The term foot drop describes a condition that presents a limp like, weak foot that causes difficulty when walking. With foot drop, also interchangeably called drop foot, a person loses the ability to raise the foot at the ankle. The condition causes the person to lift the afflicted foot high to allow the toes to clear the ground; this is known as steppage gait.
Some cases of foot drop are temporary and others are permanent. Causes of foot drop are numerous, but the most common cause is an injury to the peroneal nerve at the top of the calf behind the knee and after hip surgery. Other causes of foot drop include, Charcot Marie Tooth Disease (CMT) multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis (ALS) Lou Gehrig's disease, and muscular dystrophy. Additional causes include stroke, drug toxicity, diabetes, low back pain, and cauda equine, a compression of the lower bundle of nerves in the spinal cord.
Peroneal nerve palsy is the term used when the nerve at the top of the calf behind the knee is compressed. If the peroneal nerve is injured, it cannot support the tibialis anterior, the muscle which lifts the foot. To diagnose foot drop, a physician will take a complete medical history and may order tests such as magnetic resonance imaging (MRI) or an electromyogram (EMG).
There are shoes and straps that can mimic the natural ankle motion and help patients with foot drop. An ankle-foot orthosis is a brace, generally made of plastic, which supports the ankle and holds the foot and ankle in the correct position. These can be cumbersome, cause skin irritation and difficult to fit in a shoe. Surgical treatment is also an option and can involve decompression, and or muscle tendon transfer techniques to move strong healthy tendons to take the place of those that are not functioning properly.
Local doctors are beginning to use a new technique that uses a patient's own blood to make a powerful healing mixture. It's safe, easy and in many cases, it can help a patient avoid surgery.
Jody Trierweiler loves her job as a fitness instructor, but last summer she started having trouble making it through her classes. Pain in her ankle was interfering with her life and her ability to make a living.
"I noticed in between teaching I was limping. So I was dealing with a lot of pain and swelling."
Jody injured her ankle as a cheerleader in college and continued to re-injure it in the years since.
"I knew I wasn't going to be able to keep teaching unless I did something."
So she went to see Providence podiatrist, Dr. Harvey Lefkowitz. After ordering an MRI, he determined the tendon which glides behind her ankle bone was frayed.
It should glide smoothly in its sheath, instead it had rough edges and pieces coming off it. It was not likely to get better on its own.
Dr. Lefkowitz said, "The likely outcome would have been more fraying of the tendon just like a rope becomes frayed and eventually they tear and a ruptured tendon of course is always a surgical problem."
Steroid injections have typically been used in cases like Jody's but –
"When the tendon is frayed you run the risk of actually rupturing the tendon when you give a steroid injection."
So Dr. Lefkowitz suggested a new treatment called platelet rich plasma which is being used to help heal tissue.
The tissue is harvested from the patient's own blood and the blood is put in a machine with a special centrifuge that helps to spin off the platelet cells.
"...which are rich in growth factor. Then those cells are put in a syringe and placed into the patients injured tissue with an injection."
This can be done along with a surgical procedure, but Dr. Lefkowitz is primarily using it as a stand-alone treatment in cases like Jody's – and for patients with heel pain.
"These are patients who have failed some more traditional treatments like casting, immobilization or other types of anti-inflammatories before going to surgery which is much more invasive."
Jody had the procedure done in August and took it easy for two weeks. In 90 percent of cases there is a cure with one injection. Occasionally two or three are needed. Jody can't believe the results.
"It's nothing short of miraculous. I didn't expect results like this," she said.