The client who is unconscious is developing foot drop. what nursing action is indicated?

Foot drop, or drop foot, involves a difficulty in lifting the front part of the foot, which can causes challenges while walking. It’s a common symptom of multiple sclerosis (MS), but it can also be caused by other neurological syndromes or physical damage to a nerve.

People with this symptom tend to walk by lifting the knee, as though they were walking up stairs. Other muscle- and nerve-related symptoms of MS can compound the challenges presented by this condition.

There are many treatment options, ranging from braces to physical therapy to surgery. They may not completely restore a normal gait, but they can often reduce symptoms significantly and make walking easier.

Because MS disrupts communication between the brain and the body, nerve-related problems are common. Feelings of numbness or tingling in the extremities are often the earliest signs of MS.

Nervous system problems can develop into more serious complications. Foot drop is the result of a weakness in the tibialis anterior muscle, which is controlled by the deep peroneal nerve.

Foot drop-related walking problems can be made worse by other symptoms of MS.

Numbness in the feet can become so severe that someone with MS may have difficulty feeling the floor or knowing where their feet are in relation to the floor. This condition is called sensory ataxia. Ataxia is a muscle control problem that prevents the coordination of movement.

Many symptoms of MS can cause difficulties with walking. The general sense of fatigue that accompanies MS causes leg muscles to become tired, and tightness or spasms in the leg muscles can add to walking problems. Even without foot drop, walking can be a challenge for people with MS.

There are several early symptoms that may be associated with drop foot, including trips, falls, and changes in gait.

A few of the most common early signs of drop foot include:

• decreased muscle mass
• frequent trips or falls
• limpness of the foot
• loss of sensation in the leg or foot
• changes in gait, such as raising your leg higher or swinging your leg to the side when walking

Foot drop treatment depends primarily on the cause of the condition and the extent of the disability. Treating a herniated disc, for example, may eliminate foot drop. But spinal surgery may not solve the problem for people with MS.

Orthotics

A variety of orthotics, such as braces and splints, are available. Some are worn in the shoes, while others are worn around the ankle or near the knee.

One widely used device is the ankle foot orthosis (AFO). It helps keep the foot at a 90-degree angle to the lower leg to support it. While it can help improve your gait, it may require a larger shoe to accommodate the brace. An AFO may also become uncomfortable if worn for long periods of time.

Electrical stimulation while walking can also help reduce the symptoms of foot drop. This treatment is also known as functional electrical stimulation (FES). Small devices worn near the knee respond to the movement of the leg and send mild electrical stimuli to the muscle to help it move properly.

A 2021 study showed that both AFO and FES treatment effectively improved gait for people with stroke-related drop foot.

Physical therapy

Physical therapy may also help. A variety of exercises can strengthen the leg muscles and improve flexibility. Working with a physical therapist who has a knowledge of MS and foot drop can be especially helpful.

Surgery

If orthotics or physical therapy don’t sufficiently manage the condition, there are several surgical solutions that may help, including:

• Tendor transfer. This involves transferring a tendon that usually goes to a different part of the foot and directing it instead to the top of the foot to replace the tibialis anterior.
• Ankle fusion. This type of surgery fuses the foot and ankle to remove the burden from the surrounding muscles. However, this procedure reduces the flexibility of the ankle.
• Nerve graft or transfer. This procedure is focused on repairing damaged nerves by replacing them with healthy nerves.
• Peroneal nerve decompression. This surgery is used to treat peroneal nerve entrapment, a common cause of drop foot, by reducing pressure on the nerve.
• Lumbar decompression. This type of procedure relieves pressure on the nerves of the lower back. It usually involves removing small sections of bones from the vertebrae or from discs in the spine.

All surgeries carry risks, so it’s important to reach out to your doctor about all your treatment options. If you’re going to have surgery, be sure to understand the risks, benefits, and long-term results of your choice.

Many exercises for drop foot can help ease symptoms and help you regain mobility.

Assisted toe raises

1. Place your affected foot on top of the non-affected foot.
2. Use your non-affected foot to lift the other foot up and then lower it down slowly.
3. Repeat 10-15 times.

Ankle abduction and adduction

1. In a seated position, start by crossing your affected leg over your non-affected leg.
2. Place your hand on the toes and use your hand to slowly move the foot up and down, keeping your ankle perpendicular to the floor as you move.
3. Repeat 10 times.

Single leg stands

1. Hold onto the back of a chair and try standing on your affected leg for 10-15 seconds at a time.

Ankle eversion and inversion

1. Place your affected foot on the ground, slowly lift the outer edge of the foot up, and then lower it down.
2. Next, try lifting the inner edge of the foot and lowering it slowly.
3. Repeat each exercise 10 times.

Ankle dorsiflexion

1. In a seated position, cross your affected leg over your non-affected leg.
2. Use your hand to slowly dorsiflex your foot by moving the toes back towards the shin.
3. Repeat 10-15 times.

The amount of time it takes to recover from drop foot can vary depending on the specific cause and the severity of injury to the associated nerves. Nerve injury may only take around 3 months to recover while neuron loss caused by MS may take up to 12 months. Some nerves may never fully heal, causing the issue to become permanent.

Potential signs of healing may include:

• improvements in balance
• increased strength or muscle mass
• reduced numbness
• decreased stiffness

Drop foot is a symptom characterized by difficulty lifting the front part of the foot, which can lead to issues with mobility.

Fortunately, there are several treatment options, which may include a combination of orthotics, physical therapy, and surgical procedures.

However, it’s important to seek early treatment to improve the chances of recovery.

What causes drop foot in both feet?

Though drop foot usually only affects one foot, it can affect both feet in some cases.

This may be caused by damage or injury to the common peroneal nerves in both legs, which can occur during certain surgical procedures. Drop foot can also be caused by spinal cord injuries and systemic diseases.

How common is drop foot?

Drop foot is a symptom associated with many different conditions.

For instance, it’s estimated to affect approximately 20 percent of people after stroke and about 23 percent of those with a herniated disc affecting the L5 nerve root.

However, there is currently no research available on the overall prevalence of drop foot in the general population.

Can you walk with foot drop?

Drop foot causes issues with walking, including changes in gait or frequent falls and trips. Walking aids and devices like braces, splints, and shoe inserts can help improve mobility.

How long before foot drop is permanent?

Foot drop is often temporary and many people recover within a few months. However, it can be permanent in some cases, especially if it is caused by issues like severe nerve damage or stroke.

Is drop foot serious?

Drop foot can be a sign of other issues, some of which may be serious.

For this reason, it’s important to talk to your doctor if you experience drop foot to determine the cause and best course of treatment.