Cerebral palsy can lead to the inability to properly flex the foot and big toe, resulting in a condition called drop foot or foot drop. The words foot drop and Ankle Foot Orthosis (AFO) may be two of the first terms parents hear in relation to their child’s orthopedic status. Learning how to properly identify and treat foot drop in your cerebral palsy child can help improve their mobility and independence as they grow older.
Foot drop is the inability to lift the front portion of the foot due to weak or absent ankle strength. The foot does not clear the ground when walking, resulting in what is known as a steppage- type gait pattern. A child with foot drop may compensate and develop a walk characterized by increased knee and hip flexion to insure that the toe clears the ground.
In children with cerebral palsy, foot drop may be caused by a disruption of the neurological motor control pathway. This condition can occur in numerous disabilities such as cerebral palsy, stroke, spinal cord injury, or multiple sclerosis and can be neurological or muscular in origin. In some cases, foot drop may be temporary. In other cases, it can be a permanent condition.
If you’re concerned that your child may be experiencing foot drop or other gait abnormalities, bring these concerns to the attention of your child’s physician and ask for a referral to a specialist. In determining a diagnosis, the doctor will examine history, symptoms, your child’s level of mobility and walking pattern. Most of these factors can be determined using a visual examination. However, additional tests may be necessary including:
- Imaging studies, such as MRI, or CT scans
- Electrodiagnostic studies to assess nerve status
- A blood analysis for a possible metabolic cause
- Fasting blood sugar, hemoglobin and nitrogen and creatinine test
Left uncorrected, foot drop can put a child at risk for falls, injury, and diminished mobility. There are a variety of treatment options available. Consult your doctor to determine the best solution for your child.
Ankle Foot Orthosis (AFO)
This is the most common treatment for foot drop. These orthopedic devices support the ankle and foot to allow a more normal range of motion. AFOs can be made from a number of materials including plastics, metal, leather, or a carbon composite. Plastic AFOs can be custom molded from a cast. Problems that can develop with the use of AFOs can include sizing, difficulty obtaining the proper fit, or skin break down. Your child’s specialist will select a specific type of AFO depending on your child’s needs.
Types of AFOs
- Standard (Solid) AFO: Is the common choice for improved stability and external support and when limited ankle range of motion is needed.
- Hinged (Articulated) AFO: This type may be considered if your child has limited dorsiflexion (ability to move the foot toward the shin), experiences diminished walking speed or restricted stride length.
- Dynamic AFO (DAFO): This style of AFO may be selected to achieve better knee extension, improve motor skills or when increased stride length is desired.
- Posterior Leaf Spring Brace: Used for increased knee extension.
- Dual Carbon Fiber Spring (CFO)
Neuroprosthetics use electrical current to restore nerve function in patients who suffer from neural impairments. Familial examples include hearing aids and cardiac pacemakers. In one study, researchers compared neuroprosthesis therapy for foot drop with traditional orthotics and discovered that, compared with AFOs, neuroprosthesis appeared to enhance balance control during walking and more effectively manage foot drop. The WalkAide, Bioness Ness 300 foot drop system, and the Odstock Dropped Foot stimulator are examples of current manufactured devices.
In cases where foot drop severely compromises your child’s ability to walk, physical therapy may be needed. Specialized therapy for foot drop can include gait training or specific exercises to help affected muscles.
In severe cases, surgery may be needed. Doctors may perform a procedure involving fusing ankle or foot bones or a procedure that transfers functioning tendons to help support the foot.
If you suspect your child may have foot drop, talk with your doctor to discuss specific diagnosis and treatment options. The earlier the condition is diagnosed, the sooner therapies and orthotics can be used to increase your child’s mobility and quality of life.
By Lee Vander Loop
CP Family Network Editor