foot drop

関

下垂足

WordNet

1. utter with seeming casualness; "drop a hint"; drop names"
2. a shape that is spherical and small; "he studied the shapes of low-viscosity drops"; "beads of sweat on his forehead" (同)bead, pearl
3. a small indefinite quantity (especially of a liquid); "he had a drop too much to drink"; "a drop of each sample was analyzed"; "there is not a drop of pity in that man"; "years afterward, they would pay the blood-money, driblet by driblet"--Kipling (同)drib, driblet
4. stop pursuing or acting; "drop a lawsuit"; "knock it off!" (同)knock off
5. fall or sink into a state of exhaustion or death; "shop til you drop"
6. give birth; used for animals; "The cow dropped her calf this morning"
7. a sudden sharp decrease in some quantity; "a drop of 57 points on the Dow Jones index"; "there was a drop in pressure in the pulmonary artery"; "a dip in prices"; "when that became known the price of their stock went into free fall" (同)dip, fall, free_fall
8. a central depository where things can be left or picked up
9. the act of dropping something; "they expected the drop would be successful"
10. a free and rapid descent by the force of gravity; "it was a miracle that he survived the drop from that height" (同)fall
11. a predetermined hiding place for the deposit and distribution of illicit goods (such as drugs or stolen property)
12. leave or unload; "unload the cargo"; "drop off the passengers at the hotel" (同)drop_off, set_down, put down, unload, discharge
13. change from one level to another; "She dropped into army jargon"
14. go down in value; "Stock prices dropped"
15. let fall to the ground; "Dont drop the dishes"
16. lose (a game); "The Giants dropped 11 of their first 13"
17. omit (a letter or syllable) in speaking or writing; " New Englanders drop their post-vocalic rs"
18. take (a drug, especially LSD), by mouth; "She dropped acid when she was a teenager"
19. terminate an association with; "drop him from the Republican ticket"
20. to fall vertically; "the bombs are dropping on enemy targets"
21. pay for something; "pick up the tab"; "pick up the burden of high-interest mortgages"; "foot the bill" (同)pick
22. a linear unit of length equal to 12 inches or a third of a yard; "he is six feet tall" (同)ft
23. any of various organs of locomotion or attachment in invertebrates (同)invertebrate foot
24. a support resembling a pedal extremity; "one foot of the chair was on the carpet"
25. travel by walking; "he followed on foot"; "the swiftest of foot"
26. the part of the leg of a human being below the ankle joint; "his bare feet projected from his trousers"; "armored from head to foot" (同)human foot, pes
27. a member of a surveillance team who works on foot or rides as a passenger
28. the lower part of anything; "curled up on the foot of the bed"; "the foot of the page"; "the foot of the list"; "the foot of the mountain"
29. add a column of numbers (同)foot up
30. walk; "lets hoof it to the disco" (同)leg it, hoof, hoof it
31. a relation that provides the foundation for something; "they were on a friendly footing"; "he worked on an interim basis" (同)basis, ground
32. status with respect to the relations between people or groups; "on good terms with her in-laws"; "on a friendly footing" (同)terms
33. having feet; "footed creatures"; "a footed sofa"

PrepTutorEJDIC

1. 〈しずくが〉『したたる』,垂れる《+『down』》 / 〈物が〉『落ちる』,落下する《+『down』》 / 〈人が〉『ばったり倒れる』,崩れ落ちる / 『下落する』,減少する《+『off』(『away』)》 / 終わる,やめになる / 《副詞[句]を伴って》引き離される,落後する / (…から)手を引く,やめる《+『from』(『out of』)+『名』》 / (…に)ちょっと立ち寄る,(…を)ひょっこり訪ねる《+『in』(『by,over,round』)『at』(『on』)+『名』》 / …‘を'『したたらせる』,垂らす / (…へ)…‘を'『落とす』,落下させる《+『名』+『into』(『on』)+『名』》 / …‘を'降ろす,下げる / …‘を'減少させる / …‘を'漏らす,ふと口にする / 〈人〉に〈短い手紙・伝言〉‘を'送る / 《話》…‘を'なぐり倒す,撃ち落とす / 《話》《副詞[句]を伴って》〈人〉‘を'乗り物から降ろす / (…から)〈ある音・文字〉‘を'落とす,抜かす,省く《+『名』+『from』+『名』》 / 〈人〉‘と'関係を絶つ;〈問題など〉‘を'打ち切る / …‘を'やめさせる;(…から)…‘を'追い出す《+『名from』+『名』》 / (ばくちなどで)〈金〉‘を'なくす / 〈C〉(…の)『しずく』,したたり《+『of』+『名』》 / 〈C〉(液体・事物の)少量,微量《+『of』+『名』》 / 〈C〉あめ玉,ドロップ / 《a ~》落下,降下(fall);落下距離 / 《a ~》(…の)下落,減少《+『in』+『名』》 / 《複数形で》点滴薬 / 《話》《a ~》少量の酒 / 〈C〉《おもに米》(郵便箱などの)落とし口,差し入れ口
2. 〈C〉(人間・動物の)『足』(くるぶしから先の部分);(生物体の)足状の部分 / 〈C〉《通例the~》(高い物・長い物の)『足部』,下部,低部《+『of』+『名』》 / 〈C〉《通例the foot》(階級・地位などの)最下位《+『of』+『名』》 / 〈U〉〈C〉『歩み』,足取り / 〈C〉『フィート』(長さの単位で12インチ,30.48センチ) / 〈C〉詩脚(詩における韻律の単位) / 〈C〉《通例単数形で》(靴下の)足の部分 / 〈勘定など〉‘を'支払う
3. 《a ~》足もと;足がかり,足場 / 確実な立場,安定した地位,基盤 / (…との)間柄,相互関係《+『with』+『名』》
4. (花びん・ゴブレットなどが)足のついた,足のある / 《複合語を作って》「足が…の」の意を表す

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/22 15:11:04」(JST)

wiki en

[Wiki en表示]

Foot drop
Classification and external resources
ICD-10	M21.3
ICD-9	736.79
eMedicine	orthoped/389

Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, damage to the peroneal nerve or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. It is characterized by the inability or difficulty in moving the ankle and toes upward (dorsiflexion). The severity in foot drop can range from a temporary to permanent condition, depending on the extent of muscle weakness or paralysis. It can occur unilaterally or bilaterally. In walking, while stepping forward, the knees are slightly bent so the front of the foot can be lifted higher than usual to prevent the foot from dragging along the ground. Foot drop can be caused by nerve damage alone. However, it is also caused by muscle or spinal nerve trauma, abnormal anatomy, toxins or disease. Diseases that can cause foot drop include stroke, Amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease), muscular dystrophy, Charcot Marie Tooth disease, multiple sclerosis, and Friedreich's ataxia. It may also occur as a result of hip replacement surgery.

Features

Foot drop is characterized by steppage gait. While walking, people suffering the condition drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the dragging. This serves to raise the foot high enough to prevent the toe from dragging and prevents the slapping. To accommodate the toe drop, the patient may use a characteristic tiptoe walk on the opposite leg, raising the thigh excessively, as if walking upstairs, while letting the toe drop. Other gaits such as a wide outward leg swing (to avoid lifting the thigh excessively or to turn corners in the opposite direction of the affected limb) may also indicate foot drop.

Patients with painful disorders of sensation (dysesthesia) of the soles of the feet may have a similar gait but do not have foot drop. Because of the extreme pain evoked by even the slightest pressure on the feet, the patient walks as if walking barefoot on hot sand.

Diagnosis

Initial diagnosis often is made during routine physical examination. Such diagnosis can be confirmed by a medical professional such as a neurologist, physiatrist ), podiatrist, orthopedic spine surgeon or neurosurgeon. A person with foot drop will have difficulty walking on his or her heels. Therefore a simple test of asking the patient to dorsiflex may determine diagnosis of the problem. This is measured on a 0-5 scale that observes mobility. The lowest point, 0, will determine complete paralysis and the highest point, 5, will determine complete mobility.

However there are other tests that may help determine diagnosis. These tests include an MRI, MRN, or EMG to assess the surrounding areas of damaged nerves and the damaged nerves themselves, respectively. The nerve that communicates to the muscles that lift the foot is the peroneal nerve. This nerve innervates the anterior muscles of the leg that are used during dorsi flexion. The muscles that are used in plantar flexion are innervated by the tibial nerve and often develop tightness in the presence of foot drop. The muscles that keep the ankle from supination (as from an ankle sprain) are also innervated by the peroneal nerve, and it is not uncommon to find weakness in this area as well. Paraesthesia in the lower leg, particularly on the top of the foot and ankle, also can accompany foot drop, although it is not always linked.

A common yoga kneeling exercise, the Varjrasana has, under the name "yoga foot drop," been linked to foot drop.

Pathophysiology

The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor). Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg. The muscle that is designed to pick up the foot is the anterior tibialis. It is innervated by the deep fibular peroneal nerve, which branches from the sciatic nerve. The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space. Occasionally, spasticity in the muscles opposite the anterior tibialis exists in the presence of foot drop, making the pathology much more complex than foot drop. Isolated foot drop is usually a flaccid condition. There are gradations of weakness that can be seen with foot drop, as follows: 0=complete paralysis, 1=flicker of contraction, 2=contraction with gravity eliminated alone, 3=contraction against gravity alone, 4=contraction against gravity and some resistance, and 5=contraction against powerful resistance (normal power). Foot drop is different from foot slap, which is the audible slapping of the foot to the floor with each step that occurs when the foot first hits the floor on each step, although they often are concurrent.

Treated systematically, possible lesion sites causing foot drop include (going from peripheral to central):

1. Neuromuscular disease;
2. Peroneal nerve (common, i.e., frequent)—chemical, mechanical, disease;
3. Sciatic nerve—direct trauma, iatrogenic;
4. Lumbosacral plexus;
5. L5 nerve root (common, especially in association with pain in back radiating down leg);
6. Spinal cord (rarely causes isolated foot drop)—poliomyelitis, tumor;
7. Brain (uncommon, but often overlooked)—stroke, TIA, tumor;
8. Genetic (as in Charcot-Marie-Tooth Disease and hereditary neuropathy with liability to pressure palsies);
9. Nonorganic;
10. Cauda Equina Syndrome. Spinal cord damage caused by nerve impingement due to badly bulging disc.

If the L5 nerve root is involved, the most common cause is a herniated disc. Other causes of foot drop are diabetes, trauma, motor neuron disease (MND), adverse reaction to a drug or alcohol, and multiple sclerosis.

Gait cycle

Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular disorder that affects the patient's ability to raise their foot at the ankle. Drop foot is further characterized by an inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle inward or outward. Therefore, the normal gait cycle is affected by the drop foot syndrome.

The normal gait cycle is as follows:

• Swing phase (SW): The period of time when the foot is not in contact with the ground. In those cases where the foot never leaves the ground (foot drag), it can be defined as the phase when all portions of the foot are in forward motion.
• Initial contact (IC): The point in the gait cycle when the foot initially makes contact with the ground; this represents the beginning of the stance phase. It is suggested that heel strike not be a term used in clinical gait analysis as in many circumstances initial contact is not made with the heel. Suggestion: Should use foot strike.
• Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this represents the end of the stance phase or beginning of the swing phase. Also referred to as foot off. Toe-off should not be used in situations where the toe is not the last part of the foot to leave the ground.

The drop foot gait cycle requires more exaggerated phases.

• Drop foot SW: If the foot in motion happens to be the affected foot, there will be greater flexion at the knee to accommodate the inability to dorsiflex. This increase in knee extension will cause a stair climbing movement.
• Drop foot IC: Initial contact of the foot that is in motion will not have normal heel-toe foot strike. Instead the foot may either slap the ground or the entire foot may be planted on the ground all at once.
• Drop foot TC: Terminal contact that is observed in patients that have drop foot is quite different. Since patients tend to have weakness in the affected foot, they may not have the ability to support their body weight. Oftentimes, a walker or cane will be used to assist in this aspect.

Drop Foot is the inability to dorsiflex, evert, or invert the foot. So when looking at the Gait cycle, the part of the gait cycle that involves most dorsiflexion action would be Heel Contact of the foot at 10% of Gait Cycle, and the entire swing phase, or 60-100% of the Gait Cycle. This is also known as Gait Abnormalities.

Treatment

The underlying disorder must be treated. For example, if a spinal disc herniation in the low back is impinging on the nerve that goes to the leg and causing symptoms of foot drop, then the herniated disc should be treated. If the foot drop is the result of a peripheral nerve injury, a window for recovery of 18 months to 2 years is often advised. If it is apparent that no recovery of nerve function takes place, surgical intervention to repair or graft the nerve can be considered, although results from this type of intervention are mixed.

Non-surgical treatments for spinal stenosis include a suitable exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery that is minimally destructive of normal structures may be used to treat spinal stenosis.

Non-surgical treatments for this condition are very similar to the non-surgical methods described above for spinal stenosis. Spinal fusion surgery may be required to treat this condition, with many patients improving their function and experiencing less pain.

Nearly half of all vertebral fractures occur without any significant back pain. If pain medication, progressive activity, or a brace or support does not help with the fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be options.

Ankles can be stabilized by lightweight orthoses, available in molded plastics as well as softer materials that use elastic properties to prevent foot drop. Additionally, shoes can be fitted with traditional spring-loaded braces to prevent foot drop while walking. Regular exercise is usually prescribed.

Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is primarily used to restore function in people with disabilities. It is sometimes referred to as Neuromuscular electrical stimulation (NMES) The latest treatments include stimulation of the peroneal nerve, which lifts the foot when you step. Many stroke and multiple sclerosis patients with foot drop have had success with it. Often, individuals with foot drop prefer to use a compensatory technique like steppage gait or hip hiking as opposed to a brace or splint.

Treatment for some can be as easy as a foot-up ankle support (ankle-foot orthoses). A cuff is placed around the patient's ankle, and a hook is installed under the shoelaces. The hook connects to the ankle cuff and lifts the shoe up when the patient walks.

See also

• Yoga foot drop
• Toe walking
• Polymyositis
• inclusion body myositis

References

• Mayo Clinic. (Nov. 5 2010). Foot Drop. Retrieved from [1]
• James W Pritchett, MD. (Jun 23,2009). Foot Drop. Retrieved from [2]
• Healthcare Cost and Utilization Project. (2011). [3]

External links

• YouTube video of CMT sufferer
• Walid MS, Ajjan M, Patel N, T Guta: Cellulitis May Present As Foot Drop In A Diabetic Patient: The Internet Journal of Neurology. 2007; Volume 7, Number 1.[4]
• Foot Drop article from Emedicine.com by James W Pritchett, MD, FACS; Margaret A Porembski, MD.
• Foot Drop from the Mayo Clinic.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 下肢末梢神経症候群の概要 overview of lower extremity peripheral nerve syndromes
• 2. 腰仙部神経叢症候群 lumbosacral plexus syndromes
• 3. 高齢者におけるリハビリテーションの概要：リハビリテーションのプログラム構成および
  環境 overview of geriatric rehabilitation program components and settings for rehabilitation
• 4. 顔面肩甲上腕型筋ジストロフィー facioscapulohumeral muscular dystrophy
• 5. 膝窩（ベーカー）嚢腫 popliteal bakers cyst

English Journal

• Acute lumbosacral plexopathy from gluteal compartment syndrome after drug abuse: a case report.

• Mitsiokapa EA, Mavrogenis AF, Salacha A, Tzanos G.SourceDepartment of Physical Medicine and Rehabilitation, General University Hospital of Patras, Greece.
• Journal of surgical orthopaedic advances.J Surg Orthop Adv.2013 Summer;22(2):168-72.
• Acute lumbosacral plexus injury from gluteal compartment syndrome is extremely rare. Physicians should be aware of this diagnosis when examining patients with altered mental status, prolonged immobilization, and gluteal muscle compression. This case report presents a patient with acute complete left
• PMID 23628573

• Rapid effective trace-back capability value: A case study of foot-and-mouth in the Texas High Plains.

• Hagerman AD, Ward MP, Anderson DP, Looney JC, McCarl BA.SourceUnited States Department of Agriculture - Economic Research Service, Washington, DC, USA.
• Preventive veterinary medicine.Prev Vet Med.2013 Jul 1;110(3-4):323-8. doi: 10.1016/j.prevetmed.2012.12.011. Epub 2013 Jan 12.
• In this study our aim was to value the benefits of rapid effective trace-back capability-based on a livestock identification system - in the event of a foot and mouth disease (FMD) outbreak. We simulated an FMD outbreak in the Texas High Plains, an area of high livestock concentration, beginning in
• PMID 23317567

Japanese Journal

• Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma

• WAJIMA Daisuke,YOKOTA Hiroshi,IDA Yuki,NAKASE Hiroyuki
• Neurologia medico-chirurgica = 神経外科 52(9), 636-639, 2012-09-15
• … Nerve conduction velocity measurements at the knee joint to lower limb showed disappearance of the left peroneal nerve conduction wave, indicating that one of the causes of drop foot was common peroneal nerve palsy. … With conservative therapy, her drop foot was gradually improved, then she recovered to walk with a stick and moved to a rehabilitation hospital. …
• NAID 10030872958

• 足趾エクササイズが足内側縦アーチに及ぼす影響について

• 城下 貴司,福林 徹
• 理学療法科学 27(4), 397-400, 2012-08-20
• NAID 10031077224

Related Links

• Drop Foot – Foot Drop

ffDrop Foot – Foot Drop Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular disorder that affects the foot. Drop Foot / Foot Drop Drop Foot Indepth Important Reads Drop Foot Complications

• Foot Drop

Foot drop is a deceptively simple name for a potentially complex problem. Foot drop can be associated with a variety of conditions such as dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Common and superficial peroneal nerve, branches, and ...

Related Pictures

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★リンクテーブル★

リンク元	「下垂足」
関連記事	「drop」「foot」

「下垂足」

　　[★]

英

foot drop, footdrop, foot-drop, drop foot

同

垂れ足、尖足

「drop」

　　[★]

• n.
• vt.
• vi.

• (液体が)したたる、ぼたぼた落ちる
• (物が)(急に、思いがけなく)落ちる(down)。(花が)散る。(人が)(車などから)ひらりと(飛び)降りる(off)。(正式)(川・丘などが)下る(down)
• (人が)(疲れて・傷ついて)急に倒れる。死ぬ。(意識的に)身を伏せる
• (程度・数量・価値などが)下がる(fall)、落ちる(away)。健康や病状が悪化する
• (事が)やめになる。(～から)手を引く、やめる(from)。(視界から)見えなくなる(out of, from)。(交通・話などが)とだえる(off)
• 急に(ある状態に)なる、陥る(into, to)
• (略式)ひょいと(～に)立ち寄る(in, by, over, round)(on, at, into)。(人に)偶然であう(in)(across, on, with)
• 落後(後退)する、遅れる(away, back, off, behind)
• (動物が)生まれる
• (猟犬が)獲物を見て伏せる
• (言葉・ため息などが)(～から)ふともれる(from)
• (水・空気の流れに沿って)穏やかに動く
• (トランプ)(ブリッジなどで)(特定の札が)出るはめになる、死ぬ
• (球技)(球が)ホール(ポケット、ゴール)に入る(転がり込む)
• 逮捕される

関

decline, decrease, depression, droplet, dropping, dropwise, fall, instill, instillation, lower, lowering, reduction

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「foot」

　　[★]

関

feet