treating foot drop (Full Version)

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suhaib31302 -> treating foot drop (December 4, 2004 5:16:00 PM)

i am treating a patient from
1 week who has the foot drop since
8 months.
He was operated by some
neurosurgeon at L345 spine 6 months
before, after
having severe pain in back of leg.
but his foot drop problem could
not be solved. the surgeon operated
due to increasing in size of lamina
or any else.
i am giving him stimulation
with DL-2 and SWD at the common
peronial nerve path.and applying US
on lumbosacral spines.i gave him afo.


there is no recovery since i week.

what is your openion about........
1.> which test i should advice him
(NCV Test or EMG Test).or any other ?
2.> what should be my treatment plan?
3.> is there any cure?
4.> is its nerve suttering possible?


please give me your openion very soon.
waiting your response.................

Yours Sincerely,
SUHAIB MAJEED



Jon Newman -> Re: treating foot drop (December 5, 2004 4:09:00 AM)

Suhaib,

PT itself (in the form of stretching, strengthening and modalities) will not make the nerve grow back. Therapy would center on exercises the patient can do to encourage recruitment of the muscles in the area. Helping with compensatory strategies in the mean time would also seem prudent. My understanding is that an ankle-foot orthosis is not likely to impair return of dorsiflexion if it is to return at all.

The paitent's MD should be able to answer the other questions based on the details of the surgery.

jon



Yen -> Re: treating foot drop (December 7, 2004 7:32:00 PM)

I'd choose a nerve conduction test just to see where the injury is. The neuralgia will take at least 6 weeks to show any changes. *sighs* Nerve recovery alas. A few parallel bar ex ideas: practise the swing part of gait emphasising toes up to clear feet, step over a hoop or step onto a low step, wobbleboard ex's, bilateral weightbearing ex's eg calf raises/heel raises and biofeedback muscle stimulation.
If swelling reduces in the injured site, and if the nerve begins to recover some improvement will show with time. Don't give up yet. Possbily nerve desensitisation techniques eg stretches may help when u feel appropriate to introduce.



nari -> Re: treating foot drop (December 8, 2004 12:19:00 AM)

Suhaib

If there is no severing of the nerve,only compression, it will take about 6 weeks to show useful movement. This is not uncommon - it can occur after hip replacement as well. Almost always it is compression, or major stretching.

A foot orthosis may be needed in order for him to walk - another way, which is less inhibitory on recovery, is to softCast (a special synthetic wrap-around cast applied like taping. It allows movement in the foot and helps the foot to clear the ground during swing phase. it is widely used for a dysfunctional foot post-stroke.
Is there toe extension?

Make sure that the calf remains long - perhaps a light splint (here is where the SoftCast is great) overnight. Othrwise he could wear a boot in bed to preserve length.

It will be a long haul, but it should turn out OK.


Nari



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