Footdrop
Footdrop: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Footdrop — plantar flexion of the foot with the toes bent toward the instep — results from weakness or paralysis of the dorsiflexor muscles of the foot and ankle. A characteristic and important sign of certain peripheral nerve or motor neuron disorders, footdrop may also stem from prolonged immobility when inadequate support, improper positioning, or infrequent passive exercise produces shortening of the Achilles tendon. Unilateral footdrop can result from compression of the common peroneal nerve against the head of the fibula.
Footdrop can range in severity from slight to complete, depending on the extent of muscle weakness or paralysis. It develops slowly in progressive muscle degeneration or suddenly in spinal cord injury.
History
Ask the patient about the sign’s onset, duration, and character. Does the footdrop fluctuate in severity or remain constant? Does it worsen with fatigue or improve with rest? Ask the patient if he feels weak or tires easily.
Physical assessment
During the physical examination, assess muscle tone and strength in the patient’s feet and legs, and compare findings on both sides. Assess deep tendon reflexes (DTRs) in both legs as well. Have the patient walk; inspect his shoes for wear and observe the patient for steppage gait — a compensatory response to footdrop in which the legs are raised abnormally high.
Medical causes
Guillain-Barré syndrome
Unilateral or bilateral footdrop and steppage gait may result from profound muscle weakness caused by Guillain-Barré syndrome. This weakness usually begins in the legs and extends to the arms and face within 72 hours. It can progress to total motor paralysis with respiratory failure. The patient may also develop transient paresthesia, hypoactive DTRs, hypernasality, dysphagia, diaphoresis, tachycardia, orthostatic hypotension, and incontinence.
Herniated lumbar disk
In a patient with a herniated lumbar disk, footdrop and steppage gait may result from leg muscle weakness and atrophy. However, the most pronounced symptom is severe low back pain that may radiate to the buttocks, legs, and feet, usually unilaterally. Sciatic pain follows, typically with muscle spasms and sensorimotor loss. Paresthesia, hypoactive DTRs, and fasciculations may occur.
Multiple sclerosis
With multiple sclerosis, footdrop may develop suddenly or slowly, producing steppage gait; it typically fluctuates in severity with this disorder’s cycle of periodic exacerbation and remission. Muscle weakness, usually affecting the legs, ranges from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, visual disturbances, paresthesia, lack of coordination, and loss of vibration and position sensation in the ankle and toes.
Myasthenia gravis
Footdrop and related limb weakness are common manifestations of myasthenia gravis, which is commonly heralded by weak eye closure, ptosis, and diplopia. Skeletal muscle weakness and fatigability may progress to paralysis. Typically, muscle function worsens through the day and with exercise, and improves with rest. Involvement of respiratory muscles can cause breathing difficulty.
Peroneal muscle atrophy
Bilateral footdrop, ankle instability, and steppage gait occur early with this chronic disorder. Foot, peroneal, and ankle dorsiflexor muscles are affected first. Other early signs and symptoms include paresthesia, aching, and cramping in the feet and legs, along with coldness, swelling, and cyanosis. As the disease progresses, all leg muscles become weak and atrophic, with hypoactive or absent DTRs. Later, atrophy and sensory losses spread to the hands and forearms.
Peroneal nerve trauma
With peroneal nerve trauma, footdrop may occur suddenly, but it’s usually temporary, resolving with the release of peroneal nerve compression. It’s associated with ipsilateral steppage gait, muscle weakness, and sensory loss over the lateral surface of the calf and foot.
Polyneuropathy
With polyneuropathy, footdrop and steppage gait may accompany muscle weakness, which usually affects distal areas of the extremities and can progress to flaccid paralysis. Muscle atrophy and hypoactive or absent DTRs may occur, along with paresthesia, hyperesthesia, or anesthesia, and loss of vibration sensation in the hands and feet. Cutaneous manifestations include glossy red skin and anhidrosis.
Spinal cord trauma
Unilateral or bilateral footdrop can occur suddenly and may be permanent in patients with spinal cord trauma. In the ambulatory patient, it also produces steppage gait. Other findings vary and may include neck and back pain; paresthesia, sensory loss, and muscle weakness, atrophy, or paralysis distal to the injury; asymmetrical or absent DTRs; and fecal and urinary incontinence.
Stroke
Unilateral footdrop is a common sign of stroke, along with arm and leg weakness or paralysis. Other effects vary according to the site and severity of vascular damage. Sensorimotor disturbances may include paresthesia, dysphagia, visual field deficits, diplopia, and bowel and bladder dysfunction. Personality changes, amnesia, aphasia, dysarthria, and decreased level of consciousness may also occur.
Special considerations
Prepare the patient for electromyography to evaluate nerve function. The patient may require physical therapy for gait retraining and possibly in-shoe splints or leg braces to maintain correct foot alignment for walking and standing.
Pediatric pointers
Common causes of footdrop in children include spinal birth defects (such as spina bifida) and degenerative disorders (such as muscular dystrophy). To aid ambulation, the child should be fitted with supportive shoes and possibly in-shoe splints or braces.
Patient counseling
Instruct the patient in the use of assistive devices such as canes, crutches, or walkers, as necessary. Review the importance of asking for assistance with activities to prevent falls and promote safety. Include the patient’s family in this teaching.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Foot conditions
More Medical Textbooks Online about Foot conditions
Review other book chapters online related to Foot conditions:
Medical Books Excerpts
- Clubfoot
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Footdrop
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Footdrop
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: EXTREMITY, HAND, AND FOOT DEFORMITIES (Differential Diagnosis in Primary Care)
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