Foot Drop Workup

  • Author: James W Pritchett, MD; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Jul 13, 2011
 

Laboratory Studies

  • Workup of foot drop proceeds according to the suspected cause. In instances where a cause is readily identified, such as trauma, no specific diagnostic lab studies are required.
  • A spontaneous unilateral foot drop in a previously healthy patient requires further investigation into metabolic causes, including diabetes, alcohol abuse, and exposure to toxins. The following tests would be helpful:
    • Fasting blood sugar
    • Hemoglobin A1c
    • Erythrocyte sedimentation rate
    • C-reactive protein
    • Serum protein electrophoresis/immunoelectro-osmophoresis
    • BUN
    • Creatinine
    • Vitamin B-12 levels
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Imaging Studies

  • Plain films
    • If foot drop is posttraumatic, plain films of the tibia/fibula and ankle are appropriate to uncover any bony injury.
    • In the absence of trauma, when anatomic dysfunction (eg, Charcot joint) is suspected, plain films of the foot and ankle provide useful information.
  • Ultrasonography
    • If bleeding is suspected in a patient with a hip or knee prosthesis, ultrasonography can be helpful
  • Magnetic resonance neurography
    • If a tumor or a compressive mass lesion to the peroneal nerve is being investigated, magnetic resonance neurography (MRN) can be used. MRN has made it possible to produce high-resolution images of peripheral nerves, as well as associated intraneural and extraneural lesions.
    • MRN can be performed using a standard 1.5 Tesla MRI system and special phased array imaging surface coils.[8] These coils acquire image data simultaneously from multiple receive-only surface coils. Image data from each coil in the array are combined to form a composite image with an improved signal-to-noise ratio.
    • Compared to standard MRI, MRN allows faster acquisition of anatomically detailed images, smaller field of view, higher resolution, and thinner sections. These features provide images capable of showing the fascicular organization of normal peripheral nerves, thereby making the nerves more clearly distinguishable from other tissue (eg, tumor or blood vessels).
    • In one study, the fascicular structure seen on MRN was found to be functional using intraoperative electrophysiologic testing. The nonfascicular structures were nonfunctional.
    • Images can be processed further to allow stacking of axial sections and slicing of data in another plane of section. This is helpful in mapping longitudinal extent of nerve involvement.
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Diagnostic Procedures

  • Electromyelogram
    • In addition to the metabolic disorders listed above, the differential diagnosis of spontaneous foot drop includes spasticity, dystonia, motor neuron disease, L5 radiculopathy, lumbosacral plexopathy, sciatic nerve palsy, compressive peroneal neuropathy, peripheral neuropathy, and some myopathies. An electromyelogram (EMG) is useful in differentiating among these diagnoses.
    • This study can confirm the type of neuropathy, establish the site of the lesion, estimate extent of injury, and provide a prognosis.
    • Sequential studies are useful to monitor recovery of acute lesions.
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Contributor Information and Disclosures
Author

James W Pritchett, MD  Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center

James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Washington State Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Margaret A Porembski, MD  Physician, Hand Surgery and Specialty Orthopaedic Centers

Margaret A Porembski, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Specialty Editor Board

John S Early, MD  Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship, Baylor University Medical Center

John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association

Disclosure: AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting; Biomet Consulting fee Consulting; AO North America Grant/research funds fellowship funding; MMI inc Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Shepard R Hurwitz, MD  Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

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Diagram of the ground reaction vector during heel strike.
Common and superficial peroneal nerve, branches, and cutaneous innervation.
Deep peroneal nerve, branches, and cutaneous innervation.
Incisions for the Bridle procedure.
Posterior leg with the retrieved posterior tibial tendon above the ankle. The window in the interosseous membrane is noted with an "x".
The posterior tibial tendon (C) pulled through a slit in the anterior tibial tendon (A) and inserted into the second cuneiform. The posterior tibial tendon is anastomosed to the anterior tibial and the distal stump of the peroneus longus (B) that has been rerouted anterior to the lateral malleolus.
 
 
 
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