Foot drop

[Fuller]

Medically speaking, foot drop is an inability to dorsiflex your ankle. In mere mortals it shows up as "foot flop" when walking. Your heel hits first and the Anterior Tibialis muscle resists the opening of the ankle. No resistance from that muscle - you get the flop and it's hard to walk normally. A lack of dorsiflexion for a skier means you lose the ability to pressure the front of the ski effectively and when the affected leg is on the inside it changes how you turn. The google is full of info so I won't go any further with the established medical facts except to note the causes of foot drop are varied and include some rather concerning scenarios such as stroke, tumors pressing on a nerve, spinal / sciatic nerve problems etc.

Anyway I've come down with a "medium" case of foot drop and I've given it a week to resolve itself or at least have some improvement but so far it hasn't gotten better. I guess it could be just an over use situation, I've been tippin' and flexin' a lot lately to improve my skiing. I can't say I'm in pain but I certainly can't close my ankle with any force at all - it's just flopping around mostly.

So the question is: has anyone experienced this? What was the cause? How did you deal with it?

 

[Paul Lutes]

Drop/Flop foot is commonly associated with nerve impingement - do you have a history of lower back issues? Even if you don't, lower/back/pinched nerve is at the top of the differential. My Mom came back from a trip, schlepping around large suitcases, with with the drop/flop and hadn't had any lower back issues up to that point, and a cortisone injection cured (lower spine) it immediately. Has there been absolutely no improvement in the week you've been watching it? If yes, then continue to monitor. Even if it hasn't, I'd give it at least another week, unless it actually starts to get worse.

 

[Fuller]

I have had some vexing lower back issues as recently as a few weeks ago, but like the other times that came before, it resolved itself with some time away from skiing and Tylenol when needed. I'm pain free right now as far as the back is concerned.

 

[Uncle-A]

Sorry to hear about your condition. I have a good friend that has suffered from drop foot for about a year. It has improved recently but his doctor said to stop wearing flip flops, shower sandals, and only wear a high quality running shoe. Good Luck and feel better soon.

 

[Sibhusky]

This "vacation" you guys are having has been a health and automotive disaster.

 

[Scruffy]

Heal up soon and get your heels up there, @Fuller . Good luck!

 

[Wilhelmson]

For these type of things I really think that asking around for a good sports therapist is the way to go. If you are on a budget just say so up front. They will know exactly what to do.

 

[Jerez]

It is likely nerve impingement in the lumbar spine like @Paul Lutes said.

Just because you don't have pain in your lower back any longer, doesn't mean it isn't still happening. Lower back issues often manifest in radicular pain or numbness or weakness further down the chain. (Think Sciatica)

Don't wait to deal with it, because the longer the nerve is compromise, the longer it can take to heal. And if you wait long enough, it will not heal. (This happened to my DH. He was recently told that nothing would bring it back because it had been pinched for too long.)

As for how to deal, I would advise in this order: PT, acupuncture, epidural injections, and last resort, surgery.

2-Cents from a non-doctor but the spouse of someone whose suffered many years.

 

[Fuller]

Don't wait to deal with it, because the longer the nerve is compromise, the longer it can take to heal. And if you wait long enough, it will not heal.

That is my main concern, I'm due to leave Whitefish on 3/19 and it will take a week to get back to FL. Then I'll have to go to a walk-in clinic as my primary care doc has left the state and I haven't settled on a new one. I don't really want to start this investigation here in Montana for continuity reasons. Modern Problems...

 

[Jerez]

Waiting a few weeks won't make that much difference. I mean don't put it off for months or years... even if it gets better on its own for a while.

 

[James]

Is it on the left foot?
Wouldn’t it make it difficult to drive if on the right?
As for skiing, I would think the biggest effect is on the inside ski. You certainly can get forward without active dorsiflexion. Though I don’t know how much activity there is in eccentric contraction of the three main+ 1 muscles to control a closing ankle. It’s not just the TA.

If you want to read up on back issues, this might be the most detailed and relevant.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation (3rd Edition) - backfitpro

www.backfitpro.com

 

[Prosper]

You should be seen by a doctor who is capable of performing a thorough exam to test whether there are signs of lumbar nerve root impingement vs peripheral nerve impingement vs a central nervous system cause. If lumbar nerve root impingement is causing foot drop it is typically at the L4-L5 level. Often times there will also be a loss of sensation of the inner, upper calf on the same side of the foot drop about 1/3 of the way down between the knee and ankle. Foot drop due to peripheral nerve impingement is usually of the peroneal nerve which often will cause loss of sensation on the top of the foot and/or loss of sensation of the upper, outer lower leg on the same side of the foot drop. Foot drop due to a central nervous system issue will usually have more diffuse neurologic symptoms and findings on exam. There are other more unusual causes of foot drop which you and your doctor may or may not choose to evaluate for depending on your exact symptoms and exam findings. Hope that helps and that it gets better soon.

 

[Fuller]

Is it on the left foot?
Wouldn’t it make it difficult to drive if on the right?
As for skiing, I would think the biggest effect is on the inside ski. You certainly can get forward without active dorsiflexion. Though I don’t know how much activity there is in eccentric contraction of the three main+ 1 muscles to control a closing ankle. It’s not just the TA.

If you want to read up on back issues, this might be the most detailed and relevant.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation (3rd Edition) - backfitpro

www.backfitpro.com

It's my right foot that is the problem, it's interesting to me how it affects my skiing. On groomers I can mostly overcome the lack of dorsiflexion when making a right footed turn. Pulling the new outside ski back forces the ankle to close but it's not quite the same as actively closing it. It mostly just adds to an uncertain foot placement and a lack of confidence that I'm hooked up correctly to resist the building pressure in the bottom of the turn.

A left footed turn on piste is not so bad and actually feels normal - the right (inside) leg can pull back in the normal fashion and the left foot supports the building pressure. Where it really falls apart is in the trees, I depend on that drift and drop motion to check my speed. There's a brief moment when both ankles should be in dorsiflexion to get forward in the next turn. Having one foot doing it and the other going along for the ride creates all sorts of havoc.

Medically speaking I think I'm OK with seeing a doctor when I get back. If it gets worse I'll change my mind for sure. It seems ridiculous to me that I'm probably in the 90th percentile athletically for my age group but I now need a dermatologist, orthopedist, cardiologist, urologist, oncologist, a primary care physician and now I may need to add a neurologist. Lord have mercy!

 

[Paul Lutes]

Feel ya; growing old, not for the faint of heart.

Wait ..... how old are you??

 

[Jerez]

It's my right foot that is the problem, it's interesting to me how it affects my skiing. On groomers I can mostly overcome the lack of dorsiflexion when making a right footed turn. Pulling the new outside ski back forces the ankle to close but it's not quite the same as actively closing it. It mostly just adds to an uncertain foot placement and a lack of confidence that I'm hooked up correctly to resist the building pressure in the bottom of the turn.

A left footed turn on piste is not so bad and actually feels normal - the right (inside) leg can pull back in the normal fashion and the left foot supports the building pressure. Where it really falls apart is in the trees, I depend on that drift and drop motion to check my speed. There's a brief moment when both ankles should be in dorsiflexion to get forward in the next turn. Having one foot doing it and the other going along for the ride creates all sorts of havoc.

Medically speaking I think I'm OK with seeing a doctor when I get back. If it gets worse I'll change my mind for sure. It seems ridiculous to me that I'm probably in the 90th percentile athletically for my age group but I now need a dermatologist, orthopedist, cardiologist, urologist, oncologist, a primary care physician and now I may need to add a neurologist. Lord have mercy!

Just the beginning of the journey my friend.

 

[Fuller]

Feel ya; growing old, not for the faint of heart.

Wait ..... how old are you??

I'll be 70 next week - still a young man!

 

[RoninSkier]

Medically speaking, foot drop is an inability to dorsiflex your ankle. In mere mortals it shows up as "foot flop" when walking. Your heel hits first and the Anterior Tibialis muscle resists the opening of the ankle. No resistance from that muscle - you get the flop and it's hard to walk normally. A lack of dorsiflexion for a skier means you lose the ability to pressure the front of the ski effectively and when the affected leg is on the inside it changes how you turn. The google is full of info so I won't go any further with the established medical facts except to note the causes of foot drop are varied and include some rather concerning scenarios such as stroke, tumors pressing on a nerve, spinal / sciatic nerve problems etc.

Anyway I've come down with a "medium" case of foot drop and I've given it a week to resolve itself or at least have some improvement but so far it hasn't gotten better. I guess it could be just an over use situation, I've been tippin' and flexin' a lot lately to improve my skiing. I can't say I'm in pain but I certainly can't close my ankle with any force at all - it's just flopping around mostly.

So the question is: has anyone experienced this? What was the cause? How did you deal with it?

One of my nephews a great off piste skier had major foot damage playing league soccer. Got surgery, followed by infection, followed by more surgery. Then drop foot.

He worked with a sports spclst physio & OT, did the exercises and stimulation therapy religiously for over a year and came back.

Work with good med healthcare professionals.

GL

 

[Jerez]

One of my nephews a great off piste skier had major foot damage playing league soccer. Got surgery, followed by infection, followed by more surgery. Then drop foot.

He worked with a sports spclst physio & OT, did the exercises and stimulation therapy religiously for over a year and came back.

Work with good med healthcare professionals.

GL

what is an OT? and what kind of stimulation therapy?

 

[Sibhusky]

Occupational Therapist.

 

[Fuller]

Having now watched a number of YouTube videos on the subject I have come up with a possible theory as to what may be the cause. My Lenz heated socks have a battery that sits right on the spot where the Peroneal nerve wraps around the femoral head before heading down to the dorsum of the foot. You connect the battery to the leads of the sock and fold the sock over to keep it all in place. It's all pretty tight but not really painful. Still, given the lack of meat on my bones it's entirely conceivable that the pressure of wearing them for the last 10 days may be the culprit.

For those who are interested, this video is quite good and as a side benefit explains a lot of the anatomy in the lower leg and foot as it relates to skiers. That nerve could easily be classified as the "skier's nerve" if you want to start your turns with your feet.