Understanding and Working with Foot Drop

What exactly is foot drop? Is all foot drop the same or are there different types? What helps it, what doesn't.

By: Mariska Breland ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎

Why do I keep tripping??

What is Foot Drop?

Foot drop is one of the most common neurological problems. It can happen from damage to the peroneal nerve near the knee as the result of a knee injury or, commonly, a knee surgery gone wrong. Often, a severe nerve injury can’t be fixed, and the injury recipient will have to use a foot drop brace to assist with walking.

Foot drop can also arise from a central nervous system problem such as multiple sclerosis, stroke, or other neurological diseases. Here, both weakness and spasticity can play a role in the problem.

Is There a Best Way to Work with Foot Drop?

When working with foot drop, we usually try to determine whether the foot drop is caused by weakness of the tibialis anterior muscle, damage to the peroneal (or sciatic) nerve, damage to the spinal cord, or damage to the brain. It’s also important to assess whether the foot drop is accompanied by spasticity in the antagonist muscles. An overly tight soleus muscle or gastrocnemius muscle can prevent the tibialis anterior from firing properly, might cause co-contraction of both the calf muscles and the muscles at the front of the shin, or it could limit the movements of the ankle joint.

It’s important to note that any time a muscle has spasticity, it is also a weak muscle. Spasticity is basically a failure of the communication pathway from the spinal cord to the brain (or vice versa), in which the stretch reflex isn’t mediated by the brain. The muscle keeps contracting in a misguided effort to try to protect the joint. Until you can break that cycle of miscommunication, the spasticity will not go away. Once the spasticity pattern is broken, usually through a combination of medication, mobilization, LISTENING TO THE SPASTICITY AND ADJUSTING EXERCISES ACCORDINGLY, the weakened muscles can be strengthened.

Why Do Feet Have So Many Issues in MS and Other Conditions?  

Why are the feet so prone to problems in neurological diseases? Simply, the feet are the furthest away from the brain. Nerves have to travel from your feet all the way to your brain and back again in order to work correctly.

Although you can often get faster gains working on things like hip strength and giving better input to the eyes or vestibular system, it's ALWAYS a good idea to do foot exercises. 

Check out this classic video from Meghann designed for clients with neurological problems.

Whether or not foot drop is currently an issue, it can always become one. If you’re dealing with a neurological disease, never neglect exercising those parts of your body furthest from your brain.

To learn (a lot) more about the feet and what you can do to keep them strong, check out one of our Pilates for MS and neurological conditions workshops.

Mariska Breland is a prominent Pilates instructor and advocate for those living with neurological conditions. She was diagnosed with multiple sclerosis in 2002 and became a Nationally Certified Pilates teacher shortly afterwards. She is also a breast cancer survivor. Mariska channeled her experiences into creating transformative solutions for teachers and patients. She is notable for her neuro-based workshops, inventing the Fuse Ladder fitness apparatus, and her popular classes on Pilates Anytime. Mariska's current focus is brain-based fitness training and lifestyle guidance for patients and education for providers. She provides resources and strategies for living with neurological conditions through The Neuro Studio.