Drop Foot Series
Part 2 Drop Foot Case Study
Let’s look at Drop Foot Case Study!
A 62-year-old male presented with difficulty lifting the front of his right foot for the past three months. He reported frequent tripping, especially on carpets and uneven sidewalks, and his wife noticed a slapping sound when he walked. Symptoms started gradually in the last few months while completing his own home renovations, specifically, he was installing new floors at his house and was on his knees a lot.
Clinical Background
The patient has a history of type 2 diabetes for 12 years with mild peripheral neuropathy. He works part-time in maintenance, which often requires kneeling and squatting. There was no recent trauma.
Symptoms
– Difficulty dorsiflexing the right foot
– Frequent tripping and toe dragging
– Slapping of the foot during initial contact
– Fatigue when walking longer distances
– Mild numbness along the outer lower leg and top of the foot
Clinical Findings
Examination revealed weakness in ankle dorsiflexion and toe extension on the right side. There was less sensation along the distribution of the Common Peroneal Nerve. There is a high-stepping gait pattern to compensate for poor foot clearance. There were no joint restrictions.
Answers
Diagnosis
Drop Foot of the Right Foot secondary to Common Peroneal Nerve compression at the knee (based on weakness in ankle dorsiflexion and toe extension, sensory changes along the lateral leg and dorsum of the foot, high-stepping gait, and recent history of prolonged kneeling).
Management Plan
– Prescription of an Ankle-Foot Orthosis (AFO) to improve foot clearance and safety
– Supportive footwear with firm heel counter and secure fastening (Velcro)
– Further tests to see nerve compression severity
– Physiotherapy to strengthen dorsiflexors
– Education on avoiding prolonged kneeling or leg crossing
– Monitor nerve recovery for the next 3–6 months, assess the need for surgical intervention
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