2. Foot drop
-
Upload
sunil-kumar-daha -
Category
Health & Medicine
-
view
61 -
download
5
Transcript of 2. Foot drop
![Page 1: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/1.jpg)
FOOT DROP
PRESENTED BY:Sunil Kumar Daha
![Page 2: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/2.jpg)
![Page 3: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/3.jpg)
Introduction
• Inability of the dorsiflexion foot weakness or paralysis of the muscles that lift the foot
• A symptom
• Can result if there is injury to • the dorsiflexors or • any point along the neural pathways that supply them
![Page 4: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/4.jpg)
Muscles of Anterior Compartment of Leg
• Dorsiflexors of foot at ankle:Tibialis anteriorExtensor digitorum longusExtensor hallucis longusFibularis tertius
• Innervation to all these musclesDeep peroneal nerve
![Page 5: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/5.jpg)
![Page 6: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/6.jpg)
Sciatic nerve: Origin L4 to S3
![Page 7: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/7.jpg)
Contd…• Sciatic nerve leaves the
pelvic cavity at the greater sciatic foramen, just inferior to the piriformis muscle.
• At distal third or mid-thigh level,
it bifurcates to :Tibial nerveCommon peroneal nerve
![Page 8: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/8.jpg)
Peroneal nerve in Popliteal fossa
• Runs downward through popliteal fossa following medial border of biceps
femoris muscle
• Leaves fossa by crossing superficially, the lateral head of gastrocnemius muscle
![Page 9: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/9.jpg)
In the leg
• Passes behind the head of fibula and winds laterally
around neck of bone
• Pierce peronous longus muscle and divides into:
Superficial peroneal nerveDeep peroneal nerve
![Page 10: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/10.jpg)
![Page 11: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/11.jpg)
Common and superficial peroneal nerves, branches, and cutaneous innervation
![Page 12: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/12.jpg)
Deep peroneal nerve, branches, and cutaneous innervation
![Page 13: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/13.jpg)
![Page 14: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/14.jpg)
CentralBrain
Ex- Multiple Sclerosis
Spinal CordEx- Disc prolapse
Peripheral
NerveEx- Common peroneal nerve injury
MuscleEx- Muscle atrophy
Causes
![Page 15: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/15.jpg)
• L4-L5 disc herniation, spinal stenosis• Lumbosacral Plexus injury
Due to pelvic fracture
• Sciatic nerve injuryHip dislocation
• Injury to the kneeKnee dislocation
Motor neuron disorderPolio and amyotrophic lateral sclerosis
Neurodegenerative disorder of the brainMultiple sclerosis, stroke, cerebral palsy
Causes
![Page 16: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/16.jpg)
• External compression– During anesthesia, coma, sleep, bed rest– Plaster cast, braces– Habitual leg crossing– Sitting cross legged– Prolonged squating, kneeling
Direct trauma– Blunt injuries, lacerations– Fracture of fibula– Adduction injuries and dislocations of knee– Surgery and arthroscopy in popliteal fossa and knee
Causes
![Page 17: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/17.jpg)
• Traction injuries– Acute ankle injuries
• Masses – Ganglia, Baker’s cyst, callus, fibular tumors, osteoma, hematomas
Tumors– Nerve sheath tumors– Nerve sheath ganglia– Lipomas
Entrapment – In the fibular tunnel– Anterior (tibial) compartment syndrome
Causes
![Page 18: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/18.jpg)
• Vascular– Vasculitis, local vascular disease
• DM: susceptibility to compression, ischemic damage• Leprosy• Idiopathic
Causes
![Page 19: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/19.jpg)
Presentation
• Direct injury to dorsiflexors
• Compartment syndromes
• Anterior compartment syndrome – Nerve involved: deep peroneal nerve
• Deep posterior compartment syndrome– Nerve involved: posterior tibial nerve
• Chronic compartment syndrome
• Neurologic defects
![Page 20: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/20.jpg)
Clinical Features• Inability to point toes toward the body
(dorsi flexion)
• Tingling, numbness & slight pain in the foot
• Loss of function of foot
• High-stepping gait (called Steppage gait or Foot Drop Gait)
• An exaggerated, swinging hip motion
![Page 21: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/21.jpg)
Diagnosis• History • Clinical exam, including neurological exams• Electromyogram• Nerve conduction test• Imaging studies, such as X-rays or high-
resolution MRI (magnetic resonance imaging)
![Page 22: 2. Foot drop](https://reader033.fdocuments.us/reader033/viewer/2022061520/58f9b129760da3da068bbdfd/html5/thumbnails/22.jpg)
Treatment• Non-surgical
Orthotics, including braces or foot splint
Physicotherapy including gait training
• Surgical therapyDecompression surgeryNerve suturesNerve graftingNerve transfer Tendon transfer
The End