Foot Drop Correction 2018-02-16T12:58:11+10:00

Foot Drop Correction

Post Operation Instructions for Lower Limb Transfer 

Days 1-3 or 4

  • In patient in hospital
  • Rest in bed or chair, leg up all the time
  • Commode for toileting

Day 4 / day of discharge

  • Trial standing and walking with boot on
  • Short distances only – just to prepare for moving around at home

Discharge to end of week 2

  • Patient at home
  • Leg elevated as much as possible
  • Down only to walk for essential activities – toilet, shower, kitchen
  • Review in clinic to assess wounds end of week 2

Weeks 3-6

Boot

  • During the first 6 weeks, the boot is on 24/7 unless the wounds are being dressed or checked. The ankle needs to be kept at 90 degrees if the boot is off for this purpose.

Gentle walking

  • If leg healing well, slowly increase walking in the boot.

The protocol now varies depending on whether the tibilalis posterior transfer is an active transfer (i.e. tibialis posterior has an MRC grade of at 4 least pre-op and we are aiming to reconstruct active dorsiflexion and eversion with this muscle) or a passive transfer (i.e. tibialis posterior is weak or paralysed.

For an Active Transfer

Weeks 6-8

Boot: Off for therapy only

Learn to activate transfer

  • Lie with knees flexed and hips flexed and abducted – frog-leg position
  • Attempt to invert both feet – transferred leg will dorsiflex
  • Get patient to watch and feel this action
  • Then sit with legs hanging over the bed and dorsiflex and plantarflex both ankles
  • The patient may need to think about inverting to get this action right

Gentle walking

  • Practise walking activate dorsiflexion with every step
  • Can try walking backwards and forwards with straight knees to encourage dorsiflexion
  • Use walking aids if needed – e.g. 4-point stick, frame etc.

Restrictions: No specific passive or active ankle movement or strengthening (only walking)

Weeks 8 -10

Boot: Off for therapy and boot off to practising walking at home

Gentle walking: Practise walking activate dorsiflexion with every step only at home in a safe environment

Restrictions: No specific passive or active ankle movement or strengthening (only walking)

Weeks 10-12

Boot: Wean boot – keep n at night and when at risk for falling e.g. out on public transport, at work

Gentle walking: Practise walking with the boot off and activate dorsiflexion with every step, wear secure foot wear

Restrictions: No specific passive or active ankle movement or strengthening (only walking)

Week 12

Boot: Off completely

Walking: Increase efficiency and speed

Strength: Strengthen ankle movement in all directions

Restrictions: Avoid passive plantarflexion (ongoing), other passive ranging or gentle stretching is fine but not usually needed.

For a Passive Transfer

Weeks 6-12

Boot: Boot on 24/7 unless off to check wound

Walking: Walking as much as tolerated and as much they need to do daily activities (boot on)

Week 12

Boot: Off completely, can wean over a couple of weeks if the patient feels more secure

Walking: Increase efficiency and speed with the boot off

Strength: Strengthen ankle movement in all directions

Restrictions: Avoid passive plantarflexion (ongoing), other passive ranging or gentle stretching is fine but not usually needed