Misunderstanding of foot drop in a patient with charcot-marie-tooth disease and lumbar disk herniation

Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques

Foot drop represents a complex pathologic condition, requiring a multidisciplinary approach for appropriate evaluation and treatment. Multiple etiologic factors require recognition before considering invasive/operative intervention. When considering surgical management for the treatment of foot drop, it is first and foremost imperative to establish the cause of the condition. Not all causes resulting in clinical foot drop have surgical options. Establishing a cause allows the provider to more appropriately curtail a multidisciplinary approach to working-up, and ultimately, treating the patient. The authors offer an algorithm for evaluating and treating foot drop conditions associated with lumbar spine radiculopathy and peripheral nerve lesions.

Mechanisms of compensation in the gait of patients with drop foot

BACKGROUND

Drop foot is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, but identifying compensation mechanisms remains challenging.

METHODS

In order to identify compensatory mechanisms in patients with drop foot, this study evaluated a sample of 15 such patients using a computerized gait analysis system, as compared to a group of 15 healthy subjects.

FINDINGS

Four classes of parameters were distinguished, falling in differing intervals of percentage differences between the groups in the study. The first class comprised two kinematic parameters for which the values of percentage differences in the control group were more than 100% greater than for the patient group. The second class comprised two kinetic parameters falling in the interval of 100-49%. In the third class, in the 49-20% interval the main differences were observed for spatiotemporal parameters, whereas in the 20-4% interval the differences were distributed similarly for kinematic, kinetic and spatiotemporal parameters.

INTERPRETATION

These differences in gait pattern between the groups may be related to both primary motor deficits and secondary compensatory mechanisms. Generally, we conclude that drop foot affects the patients' overall kinematic and kinetic gait parameters, with compensation seen as a chain originating from a change of movement within the ankle joint.