Spinal Stenosis and Foot-Drop

by LMatthews on October 24, 2011

spinal stenosis foot drop posture

Foot drop posture, a possible result of spinal stenosis.

Foot drop and spinal stenosis are often connected, although this association may be overlooked despite the possibility of serious accidents occurring as a result of the drop foot phenomenon. Patients usually feel like their foot is floppy and slaps against the ground when walking. The symptom usually suggests nerve damage, muscle damage, or some kind of structural abnormality affecting the foot and it is a condition affecting the patient’s ability to raise his or her foot at the ankle. Patients also have problems pointing the toes towards the body (dorsiflexion) or moving the ankle inward or outward. Some patients have accompanying pain in the ankle, weakness, and/or numbness, all of which can adversely affect walking ability and lead to trips and falls. Patients may develop a characteristic high-stepping walk (known as steppage gait or footdrop gait) which can alert physicians or physical therapists to the condition.

Causes of Foot Drop

Foot drop can be a temporary or permanent symptom and in cases where the condition is caused by spinal stenosis it can also be intermittent as the nerves innervating the ankle may be pinched during inflammatory episodes but functional at other times. The peroneal nerve is a common site of injury in cases of foot drop and this nerve runs deep within the lumbar and sacral spine as a division of the sciatic nerve. The nerve extends right down the outside of the lower legs and branches into the ankle, foot, and then the outside two toes. Lumbar spinal stenosis from disc herniation at L4, or L5 for example can cause peroneal nerve damage, as can conditions such as spondylolisthesis (spinal slippage), direct trauma to the spine, and bone fractures, along with spinal tumors. The L4-L5 region is a common site of radiculopathy associated with foot drop and is most often caused by a herniated disc, or foraminal stenosis, possibly from congenitally small foramen in the spine. The resulting peroneal peripheral nerve damage then results in a weak anterior tibialis muscle.

Diagnosing Foot Drop and Spinal Stenosis

spinal stenosis foot dropFoot drop may also occur in patients with Amyotrophic Lateral Sclerosis, Multiple Sclerosis, and Parkinson’s Disease and can result from nerve damage occurring during hip or knee replacement surgery. Determining the cause of the drop foot is paramount in providing the best care for the patient as back surgery may not be appropriate for all but may be necessary where a mechanical cause is to blame for the nerve dysfunction. Full physical assessment and detailed medical history are part of the diagnostic process, along with MRI scans and electromyograms in some cases. When diagnosing foot drop a physician will usually carry out a blood analysis in order to rule out possible metabolic causes of the symptom. Diabetes, alcoholism, and toxins in the body can all be culprits when assessing potential nerve damage. A number of patients ultimately diagnosed with Multiple Sclerosis later recall a fall or trip that could be attributed to foot drop and early signs of nerve demyelinationg and dysfunction, making it important that the condition be recognized early and treatment started as soon as possible for such illnesses that are more easily slowed down than cured. Peripheral causes of foot drop are usually well recognized but those emanating from the central nervous system are less easy to spot in most cases, leaving a patient without an accurate diagnosis and, therefore, without recourse to proper treatment.

Herniated Discs and Foot Drop


Where a disc herniation is thought responsible for spinal stenosis, nerve compression, and subsequent drop foot it is usually necessary for a patient to undergo a discectomy in the lumbar spine, possibly along with spinal fusion depending on the number of levels operated on and the condition of the surrounding vertebral levels and intervertebral discs. Some patients may instead undergo a decompressive laminectomy in the spine, sometimes using minimally invasive back surgery techniques, whereas others will need open back surgery to remove significant areas of degenerated tissue and have hardware and bone grafts installed for spinal fusion.

Cervical Spinal Stenosis and Foot Drop

Cervical spinal stenosis can also be responsible for foot drop, though less commonly than stenosis at L4-L5. Those with spinal upper motor neuron pathology have an incidence of around 50-70% of foot drop which may be caused by myelopathy in the cervical spine. This can occur when cervical spinal stenosis becomes severe and affects the spinal cord itself rather than just the cervical spinal nerves exiting the spinal column. In such cases it is likely that the patient will need a laminectomy to ease the pressure on the cervical spinal cord and possibly spinal fusion to realign and stabilise the cervical spine. Some patients find their symptoms relieved through epidural steroid injections as this can ease inflammation in or around the nerves. Such injections may also prove diagnostic of pinched nerves and give a surgeon an insight into the likelihood of spinal surgery relieving the condition on a longer-term basis. NSAIDs may also form part of the treatment for foot drop as patients may be experiencing leg, ankle, or foot pain along with back ache and other symptoms of spinal nerve and peripheral nerve compression.

Treating Foot Drop

foot drop brace spinal stenosisDepending on the speed of diagnosis and intervention in a case of foot drop the underlying problems may be resolved sufficiently to enact a full recovery. In other cases, particularly where the cause of foot drop is progressive and degenerative the symptom may require palliative care instead. Patients may be given a brace or splint (orthosis) for the foot and lower leg to hold the ankle in position and prevent tripping over the toes when walking. In conditions where the nerve damage is able to be repaired it is important not to overuse such supportive devices as the leg muscles may be further weakened through reliance on the brace, making recovery more difficult. A physical therapist should be able to provide individual guidance to patients on recovering from spinal stenosis and drop foot where surgery has successfully relieved pinched or trapped nerves.


References

Franklin D Westhout, MD, Laura S Paré, MD, FRSC(c), and Mark E Linskey, MD. Central Causes of Foot Drop: Rare and Underappreciated Differential Diagnoses. J Spinal Cord Med. 2007; 30(1): 62–66.

{ 1 comment… read it below or add one }

Butch November 19, 2011 at 4:54 pm

This is very interesting. I want to say when I was a child toys you had to play with & now the toys play with the kids. This is about the medical difference between then and now. Let me first say I have always walked like this, I use to bowl and the coaches noticed how I always planted my foot which is planting your heel like stomping it to the ground. No doctor thought anything of it. I also walk with my toes aimed outward but again nobody noticed.

I have a sister that is younger than half my age, She is 14. Her doctors noticed she walks on her toes all the time so they looked into it. What happened was the brain stem funnel area is over sized, a Ciare with a Serinx, which means it was over sized and blocked spinal fluid flow and blew a hole in the brain stem in the spine which is now GOOD. She went through a 6 hour surgery but that is how they found it, with me doctors didn’t pay attention to how I walked almost 30 years ago, anyways on to me and this topic at hand

I always had back pain, even as a child although my mother wrote it off because my Dad had back surgery around that time. Two years ago I was told I had Degenerative Disk and Tail Bone by X-Ray although the Orthopedic I seen this year said that X-Ray didn’t look horrible but it didn’t look good, to the point he couldn’t make a call

My build is very off, my legs are 24″ long and I’m 6 feet tall, my body is 14″ thick at my shoulders, and I couldn’t go through the MRI so we had to result in a good CT Scan. The doctor said the rulings would prevail to be worse by MRI, as they can only say what the CT Scan shows 100% and here is what it shows

I have Congenital Short Pedicle’s in the lumbar section resulting in at least Severe Spinal Stenosis, Bi-Lateral Facet Hypertrophy at the same levels and Calcification of the Posterior Ligament at the same levels. It is also said that I have a deep lumbar curve, and some Vertebrae’s are close to touching at one end with a larger gap at the other end, which also says the Disks are unremarkable and further MR Imagining is highly suggested.

The pain is severe, and I have been given every kind of miracle drug to therapy. The reason I’m posting this is the way I walk, and therapy trying to reteach me. I walk according to them with my knee’s locked and they are trying to get me to bend my knee’s when I take a step to remove loads on the spine, but when you have walked like this so long its hard to change.

I believe this here is EXCELLENT information, as this describes my walking. I can’t bend backwards 1°, when they did in therapy my legs folded up, and they are numb and burn most of the time, and they feel like a hamstring down the whole leg with the throbbing of a tooth ache.

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