia Saeed, Piravin Kumar Ramakrishnan, Sashin Ahuja, Debasish Pal
Foot drop is defined as weakness of ankle dorsiflexion with a Medical Research Council (MRC) grade of 3/5 or less.1 The overall incidence of foot drop secondary to lumbar degenerative disease (LDD) is not widely reported in the literature but is said to be approximately 3–5%.2 The proposed mechanism is due to compression of the L5 nerve root from disc herniation, facet cysts, ligament hypertrophy, osteophytes or a combination of these factors.3–8 However, there is also evidence to suggest other nerve roots, such as L4 and S1, may contribute to the innervation of the anterior tibialis muscle which is responsible for the foot drop.9–10 Foot drop often presents as weakness in the dorsiflexion of the foot or great toe associated with leg pain and/or sensory changes in the corresponding dermatomal supply. The disabling nature of this condition and its impact on the affected person can be life changing. It can lead to increased falls and injuries as well as have a socio-economic impact due to inability to work and mental health impairments. It is therefore important to establish a standardised practice of care for these patients in order to achieve the best possible outcomes.
Review of ankle rehabilitation devices for treatment of equinus contracture
Published in Expert Review of Medical Devices, 2022
Kamila Dostalova, Radek Tomasek, Martina Kalova, Miroslav Janura, Jiri Rosicky, Marek Schnitzer, Jiri Demel
Blaya et al. [64] developed SEAs (series elastic actuators – DC motor and a spring) actuated AAFO with variable impedance control. Its advantage lies in its low impedance friction, high force fidelity, good control bandwidth, capability of storing energy and filtering out unwanted collisions, backlash, and torque ripple. The impedance of joint assistance is actively adjusted to minimize the impact load with the ground during the stage of controlled plantarflexion by adjusting the stiffness of the joint. Smooth plantarflexion during the pre-swing phase is ensured by minimizing the joint impedance. The drop foot is controlled by a torsional spring-damper. Sensory control is carried out using a potentiometer, force sensors, and a foot switch. This AAFO weighs 2.6 kg. Clinical tests conducted with two patients with foot drop had shown certain treatment benefits. Zero, constant, and variable impedance control strategies were evaluated for each participant and the results were compared with the mechanics of three normals corresponding to age, weight, and height. Actively setting the joint impedance reduced the incidence of foot slap and the kinematics of the ankle swing phase was more similar to normal compared to the zero and constant impedance control schemes [64].