Foot Drop In Patients Research Articles

Foot drop in critically ill patients: a narrative review of an elusive complication with intricate implications for recovery and rehabilitation.

Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of foot drop in critical care patients may result from various underlying causes, including neurological injuries, muscular dysfunction, nerve compression, or vascular compromise. Understanding the etiology and assessing the severity of foot drop in these patients is essential for implementing appropriate management strategies and ensuring better patient outcomes. In this comprehensive review, we explore the complexities of foot drop in critically ill patients. We search for the potential risk factors that contribute to its development during critical illness, the impact it has on patients' functional abilities, and the various diagnostic techniques adopted to evaluate its severity. Additionally, we discuss current treatment approaches, rehabilitation strategies, and preventive measures to mitigate the adverse effects of foot drop in the critical care setting. Furthermore, we explore the roles of critical care physical therapists, neurologists, and other healthcare professionals in the comprehensive care of patients with foot drop syndrome and in such highlighting the importance of a multidisciplinary approach.

Ankle dorsiflexion assistance of patients with foot drop using a powered ankle-foot orthosis to improve the gait asymmetry

BackgroundFoot drop is a neuromuscular disorder that causes abnormal gait patterns. This study developed a pneumatically powered ankle-foot orthosis (AFO) to improve the gait patterns of patients with foot drop. We hypothesized that providing unilateral ankle dorsiflexion assistance during the swing phase would improve the kinematics and spatiotemporal gait parameters of such patients. Accordingly, this study aims to examine the efficacy of the proposed assistance system using a strategy for joint kinematics and spatiotemporal gait parameters (stride length, swing velocity, and stance phase ratio). The analysis results are expected to provide knowledge for better design and control of AFOs in patients with foot drop.MethodTen foot drop patients with hemiparesis (54.8 y ± 14.1 y) were fitted with a custom AFO with an adjustable calf brace and portable air compressor for ankle dorsiflexion assistance in the gait cycle during the swing phase. All subjects walked under two different conditions without extensive practice: (1) barefoot and (2) wearing a powered AFO. Under each condition, the patients walked back and forth on a 9-m track with ten laps of level ground under the supervision of licensed physical therapists. The lower-limb joint and trunk kinematics were acquired using 12 motion-capture cameras.ResultsWe found that kinematic asymmetry decreased in the three lower-limb joints after ankle dorsiflexion assistance during the swing phase. The average ankle-joint angle increased after using the AFO during the entire gait cycle. Similarly, the knee-joint angle showed a slight increase while using the AFO, leading to a significantly decreased standard deviation within patients. Conversely, the hip-joint angle showed no significant improvements with assistance. While several patients exhibited noticeably lower levels of asymmetry, no significant changes were observed in the average asymmetry of the swing velocity difference between the affected and unaffected sides while using the AFO.ConclusionWe experimentally validated that ankle dorsiflexion assistance during the swing phase temporarily improves gait asymmetry in foot-drop patients. The experimental results also prove the efficacy of the developed AFO for gait assistance in foot-drop patients.

Effectiveness of 3D printed carbon fiber composite strut in customized ankle foot orthosis

This study aims to fabricate customized Ankle Foot Orthosis (cAFO) using Additive Manufacturing (AM), for investigating the effectiveness of straight Carbon Fibre Strut (CFS) that enhances push-off limits of drop foot (DF) gait. Three patients with unilateral DF were studied and two different host materials were used to fabricate cAFO from two different AM machines. A comparative quantitative study between the gait pattern of normal foot and DF (on affected side for same patient) for CFS efficacy was done by conducting two gait trials: with and without cAFO. The study shows CFS with cAFO is an effective additive manufactured mechanical component for DF patients to improve lower extremity functionality. CFS stores and releases energy during various phases of the gait cycle required for normal gait functionality for instance an improvement can be seen in deviation in ankle power to +36.84 % and +60.57 % for patients under consideration. In design domain, previous studies confined to L shaped strut, also clinical validation of straight strut is very limited. In this article clinical validation of straight strut with rectangular cross-section on DF patient is presented by using state-of-the-art tools, gait lab and design software's, resulting in better customization and ankle–foot mobility with reduced plantarflexion.

Application of an adjustable medical foot support pillow to prevent foot drop in patients with stroke.

Foot drop is one of the most common complications after stroke. This study investigates the role of an adjustable medical foot support pillow in preventing foot drop and improving the lower limb function of patients after stroke. A total of 88 patients with strokes admitted to our hospital from September 2019 to September 2020 were selected and categorised into the control (n= 44) and intervention groups (n= 44) using a random number table. The control group received routine rehabilitation nursing, while the intervention group adopted a self-made adjustable medical foot support pillow based on routine rehabilitation nursing. After four weeks, the simplified Fugl Meyer Assessment (FMA) and the modified activities of daily living (ADL) scales were used to measure the ankle range of motion of the lower limbs. The lower limb motor function, ADL, and ankle mobility before and after treatment, as well as the incidence of foot ptosis, were compared between the two groups. After the procedure, the intervention group was superior to the control group in the FMA score of the lower extremities, ADL score, and ankle joint mobility in the lower limbs, indicating statistically significant differences (P< 0.05). The incidence rate of foot drop was lower in the intervention group than in the control group, and the difference was statistically significant (P< 0.05). The adjustable medical foot support pillow can prevent foot drop in patients after stroke, improve lower limb function, provide a favourable basis for walking training, and improve the ADL of patients.

Gait Characteristics Following Stroke: A Prospective Crossover Study to Compare Ankle-Foot Orthosis with Functional Electrical Stimulation.

Management of foot-drop following stroke can be addressed with ankle-foot orthosis (AFO) or functional electrical stimulation (FES) of the peroneal nerve. There is limited evidence regarding the efficacy of FES as a substitute for a conventional ankle-foot orthosis. The aim of this study was to compare efficacy of FES against AFO in management of foot-drop in patients following stroke. Twenty patients (ten per group) were enrolled in this prospective crossover trial. Group A patients received gait training with AFO during first week followed by training with FES during second week and vice-versa for group B. Outcome parameters following AFO/FES training included Ten-meter, Six-minute walk test and spatiotemporal gait parameters. Patient satisfaction level was assessed using feedback questionnaire. Friedman test and Wilcoxon signed-rank test were performed to compare outcomes between barefoot, AFO and FES. The P value < 0.05 was considered statistically significant. Nineteen males and one female aged 45.5 ± 9.45 years were recruited. Statistically significant improvement was observed in Ten-meter and Six-minute walk tests, gait speed, Timed up and go test (TUG), stance-swing ratio and single-limb support among users of FES as compared to AFO and barefoot. There was no statistical difference observed in other gait parameters. Physiological cost index (PCI) showed trend in improvement among FES users. Patient satisfaction scores were higher for FES users. Quantitative and qualitative results were in favour of FES as compared to AFO and barefoot suggesting that FES can be a potential orthotic intervention in hemiplegic patients.

A novel apparatus to assess the mechanical properties of Ankle-Foot Orthoses: Stiffness analysis of the Codivilla spring

Ankle-Foot Orthoses (AFOs) are the most common devices prescribed to support the ankle and restore a quasi-normal gait pattern in drop-foot patients. AFO stiffness is possibly the main mechanical property affecting foot and ankle biomechanics. A variety of methods to evaluate this property have been reported, however no standard procedure has been validated and widely used. This study is reporting the repeatability of a novel apparatus to measure AFO stiffness in ideal frictionless conditions.The apparatus is based on a servo-hydraulic testing machine and allows to apply a displacement-controlled rotation of the AFO shell, simulating the physiological ankle dorsi/plantarflexion movement. The repeatability of the apparatus in measuring AFO stiffness in dorsiflexion and plantarflexion was assessed intra- and inter-session in a sample of standard polypropylene AFOs of different sizes (Codivilla spring).The repeatability of the apparatus in measuring the AFO stiffness was high. The Intra- and Inter-session Coefficient of Variation ranged between 0.02 ÷ 1.3 % and 1.3 ÷ 5 %, respectively. The Intra Class Correlation Coefficient ranged between 0.999 ÷ 1 intra- and 0.993 ÷ 0.997 inter-session. AFOs stiffness was observed to increase with the AFO size.The setup is easy to replicate and can be implemented with any torsion-controlled servo-hydraulic testing machine and has resulted simple to use and flexible enough to adapt to AFOs with different sizes. The frictionless contacts characterizing the apparatus make it possible to measure the ideal AFO stiffness by excluding the effect of the fixation methods to the leg and help to improve the repeatability of measurements.

Development of a Novel Passive-Dynamic Custom AFO for Drop-Foot Patients: Design Principles, Manufacturing Technique, Mechanical Properties Characterization and Functional Evaluation

Ankle foot orthoses (AFOs) are medical devices prescribed to support the foot and ankle of drop-foot patients. Passive-dynamic AFOs (PD-AFOs) are an effective solution for less severe cases. While off-the-shelf PD-AFOs are rather inexpensive, they provide poor anatomical fit and do not account for the required patient-specific biomechanical support. Three-dimensional (3D) scanning and manufacturing technologies allow manufacturing PD-AFOs customized for the patient’s anatomy and functional needs. This paper aimed to report the overall procedure for designing and manufacturing a novel, fiberglass-reinforced polyamide, custom PD-AFO. The feasibility of the proposed procedure was tested in a case study. The methodology can be divided into the following steps: (i) foot and leg scanning, (ii) 3D design, and (iii) additive manufacturing via selective laser sintering. A custom PD-AFO was designed and manufactured for a 67-year-old male drop-foot patient following paraparesis in severe discarthrosis after spine stabilization surgery. AFO mechanical properties were measured via an ad hoc setup based on a servohydraulic testing machine. The functional outcome was assessed via gait analysis in three conditions: shod (no AFO), wearing an off-the-shelf PD-AFO, and wearing the patient-specific PD-AFO. As expected, wearing the PD-AFO resulted in increased ankle dorsiflexion in the swing phase with respect to the shod condition. Sagittal rotations of the hip, knee, and ankle joints were similar across PD-AFO conditions, but the custom PD-AFO resulted in faster walking speed with respect to the off-the-shelf (walking speed: 0.91 m/s versus 0.85 m/s). Additionally, the patient scored the custom PD-AFO as more comfortable (VAS score: 9.7 vs. 7.3). While the present analysis should be extended to a larger cohort of drop-foot patients, the novel PD-AFO seems to offer a valid, custom solution for drop-foot patients not satisfied with standard orthotics.

Postoperative foot drop in patients receiving lung transplantation: increasing awareness and preventing risks

Postoperative foot drop in patients receiving lung transplantation: increasing awareness and preventing risks

Foot drop in patients treated with bortezomib – a case series and review of the literature

Bortezomib-induced peripheral neuropathy (BIPN) has a profound impact on quality of life, which is an important issue considering the growing number of survivors of multiple myeloma and amyloidosis. BIPN is typically symmetric, distal, "stocking and glove" distribution and predominantly consists of sensory rather than motor symptoms. In this case series, we report an acute neurotoxicity syndrome induced by bortezomib, which is clinically distinct from BIPN by not being peripheral and distal. We describe six patients that developed unilateral or bilateral foot drop attributed to bortezomib. With bortezomib discontinuation symptoms improved gradually over months to years.

Functional Electrical Stimulation System for Drop Foot Correction Using a Dynamic NARX Neural Network

Neurological diseases may reduce Tibialis Anterior (TA) muscle recruitment capacity causing gait disorders, such as drop foot (DF). The majority of DF patients still retain excitable nerves and muscles which makes Functional Electrical Stimulation (FES) an adequate technique to restore lost mobility. Recent studies suggest the need for developing personalized and assist-as-needed control strategies for wearable FES in order to promote natural and functional movements while reducing the early onset of fatigue. This study contributes to a real-time implementation of a trajectory tracking FES control strategy for personalized DF correction. This strategy combines a feedforward Non-Linear Autoregressive Neural Network with Exogenous inputs (NARXNN) with a feedback PD controller. This control strategy advances with a user-specific TA muscle model achieved by the NARXNN’s ability to model dynamic systems relying on the foot angle and angular velocity as inputs. A closed-loop, fully wearable stimulation system was achieved using an ISTim stimulator and wearable inertial sensor for electrical stimulation and user’s kinematic gait sensing, respectively. Results showed that the NARXNN architecture with 2 hidden layers and 10 neurons provided the highest performance for modelling the kinematic behaviour of the TA muscle. The proposed trajectory tracking control revealed a low discrepancy between real and reference foot trajectories (goodness of fit = 77.87%) and time-effectiveness for correctly stimulating the TA muscle towards a natural gait and DF correction.

Results of late-period physical therapy practice in foot-drop patients who underwent tibialis posterior tendon transfer

Amaç: Bu çalışma periferik sinir yaralanması sonrasında düşük ayak gelişmiş bireylerde uygulanan tibialis posterior tendon transferlerinde, geç dönemde meydana gelen biyomekanik sorunlar ve bu sorunların tedavisi için uygulanan, geç dönem fizyoterapinin etkinliğini belirlemek amacıyla planlandı. Yöntem: Çalışmaya tendon transferi yapılmış ve 6 ay ve üzeri süreyi doldurmuş olan 22 birey dahil edildi. Bireylerle ilgili demografik bilgi ve komplikasyonlar kayıt edilerek, ayak bileği kas kuvveti, eklem hareket açıklığı ölçüldü. Ayrıca bireylerde eklem pozisyon hissi, denge ve yaşam kalitesi değerlendirildi. Cerrahi sonrası başarı için Stanmore Sistem Sorgulaması kullanıldı. Olgulara genel olarak, ısı modaliteleri, nöromuskuler elektrik stimülasyonu, egzersiz, bantlama ve ortezlemeyi içeren, bireylerin spesifik gereksinimleri gözetilerek planlanan fizyoterapi programı uygulandı. Tedavilere 6 hafta süreyle haftada 3 gün olmak üzere devam edildi. Tedavi öncesi yapılan değerlendirmeler, 4., 6. haftalarda ve 3 ayda tekrar edildi. Bulgular: Çalışma süresi içerisinde bireylerin ayak bileği kas kuvveti, her iki ayakta da arttı. Bunlara ek olarak, propriyosepsiyon ve dengede olumlu gelişmeler meydana geldi. Tüm bu gelişmeler sayesinde, olguların yaşam kalitesi de pozitif yönde etkilendi. Sonuç: Çalışma sonucunda, tendon transferi sonrası geç dönemde uygulanan fizyoterapi programının, geç dönemde olgularda görülen problemler üzerinde etkin olduğu gösterildi. Detaylı değerlendirme ile planlanan fizyoterapi programının, hasta memnuniyetini ve cerrahi başarıyı arttırdığı belirlendi.

MM-368: Foot Drop in Patients Treated with Bortezomib- A Case Series and Review of the Literature

Context Bortezomib-induced peripheral neuropathy (BIPN) has a profound impact on quality of life, which is an important issue considering the growing number of survivors in multiple myeloma (MM) and light-chain amyloidosis. BIPN is typically symmetric, distal, “stocking and glove” distribution and predominantly consists of sensory rather than motor symptoms. Motor neuropathy induced by bortezomib is uncommon and has been addressed specifically only in case reports and case series. No data has been published on foot drop in the context of bortezomib treatment. Objective Define the characteristics of foot drop associated with bortezomib treatment. Methods We identified the hospital records of 6 patients treated with bortezomib for MM or amyloidosis that developed foot drop, temporally related to bortezomib treatment. Results Six patients, 5 of whom are males, with a median age of 65 years (range 46–74), experienced foot drop. Patients were treated between 2010 and 2020. Three patients had MM, and 3 had AL amyloidosis. In four patients, the involved light chain was lambda, and in two, it was kappa. Two patients received the bortezomib intravenously, and 4 received it subcutaneously. Two patients received bortezomib at a twice-weekly schedule. Two patients did not have “classical” bortezomib peripheral neuropathy prior to the development of the foot drop. Two patients developed the foot drop in the first cycle, and 1 developed it 1 month after treatment discontinuation. One patient developed a foot drop that resolved after bortezomib was discontinued and recured when bortezomib was resumed. One patient had bilateral foot drop. Four patients reported complete resolution 1 year after treatment discontinuation, whereas two patients had gradual improvement but not complete resolution of their foot drop. Conclusions Clinicians need to be aware of the risk for “non-classical” rare neuropathies associated with bortezomib and should monitor for these toxicities and promptly discontinue bortezomib to prevent irreversible nerve damage. Other possible reasons for foot drop, such as compressions due to tumor infiltration or weight loss, should be considered.

Poster: MM-368: Foot Drop in Patients Treated with Bortezomib- A Case Series and Review of the Literature

Poster: MM-368: Foot Drop in Patients Treated with Bortezomib- A Case Series and Review of the Literature

Investigating the effect of innovative storing-restoring hybrid passive ankle-foot orthosis on braking and propulsion impulse of walking in drop-foot patients: a prospective cohort study

Background: Drop foot is a disorder that is characterized by reduction in speed and the patients’ inability to propel the paretic side, which disrupts the walking patterns. Ankle-foot orthoses (AFO) are widely prescribed in these patients in order to facilitate their leg propulsion and foot clearance during the swing phase. The purpose of this study was to use the correlation between effect of innovative AFO on braking and propulsion impulse and speed, in order to interpret the innovative AFO’s influence on the paretic and nonparetic side in drop-foot patients. Methods: Ten participants with drop foot walked at their self-selected speed, in order to collect the kinetic and kinematic data. The anteroposterior ground reaction force (GRF) components were extracted from the decomposition method with an innovative storing-restoring hybrid passive AFO and compared with baseline shoes only for both paretic and nonparetic sides. Results: There is a strong correlation between the innovative AFO speed and the anteroposterior component of GRF. After that, correlation was found between anteroposterior GRF and the storing-restoring hybrid passive AFO in comparison with baseline shoes only in both the paretic and nonparetic sides. Conclusions: This study demonstrated a strong correlation during walking between speed and the propulsion and braking impulses of the anteroposterior component of GRF on both sides. Level of Evidence: Level II.

The effect of articulated AFO with hydra pneumatic damper in biomechanical characteristic of drop foot: A pilot study.

Background: Ankle Foot Orthosis (AFOs) are frequently prescribed in the management of drop-foot patients. However, few studies have examined the benefits of different design of Ankle Foot Orthosis with extra elements like dampers or springs. Therefore, the objective of this study was to investigate the efficacy of articulated Ankle Foot Orthosis with Hydra pneumatic damper, in kinetic, kinematic and spatiotemporal parameters of drop foot patients. Methods: Ten drop foot patients were recruited for this study, walked at self-selected comfortable speed. A three-dimensional motion analysis, were used for obtaining kinetic, spatio-temporal and kinematic gait parameters. Results: The articulated Ankle Foot Orthosis with Hydra pneumatic damper was significantly improved speed, cadence, step length of walking (p<0.005). Furthermore, the peak and mean of moment, push off velocity and energy storing/returning were significantly improved by articulated Ankle Foot Orthosis with Hydra pneumatic damper (p<0.005). Conclusion: The newly designed articulated Ankle Foot Orthosis with Hydra pneumatic damper improved the ankle moment in at the loading response, power generation and the ankle range in drop foot patient.

Comparison the effect of kinetic parameters of innovative storing-restoring hybrid passive (comfort gait) ankle-foot orthosis (AFO) with posterior leaf spring AFO in drop-foot patients: a prospective cohort study

Background: Drop-foot syndrome is a disorder in which the dorsiflexor muscles are weakened or completely paralyzed, leading to foot slapping after the initial contact and foot-dragging during the swing phase. Passive and hybrid passive ankle-foot orthoses (AFOs) are often prescribed as an intervention for this disorder; however, the effects of these AFOs on kinetic parameters during the gait of drop-foot patients seem unclear. This study aimed to compare the affected lower limb joints of ankle, knee, and hip kinetics parameters (moments and powers) during walking in drop-foot patients using an innovative AFO storing-restoring hybrid passive AFO, named “Comfort Gait” and posterior leaf spring (PLS) AFO. Methods: Ten drop-foot patients were recruited in the current study to walk at a comfortable self-selected speed while wearing two different AFO selections. Kinetic parameters with a motion capture system were obtained for these patients. Results: The results of this study revealed a significant increase in the peak values of kinetic parameters of the lower limb of the affected side (ankle, knee, and hip moments and powers) with the innovative designed AFO when compared to PLS AFO (P&lt;0.05). Conclusions: The significant increase of kinetic parameters in drop foot with use of the Comfort Gait as compared to the PLS AFO might suggest the effectiveness of this innovative AFO in improving the gait of foot drop patients more than the use of PLS AFO. Level of Evidence: Level II

Pneumatic AFO Powered by a Miniature Custom Compressor for Drop Foot Correction

For active AFO applications, pneumatic remote transmission has advantages in minimizing the mass and complexity of the system due to the flexibility in placing pneumatic components and providing high back-drivability via simple valve control. However, pneumatic systems are generally tethered to large stationary air compressors, which greatly limit the practical daily usage. In this study, we implemented a wearable custom compressor that can be worn at the trunk of the body and can generate up to 1050 kPa of pressurized air to power an unilateral active AFO for dorsiflexion (DF) assistance of drop-foot patients. In order to minimize the size and weight of the custom compressor, the compression rate of the custom compressor was optimized to the rate of consumption required to power the active AFO. The finalized system can provide a maximum assistive torque of 9.8 Nm at a functional frequency of 1 Hz and the average resistive torque during free movement was 0.03 Nm. The system was tested for five hemiplegic drop-foot patients. The proposed system showed an average improvement of 12.3° of ankle peak dorsiflexion angle during the mid to late swing phase.

Immediate Effect of Foot Drop Stimulator in Outpatients with Chronic Stroke: A Mixed Method Study

Background: The foot drop stimulator is designed to improve the walking ability of foot drop in patients after stroke, however, studies on clinical effects are still lacking. Objective: To investigate the effect of a foot drop stimulator on the walking and balancing abilities of foot drop patients after a stroke. Design: One-Group (Pretest-Posttest) Design. Methods: All subjects walked in all three conditions: foot drop stimulator (FDS) ankle foot orthosis (AFO) and barefoot. Primary outcome measures were assessed for walking and balance using a 10-m walking test (10MWT) and a timed up and go test (TUG). Secondary outcome measures consisted of a brief user interview, and the patients recorded the advantages and disadvantages of each condition. Results: FDS, AFO, and barefoot conditions showed a statistically significant difference in 10MWT and TUG (P .05). Conclusion: In this study, the foot drop stimulator contributed to improving the balance ability, and the walking ability was similar to the effect of the anklefoot orthosis.

Effects of an Elastic AFO on the Walking Patterns of Foot-drop Patients with Stroke

Effects of an Elastic AFO on the Walking Patterns of Foot-drop Patients with Stroke

Case Series: Management of Foot Drop

Aim: To highlight the functional outcome of surgical management of foot drop in patients with Hansen disease.&#x0D; Case Presentation: We present three cases of foot drop following Hansen’s disease that were managed surgically by Tibialis posterior transfer. The patients had preoperative physiotherapy for ten days and postoperative physiotherapy for four weeks. Their post-operative periods were uneventful and the corrections were satisfactory.&#x0D; Discussion: Involvement of common peroneal nerve in Hansen’s disease usually results in paralysis of the anterior tibial and/or peroneal muscles. Hansen’s disease patients with foot-drop walk with a ‘high-stepping gait’, lifting the leg high as if climbing steps even while walking on level ground. When the paralysis has been present for more than six months to one year without recovery, the best option of treatment at this stage is corrective surgery and the main aim of the corrective surgery is to restore active dorsiflexion of the foot so that the gait becomes normal. This is achieved by re-routing the tendon of Tibialis posterior muscle, brings that tendon to lie in front of the ankle and is anchored distally. If the tendo-achillis tendon is found to be tight, it should be lengthened as the first step of the Tibialis posterior transfer operation.&#x0D; Conclusion: Surgical correction of foot drop usually leads to restoration of active dorsiflexion of the foot thereby preventing development of secondary deformities and ulceration. Our patients were able to dorsiflex their feet after the surgical correction.