What is a foot drop?
In a foot drop (drop foot, pes equinus) the heel does not reach ground contact. Patients therefore walk with a toe pointed gait.
Physiotherapy
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Heel elevation
The dynamic foot drop
In foot drop (drop foot, pes equinus), the foot is permanently in extension, which is accompanied by an elevation of the heel. As a result, the foot only touches the ground with the ball of the foot. A stable stance is therefore hardly possible. In addition, the foot cannot be rolled correctly.
Dynamic foot drop is one of the most common motor impairments in children and adults with infantile cerebral palsy. However, the deformity also occurs in other diseases and disabilities. It is often a shortening of the calf muscles. At the same time, malalignments of the lower ankle joint, such as a bent or clubfoot position, are usually observed. During growth, there is often an increase in the pointed foot position, which may then have to be surgically corrected if it is severe and increasingly stiff.
Decades of experience
Excellent orthosis concept
The following options exist for the therapy and prophylaxis of a dynamic foot drop:
- physiotherapy
- orthopedic aids
- drug treatment (e.g. injection of botolinum toxin for temporary weakening of the calf muscles)
- redression plaster
- surgical correction
With regard to orthopedic technical fittings, the usual standard fittings, such as night bedding shells and lower leg orthoses made of different materials and in different designs, could not satisfy us. We regularly observed that when the orthosis attempted to strongly stretch the calf muscles, the heel slipped out of the foot socket, which significantly reduced or completely eliminated the correction effect. It can even cause the foot to break open in the lower ankle joint, promoting a buckling flatfoot position.
Night positioning orthoses were very poorly accepted by patients and hardly used in practice.
Many orthoses were too weak in terms of correction and, due to their design, were not capable of permanently eliminating the malposition. Stiff, immobile orthoses, such as inner shoes, were also unable to satisfy our requirements due to the lack of dynamics.
We therefore drew up a catalog of requirements for a new type of orthosis to be constructed and implemented it consistently over several years of intensive work - under strict observation of the therapeutic results. Since then, the resulting orthosis, the lower leg orthosis made of cast resin with a ring frame, has been used in our company in various designs. Over the years, this product has been further refined and improved. As a result, we are now able to exclusively offer an orthopedic device that, when correctly indicated, has proven to have a high success rate in the treatment of spastic foot drop.
Our great experience has taught us that this aid can also be successfully used for other diseases and disabilities with deformities of the lower and upper ankle joint.
Lower leg orthosis
High success rate
In 2005, a paper on the correction success with the transtibial orthosis was published by Dr. Monique Baise and Kurt Pohlig (1) and awarded the 1st MOT Prize. The success rate of the correction of the foot drop was on average more than 83%. This result could be achieved in most patients after a wearing time of less than 3 months, so that thereafter a limitation of the orthosis wearing time to the night was possible. During the day, in many cases only a small foot orthosis, such as the TR ring orthosis, was subsequently required to correct the bent foot, which can be worn completely inconspicuously in the shoe in everyday life. To secure the correction achieved, the lower leg orthosis was usually continued to be worn at night until it became too small due to growth.
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Success rate after drop foot removal |
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drop foot |
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89,16% |
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pointed kink foot |
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82,47% |
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pointed club foot |
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80,00% |
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total |
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83,85% |
Another important result of the study was the improvement of motor skills, especially of the more disabled children. Before the orthosis was fitted, 13 of 178 children were only able to walk with assistance and 25 children were unable to walk at all. With the help of the lower leg orthosis, only one child was still unable to walk. In 35 children, the motor level had improved to a higher locomotion level.
In the following period, our orthoses were the subject of several scientific papers. In his diploma thesis Schenk (2) came to the conclusion that the treatment of the child's spastic foot drop with our lower leg orthoses is the most economical compared to other orthosis systems, although the orthosis is initially more expensive to purchase than most other systems.
In 2008, Metzler (3) came to the conclusion after instrumental gait analysis of patients treated by us that our orthosis system, if correctly indicated, can significantly improve the foot drop malposition even without botolinum toxin and surgical intervention.
In his master's thesis in 2012, Grasl (4) compared the treatment of spastic drop foot with our orthoses compared to the combination of orthopedic shoes and night positioning orthoses. This work also showed that the modern treatment of this deformity with movable joints and locking of the deformity is far superior to the usual conservative treatment, usually associated with immobilization of the joints.
Literatur:
(1) Baise/Pohlig 2005, Behandlung des reversiblen dynamischen Spitzfußes mittels Unterschenkelorthesen mit ringförmiger Fußbettung, MOT 3/05
(2) Schenk Bernard 2005, Relation zwischen Kosten und Heilerfolg von Unterschenkelorthesen, Diplomarbeit Fachhochschule München
(3) Metzler V. et al 2008, Improvement of gait pattern for children with
infantile cerebral palsy and dynamic pes equinus after treatment with hinged subtalar circular locking ankle-foot-orthoses, FTR Bil Der J PMR Sci 2008;3:92-97
(4) Grasl Ch. 2012: Der Einsatz dynamischer Orthesen mit ringförmiger Fußfassung bei einem reversiblen Spitzfuß bedingt durch Infantile Zerebralerebralparese, Master-Thesis, Zentrum für Management und Qualität im Gesundheitswesen der Donau-Universität Krems