Foot Drop: The causes and anatomy

Do you or someone you know suffer from foot drop? Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to afoot drop nerve, or paralysis of the muscle/s in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself.

The most common cause of foot drop is injury to the peroneal nerve as it passes around the outside of the knee. The peroneal nerve is a branch of the sciatic nerve that wraps from the back of the knee to the front of the shin and travels down into your foot. Because it sits very close to the surface near your knee, it may be damaged easily. This can be caused by prolonged compression of the nerve while sitting cross-legged or having your leg leaning against something, a sports or impact injury to the knee or lower leg, knee or hip replacement surgery.

Nerves are part of the “electrical wiring” system that carries messages between the brain and the rest of the body. Motor nerves carry messages between the brain and muscles to make the body move. Sensory nerves carry messages between the brain and different parts of the body to signal pain, pressure, and temperature. And most nerves, such as your peroneal, have both sensory and motor components.

Pressure or stretching injuries can cause fibers within the nerve to break. This may interfere with the nerve’s ability to send or receive signals, without damaging the insulating cover, similar to a wire you find in your home or electronic devices. However, nerves can heal, and with time, this injury is likely to fully heal and you can likely make a complete recovery.

When a nerve is cut, both the nerve and the insulation are severed. The end of the fiber farthest from the brain dies., but the end that is closest to the brain does not die and after some time, may begin to heal by developing finger-like sprouts that begins to look for its partner end. If those sprouts reach the other end, your function and/or sensation will be restored. If not, surgery may or may not work to repair the damaged nerve.

a1Compression of the peroneal nerve can lead to pain, numbness, and/or weakness to the foot, ankle, or outer portion of your lower leg. Once a nerve is injured the symptoms will typically occur below the site of injury and can last minutes or hours, or with a more severe injury, it can cause months or a lifetime of disability.

The common personal also has multiple branches that vary in function. Some branches just innervate our skin and so compression or injury to this portion may only cause numbness or a tingling sensation to our lower leg or foot. And then other branches support our muscles of the lower leg and foot, most notable being the anterior tibialis muscle that controls your ability to lift your foot off the ground.

The tibialis anterior muscle runs along the front to outside portion of your lower leg. It begins just below the outside of your knee, and inserts into your foot, just below the front of the ankle. The most important function of this muscle is to lift the foot during gait so you do not drag your toes on the ground, which can be a fall hazard. It also controls your foot as you strike the ground with your heal during walking, allowing your foot to slowly lower to the ground giving you more stability, and preventing the notorious foot slap that is associated with foot drop. When this happens, likely an AFO will be prescribed to improve that ankle stability and prevent tripping over your toes.

So there you have it. That is the basic anatomy and physiology of foot drop. If you think you may suffer from this condition, or just want to learn more about it. Stop by and see me or another one of our physical therapists today!

Michael Phillip, PT

Physical Therapist – South Office

Back Pain Prevention

Chronic low back painIf you suffer from lower back pain you are not alone. As someone who has suffered three episodes of intense LBP within the past ten years, I am among the millions of people who suffer from this condition. It is the number one reason to visit your doctor or miss work, and if you have never experienced LBP you are a in a significant minority. Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it difficult to move. It can start quickly if you fall or lift something too heavy, or it can get worse slowly. Discs that sit between the vertebrae of the spine can rupture or break down. Muscles can strain or tear.

We use our back all day, throughout the day, and it can suffer extraordinary forces through our frequent bad habits while lifting, carrying heavy things, or even during sitting. Even if we think we are using the best posture and mechanics, we still can be setting ourselves up literally for a rude awakening.

So here are the best 8 ways to prevent LBP:

  1. Always warm up before exercise or other strenuous physical activity, including work activities that involve lifting or bending.
  2. Don’t slouch or lean forward when standing or sitting. Your back supports your weight the best when it is in its natural alignment.
  3. At home or work, sit in a chair with good lumbar support and proper position and height for the task.
  4. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support while sitting at your desk or even for long commutes. (Tip: Roll up a medium sized towel and wrap plastic wrap around it several times to hold it together. It will last longer and can work just as good as a $50 lumbar roll! I have one in my car!)
  5. Wear comfortable, low-heeled shoes if you need to be on your feet for extended periods.
  6. Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach strain2a-BBmuscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. And ask for help when transferring heavy or odd shaped items.
  7. Limit excessive body weight around the abdomen. Maintain a diet with sufficient daily intake of calcium, phosphorus, and vitamin D, which will help to promote new bone growth.
  8. And last but definitely not least, if you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate at a faster rate.

Recurring back pain is often preventable and can often times become worse if we do not take care of our backs once an initial injury has occurred. If you have suffered a lower back injury, you need to take immediate actions to correct the reason you developed LBP in the first place and take proactive measures to eliminate these factors from occurring in the future.

Your best bet of preventing LBP from becoming chronic or recurring is to visit a physical therapist. Physical therapists are highly trained professionals who are experts in the musculoskeletal system. They can show you things such as weakness in your core muscles you didn’t think you had, faults in your lifting mechanics or posture, and even how the way you run or exercise can cause trips to the ER and years of pain.

Even if you do not have current LBP, I think you would agree that taking the time out of your day now is better than experiencing the symptoms in the future.

Remember:

“An ounce of prevention is worth a pound of cure.”  – Benjamin Franklin

Michael Phillip, PT

Physical Therapists – South Office