Foot Drop

spinal stenosis

Foot drop is a colloquial term for a particular symptom often associated with sciatica. The condition is described as the inability to elevate the front of the foot due to actual or perceived muscular weakness, also known as a dorsiflexion deficit. In the vast majority of cases, a structural issue is blamed for the pain and often operated upon using the latest spinal surgery techniques. Unfortunately, many patients do not find relief from their sciatica and associated lower body issues due to poor treatment results, or far more commonly, misdiagnosis of the root cause of the symptoms.

Foot drop is not difficult to diagnose, since most patients will notice it for themselves. It is common for affected sufferers to have difficulty walking normally, since the front of the foot will not operate in a manner consistent with a normal gait. Patients usually shuffle along with the foot pointed straight out, or even down, and typically have difficulty in climbing stairs or moving quickly without hitting their toes. Some patients have variable degrees of a dropped foot, with the symptoms coming and going to one extent or another, predictably or unpredictably. Many other patients have total objective loss of functionality, also known as complete foot drop. These patients can not elevate the frontal foot at all, despite their best efforts.

The most common reason for foot drop to occur is a problem with the L5 spinal nerve root. This structure is located in the lower lumbar spine, right above the lumbosacral juncture. The L5 vertebral level is one of the most common locations in the spine to suffer a variety of degenerative conditions, including the universality of disc desiccation, the common incidence of herniations and the normalcy of spinal osteoarthritic change. Other less common conditions also affect this level more than other spinal areas, including spondylolisthesis, lumbar scoliosis and various degrees of hypolordosis and hyperlordosis.

The overwhelming majority of affected patients will receive diagnostic imaging of the lumbar spine, usually in the form of CT scan, or better yet, magnetic resonance imaging. The findings will almost surely show one or more of these structural degenerative conditions, since these exist in virtually the entire adult population. Regardless of the structural problem located, there is almost a 100% chance that it will be blamed for sourcing the foot drop, without any additional thought. Patients with access to truly quality care will enjoy the benefit of neurological symptom correlation, which is one of the better ways of avoiding misdiagnosis. The rest are simply often scheduled for surgery or long term conservative care with no follow up testing at all...

Foot drop can surely occur due to herniated discs and other structural concerns, such as the incidence of osteophyte growth in the lower lumbar vertebrae. However, in many cases, non-structural processes are at work which cause the drop foot to exist and the structural findings, if any, may be only contributory or even coincidental to the symptomatic expression. I see this often in patients who still have dorsiflexion deficit, despite active and sometimes surgical treatment.

A great many patients have disc or vertebral issues at L5, since these are almost a given in the human spine. However, when symptomatic correlation is performed correctly, the actual expression will usually be far too diverse and widespread to possibly be explained from single L5 nerve compression. Regardless, surgery is often performed and results are, as expected, abysmal. Objective neurological correlation would save these patients from a world of anatomical injury and pain as they waste time, money and hope pursuing treatment which is not appropriate or indicated... Similarly, simply learning more about a diagnosed condition will help a patient see the holes in the working diagnostic theory. It is for this reason that I strongly urge all patients with foot drop, sciatica or general back pain to take active roles in their own care and thoroughly research their diagnoses, treatment options and prognoses, before agreeing to any ongoing or invasive therapy plan.