Abstract and Introduction
Abstract
Background: Injury to the neurological pathway that enables ankle dorsiflexion is likely to cause foot drop. This pathway includes the motor cortex; lumbosacral plexus; and the sciatic, tibial, and peroneal nerves. Nerve damage typically occurs due to compression, entrapment, traction, or direct trauma to the nerve due to several etiologies. However, there are limited reports on the incidence, etiology, and factors associated with foot drop.
Methods: The authors reviewed their clinic's data from 1022 patients with foot drop from 2004 to present to determine the incidence, causes, and risk factors of foot drop. Microsoft Excel was used for descriptive statistical data analysis and graphing.
Results: A total of 21 causes of foot drop were found. Of 1022 patients, 142 (13.9%) had foot drop after lumbosacral (LS) spine surgery, while 131 patients (12.8%) with LS spine complications who had not undergone surgery also reported foot drop. The LS spine complications and surgeries were influenced by age (median age, 63 and 55 years, respectively) and were marginally higher in male patients (54%). A total of 79 patients (7.8%) with foot drop had previously undergone hip replacement surgery. Older age (median age, 60 years) and female sex (85%) were risk factors for hip replacement surgery resulting in foot drop. In contrast, younger age and male sex were the risk factors for gunshot and stab wounds, injection drug use, drug or medication overdoses, and motor vehicle accidents resulting in foot drop.
Conclusions: Failed back surgery syndrome is the leading cause of foot drop after lumbosacral spine and hip replacement surgeries in both male and female older (median age, 60 years) patients. However, most (85%) of the foot drop patients in the present study who underwent hip replacement surgery were female patients. Sports and recreational activities, motor vehicle accidents, drug use, and violence are common causes of foot drop in younger male adults.
Introduction
The inability or diminished ability to lift the foot is primarily the result of neurological disorders. The origin of the neurological impairment can be central (motor cortex lesions [cerebral palsy and stroke]), intraspinal (nerve root L4, L5, S1, and S2 damage), or peripheral (lumbosacral plexus, mononeuropathies of the deep peroneal, common peroneal, or sciatic nerves).[1,2] Carolus et al[3] recently reported that lumbar spinal nerve root damage (radiculopathy) and peroneal nerve compression were the most frequent causes of foot drop, followed by polyneuropathy and nerve trauma in 65 patients with foot drop. Radiculopathy is typically associated with back pain and numbness while patients with neuropathies do not report pain.[2] Ma et al[4] also recently reported that 22.9% of their foot drop cases were due to lumbar disc degeneration. Amin et al[5] found that 95% of this degeneration occurs at L4-L5 or L5-S1 as the dorsiflexor muscles of the ankle (ie, tibialis anterior, extensor digitorum peroneus tertius, and extensor hallucis longus) are primarily innervated by L5 nerve roots. Bakhsh[6] reported that the long-term outcome of lumbar disc surgery was unsatisfactory, and new neurological deficits caused foot drop postoperatively in 8.8% of their patients. Failed back surgery syndrome (FBSS) is a leading cause of postoperative back and leg pain, injury, and foot drop.[6–8] Dellon[9] found that 58.4% of 24 cases of palsy developing after hip or knee arthroplasty were due to sciatic or peroneal neuropathy. Falls, motor vehicle accidents, sports and recreational activities, knee replacement surgeries, tumors, cysts, gunshot wounds, and stab wounds are other known causes of foot drop.
Presenting symptoms depend on the location, type, and severity of the injury. Ultrasonography and magnetic resonance imaging are more powerful tools to identify the lesion directly, and electromyography and nerve conduction study results are used to diagnose and grade nerve injuries. Here, the authors reported the frequent and rare causes of foot drop in 1022 patients who received consultations at their clinic over 18 years.
ePlasty. 2023;23(e16) © 2023 HMP Communications, LLC
