Drop-Foot and Foot-Drop What It Is, Causation and Innovative Rehabilitation at NeuLife Rehab

General Description and Presentation

Drop-foot and foot-drop are alternate names for the same condition. For our purposes, we will use the term drop-foot.

Drop-foot is a gait disorder that affects how an individual walks. The term, “gait” refers to how one steps, walks or runs. Specifically, drop-foot refers to how one manipulates the front part of the foot while ambulating. The part of the foot involved is usually called the forefoot.

Foot-drop is medically defined as a weak anterior tibialis muscle and is usually caused by lower motor neuron disease¹. The condition manifests itself by an impaired ability to raise the toes or the entire foot from the ankle level. One sign of it is the inability to point the toes toward the body, which is called dorsiflexion.

Because the individual may be unable to fully raise the front part of his or her foot he or she drags it. To compensate for the dragging, he or she may try to lift the affected foot by raising the thigh to enable the foot to clear the floor, however, doing so can result in a characteristic slapping of the affected foot on the floor because it lands from a higher position than normal. The condition is often also typified by the affected leg being slightly bent at the knee to prevent the foot from dragging.

The condition may be permanent or temporary, and it may be unilateral or bilateral. The characteristics and extent depend in part upon the degree of the weakness or paralysis that attend it. Whatever its variant, proper and timely acute and post-acute rehabilitation may determine the difference between disability and independence. The post-acute, specialized rehabilitation such as that rendered by NeuLife Rehab in Mount Dora, Florida consist of innovative, clinically relevant services that nurture the whole person to health and to independence to the fullest degree that his or her physical and mental abilities allow.

Causation

Foot-drop is the direct result of weakness or paralysis of muscles that control the movement of the foot. It is a neurologic condition, but an initial trauma that caused it may have been neurologic, orthopedic or of some other kind. It may also result from a disease process. Some of the causes include:

• Radiculopathy in the lumbar spine (specifically, L4-L5), caused by either a herniated nucleus pulposus or foraminal stenosis, and peroneal peripheral neuropathy.
• Axonal or demyelinating damage along the whole peripheral nervous system: conus medullaris, cauda equina, nerve plexus, and peripheral mixed nerve. .
• Central nervous system pathology 
• Nerve root injury, which can be the consequence of a spinal cord injury (SCI). In the vernacular, a nerve root injury is sometimes called a “pinched nerve”.
• Traumatic brain injury (TBI) or mild brain injury (MBI) may cause drop-foot. This is especially true if the TBI or MBI occurs to the motor cortex of the brain. The motor cortex is located to the rear of the frontal lobe. It is located in front of a furrow that separates the frontal lobe from the parietal lobe. In order to effect goal-directed movements, the motor cortex must get information from other areas of the brain. The information includes about the body’s position in space, (from the parietal lobe), about the goal to be attained and the strategy to attain it (from the anterior part of the frontal lobe), about memories of prior strategies used (from the temporal lobe), and others.

Rehabilitation

When surgical or neurological recovery are not options for the correction of drop-foot, an individual needs other modalities of innovative post-acute rehabilitation. NeuLife Rehab in Mount Dora, Florida furnishes innovative therapies for individuals with drop-foot. Among the therapy is the use of an ankle-foot orthosis. The purpose of an ankle-foot orthosis is to provide toe dorsiflexion during the swing plase of stepping, medial or lateral stability of the ankle during stance, and if needed, pushoff stimulation during the late stance phase².

Another approach to post-acute rehabilitation for drop-foot is through the use of peroneal nerve stimulation. This is usually used when the cause of the condition is hemiplegia. This therapy, when appropriate, may have an advantage over the use of an ankle-foot orthosis by providing an active gait correction and can be tailored to the individual. An electrical impulse to the peroneal nerve can be controlled by a switch in the heel of the affected limb. The switch is activated when the foot is lifted and stops when the foot contacts the ground. This achieves dorsiflexion and eversion during the swing phase of gait. Peroneal nerve stimulation has potential advantages over an AFO in that it provides active gait correction and can be tailored to individual patients. A short burst of electrical stimulation is applied to the common peroneal nerve between the popliteal fossa and the fibular head. This burst is controlled by a switch in the heel of the affected limb. The stimulator is activated when the foot is lifted and stopped when the foot contacts the ground. This achieves dorsiflexion and eversion during the swing phase of gait³. Eversion is the movement of the sole of the foot away from the center line of the body.

When an individual becomes a Client of NeuLife Rehab in Mount Dora, Florida, he or she undergoes an independent functional evaluation administered by a multi-disciplinary team of professionals that may consist of:

• Board Certified Neurologist
• Board Certified Behavior Analyst
• Board Certified Physiatrist
• Neuropsychologist
• Psychologist
• Board Certified Psychiatrist
• Speech Language Pathologist/Cognitive Therapist
• Physical Therapist
• Occupational Therapist
• Nurses
• Certified Rehab Counselor

From the results of the independent functional evaluation, the professionals of NeuLife Rehab formulate a Client Goal Plan. The Client Goal Plan guides the clinically relevant services delivered by NeuLife Rehab. The Client Goal Planit guides the cognitive, psychiatric, neurologic, psychological and neuropsychological therapy of the Client. The goal of NeuLife Rehab’s innovative post-acute rehabilitation is the attainment for our Clients of independence to the fullest extent that his or her physical and mental abilities permit.

NeuLife Rehab in Mount Dora, Florida consistently provides the highest standard of care in the delivery of clinically relevant services to achieve successful, sustained outcomes and exceed the expectations of all persons served.

NeuLife Rehab consistently provides the highest standard of care in the delivery of clinically relevant services to achieve successful, sustained outcomes and exceeds the expectations of all persons served. Our philosophy of that healing, wellness, and personal fulfillment are best accomplished in an uplifting, therapeutic environment where caring staff encourage, assist and support each Client so he or she may achieve specific goals. NeuLife Rehab believes personal fulfillment is equally as important as goals to increase function and independence.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” —  the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with Traumatic Brain Injury
(TBI), Spinal Cord Injury (SCI), Amputations, Burns and other Catastrophic Injuries and Challenging Diagnoses.

2725 Robie Avenue

Mount Dora, Florida 32757