FOOT DROP / HIGH STEPPING GAIT Physiotherapy Mx

Definition

It is an abnormal neuromuscular disorder that affects the patient’s ability to raise their foot at the ankle.

Due to paralysis of the ankle dorsiflexors (tibialis anterior) the planterflexors overact causing the toes to go and first contact the ground, so to avoid this patient flex his hip and raise foot and slap on the floor forcibly.

Gait analysis

Due to paralysis of dorsiflexors: patient cannot use dorsiflexors to attain normal neutral position of the ankle, which is necessary to complete the task of clearing the foot during swing phase.To compensate for inability to dorsiflex the ankle by increasing the hip and knee flex above normal amount by circumduction of the entire hip or hip hiking.

- Associated condition : GBS / Polio / Spinal disc herniation / peroneal muscle or nerve injury / stroke

PT management

For early cases: conservative treatment can be adopted, put patient on L – splint / bandage.

Then followed by active or passive physiotherapy: Training should be first on the even surface and then on uneven surface

Ankle exercise to strength anterior tibialis
Strengthening of calf muscle can ensure that ankle ROM is well maintained
Neuromuscular electrical stimulation help in contracting muscle to have a movement and function properly
Stretching of the contracted muscle
Back strengthening exercise, if there is weakness of the anterior tibialis caused by sciatica compression
Gait training by parallel bar walking using a mirror as a biofeedback
Assistive device like AFO (Ankle Foot Orthosis).