22/06/2024
⚠️Foot Drop Exercises
Foot drop is a general term for a condition resulting in difficulty lifting the front part of the foot and toes. It often results in difficulty walking, as the individual is at higher risk of falls if the foot drags or the toes get caught on the ground. Fortunately, there are ways to regain strength and mobility in the foot — and one of the best methods includes foot drop exercises.
Exercises for foot drop are designed to help strengthen the lower limb muscles to improve the ability to lift the foot up again. Exercise also helps stimulate and rewire the brain, which makes it an effective way to overcome foot drop after a stroke or brain injury.
🔴Anatomy
The common peroneal nerve is the smaller and terminal branch of the sciatic nerve which is composed of the posterior divisions of L4, 5, S1, 2. The nerve can be palpated behind the head of the fibula and as it winds around the neck of the fibula.
Commonly, with damage to the common peroneal nerve, there will be weakness of tibialis anterior and other key dorsiflexors of the foot.
🔴Causes
Foot drop has several possible causes, typically due to an issue with your nerves and/or muscles. The most common causes are lumbar radiculopathy and peroneal nerve injury.
Other causes include:
▶️Brain conditions.
▶️Motor neuron conditions.
▶️Peripheral neuropathies.
▶️Muscle conditions.
✳️Lumbar radiculopathy
Radiculopathy happens when one of your nerve roots (where your nerves join your spinal column) is compressed or irritated.
Lumbar radiculopathy refers to a pinched nerve in your low back. Nerves that start in this area of your back extend down to your legs and feet. Your lumbar spine consists of the five bones (vertebra) in your lower back, labeled L1 to L5.
L5 radiculopathy specifically is a common cause of foot drop.
Radiculopathy usually happens due to narrowing of the space where your nerve roots exit your spine. This can be from:
▶️Spinal stenosis.
▶️Bone spurs.
▶️Herniated disk.
▶️Lumbar spondylosis.
✳️Peroneal nerve injury
Your common peroneal nerve is a peripheral nerve that extends down your leg. It’s a branch of the sciatic nerve that travels from the back of your thigh along the outside of your knee to the front of your lower leg. It supplies movement and sensation to your lower legs, feet and toes.
Several things can damage your common peroneal nerve and cause foot drop. Often, peroneal nerve injuries develop because of a traumatic injury to your knee, leg or ankle. These injuries include:
▶️Ankle fracture.
▶️Fibula fracture.
▶️Knee dislocation.
▶️Knee fracture.
✳️Injuries to your sciatic nerve in your buttock or back of your thigh can also cause a foot drop.
Your risk of peroneal nerve damage increases if you:
▶️Often sit with your legs crossed at your knee.
▶️Have your leg in a cast.
▶️Are on bed rest.
▶️Have lost weight.
✳️Sometimes, a tumor or cyst in your peroneal nerve can cause a foot drop. Inflammatory conditions, such as rheumatoid arthritis or lupus, can also damage your peroneal nerve.
Your peroneal nerve is a peripheral nerve (nerves outside your brain and spinal cord). Any condition that affects peripheral nerves, such as Charcot-Marie-Tooth disease or acquired peripheral neuropathy, can affect your peroneal nerve and cause foot drop.
🔴Other causes of foot drop
Brain conditions that can cause foot drop include:
▶️Multiple sclerosis (MS).
▶️Stroke.
▶️Cerebral palsy.
▶️Parkinson’s disease.
Motor neuron disorders that can cause foot drop include:
▶️Polio.
▶️Spinal muscular atrophy.
▶️Amyotrophic lateral sclerosis (commonly known as Lou Gehrig’s disease).
Less commonly, muscle conditions, such as muscular dystrophy or myositis, can also lead to foot drop.
🔴Symptoms
The most common symptom of foot drop is difficulty raising the front part of your foot. This can make it difficult to walk on your toes. Other symptoms of foot drop may include:
▶️Difficulty moving your ankle.
▶️Difficulty bending your knee.
▶️Dragging your toe when you walk.
▶️A high steppage gait (a way of walking where you lift your leg high to clear your foot).
▶️Pain in your leg, hip, or back.
▶️Muscle weakness in your leg.
▶️Numbness in your leg.
▶️Tingling in your leg.
🔴How Does Physical Therapy Help Foot Drop?
Foot drop (also called drop foot) is a condition that impairs your ability to lift the top part of your foot (and our toe area) up toward your shin. This movement is known as dorsiflexion, and it’s important for walking properly and maintaining balance.
To move your muscles, the brain must send signals that tell your muscles when to contract and relax. When a brain injury or stroke affects the areas of the brain that sends these signals, it can lead to foot drop. However, foot drop can also occur due to damage to the muscles or nerves in the lower leg that directly perform dorsiflexion, or the nerve roots originating from the lumbar spine (specifically L4 and L5).
Foot drop exercises help strengthen the muscles in the area and rewire the brain to improve your brain’s ability to send the correct signals to move your foot. This rewiring process is known as neuroplasticity, and it’s key to foot drop recovery.
Consistent practice of therapeutic exercises and movement retraining provides the brain with the stimulation it needs to relearn the skill of dorsiflexion.
Now that you know why exercises for foot drop are important, let’s start exercising.
1. Ankle Dorsiflexion
2. Ankle Adduction/Abduction
3. Assisted Toe Raises
4. Toe Raise “Negatives”
5. Heel Raises
6. Ankle Eversion
7. Ankle Inversion
8. Single Leg Stance
9. Hip External and Internal Rotation
10. Hip Rotation Slides
These last two foot drop exercises target the legs, which can be helpful for patients with severe foot drop when it’s coupled with other lower limb impairments.
🔴Ankle Foot Orthotics
Ankle foot orthotics offer support to the foot so that it doesn’t drag on the floor, which helps reduce the risk of tripping and falling. Foot drop braces are notorious for having low compliance rates, though, because they can be uncomfortable. But if your therapist suggests wearing an AFO, you need to wear one to prevent the risk of falling and fracturing a hip, or worse.
Also, be aware that when the foot and lower leg muscles are neglected, you run the risk of worsening the weakness and foot drop condition (“use it or lose it”). To prevent foot drop from worsening, the use of an AFO should always be accompanied with gait training and consistent foot drop exercises to encourage recovery and keep the brain stimulated.
🔴Surgery
If foot drop has not improved after consistent, long-term rehabilitation, nerve transfers can be considered. This surgery works by taking donor “redundant nerves” from other parts of the body and transferring them to the affected area.
Surgery is an invasive treatment that should be a last resort. Usually, doctors recommend surgery if foot drop has not improved after 6-12 months of consistent rehabilitation. Following nerve transfers, it can take anywhere from a few months to years of additional rehabilitation to retrain the motor function, but results have been promising in this relatively novel intervention.
🔴Stimulate the Brain with Foot Drop Exercises
The first line of defense against foot drop is rehab exercise. Regular, consistent practice helps rewire the brain and improve mobility in the foot and lower extremities.
By combining exercises for foot drop with other techniques, like electrical stimulation, gait and balance retraining, patients can boost recovery further. When foot drop is severe, patients can start with passive exercise and work their way up from there and may consider an AFO or even surgery if the condition is not improving.
✨We hope this guide has helped you understand your options for overcoming foot drop.
