Foot drop is defined as a significant weakness of ankle and toe dorsiflexion. Causes of foot drop vary from neuropathies of different origin such as diabetic, drug toxicity, stroke to acute injury by direct trauma. The common denominator is a peripheral nerve injury which affects the muscles that control the flexion of the foot on the heel; this is sometimes referred as ‘steppage gait’ because the affected individual tends to walk with an exaggerated flexion of the hip and knee to prevent the toes from catching on the ground. Injury to the dorsiflexor muscles or to the neural pathway that supplies them will result in a foot drop.
The sciatic nerve leaves the pelvis through the greater sciatic foramen just below the piriformis muscle. Subsequently, the sciatic nerve bifurcates to form the tibial and peroneal nerves. The perineal nerve fibers run more superficially and are susceptible to injury even prior to its bifurcation when they are still part of the sciatic nerve. Injury to the peroneal nerve can occur at any point from the sciatic nerve trunk to the individual fibers down in the lower leg; severe injuries frequently result in foot drop. Direct trauma that disrupts the integrity of the nerve fibers or compression injuries that result in ischemia of blood supply to the nerve itself can both cause foot drop as an end result.
Foot drop that is the result of a chronic medical condition rarely supports a legal cause of action. Acute injury to the nerve supply at any point along the neural pathway which result in peroneal nerve palsy is of particular concern because these can be prevented if proper precautions are taken. Acute injury that result in peroneal nerve palsy include:
Direct compression on the peroneal nerve during surgery (stirrups)
Malposition on the operating room table
Injury to the peroneal portion of the sciatic nerve
Compartment syndromes (anterior, deep posterior) are acute surgical emergencies that are due to edema or hemorrhage in the muscles of the anterior and/or posterior compartments which when left untreated or treated in a delayed fashion may lead to foot drop.
Acute injuries to the peroneal nerve usually become symptomatic shortly after the conclusion of the surgical procedure when the anesthesia used for the surgery wears off. Symptoms experienced by the patient depend on the level where the nerve injury occurred at. Sciatic nerve injuries will produce gluteal pain that radiates down the leg. Direct injuries to the perineal nerve after it separates itself from the tibial nerve will present themselves with pain and lack of functionality. Attempts at walking even short distances reveal an acute deficit.
Surgical injuries to the perineal nerve caused by a stitch or a suture ligature are amenable to reversal with timely surgical intervention. Early nerve decompression, nerve repair and nerve grafting can aid in restoring functionality. Electromyography can confirm the type of neuropathy, establish the site of the lesion and estimate the extent of the injury. Recovery is unpredictable and related to the underlying cause.
If you believe that you or your loved is suffering from foot drop following a surgical procedure, have been misdiagnosed, victims of a traumatic peroneal nerve palsy or wrongly treated and suspect the complications may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
Contact Information For a free confidential consultation and receive a response within 24 hours (when possible), please contact us by phone, fax or e-mail with your question or concern.
Website disclaimer: The materials on this website have been prepared by Gorovitz & Borten, P.C. for informational purposes only and are not intended, and should not be construed as legal advice. This information is not intended to create and receipt of it does not constitute a lawyer-client relationship. Similarly, any submission or receipt of information using electronic "Contact Us" form does not create a lawyer-client relationship. Internet and online readers should not act upon any of the information contained on this website without seeking professional counsel. (See Terms and Conditions).