What is foot drop Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground. Foot drop can be caused by nerve damage alone or by muscle or spinal cord trauma, abnormal anatomy, toxins, or disease. Toxins include organophosphate compounds which have been used as pesticides and as chemical agents in warfare. The poison can lead to further damage to the body such as a neurodegenerative disorder called organophosphorus induced delayed polyneuropathy. This disorder causes loss of function of the motor and sensory neural pathways. In this case, foot drop could be the result of paralysis due to neurological dysfunction. Diseases that can cause foot drop include trauma to the posterolateral neck of fibula, stroke, amyotrophic lateral sclerosis, muscular dystrophy, poliomyelitis, Charcot Marie Tooth disease, multiple sclerosis, cerebral palsy, hereditary spastic paraplegia, Guillain–Barré syndrome, and Friedreich's ataxia. It may also occur as a result of hip replacement surgery or knee ligament reconstruction surgery. Signs and symptom Human lower leg anatomy Foot drop is characterized by steppage gait.[1]While walking, people suffering the condition drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the dragging.[2] This serves to raise the foot high enough to prevent the toe from dragging and prevents the slapping.[3][4] To accommodate the toe drop, the patient may use a characteristic tiptoe walk on the opposite leg, raising the thigh excessively, as if walking upstairs, while letting the toe drop. Other gaits such as a wide outward leg swing (to avoid lifting the thigh excessively or to turn corners in the opposite direction of the affected limb) may also indicate foot drop.[5] Patients with painful disorders of sensation (dysesthesia) of the soles of the feet may have a similar gait but do not have foot drop. Because of the extreme pain evoked by even the slightest pressure on the feet, the patient walks as if walking barefoot on hot sand. Pathophysiology The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor). Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg. The anterior tibialis is the muscle that picks up the foot. Although the anterior tibialis plays a major role in dorsiflexion, it is assisted by the fibularis tertius, extensor digitorum longus and the extensor halluces longus. If the drop foot is caused by neurological disorder all of these muscles could be affected because they are all innervated by the deep fibular (peroneal) nerve, which branches from the sciatic nerve. The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space. Occasionally, spasticity in the muscles opposite the anterior tibialis, the gastrocnemius and soleus, exists in the presence of foot drop, making the pathology much more complex than foot drop. Isolated foot drop is usually a flaccid condition. There are gradations of weakness that can be seen with foot drop, as follows: 0=complete paralysis, 1=flicker of contraction, 2=contraction with gravity eliminated alone, 3=contraction against gravity alone, 4=contraction against gravity and some resistance, and 5=contraction against powerful resistance (normal power). Foot drop is different from foot slap, which is the audible slapping of the foot to the floor with each step that occurs when the foot first hits the floor on each step, although they often are concurrent. Treated systematically, possible lesion sites causing foot drop include (going from peripheral to central): Neuromuscular disease;Peroneal nerve (common, i.e., frequent) —chemical, mechanical, disease;Sciatic nerve—direct trauma, iatrogenic;Lumbosacral plexus;L5 nerve root (common, especially in association with pain in back radiating down leg);Cauda equina syndrome, which is cause by impingement of the nerve roots within the spinal canal distal to the end of the spinal cord;Spinal cord (rarely causes isolated foot drop) —poliomyelitis, tumor;Brain (uncommon, but often overlooked) —stroke, TIA, tumor;Genetic (as in Charcot-Marie-Tooth Diseaseand hereditary neuropathy with liability to pressure palsies);Nonorganic causes. If the L5 nerve root is involved, the most common cause is a herniated disc. Other causes of foot drop are diabetes (due to generalized peripheral neuropathy), trauma, motor neuron disease (MND), adverse reaction to a drug or alcohol, and multiple sclerosis. Gait cycle Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular disorder that affects the patient's ability to raise their foot at the ankle. Drop foot is further characterized by an inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle inward or outward. Therefore, the normal gait cycle is affected by the drop foot syndrome. The normal gait cycle is as follows: Swing phase (SW): The period of time when the foot is not in contact with the ground. In those cases where the foot never leaves the ground (foot drag), it can be defined as the phase when all portions of the foot are in forward motion.Initial contact (IC): The point in the gait cycle when the foot initially makes contact with the ground; this represents the beginning of the stance phase. It is suggested that heel strike not be a term used in clinical gait analysis as in many circumstances initial contact is not made with the heel. Suggestion: Should use foot strike.Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this represents the end of the stance phase or beginning of the swing phase. Also referred to as foot off. Toe-off should not be used in situations where the toe is not the last part of the foot to leave the ground. The drop foot gait cycle requires more exaggerated phases. Drop foot SW: If the foot in motion happens to be the affected foot, there will be greater flexion at the knee to accommodate the inability to dorsiflex. This increase in knee flexion will cause a stair-climbing movement.Drop foot IC: Initial contact of the foot that is in motion will not have normal heel-toe foot strike. Instead, the foot may either slap the ground or the entire foot may be planted on the ground all at once.Drop foot TC: Terminal contact that is observed in patients that have drop foot is quite different. Since patients tend to have weakness in the affected foot, they may not have the ability to support their body weight. Often, a walker or cane will be used to assist in this aspect. Drop Foot is the inability to dorsiflex, evert, or invert the foot. So when looking at the Gait cycle, the part of the gait cycle that involves most dorsiflexion action would be Heel Contact of the foot at 10% of Gait Cycle, and the entire swing phase, or 60-100% of the Gait Cycle. This is also known as Gait Abnormalities. DiagnosisEdit Initial diagnosis often is made during routine physical examination. Such diagnosis can be confirmed by a medical professional such as a neurologist, orthopedic surgeon or neurosurgeon. A person with foot drop will have difficulty walking on his or her heels because he will be unable to lift the front of the foot (balls and toes) off the ground. Therefore, a simple test of asking the patient to dorsiflex may determine diagnosis of the problem. This is measured on a 0-5 scale that observes mobility. The lowest point, 0, will determine complete paralysis and the highest point, 5, will determine complete mobility. There are other tests that may help determine the underlying etiology for this diagnosis. Such tests may include MRI, MRN, or EMG to assess the surrounding areas of damaged nerves and the damaged nerves themselves, respectively. The nerve that communicates to the muscles that lift the foot is the peroneal nerve. This nerve innervates the anterior muscles of the leg that are used during dorsi flexion of the ankle. The muscles that are used in plantar flexion are innervated by the tibial nerve and often develop tightness in the presence of foot drop. The muscles that keep the ankle from supination (as from an ankle sprain) are also innervated by the peroneal nerve, and it is not uncommon to find weakness in this area as well. Paraesthesia in the lower leg, particularly on the top of the foot and ankle, also can accompany foot drop, although it is not in all instances. A common yoga kneeling exercise, the Varjrasana has, under the name "yoga foot drop," been linked to foot drop. Vajrasana yoga foot drop --- Yoga foot drop is a kind of drop foot, a gait abnormality. It is caused by a prolonged sitting on heels, a common yoga position of vajrasana. The name was suggested by Joseph Chusid, MD, in 1971, who reported a case of foot drop in a student who complained about increasing difficulty to walk, run, or climb stairs. The cause was thought to be injury to the common peroneal nerve, which is compressed and thereby deprived of blood flow while kneeling. Yoga foot drop is a potential adverse effect of yoga, allegedly unmentioned by yoga teachers and books

*Paralysis* *Today about* Definition Paralysis is the inability – whether temporary or permanent – to move a part of the body. In almost all cases, paralysis is due to nerve damage, not to an injury to the affected region. For instance, an injury in the middle or lower regions of the spinal cord is likely to disrupt function below the injury, including the ability to move the feet or feel sensations, even though the actual structures are as healthy as ever. The spinal cord is like the brain’s relay system, so when something in the spinal cord doesn’t work or is injured, paralysis is often the result. These injuries can be the product of traumatic accidents, or diseases such as strokes and polio. Most spinal cord injuries are incomplete, which means that some signals still travel up and down the cord. With an incomplete injury, you may retain some sensation and movement all the time, or the severity of the paralysis may change sometimes on a highly unpredictable basis. A complete spinal cord injury, by contrast, completely compressed or severs the nerves in the spinal cord, making it impossible for the signal to travel. Types of Paralysis Temporary and permanent paralysis Paralysis can either be temporary or permanent. Bell’s palsy is a relatively common cause of temporary paralysis that causes temporary facial paralysis. Sometimes paralysis that occurs after a stroke can also be temporary. Paralysis caused by serious injury, such as a broken neck, is usually permanent. Examples of localised paralysis include: Facial paralysis – which is usually limited to one side of the face Paralysis of the hand Paralysis of the vocal cords – vocal cords are bands of tissue and muscle used to generate speech; paralysis usually only affects one vocal cord, which means the person is able to speak but their voice will be hoarse There are four generalized paralysis, however, which have to do with the portion of the body that is affected. Monoplegia Monoplegia is paralysis of a single area of the body, most typically one limb. People with monoplegia typically retain control over the rest of their body, but cannot move or feel sensations in the affected limb. Cerebral palsy, injuries and ailments can lead to this form of partial paralysis, including: Strokes Tumors Nerve damage due to injuries or diseases Nerve impingement Motor neuron damage Brain injuries Impacted or severed nerves at the affected location Hemiplegia Hemiplegia affects an arm and a leg on the same side of the body, and as with monoplegia, the most common cause is cerebral palsy. Hemiplegia often begins with a sensation of pins and needles, progresses to muscle weakness, and escalates to complete paralysis. Hemiplegia should not be confused with hemiparesis, which refers to weakness on one side of the body. Nevertheless, hemiparesis is often a precursor to hemiplegia, particularly for people with neurological issues. Paraplegia Paraplegia refers to paralysis below the waist, and usually affects both legs, the hips, and other functions, such as sexuality and elimination. Though stereotypes of paraplegia hold that people with this condition cannot walk, move their legs, or feel anything below the waist, the reality of paraplegia varies from person to person and sometimes, from day to day. Spinal cord injuries are the most common cause of paraplegia. These injuries impede the brain’s ability to send and receive signals below the site of the injury. Some other causes include: Spinal cord infections Spinal cord lesions Brain tumors Brain infections Rarely, nerve damage at the hips or waist; this more typically causes some variety of monoplegia or hemiplegia. Brain or spinal cord oxygen deprivation due to choking, surgical accidents, violence, and similar causes. Stroke Congenital malformations in the brain or spinal cord Quadriplegia Quadriplegia, which is often referred to as tetraplegia, is paralysis below the neck. All four limbs, as well as the torso, are typically affected. Some quadriplegics spontaneously regain some or all functioning, while others slowly retrain their brains and bodies through dedicated physical therapy and exercise. Spinal cord injuries are the leading cause of quadriplegia. The most common causes of spinal cord injuries include automobile accidents, acts of violence, falls, and sporting injuries, especially injuries due to contact sports such as football. Traumatic brain injuries can also cause this form of paralysis. Other sources of quadriplegia include: Acquired brain injuries due to infections, stroke, and other disease-related processes. Loss of oxygen to the brain and spinal cord due to choking, anesthesia-related accidents, anaphylactic shock, and some other causes. Spinal and brain lesions Spinal and brain tumors Spinal and brain infections Catastrophic nerve damage throughout the body Congenital abnormalities Early brain injuries, especially pre-birth or during-birth injuries that lead to cerebral palsy, which can produce a range of symptoms, including varying degrees of paralysis Allergic reactions to drugs Drug or alcohol overdoses Partial or complete paralysis Paralysis can be: Partial – where there is some muscle function and sensation; for example, if a person can move one leg but not the other, or feel sensations such as cold and heat Complete – where there is complete loss of muscle function and sensation in affected limbs Spastic or flaccid paralysis Paralysis can be: Spastic – where muscles in affected limbs are unusually stiff or display spasms, and movements are not under the control of the individual (read about spastic paraplegia) Flaccid – where muscles in affected limbs are floppy and weak; muscles in flaccid paralysis may shrivel Epidemiology about paralysis in US Paralysis is dramatically more widespread than previously thought. Approximately 1.7 percent of the U.S. population, or 5,357,970 people were living with some form of paralysis, defined as a central nervous system disorder resulting in difficulty or inability to move the upper or lower extremities. The leading cause of paralysis was stroke (33.7 percent), followed by spinal cord injury (27.3 percent) and multiple sclerosis (18.6 percent). Causes The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are: Stroke Tumor Trauma (caused by a fall or a blow) Multiple sclerosis (a disease that destroys the protective sheath covering nerve cells) Cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth) Metabolic disorder (a disorder that interferes with the body’s ability to maintain itself) Damage to the spinal cord is most often caused by trauma, such as a fall or a car crash. Other conditions that may damage nerves within or immediately adjacent to the spine include: Tumor Herniated disk (also called a ruptured or slipped disk) Spondylosis (a disease that causes stiffness in the joints of the spine) Rheumatoid arthritis of the spine Neurodegenerative disease (a disease that damages nerve cells) Multiple sclerosis Damage to peripheral nerves may be caused by: Trauma Compression or entrapment (such as carpal tunnel syndrome) Guillain-Barré syndrome (a disease of the nerves that sometimes follows fever caused by a viral infection or immunization) Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (a condition that causes pain and swelling in the protective sheath covering nerve cells) Radiation Inherited demyelinating disease (a condition that destroys the protective sheath around the nerve cell) Toxins or poisons Symptoms Usually paralysis are occur along with some of the following symptoms – Loss of consciousness (could be brief) or confusion Clumsiness and numbness Severe headache Difficulty breathing Drooling Cognitive difficulties, difficulty writing or speaking Changes in mood or behavior Loss of bladder or bowel control Loss or changes in vision and/ or hearing Nausea with or without vomiting Complications Because paralysis causes immobility, it has a rather significant effect on the other systems in the body. These include: Changes to circulation and respiration Changes to the kidneys and gastrointestinal system Changes to muscles, joints, and bones Spasticity of the limbs Muscle spasms Pressure sores Edema Blood clots in the lower limbs Feelings of numbness or pain Skin injury Bacterial infection Disruption of the normal working of the tissues, glands, and organs Constipation Loss of control of urination Sexual difficulties Abnormal sweating Abnormal breathing or heart rate Balance problems Difficulty thinking Behavioral issues Difficulty speaking or swallowing Vision problems Diagnosis The first step in diagnosis of paralysis is physical exam by the doctor. Next the doctor will talk about the symptoms and family history. Diagnosing will not be difficult if the cause of paralysis is obvious, for example, paralysis after a stroke. If the cause is not obvious, then the physician will order specialized tests such as: X-ray CT scan (Computed tomography) MRI (Magnetic Resonance Imaging) scans Electromyography (usually used to diagnose Bell’s palsy) If required the patient will then be referred to a neurologist. Treatment and Medications A wearable electronic device that helps recover arm function by delivering tiny electrical currents to the nerves thereby activating hand and arm muscles. This method is called Functional Electrical Stimulation or FES. If cure or recovery from paralysis is not possible, various mobility aids such as wheelchairs and orthoses are available for people with paralysis. Prosthetics and orthoses: Prosthesis is a device that replaces or extends a limb, extremity, or other body part. Orthoses are external mechanical devices which support, prevent, correct and assist body segments in neuromuscular skeletal conditions. Medication and aids for managing paralysis In most cases, spinal cord injury and paralysis result in the loss of normal bowel and bladder function. So, a catheter is used to empty urine from the bladder. Bowel retraining, enemas, and sometimes colostomy (surgery of the bowel) are done to help people with paralysis empty their bowel. Pain caused by nerve damage is normally relieved through medicines such as amitriptyline or pregabalin, since common painkillers like paracetamol or ibuprofen are ineffective in such type of pain. Breathing difficulties that arise through spinal cord injury to the upper neck is often treated using positive pressure ventilators that are either invasive or non-invasive. For abnormally stiff muscles (spasticity) and involuntary muscle spasms, treatment involves use of muscle relaxants such as Baclofen, Tizanidine or Dantrolene. Sometimes, Botox is given for localised spasms. A relatively new treatment for management of spastic paralysis is the intrathecalbaclofen (ITB) therapy in which consistent optimal dosage of Baclofen is delivered via a programmable drug pump implanted in the fluid-filled space around the spinal cord. It is important to note that pressure ulcers can develop if a person is unable to move regularly due to paralysis. Care must be taken to ensure that preventive measures such as changing position regularly or pressure relieving devices are used. Rehabilitation may involve: Physiotherapy – to improve mobility Speech therapy – to improve communication Occupational therapy – to improve daily functions such as eating, cooking, toileting and washing. Prevention Reducing the number of controllable risk factors is the best way to prevent a stroke. This can include: Stopping smoking Losing weight Eating a balanced diet low in sodium and saturated and trans fat Moderating alcohol intake (no more than 2 small drinks per day) Exercising regularly in order to stay physically fit Maintaining good control of existing medical conditions such as diabetes, high blood pressure and high cholesterol

70 years old female patient came with c/o pain in both knee joints

An 16 years old male is having weakness of left upper limb with wasting over a period of last 6 months. Also gives history weaked grip of left hand . Apparently everything looks normal as no other symptoms What next should be done for further evaluation of this case

12 yr old boy with progressive weakness in all four limb and dysarthia.