Foot Drop- Cbl

CBL CASE-I Muscle Atrophy

The muscles of the different compartments of the leg Compartment

Muscle

Action

The anterior compartment

Tibialis anterior, Extensor digitorum longus, Extensor hallicus longus Peroneus tertius

Dorsiflex the foot and toes (pull the foot and toes upward). Tibialis anterior also assists turning the foot inward.

The lateral compartment

Peroneus longus and Peroneus brevis muscles

Eversion & Plantar flexion

The posterior compartment

Gastrocnemius, Soleus and Plantaris

Plantar flexion

The deep posterior compartment

Tibialis posterior, Flexor digitorum longus, and Flexor hallicus longus

Plantarflexion, Tibialis posterior pulls the foot inward, Flexor digitorum longus flexes the toes, and Flexor hallicus longus flexes the big toe.

Anterior compartment muscles

Superficial posterior compartment muscles

Deep posterior compartment muscles

Muscles supplied by the Superficial and Deep Peroneal N. Superficial peroneal nerve : • Supplies all lateral compartment leg muscles • Peroneus (Fibularis) longus: helps steady leg on foot when stand on one leg & • Peroneus (Fibularis) Brevis: Evert and plantar flex the foot Deep peroneal nerve • Supplies all anterior compartment leg muscles • Tibialis anterior:Dorsiflexor and invertor of foot . • Extensor digitorum longus extend toes • Peroneus (Fibularis) tertius dorsiflexion of foot

Blood supply to the muscles of the leg Anterior Tibial artery (smaller branch of popliteal A) Supplies the anterior compartment of leg Posterior Tibial artery (Larger terminal branch of popliteal artery) Supplies posterior and lateral compartment of leg(lateral compartment by the Peroneal A branch of the Posterior Tibial A)

Ant. Tibial Artery

Post. Tibial Artery

Development of atrophy of the right leg muscles The patient is suffering from chronic compartment syndrome. A tough fascia surrounds the muscles in the lower leg and is attached to the bone rigidly. This fascia or "compartment" is slightly flexible and allows little room for the muscles to contract with exercise. If there is an increase in the contents of the compartment beyond the fascia's ability to stretch, pressure is felt on the nerves, and blood vessels in the compartment.

Atrophy of the leg muscles

Fracture of the leg bones Injury to the blood vessels Bleeding into the compartment ↑ the pressure in the compartment Blood vessels are compressed Blood flow to and from the muscle is shut off

Nerves are pinched Feet and lower legs become numb

Pain toward the outside of the shin because of Fascial hernias Compartment syndrome

Fascial hernias These little balloon-like pouches bulge from under the skin on the lower shin. Small fascial hernias are common to allow blood vessels and nerves to expand.Larger holes can develop due to the pressure of compartment syndrome can actually allow muscle to be pushed through. This can cause pain and tenderness, numbness and tingling in the foot.

Compartments of the leg

Development of foot drop following leg injury in this patient • The Peroneal nerve studies show absent motor activity which means that the muscles of the anterior and lateral compartments of the leg were affected whose main functions are dorsi flexion of the ankle , digital extension and eversion of the foot thus the foot drop is seen due to the absence of the action of these muscles

How did wearing cowboy boots help him while walking ? The boots help to maintain the angle of the foot to the leg and decrease the degree of the plantar flexion (which would result in the dragging of the foot while walking)

What physiotherapy measures would you suggest for this patient ? • Gentle massage and Passive movements to improve the blood and lymphatic circulation • Remedial exercises depending on the power of the individual groups of muscles. Assisted exercises are given to muscles whose power is 1 and gravity, eliminated exercises are given to muscles whose power is 2. The elimination of gravity is done by exercise with the limbs in sling suspension • Hydrotherapy: exercises in a pool of warm water • Graded active exercises depending on the power of the muscles. Exercises against gravity are given to muscles whose power is 3. Exercises against resistance are given to muscles which show power 4. Cycling is a good form of exercise against resistance. • Electrical stimulation in severe cases • Splints with springs and AFO( ankle foot orthosis) with a 90º foot drop stop

AFO Solid Ankle

AFO Articulated Ankle