Foot Drop In Patients Research Articles

External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective analysis of 200 cases.

Peroneal nerve entrapment is the most common peripheral mononeuropathy of the lower limbs. Foot drop, a common presentation, leads to an impaired eversion and dorsiflexion of the foot. An intriguing observation is the occurrence of foot drop secondary to weight loss. A retrospective study of patients surgically treated for peroneal nerve entrapment was performed between January 1, 1995 and December 31, 2016, at the Department of Neurosurgery, Genk, Belgium. Out of a total of 421 patients, 200 patients with foot drop secondary to weight loss were included. For each subject, motor and sensory outcomes after external neurolysis were investigated. As a primary objective, we examined the postoperative outcomes of external neurolysis as a treatment for foot drop in patients with peroneal nerve entrapment at the fibular head secondary to weight loss. As a secondary objective, we analyzed the correlation between patient characteristics and the success rate of external neurolysis. When defining success as a postoperative MRC score of 4 or 5, external neurolysis has a success rate of 85% in patients with foot drop secondary to weight loss. A significant difference (P = < 0.0001) between postoperative and preoperative MRC scores indicates that external neurolysis leads to significant improvement of motor function in patients with foot drop secondary to weight loss. A multiple logistic regression model showed that "preoperative MRC scores" and "duration of symptoms" were the only variables with an impact on postoperative MRC scores. Other variables such as "age," "gender," and "side of entrapment" had no significant impact on postoperative results. Statistical analysis emphasizes the important role of external neurolysis in the treatment of peripheral peroneal nerve entrapment. Therefore, external neurolysis at the fibular head should be regarded as a very effective and safe procedure in patients with foot drop secondary to weight loss.

Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy.

The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=−3.52, CS=52%), but not the left TAm (t= −3.35). Flexion-abduction with external rotation pattern to the right (t= −2.46, CS=55%) and left (t=−2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=−0.25) and left (t=−1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.

Risk Factors Analysis for Foot Drop Associated with Lumbar Disc Herniation: An Analysis of 236 Patients

To identify the risk factors for foot drop in patients with lumbar disc herniation (LDH). Two hundred thirty-six patients who underwent surgery for LDH were retrospectively reviewed. Foot drop was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test. Possible risk factors, including demographic and radiographic parameters, were evaluated by multivariate logistic regression analysis. Fifty-two patients (22.9%) suffered from foot drop. Multivariate logistic regression analysis revealed that diabetes mellitus, disc calcification, patients who had an acute episode or acute-on-chronic episode, and patients who presented with lateral recess or extraforaminal type of disc herniation were at greater risk of foot drop. Notably, patients who had a canal occupancy rate of more than 50% were at greater risk of foot drop compared with patients who had a canal occupy rate of less than 25%. With a 1.0-mm increase in anteroposterior diameter of the index spinal canal, the risk of developing foot drop decreased to 51.8% in these patients (P < 0.05). The following factors may affect the development of foot drop in patients with LDH: 1) diabetes mellitus; 2) patients with an acute episode or acute-on-chronic episode; 3) patients with lateral recess or foraminal type of herniation; 4) disc calcification; 5) canal occupancy rate greater than 50%; and 6) the anteroposterior diameter of canal. Surgical treatments for patients with those risk factors should be implemented positively during the follow-up period to reduce possible adverse outcomes.

Adaptive Control of an Actuated Ankle Foot Orthosis for Foot-Drop Correction

This paper deals with the control of an actuated-ankle-foot-orthosis (AAFO) intended to help foot-drop patients. The foot-AAFO system is driven by the human torque delivered by the muscles spanning the ankle joint and by the AAFO’s actuator’s torque. A model reference adaptive control is proposed to dorsiflex the foot during the swing phase. Unlike most classical model-based controllers, the proposed one does not require any prior estimation of the system’s (foot-AAFO) parameters. The ankle reference trajectory was extracted during gait activities of healthy subjects in a clinical environment. The input-to-state stability of the foot-AAFO system with respect to a bounded human muscular torque is proved in closed-loop based on Lyapunov analysis. Preliminary experimental results show satisfactory tracking performances of the reference trajectory within few steps. Furthermore, the muscular activities for the tibialis anterior (TA) and gastrocnemius (GA) muscles when wearing the AAFO were reduced by 30% and 12% respectively.

Treatment effect analysis of foot drop type in 34 cases of lumbar disc herniation

Objective To investigate treatment effect of the type of foot drop in patients with lumbar disc herniation. Methods Clinical data of 34 patients with foot drop in lumbar disc herniation who were treated in Spinal Surgery Department of Shunyi District Hospital of Beijing from January 2006 to December 2013 were retrospective analyzed, all patients were treated by operation.After 24 months of follow-up, the effect was observed, the prognosis and related factors were analyzed. Results Two years after operation, the recovery of the patients was excellent in 4 cases and good in 19 cases, common and poor in 11 cases, and the excellent and good rate was up to 67.6%(23/34). Analysis results showed that after 3 to 24 months after surgery, the anterior tibial muscle strength grades(grade 0-5) corresponding score were 28 points preoperatively, 59 points at 3 months after surgery, 69 points at 6 months after surgery, 92 points 1 year after surgery, reached 95 points 2 years after surgery.Muscle strength score of patients with an increasing trend, especially after 3 months to 12 months after the operation. Conclusion The drop occurred should be operated as soon as possible, recommendations for open surgery, complete decompression, avoid injury.Three months to 1 years after operation is the key period of recovery. Key words: Foot drop; Lumbar disc herniation; Surgery; Prognosis

Perceived Exertion Is Lower When Using a Functional Electrical Stimulation Neuroprosthesis Compared With an Ankle-Foot Orthosis in Persons With Multiple Sclerosis: A Preliminary Study.

This study investigates the direct comparison of energy cost, efficiency, and effort between an ankle-foot orthosis (AFO) and a functional electrical stimulation (FES) device for foot drop in ambulatory patients with multiple sclerosis. Twenty adults (32-74 years old; 55% female) with a diagnosis of multiple sclerosis resulting in foot drop participated in a crossover, counterbalanced preliminary study. Each participant was tested on different days, with each session consisting of a separate walk trial per prosthetic device. Heart rate, oxygen consumption, speed, distance, and self-reported exertion were measured independently for each device walk trial. Repeated-measures analysis of variance with device and visit number as within-participants independent variables were run for the primary outcome variables of perceived exertion, energy, and metabolic efficiency. A significant main effect of device was found for perceived exertion (P = 0.01), with participants reporting decreased exertion levels (Borg Scale) when using the FES compared with the AFO (mean difference, 1.63; 95% confidence interval, 0.49-2.76). Energy and efficiency did not significantly differ by device. Results suggest that further investigation of the potential advantages of FES devices over traditional AFO is warranted. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) describe the potential differences between an AFO and FES for the treatment of foot drop in patients with multiple sclerosis, (2) understand the mechanisms and prevalence of foot drop in patients with multiple sclerosis, and (3) recognize the potential benefit of improved perceived exertion found when using FES for the treatment of foot drop in patients with multiple sclerosis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Triple Tendon Transfer for Correction of Foot Deformity in Common Peroneal Nerve Palsy.

Anterior transfer of posterior tibial tendon (PTT) is the most common technique to correct foot drop in patients with common peroneal nerve palsy. It does not address the loss of toe extension or "toe drop." This may affect the gait pattern, and patients may not tolerate it. Described here is a technique that addresses toe drop associated with common peroneal nerve palsy. A new technique of tendon transfer using the PTT, flexor hallucis longus (FHL) tendon, and flexor digitorum longus (FDL) tendon was performed on 15 patients (13 males and 2 females) with complete common peroneal nerve palsy from 2009 to 2013. Minimum follow-up was 12 months (range, 12-50 months). The mean age was 37 years (range, 20-52 years). Based on the evaluation criteria of Carayon et al, the postoperative results for foot drop correction were excellent in 9 (60%), good in 5 (33%), and moderate in 1 (7%), and the mean active range of motion of the ankle was 46 degrees. Postoperative extension evaluation of the toes was excellent in 7 (47%), good in 5 (33%), and moderate in 3 (20%). Releasing and transferring of FDL and FHL to the toe extensors along with the anterior transfer of the PTT neutralized the deforming forces and allowed for active toe extension while strengthening ankle dorsiflexion. Movahedi Tendon Transfer was a reliable method to achieve a balanced foot and toe dorsiflexion for complete common peroneal nerve palsy. Level IV, retrospective case series.

Immediate effects of using ankle-foot orthoses in the kinematics of gait and in the balance reactions in Charcot-Marie-Tooth disease

The Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy with progressive distal muscle atrophy and weakness, mainly in lower limbs, that evolves limiting the gait and balance. The objective of the study was to analyse the immediate effects of using Ankle-Foot Orthosis (AFO) in the gait's kinematics and balance in patients with CMT. Nine individuals were evaluated by Tinetti scales and Dynamic Gait Index (DGI) and gait's kinematics parameters through the motion capturing system. These evaluations were done before and during the use of AFO. Two-Way repeated analysis of variance was done to try the main or interaction effects related to "orthoses" and "repetition". A significant interaction effect was observed between the gait cycle and use the AFO to the average velocity (Wilks' Lambda=0.156, p=0.030, η2=0.844) like significant main effects in the ankle joint to the gait cycle (Wilks' Lambda=0.091, p=0.008, η2=0.909) and the use of AFO (Wilks' Lambda=0.444, p=0.013, η2=0.556). It was observed a significant change in the DGI scale during the use of AFO (p&lt;0.05). The use of AFO promoted immediate effects on gait kinematics and in balance reactions. The results suggest that the use of AFO is an efficient strategy to stabilize the ankle joint, besides avoiding foot drop in patients with CMT.

Robotic ankle foot orthosis with gait adaptive controller though artificial touch sensor for improving gait among drop foot patients

چكيده عارضه افتادگي پا را می‌توان بيماري عصبي، عضلاني و ناشي از نقص ژنتيکي، جراحات جنگي، تصادف، رشد غده‌ها و برخي سکته‌هاي مغزي ذکر کرد که در اثر آن عصب پا دچار آسيب ديدگي دایم يا برگشت‌پذير مي‌شود. در اثر اين عارضه شخص مجبور مي‌شود براي جبران اين نقص که موجب ناتواني در باز و بسته ‌کردن مچ پا مي‌شود، از ارتز استفاده کند. يا اين که مشکل لنگيدن پا براي وي به وجود خواهد آمد. دستگاه ارتز رباتيک هوشمند شامل صفحه حسگر فشار کف پا، نرم‌افزار محاسبه‌گر و بخش ربات متحرک است. با توجه به مدل ساخته شده بر اساس اطلاعات حرکتي افراد دچار افتادگي پا مشخص شد که نياز به سامانه رباتيکي است که بتواند ميزان گشتاور مورد نياز بيمار را براي راه رفتن بهبود بخشد و به همين دليل طراحي ارتز جديدي لازم بود که بر اساس سنجش فشار کف پا در شرايط گوناگون راه رفتن بتواند ميزان گشتاور جبراني مورد نياز را براي سامانه رباتيک تشخيص دهد و توسط نيروي الکتريکي تأمين نمايد. براي ايجاد ارتباط بين اين سامانه تأمين گشتاور و فشار سنجش شده از فشارسنج از مدل‌هاي هوشمند استفاده شده است. اين سامانه باعث بهبود عملکرد و رفع ناتواني فرد دچار افتادگي پا مي‌شود و توانايي شخص را در راه رفتن بهبود مي‌بخشد.کاهش فشار و آسيب به تاندون‌ها، کاهش ضربه به مفاصل، کمک به بهبود بيماري با استفاده از سامانه رباتيک و جبران ضعف عملکرد عضلات، از جمله اهدافي پيش‌بيني شده براي ساخت دستگاه بود. كليد واژه‌ها: اختلالات عصبي، افتادگي پا، مرکز فشار، راه رفتن

The mechanism and clinical effectiveness of the six-step Chinese Daoyin technique on hemiplegic patients with drop-foot

Objective: The aim of this study was to improve the Chinese Daoyin technique (physical and breathing exercises), which is an ancient rehabilitation method, to elevate its effect and to standardize its operational procedure. Methods: Based on the ancient Chinese Daoyin technique, a six-step method was developed including: 1) motion imagination and imitation; 2) mental and breathing regulation; 3) target point determination; 4) motion percussion; 5) motion persistence; 6) relaxation. Sixty drop-foot patients who suffered from hemiparesis after a stroke were randomly divided into the experimental group and the control group. Functional evaluation including Fugl-Meyer assessment score, Lovett manual muscle test (MMT), active range of motion of the ankle joint and electromyography were performed before and after the training course. The data were analyzed using the statistical software SPSS 12.0. Results: The differences between the two groups were significant. The effectiveness of the six-step group was significantly better than the effectiveness of the control group. Conclusion: The six-step method of the Chinese Daoyin technique is an effective rehabilitation training method for drop-foot in stroke patients with hemiparesis.

Tibialis anterior branch involvement in fibular intraneural ganglia

Fibular (peroneal) intraneural ganglia classically present with predominant tibialis anterior weakness, for which there is no clear anatomical explanation. We identified a new imaging pattern, which consisted of involvement of a proximal tibialis anterior branch, in patients with fibular intraneural ganglia. This study characterizes the cystic involvement of this tibialis anterior branch and evaluates its significance. The magnetic resonance imaging (MRI) and clinical data of 23 patients with fibular intraneural ganglia were retrospectively reviewed. The tibialis anterior branch was consistently involved with the cyst, and this involvement, although variable, was more prominent than the cystic involvement of other terminal branches of the fibular nerve. The finding of cyst extension within a muscle end-organ branch seems likely to explain, in part, the characteristic clinical finding of preferential foot drop in patients with fibular intraneural ganglia.

Centre of pressure paths'for normal subjects and a drop-foot patient

Contemporary physiotherapy for neurologically impaired patients puts emphasis on the management of spasticity. A randomised controlled trial of the Odstock dropped foot stimulator (ODFS), a common peroneal stimulator used to correct drop-foot during walking, showed a reduction in spasticity of the quadriceps muscles in a sample of 32 chronic hemiplegic subjects. Both treatment (FES) and control groups received a course of ten physiotherapy sessions during the first four weeks of the trial period. The treatment group used the stimulator as part of the physiotherapy sessions and independently each day as they found useful. Both groups received the same amount of therapy contact time. The treatment group continued to use the stimulator for the 12-week period.Assessments also included measurement of walking speed and effort of walking, gait analysis and mobility and quality of life questionnaires. Results of these tests are not presented in this paper but are referred to in relation to changes in spasticity.Spasticity of the quadriceps muscles was measured using the Wartenberg pendulum test. Results showed that during the first four-week period both groups had a reduction in spasticity which was statistically significant in the control group; measured by both the relaxation index (p = 0.005) and the area beneath the curve (p = 0.036) and in the FES group only as the area beneath the curve (p = 0.028) At 12 weeks, reduction in spasticity in the control group was no longer statistically significant in either of these parameters, whereas in the treatment group reduction measured as area beneath the curve was statistically significant (p = 0.001). There was no statistically significant difference between the two groups.These results are discussed in relation to the subject of measurement of spasticity, the effect of physiotherapy on spasticity and observations made on changes in speed and effort of walking.