Foot drop in gait is a common problem in many neurological conditions. It may present like a foot drag, scuffing of toes, or cause increased trips or falls as there is limited toe and foot clearance, particularly on uneven surfaces. Foot drop can also become more obvious after a period of walking as the muscle fatigues, and it can lead to other compensatory walking patterns. Compensatory patterns include high stepping (lifting more from the hip), hip hitching where the pelvis tilts, increased swinging of leg out to the side as well as slowed speed and distance. Over time, these compensatory walking patterns can lead to other complications such as back pain for example.

One of the most common reasons for foot drop is when muscles that control the ankle weaken. The dorsiflexors (primarily Tibialis Anterior) are located in the anterior, lateral part of your shin, just below the knee. This muscle is responsible for lifting the forefoot up, which is an important action within walking or gait.

During the swing phase of gait, the Tibialis Anterior muscles are switched on in a coordinated manner to pull the forefoot and toes up towards the shin. By doing this, as the foot lands on the ground, a heel strike is achieved with forefoot and toe contact happening a fraction of a second later.

If you notice that you present with some of the gait patterns of a foot drop, it is advisable to have an assessment with a neurological physiotherapist to see what level of support you may require.

In some cases, if you have a milder foot drop, for example one that presents after a period of walking or with fatigue, your therapist may provide an exercise program to strengthen the Tibialis Anterior and muscles responsible for lifting the forefoot and toes off the floor while stretching other muscles of the calf complex to ensure you have adequate ankle range of motion.

They may also explore off the shelf orthotic devises such as Dictus bands, the Saebo Step or a heel wedge to see if an improvement in function can be achieved with a minimally restrictive device.

If the cause of your foot drop is related to spasticity in the antagonist (opposing) muscles of the calf complex, you may also be referred to a neurologist for assessment for Botox therapy consideration as a complementary treatment to exercises.

When the foot drop is caused by a more severe weakness of the Tibialis Anterior, you may be considered for electrical stimulation. Electrical stimulation is a mode of therapy that applies an electrical current directly on the peripheral nerves where it enters the muscle. This enables muscles that receive very little innervation from the central nervous system (brain and the spinal cord) to have an opportunity to strengthen as it acts directly on the muscles.

Regular use of electrical stimulation has demonstrated to increase muscle bulk and strength. When electrical stimulation is used in conjunction with functional training, it is referred to as functional electrical stimulation (FES). For foot drop, FES can be applied to the Tibialis Anterior during swing phase to support the weak muscle and aid foot clearance as part of the Physiotherapy program to improve both the pattern and efficiency of walking.

This technology can also be used in the form of orthotics and some of the examples include Bioness L300Go and the WalkAid. Both of these systems use FES controlled via a sensor to ensure correct timing of the stimulation.  As the foot enters the swing phase of gait, the sensor recognises the change in position and / or weightbearing and stimulates the Tibialis Anterior to switch on and cause the forefoot to lift up. This enables a better clearance of the foot as the leg swings forwards and a more effective ‘heel strike’ as the foot contacts the ground avoiding risk of tripping.

There are also other orthotic devises known as ankle foot orthoses (AFOs) that provide ankle stability and can be used for improving foot clearance for people with more severe dorsiflexor and Tibialis Anterior weakness. The type of AFO will depend on various factors such as the degree of dorsiflexor weakness, strength of other lower limb muscles and presence of spasticity. Customised orthoses are usually best prescribed by orthotists who can take a cast of the foot and leg.

For more information and guidance please contact Advance Rehab Centre on 9906 7777 or artarmon@archealth.com.au