Drop foot secondary to lumbar radiculopathy

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Drop foot secondary to lumbar radiculopathy

Postby Paula » Tue Nov 01, 2011 6:22 pm

Patient had a micro endoscopic decompression for spinal stenosis approx 6 years ago and has a drop foot with MMT of 3+ for ankle DF. I evaluated patient for a diagnosis of gait disorder and imbalance. Would exercises to try to increase patient's DF strength be more effective than electrical stim to the peroneals or should the patient get a hinged AFO. Patient has had hx of falls on uneven terrain secondary to the drop foot. All other strength of ble's is wfl/wnl. Patient does demonstrate significant instability with static/dynamic activties with decreased BOS and alteration of somatosensory cues.
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Re: Drop foot secondary to lumbar radiculopathy

Postby kwyss » Thu Nov 03, 2011 11:18 pm

Does the patient report any change in strength of his LE over the last year. Was an EMG done revealing if there is nerve damage? Since there is 3+/5 I would first consider a less restricting orthotic device to encourage active use of dorsal flexors.
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Re: Drop foot secondary to lumbar radiculopathy

Postby DCandy » Sat Nov 05, 2011 11:51 am

I agree with kwyss on the AFO. Since the patient has 3+/5, they should at least be able to keep the foot dorsiflexed during swing phase thus minimizing their fall risk from dragging their toes. Active/active resistive strenghtening should almost definately be included. In regards to Estim, I think that depends largely on the source of the weakness. If it is muscular in nature only, estim may be an effective adjunct. However, if there are signs of continued nerve compression centrally (+ SLR, sensory or reflex changes), it would probably be better to focus on the central component addressing the stenosis.

You can electrically induce the muscle to contract as hard as you want, but if the message isn't making it from the brain to the ankle due to neural compromise in the spine, you probably won't see a functional carry-over from estim.
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Re: Drop foot secondary to lumbar radiculopathy

Postby Paula » Wed Nov 09, 2011 7:27 pm

Patient's weakness is a result of prolonged nerve compression prior to having the surgery. He did not have any change in strength since the surgery per patient report. Since I am treating him for a gait disorder...it is evident that the weakness is a factor. I agree that some type of AFO will be most beneficial and surprised that this has not been recommended in all the years since his surgery. Additionally, I will try kinesio tex tape to facilitate dorsiflexion.
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Re: Drop foot secondary to lumbar radiculopathy

Postby justCat » Wed Dec 07, 2011 12:04 am

I agree with the AFO and have u given thought to the use or ESTIM with manual resistance.
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Re: Drop foot secondary to lumbar radiculopathy

Postby Jbeas » Tue Feb 07, 2012 3:13 pm

The last experience of any new E-stim guidelines was in 2010 and it suggested FES only used for MMT at 2/5 or less and Muscle re-ed at MMT of 0/5. So since the MMT was at 3/5 i don't know how effective E-stim would even be at this point.
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