What is Foot Drop?
Foot drop is a common term used to describe weakness of the ankle and foot most commonly due to a nerve injury. Foot drop makes it difficult to lift your foot and toes during walking, causing your foot to drag or slap on the ground. This can negatively affect your walking, balance and safety.
What Causes of Foot Drop?
Below are the most common causes of foot drop:
Fibular nerve injury at the knee – The fibular (aka peroneal) nerve is a branch of the sciatic nerve that runs on the outer side of the knee and leg. It controls the muscles that lift the foot as well as gives sensation to the top of the foot. The fibular nerve is vulnerable at the outer knee and can get injured with trauma, surgery or certain leg positions.
Sciatic nerve injury at the pelvis or thigh – The sciatic nerve is the major nerve of the leg. It runs from the tailbone, through the buttocks and thigh before it splits into two nerves at the back of the knee. This nerve controls the movement of the foot and ankle as well as gives sensation to the leg. The sciatic nerve can get injured during hip surgery or other trauma to the pelvis or thigh. It can also get compromised with repeated postures that place excessive pressure on the buttock or thigh.
Spinal nerve injury – The L4 and L5 spinal nerves become the sciatic nerve after they exit the spine and tailbone. These nerves control the movement of the foot and ankle as well the movement of the outer hip. These nerves can get compressed by herniated discs, arthritis or spinal stenosis leading to foot drop and sometime weakness of the hip. Spinal surgeries at these levels can also injure these nerves leading to foot drop, pain and numbness.
Other Conditions of the brain and spinal cord can also cause foot drop. A stroke, spinal cord injury or multiple sclerosis can cause weakness of the leg and ankle as well. This is often accompanied by severe muscle tightness (known as spasticity) and other neurological deficits. Rare muscle or nerve disorders such as muscular dystrophy or ALS can also be a very rare cause of foot drop.
Evaluation of Foot Drop is essential to identify the cause of the condition and to plan a proper treatment. A comprehensive physical exam, a nerve study and advanced imaging are often used to form a diagnosis.
Treatment of Foot Drop at Integrative Rehab Medicine:
Foot drop treatment typically involves nerve hydrodissection injections to decompress the nerve and stimulate healing. This is done with natural agents such as Dextrose or Platelet Rich Plasma (PRP). Physical therapy, home exercises, energy modalities and nutritional support are also prescribed.
- Nerve Hydrodissection
- Lumbar epidural injections
- Dextrose 5%
- Platelet Rich Plasma (PRP)
Understanding Foot Drop Treatment
Nerve Hydrodissection is the main technique used when treating foot drop. This is a nonsurgical injection technique used to release inflamed and injured nerves and stimulate healing. With ultrasound guidance, a thin needle is used to carefully inject a healing solution around the nerve, separating it from the surrounding tissues. Nerve hydrodissection quickly resolves nerve inflammation and swelling, allowing the nerve to regain normal function and heal. We use natural solutions to heal the nerves such as Dextrose 5% and Platelet rich plasma (PRP).
Lumbar epidural injections are used when the spinal nerves are involved. Caudal epidural injections can be given through a small opening in the tailbone. This technique allows for large volumes of solution to be injected around many spinal nerves. This can be performed with ultrasound or X-ray guidance. Transforaminal epidural injections can also be used to deliver the healing solution directly to a spinal nerve. This is done with X-ray guidance and allows precise placement of the needle next to the nerve root as it exits the spine.
Dextrose 5% – a type of sugar solution that is diluted in sterile water and used to inject around inflamed nerves. Numerous studies have shown that 5% dextrose injections are effective for many nerve conditions such as carpal tunnel syndrome, ulnar neuropathy, sciatica and cervical radiculopathy. Dextrose 5% can quickly turn off nerve pain and inflammation, reduce nerve swelling, and stimulate nerve healing.
Platelet Rich Plasma (PRP) – a solution of concentrated platelets made by spinning your blood in a centrifuge. When injected around the nerves, platelets release growth factors that initiate the healing process. Animal and human studies have shown that PRP injections can activate helper cells that support nerve health and regeneration, as well as promote growth of myeline (the outer sheath of nerves) and axons (inner fibers). PRP also improves blood supply to nerves, resolves nerve pain and inflammation and stimulates muscle growth.
What Should You Expect in This Non-surgical Foot Drop Treatment?
After a diagnosis is made, Dr. Sebastian will recommend what nerves need to be treated and which solution should be use. Foot drop treatments are well tolerated by most patients and may take anywhere from 20 to 60 minutes. At times, the injections may cause mild discomfort or numbness, but this is temporary and well tolerated. Most patients need a series of treatments that are spaced anywhere from 2 to 6 weeks apart. Physical therapy and nutritional support is used during the healing phase and is necessary for best results. Some patient notice improvement early on, but in some cases, healing and functional changes may take several months.
Doctor Sebastian Klisiewicz is a leading specialist in the treatment of foot drop in Southwest Florida. If you feel you have foot drop and you live in Naples, Bonita Springs, Fort Myers or Cape Coral, we would love for you to set up a consultation with Doctor Sebastian at our Estero Florida orthopedic and pain management clinic.
Discuss your options with Dr. Sebastian and the Integrative Rehab Medicine Team. Watch our treatment and testimonial videos on our YouTube Channel under Dr. Sebastian Klisiewicz. Visit our website for more information and follow us on Facebook.