Dr. Ebraheim’s educational animated video describes the condition known as foot.drop , which occurs due to Peroneal nerve injury . Causes and treatment of Peroneal nerve injury is outlined .
What is foot drop?
The inability to raise the front part of the foot due to weakness or paralysis of the tibialis anterior muscle that lifts the foot.
A common symptom of foot drop is high steppage gait often characterized by raising the thigh up in an exaggerated fashion while walking.
When the person with foot drop walks, the foot slaps down onto the floor.
Foot drop usually results from injury to the peroneal nerve which is susceptible to injury at any point of its course.
The peroneal nerve begins from the L4,L5, S1 and S2 nerve roots and joins the tibial nerve to form the sciatic nerve.
The sciatic nerve starts n the lower back and runs through the buttock and lower limb.
In the lower thigh, just above the back of the knee, the sciatic nerve divides into two nerve, the tibial and peroneal nerves, which innervate different parts of the lower leg.
The common peroneal nerve then ravels anterior, around the fibular neck, dividing into superficial and deep peroneal nerves.
The deep peroneal nerve gives innervation to the tibialis anterior muscle of the lower leg which is responsible for dorsiflexion of the ankle.
Conditions causing foot drop:
1-L4-L5 disc herniation
A herniated disc compressing the L5 nerve root may cause foot drop.
2-Lumbosacral plexus injury due to pelvic fracture
3-Sciatic nerve injury: hip dislocation
The common peroneal division of the sciatic nerve is commonly injured during fracture dislocation injuries involving the hip.
4-Injury to the knee: kee dislocation
In the event of a knee dislocation, it is important to check for common peroneal nerve and popliteal artery injury.
5-Established compartment syndrome
•Foot drop is a late finding
•Irreversible muscle and nerve ischemia occur in patients if fasciotomy is not performed.
•Fasciotomy should be done early.
•4 hours of ischemia may be tolerated, but by 8 hours, the damage is often irreversible.
Treatment of peroneal nerve injury/foot drop:
•If a disc herniation in the low back is impinging on the nerve and causing symptoms of foot drop, then the herniated disc should be treated or removed.
•Obtain EMG and nerve studies of the patient.
•Recovery may take 1 year to 18 months.
•The big toe is the last to recover.
•If no recovery is achieved, explore the nerve for repair, graft or tendon transfer.
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