Managing foot drop

If you have foot drop, you'll find it difficult to lift the front part of your foot off the ground. This means you'll have a tendency toscuff your toes along the ground, increasing your risk of falls . To prevent this, you may lift your foot higher than usual when walking.

Recovery depends on the cause of foot drop and how long you've had it. In some cases it can be permanent.

Making small changes in your home, such asremoving clutter and using non-slip rugs and mats, can help prevent falls . There are also measures you can take to help stabilise your foot and improve your walking ability.

These measuresinclude:

• physiotherapy to strengthen your foot, ankle and lower leg muscles
• wearing an ankle-foot orthosis to hold your foot in a normal position
• electrical nerve stimulation in certain cases it can help lift the foot
• surgeryan operation to fuse theankle or foot bones may be possible in severe or long-term cases

Some of these treatments are discussed in more detail below.

Ankle-foot orthosis

An ankle-foot orthosis (AFO) is worn on the lower part of the leg to help control the ankle and foot. It holds your foot and ankle in a straightened position to improve your walking.

If your GP thinks an AFO will help, they'll refer you for an assessment with an orthotist (a specialist who measures and prescribes orthoses).

Wearing a close-fitting sock between your skin and the AFO will ensure comfort and help prevent rubbing. Your footwear should be fitted around the orthosis.

Lace-upshoes or those with Velcro fastenings are recommended for use with AFOs because they're easy toadjust. Shoes witha removable inlay are also useful because they provide extra room. High-heeled shoes should be avoided.

It's important to break your orthosis in slowly. Once broken in, wear it as much as possible while walking because it will help you walk more efficiently and keep you stable.

Electrical nerve stimulation

In somecases, an electrical stimulation device, similar to a TENS machine,can be used to improve walking ability.Itcan help you walk faster, with less effort and more confidence.

Two self-adhesive electrode patches are placed on the skin. One is placed close to the nerve supplying the muscle and the other over the centre of the muscle. Leads connect the electrodes to abattery-operated stimulator, which is the size of a pack of cards and is worn on a belt or keptin a pocket.

The stimulator produces electrical impulses that stimulate the nerves to contract (shorten) the affected muscles. The stimulator is triggered by a sensor in the shoe and isactivated every time your heel leaves the ground as you walk.

If your GP or consultant thinks you'll benefit from using an electrical stimulation device, you'll be referred toan orthopaedic foot and ankle surgeon for an assessment. You may then be referred to a specialist unit totry the device and assess its suitabilty.

For long-term use, it may be possible to have an operation to implant the electrodes under your skin. The procedure involves positioning the electrodes over the affected nerve while you're under general anaesthetic .

TheNational Institute for Health and Care Excellence (NICE) advises that electrical stimulation can be used to treat people with foot drop caused by damage to the brain or spinal cord,provided:

• the person understands what's involved and agrees to the treatment
• the results of the procedure are closely monitored

Read the NICE guidance about Functional electrical stimulation for drop foot of central neurological origin .

Surgery

Surgery may be an option in severe or long-term cases of foot drop that have caused permanent movement lossfrom muscle paralysis.

The procedureusually involves transferring a tendon from the stronger leg muscles to the muscle that should be pulling your ankle upwards.

Another type of surgery involves fusing the foot or ankle bones to help stabilise the ankle.

Speak to your GP or orthopaedic foot and ankle specialist if you're thinking about having surgery for foot drop. They'll be able to give you more information about the available procedures and anyassociated pros and cons.