FOOT DROP (also known as drop foot)
Foot Drop or “drop foot “is a condition where a person has difficulty lifting the front part of the foot. If you have foot drop, you will tend to drag your toes across the ground during walking. You may compensate for this problem by lifting your knee higher. In mild cases of foot drop, you will hear and feel your foot “slap” on the ground during walking
Foot drop is a sign of an underlying problem with nerves or muscles and can be the first indication of a serious medical problem. When foot drop is discovered, medical evaluation is recommended immediately to determine the underlying cause. Foot drop or drop foot can be very effectively treated with the Richie Brace®.
Causes of Foot drop or drop foot:
1. Nerve injuries
The muscles which lift the front part of the foot to clear the ground during walking are located on the front of the lower leg. These muscles receive stimulation from the common peroneal nerve which runs down the back of the thigh as part of the sciatic nerve.
The common peroneal nerve and the sciatic nerve can be injured from:
hip replacement surgery
Sitting for prolonged periods with your legs crossed
squatting for prolonged periods
2. Spine, Brain and peripheral nerve disorders
Nerve input to the muscles of the leg is often controlled at higher levels of the spinal cord and brain. Diseases or injuries of the brain or spinal cord can cause mild or severe forms of foot drop.
• In the spinal cord, pressure from a herniated disc can cause foot drop and often can be accompanied by numbness on the front or side of the leg. The foot drop can be subtle, often noticed by the patient hearing their foot “slap” on the ground during walking.
• A stroke can cause damage to certain parts of the brain which controls the muscles of the leg. Foot drop can sometimes be the first evidence that a patient has suffered a stroke.
• Traumatic brain injuries can cause foot drop. Cerebral palsy, another form of brain injury commonly causes foot drop. Often the foot drop is due to severe spasticity of the calf muscles.
• Multiple sclerosis is a disease of the nerve cells in the brain and spinal cord. This disease can cause muscle weakness and fatigue which can show up as a foot drop condition during walking.
• Charcot-Marie-Tooth disease is a hereditary disorder which damages the nerves in the arms and legs. Patients with this disease often develop foot drop along with high arches and numbness in the feet.
• Peripheral neuropathy is a general term describing disease of the nerves primarily in the lower legs and feet. Diabetes is a common cause of peripheral neuropathy. Muscle weakness from peripheral neuropathy can cause foot drop.
3. Muscle diseases
Less common, diseases of muscles can cause overall weakness of the legs. Depending on severity of the disease, and the affected muscle groups, foot drop may become a dominant problem during walking. Muscle diseases include muscular dystrophy, polio and amyotrophic lateral sclerosis (ALS).
Treatment of Foot Drop
Treatment is often focused on the underlying cause of foot drop. Physical impingement on nerves can often be treated successfully with physical therapy and sometimes surgery. Nerves can often recover from temporary injury. Severed nerves or diseased nerves often never recover.
Whether the condition is expected to be temporary or permanent, patients with foot drop are often prescribed ankle braces or ankle-foot orthoses (AFO braces) to improve stability in gait and prevent trips and falls.
Braces used for Foot Drop
In the early treatment of foot drop, patients are usually prescribed a pre-fabricated or off-the-shelf type of brace to support their foot during walking. These types of devices are preferred because they are less expensive than custom braces and can be fitted and dispensed immediately to the patient in the hospital or clinic setting.
Pre-fabricated foot drop braces can take the form of plastic ankle-foot orthotic (AFO) shell braces which cover the bottom of the foot and extend up the back of the leg to just above the top of the calf muscle. Depending on the shape of the device, a “leaf spring” effect can be achieved as the device bends during walking and provides recoil of the brace to aid in push off.
Another popular pre-fabricated foot drop brace is a carbon fiber device which eliminates the bulky plastic on the back of the leg and instead uses a single strut which connects the foot plate to the upper part of the leg. These braces also can provide energy return to the foot and leg during walking.
Custom ankle-foot orthoses are used when long term treatment is anticipated, when there is significant deformity or when specialized hinges are needed to control the ankle joint. These braces are almost always made of plastic and required custom fitting from a cast taken of the patient’s foot and leg.
The Richie Brace: A significant improvement for AFO treatment of Foot Drop
There are three common complaints about custom ankle-foot orthotics used to treat foot drop:
- The braces are traditionally designed to cover the back of the lower leg all the way up to the knee joint.
- The braces are made of thick plastic which bulky and take up significant room inside the shoe.
- The thick plastic braces get hot and trap moisture against the leg.
- Regardless of the severity of drop foot, the braces are often prescribed with a generic solid shell design without flexion joints. A stiff, restrictive gait results which increases the risk of falling. Driving an automobile with a solid AFO brace is impossible, if not un-safe.
The solution: A custom drop foot brace which is light and flexible like a sports brace.
The Richie Brace was originally designed for athletes to treat ankle sprains and ankle instability. Doctors quickly learned that the Richie Brace was a superb foot drop brace with considerable advantages over thick solid plastic AFO braces.
The basic design of all Richie Braces includes:
- Thin, lightweight plastic with no coverage in back of the ankle: thus, no compromise of shoe fit
- Custom molded foot plate for optimal support of the foot
- Foot orthotic correction of deformity when the foot rolls inward (pronation) or outward (supination).
- Single strap closure for easy application and removal
- Sport stirrup brace design: no need to cover the entire leg
Two Richie Brace models have been specifically designed for treatment of foot drop:
This brace incorporates all of the unique Richie Brace® features and also includes a two Tamarack® flexural ankle joints which provide a spring-like effect to lift the front of the foot during walking. The result is a lifting action to control foot drop during the swing phase, but an unrestricted motion of the foot when on the ground. Walking can be restored to near-normal and driving an automobile is no longer a restriction.
There are specific patient requirements for suitability for use of the Richie Dynamic Assist Brace®:
- Patient must have a stable knee-no wobble or rocking of knee during walking
- Patient must have good range of motion of their ankle joint
- Patient cannot have spasticity of their calf muscle
In use for over 15 years, thousands of foot drop patients have traded their bulky solid AFO braces in favor of the Richie Dynamic Assist Brace®. Many of these patients have returned to sports including tennis and jogging. One patient with severe dropfoot was able to hike the entire 500 mile segment of the Camino Frances route of the Camino Santiago de Compostela Pilgrimage. (See Testimonial)
This brace incorporates all the unique Richie Brace® features and also includes a double rivet ankle joint system which restricts ankle motion to under five degrees. The result is control of foot drop, while allowing more ankle flexion than a solid AFO brace.
The Richie Brace-Restricted Hinge would be indicated for patients who do not meet criteria for the Richie Dynamic Assist brace, most notably those with reduced range of motion of their ankle joint or those with muscular spasticity.
For before and after videos of foot drop patients, click here
For testimonials, click here