Stem would be “examine this patient’s leg” or “examine this patient’s gait”
- Stand and look
- Ask to remove trousers (even if stem is examine gait)
- At this point may not see anything as patient not walking
- Look for scars at knee, buttocks and scars at the back
- Look for wasting of muscles
- Look for Foot deformities [Pes cavus/ Planus], claw toes [think CMT]
- May see AFO or splints for foot drop/ walking aid
- Walk the patient
- Foot drop gait with high steppage gait
- Loss of first rocker with slapping of the feet
- “I note that there is unilateral foot drop gait, will go on to evaluate for the level of involvement”
- Comment on associated gait pattern
- Hands on thigh, recurvatum in Polio?
- Return
- Special test - ask to heel walk to confirm inability to.
- Check spine if you see there if foot drop.
- Check for spinal dysraphism
- Previous instrumentation for L4/5 radiculopathy
- Do trendelenberg test - for glutes weakness in L5 radiculopathy
- Lie patient down
- Look closely for scars again - buttock, lateral knee
- Check correctibility of the foot drop
- Check sensory - DPN, SPN, PTN
- Check Motor
- Ankle dorsiflexion
- Eversion
- Inversion [L5]
- Hip abduction with patient at the side [L5]
- Check pulses
- Causes
- Scar - traumatic, iatrogenic, neoplastic, infection, disc herniation
- No scar - traumatic (posterior hip dislocation), neoplastic (compression, neurologic (Hemiplegic CP), Polio
- Systemic diseases such as diabetes, vasculitis, connective tissue, and autoimmune disease may also be the etiological cause.
- In these circumstances, foot drop is almost always unilateral.
Glutes
(Superior gluteal n.) | inversion
(tibial n.) | Eversion
(peroneal n.) | |
L5 radiculo | NO | NO | NO |
Sciatic nerve | OK | NO | NO |
CPN | OK | OK | NO |
