Case 12 Drop Foot Gait


Case 12
Drop Foot Gait
Relevant Questions
What happened ?                                 When and how it happened ?

Introduction ownself
Exposure – Upto Umbilicus 
Hand scrubbing
Look- Standing Patient

Comment on Footwears
Alignment       -           Front        Leg , foot and toes look normal with normal overlying skin
Wasting of Muscles on anterolateral muscle compartment             (Anterior + Peronei group of muscles )
                                    Side          Knee fully extended
                                    Back
      Any Scar on Buttock , Posterior Thigh , Around Knees ?
      Calf symmetrical with normal overlying skin
      Heel has normal varus

Gait                                         Drop foot gait , High stepping
Squating                                  heel at the same level

Check Lumbar region before lying down the patients
Lie down Patient
After lying down check plantar surface of the feet.
Feel
                                                Temperature
                                                Superficial Palpation – leg , ankle , hindfoot, forefoot
Deep Palpation – tibia, Medial Malleolus , Calcaneum,First Metatarsal , Phalanges , other Metatarsals , Navicle , Lateral Malleolus, Fibula
Movement                               Plantarflexion / Dorsiflexion – cup the heel during measurement
                                                Inversion / Eversion- lock talus
LLD
Measure Foot Size –
Medial Side       Medial Malleolus to Heel Tip
Medial Malleolus to Ist MT Head
Lateral Side      Lateral Malleolus – Heel Tip
                        Lateral Mallolus to 5th MT head
Ligamentous Stability – MCL
                                    LCL
                                   
 Neurovascular Assessment

Sensory Examination               Dorsum , Ist Web Space , Plantar Surface of Feet
Tinels Sign over Fibular Neck
Motor Examination
Power of the Muscles –                       TA / EHL /EDC ;
TP/ Gastrosoleus / FHL;
Peronei
Also check power of Hamstrings ,
Reflexes

Vascular Examination – DPA / PTA


Discussion
Nerve Supply
                        Superficial Peroneal Nerve –   Outer Calf and Dorsum of Foot –Sensory Supply
                                                                         Peroneus Longus and Brevis – Motor
           
                        Deep Peroneal Nerve   -           Ist Web Space , lateral border of foot –           Sensory Supply
                                                                        Dorsal motor Group -                          Motor Supply
                                                                       
                                                                     
            Causess of Drof Foot Gait
Lumbar Radiculopathy- Posterolateral Disc Herniation L 4 – 5
Trauma – Fibula Neck fracture , Dislocation of Knee , THA / TKR
Entrapment of CPN at Fibular Neck
Achilles Tendon Rupture
Nerve Root Irritation – Spondylolysis, Recess Stenosis
Intraneural Tumors
Neurological Disorders
Management
Neurotropic medications
AFO Splint
Anterior Transfer of Tibialis Posterior to dorsum


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