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Understanding Foot Drop After TBI: Causes, Side Effects, and Treatments

Woman doing floor exercises and stretching her feet because she has foot drop after TBI

Foot drop after TBI is caused by the inability to lift the front of the foot — a movement known as dorsiflexion. This can make walking difficult.

Treatment for foot drop can take many different forms, because each person responds to treatment differently. Therefore, what works for one person may not work for others.

To help you make an informed decision, this article will walk you through the causes and treatment options for foot drop after TBI.

Causes of Foot Drop After TBI

Foot drop, sometimes called drop foot, occurs when a person struggles with dorsiflexion: the movement of lifting the front part of their foot up towards their shin.

Foot drop after TBI is usually caused by damage to the neural pathways responsible for activating the anterior (front) muscles of the leg.

The brain injury disrupts the central nervous system’s ability to send signals to these muscles, making it difficult if not impossible to control dorsiflexion.

Sometimes foot drop after TBI is not caused by direct damage to the brain, however. Rather, a pinched peroneal nerve – which could occur during an accident – might also be the culprit.

Understanding the cause of your foot drop is crucial for achieving recovery because treatment will differ according to the cause. Therefore, have your doctor perform a thorough evaluation and diagnosis of your foot drop before seeking treatment.

Side Effects of Foot Drop  

The signs and effects of foot drop following a brain injury go beyond simple weakness in the foot. In fact, there are some specific symptoms of foot drop that doctors look for to make a correct diagnosis. These include:

  • Curled toes toward the balls of the feet
  • Extensive bending of the knee to compensate for foot drop.
  • Persistent corns on the base of the foot

Once your doctor has determined the cause of your foot drop after TBI, you can begin trying some different solutions.

Treatments and Solutions for Foot Drop After TBI

There are multiple solutions for foot drop available. Some solutions will work better for you than others, which is why it is important to understand your options.

The following are a few examples of the different types of foot drop treatments your physical therapist might suggest.

1. Foot Drop Exercises

man practicing foot drop exercises after tbi

©iStock/Mladin Zivkovic

One of the best ways to treat foot drop is to rewire the brain to control your foot’s dorsiflexion again.

You can do this by activating neuroplasticity, which allows the brain to form new neural pathways in response to repetitive practice.

Since foot drop after TBI is a result of lost communication between your brain and foot muscles, practicing enough foot drop exercises will help restore that connection and improve your dorsiflexion.

Even just moving your foot a little bit will activate neuroplasticity. Some of the best foot drop exercises for brain injury include:

  • Negative toe raises. Start by pointing your foot up toward your body as high as you can. Then, instead of letting it drop, slowly lower your foot back down to a neutral position. Repeat 10 times.
  • Ankle eversion. Place your affected foot on the ground. Next, lift the outer edge of your foot up, so that your foot is bending inwards. Focus on initiating the movement from your ankle only, do not move your leg. Repeat ten times.

Again, these exercises are a great way to improve function in your foot. But what if your foot drop is so severe that you cannot move it at all?

2. Passive Exercise

therapist stretching patient's foot with exercise band

With passive exercises, therapists help patients improve their foot drop by supporting the correct movement patterns.

Interestingly, even passively moving your foot in the correct way can activate neuroplasticity, which will help you regain dorsiflexion.

Usually, a physical therapist will perform passive exercises on your foot, but you can also do them yourself at home. Two examples of passive exercises you can do on your own are:

  • Passive ankle dorsiflexion. Sit in a comfortable position and cross one leg over your other. Then, use your hand to move your foot up towards your knee and back down. Repeat ten times, then switch to your other foot.
  • Assisted toe raises. If you can only move one foot, this exercise can help you strengthen your other ankle. First, place your strong foot underneath your affected one. Then, use your good foot to lift up your weak foot. Make sure you keep your heel on the ground at all times. Finally, lower the foot back down. Repeat ten times.

Passive foot drop exercises can also help improve blood flow and prevent contractures.

3. Functional Electrical Stimulation

If passive exercise does not seem to work for you, functional electrical stimulation (FES) might help.

FES involves sending small electrical impulses into the weakened muscles of the foot to create a contraction. Reactivating these muscles encourages dorsiflexion and engages neuroplasticity.

Ideally, FES should be used in conjunction with passive exercise. Ask your therapist to have them show you how to use FES at home.

4. Medication

pharmacist handing customer medication for foot drop after TBI

Some medications can help promote the healing of damaged nerves. This can help speed up the process to regain dorsiflexion.

For example, erythropoietin is a hormone naturally produced by the body. Not only does it have anti-inflammatory properties, but it also helps regulate the regrowth of nerves.

Therefore, many doctors will prescribe this hormone and other similar medications to promote a fuller recovery from foot drop after TBI. Of course, no medication can replace the work you must do in therapy. But it can assist.

Ask your doctor about any medications before starting them.

5. Surgery

Finally, severe cases of foot drop may require surgical interventions. Some example of surgical treatments that can help improve dorsiflexion include:

  • Nerve transfers. This procedure involves taking “donor nerves” from other parts of the body and using them to connect the ends of the divided nerve. This helps restore function.
  • Decompressive surgery. If the peroneal nerve is pinched, surgery can help relieve pressure on the nerve, which may help improve dorsiflexion.

These surgeries are invasive, however, and are often used as a last resort.

How to Use Ankle Foot Orthotics for Foot Drop

Close-up of ankle brace on man's foot

Ankle foot orthotics, also known as AFOs, support the foot so that it doesn’t drag on the floor. They can help you avoid tripping on your foot as you walk, which reduces your risk of injury.

However, AFOs are not permanent solutions for foot drop. In fact, most therapists consider them compensatory tactics, which help you compensate for lost function.

These are great in the beginning of recovery. However, if you rely on compensatory tactics like AFOs too much, you can develop learned non-use, which causes you to lose more function.

That’s why, if you decide to use an AFO, make sure you also practice foot drop exercises every day.

Recovering From Foot Drop After TBI

Foot drop after TBI is a common problem that can impair walking. Fortunately, there are many types of treatments available to help you overcome foot drop.

Daily foot drop exercises are the best way to treat foot drop. They help rewire the brain and improve your dorsiflexion. Surgery and some medications can also help.

However, recovery from foot drop can take some time. While you are working on your treatment, AFOs can help keep your foot straight and prevent contractures. But it is important to keep up with your exercises.

The more foot drop exercises you perform, the more function you can regain, until you no longer require an AFO. Good luck!

Featured Image: ©iStock/Ridofranz

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