The approach of foot drop in the primary health care: a case report
DOI:
https://doi.org/10.32385/rpmgf.v37i5.13066Keywords:
Foot drop, Common peroneal nerve, SteppageAbstract
Introduction: Foot drop is defined by the inability to elevate the foot due to diminished strength of the dorsiflexor muscles. To elaborate a treatment plan, it is necessary to determine its etiology. Thus, the family doctor must recognize the situations in which the management of foot drop can be done exclusively in primary health care, differentiating from those that may require observation and assessment in-hospital care.
Case description: 71-year-old man with arterial hypertension and dyslipidemia, medicated with indapamide. An appointment with the family doctor referred that, two days ago, had remained seated for two hours with the right leg crossed over the contralateral lower limb. By getting up, the patient noticed right foot numbness and inability to elevate the same foot. At the physical examination, he presented a steppage gait, with right foot drop and decreased sensitivity of the back of the foot. It was requested electromyography, which documented severe axonal damage of the right common peroneal nerve below the fibular neck, compatible with prolonged compression. The patient was submitted to physiotherapy sessions, demonstrating complete clinical resolution of foot drop after three months.
Comment: The neuropathy of the common peroneal nerve is the main cause of foot drop and the third most frequent focal neuropathy, after the median nerve and cubital nerve. Compression remains the most frequent etiology. The most affected site is at the level of the fibular neck, manifested by steppage gait, consequent to decreased strength of the dorsiflexor muscles of the foot. Even though the diagnosis is usually clinical, most of the patients require electromyography. The initial treatment tends to be conservative, with a frequent resolution of the complaints in three months. This is a condition that may be uncommon in family medicine’s clinical practice, but its approach could be, many times, managed in primary health care. It is important to know how to reassure the patients about the semiology, therapeutic approach, and prognosis.
Downloads
References
Elkwood AI, Kaufman MR, Abdollahi H. Foot drop: etiology, diagnosis, and treatment. UpToDate [Internet]; 2019 [updated 2021 May 10; cited 2020 Sep 2]. Available from: https://www.uptodate.com/contents/foot-drop-etiology-diagnosis-and-treatment
Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle and foot. Foot Ankle Clin. 2011;16(2):255-74.
Lezak B, Massel DH, Varacallo M. Peroneal nerve injury [Internet]. Treasure Island: StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549859/
Carolus AE, Becker M, Cuny J, Smektala R, Schmieder K, Brenke C. The interdisciplinary management of foot drop. Dtsch Arztebl Int. 2019;116(20):347-54.
Waldman S. Common peroneal nerve entrapment. In: Waldman S. Atlas of common pain syndromes. 4th ed. Elsevier; 2018. p. 472-5. ISBN 9780323547321
Miller SD. Nerve disorders of the hallux. Foot Ankle Clin. 2009;14(1):67-75.
Poage C, Roth C, Scott B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg. 2016;24(1):1-10.
Rutkove SB. Overview of lower extremity peripheral nerve syndromes. UpToDate [Internet]; 2020 [updated 2020 Feb 14; cited 2020 Sep 2]. Available from: https://www.uptodate.com/contents/overview-of-lower-extremity-peripheral-nerve-syndromes
Bsteh G, Wanschitz JV, Gruber H, Seppi K, Löscher WN. Prognosis and prognostic factors in non-traumatic acute-onset compressive mononeuropathies: radial and peroneal mononeuropathies. Eur J Neurol. 2013;20(6):981-5.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
