The dorsiflexion weakness
What is a palsy of the foot?
A paresis is a motor weakness or a slight paralysis. Dorsiflexion weakness is usually caused by damage to the nerves. Often it is Peroneal nerve affected.
Due to the damage, the electrical impulses can no longer be passed on and the muscle cannot contract, the contraction does not occur. As a result, the foot can no longer be lifted. The cause of this is a disease of the nervous system. This is why these symptoms are also referred to as neurological failure.
The causes of foot palsy can be numerous. The function of the foot muscle is only impaired because it lacks the electrical impulses from the associated nerve. The lack of impulse from the nerve can be caused by damage to the central nervous system (brain and spinal cord). The cause of this can be a stroke or multiple sclerosis.
A common cause of dorsiflexion weakness is a herniated disc. The herniated disc compresses the nerves in the area of the spine. This also applies to spinal stenosis (narrowing and compression of the spinal cord).
Other causes can be found in the area of the peripheral nervous system. The peripheral nervous system is a network of nerves outside of the spinal cord. The peripheral nerves emerge from different segments of the spinal cord and run in different parts of the body. Several segments of these nerve fibers also combine to form what is known as the sciatic nerve. The sciatic nerve runs towards the thigh and divides above the knee into the peroneal nerve, which innervates the lifting muscles. If the nerve is damaged anywhere in its course, this leads to a palsy of the foot. Nerve damage can occur, for example, during hip joint operations or interventions on the knee joint. An injury in the area of the fibula head can also be the cause.
More information on the topic Spinal stenosis you'll find here.
The herniated disc as the cause
If the L5 segment has a herniated disc, the core of the disc slips out of its original position and presses on the nerve roots or nerve fibers in the area of the spinal canal.
If the nerves of the L5 segment are damaged, various symptoms occur. On the one hand, sensitivity disorders occur in the area of the inner thigh and on the foot. The patient expresses this as an unpleasant tingling sensation or a feeling of numbness. On the other hand, it is also possible that the motor nerve fibers that supply the foot muscles are damaged by the herniated disc in the area of the spine. This can then result in palsy of the foot.
Read more about the topic here: Symptoms of a herniated disc of the lumbar spine.
Other accompanying symptoms
A foot palsy often has dramatic consequences for those affected. An intact function is of great importance for walking and climbing stairs. In the event of a loss of function, the patient is therefore extremely limited.
Depending on the cause of the foot dorsiflexion paresis, other accompanying symptoms may occur. In the case of a herniated disc, for example, this is back pain, which can often radiate into the foot. Feelings of numbness in the area of the leg or on the back of the foot can also be accompanying symptoms of palsy of the foot. Sometimes an accompanying sensitivity disturbance manifests itself as an unpleasant tingling sensation.
In the case of a serious herniated disc in the L5 area, the nervous system of organs can also be disturbed. Bladder and rectal emptying disorders occur. The affected patients are incontinent and can no longer voluntarily control the discharge of urine and stool.
The pain as a symptom
Whether you have pain with a dorsiflexor palsy depends on the underlying disease. A herniated disc in the L5 area usually causes severe pain. Sensory disturbances are also accompanying symptoms.
If the peroneal nerve in the area of the fibula head is damaged by pressure, for example if you kneel too long or cross your legs, then pain is usually not an accompanying symptom. Even slowly growing tumors that damage the nerves often do not cause pain.
Find out all about the topic here: Symptoms of a herniated disc.
The diagnosis of a foot palsy can usually be made relatively easily. The anamnesis and the clinical picture are often very impressive. The patient describes problems walking and especially climbing stairs. This altered gait pattern is also noticeable in the physical examination. In addition, the reflex of the peroneal nerve can be triggered in a weakened manner. The peroneal nerve is the nerve that supplies the muscles of the foot. If this nerve is damaged, the associated reflex is logically hardly present.
Further examinations are available to confirm the diagnosis. The measurement of the nerve conduction velocity using electroneurography is particularly suitable for this. The guide speed will be slowed even with a partial damage. When looking for the cause of a dorsiflexor palsy, further diagnostics, such as imaging, are usually necessary.
Find out more about the topic here: Electroneurography.
The strength levels in paresis
A division into strength levels is used to assess muscle strength in the physical examination. There are six different strength levels from zero to five. In order to indicate the correct strength level for a muscle, it is tested against resistance.
The normal is given as strength grade five out of five (5/5). If an active movement of the foot is only possible against slight resistance, then there is already a weakness of the foot muscles, this would be seen as a slight decrease in strength with a strength grade four out of five (4 / 5) specify. If the muscle can only be moved against gravity (without further resistance), one speaks of a strength reduction with strength degree three out of five (3/5).
If the patient can only move the foot by releasing the force of gravity, the degree of force is two out of five (2/5). A strength level of one in five (1/5) is when there is muscle contraction (visible or palpable) when no movement is possible.
A degree of strength zero out of five (0/5) then describes a complete paralysis of the muscles. No more muscular activity can be detected
How to treat dorsiflexor palsy depends in the vast majority of cases on the underlying cause. This must be treated to prevent further nerve damage. However, a consistent exercise program as part of physiotherapy is recommended for all patients. There are also aids such as a splint that support the patient in coping with everyday life.
There are various options for treating foot palsy, depending on the cause. If the nerve has been damaged by pressure on the head of the fibula, it is often advisable to wait and see. Usually the paralysis regresses spontaneously. If there is no improvement after 6 weeks, an operation is necessary. It looks similar with herniated discs. In the case of pronounced dorsiflexion weakness, however, an operative intervention would be planned as soon as possible.
An exercise program as part of physiotherapy is essential for all patients with paresis. However, the exercises should be performed continuously in order to make progress. In this way, the forecast can also be significantly improved.
There are many different exercises available. For example, you can only activate the foot muscles by walking barefoot. Massages with a hedgehog ball can also improve blood circulation in the foot.
Other exercises, on the other hand, aim to strengthen the foot muscles. A Thera-Band, for example, is suitable as an aid. You tighten this band around your foot while sitting and slowly move your toe back and forth against the resistance of the Thera band. But you can also train your foot muscles without aids. You sit on a chair, you press your heels firmly on the floor and now you try to lift both toes off the floor at the same time.
If the dorsiflexion weakness is caused by a herniated disc, you should also train the back muscles. Here, too, there are various exercises that you can do alone at home following instructions.
Here you will find useful exercises for a herniated disc.
The splint as an aid
In the meantime there are also numerous aids that support patients with foot dorsiflexion paresis to actively participate in everyday life. A splint or foot lifter orthosis is particularly indicated when there is a slight reduction in strength in the foot muscles. The affected patients often suffer from an unsteady gait. The splint gives more stability and leads to a significant improvement in the gait pattern.
The rails are available in a wide variety of designs, from rigid to flexible material. They are individually adapted to the patient's foot.
Find out more about the topic here: Orthosis for the foot.
What is the healing like?
Whether a dorsiflexion weakness can be cured depends on its extent and cause. If the peroneal nerve was completely severed by an operation, healing is unlikely. Even with complete paralysis due to a stroke, the foot palsy will remain.
If the nerve is only damaged for a short time and can be relieved by an (operative) decompression, the symptoms can recede completely. However, you can definitely try to improve the degree of strength reduction through physiotherapeutic measures and an exercise program at home.
However, this is also difficult with complete paralysis. Then the patient often only has aids that support him in coping with his everyday life.
Find out more about: Therapy of a stroke.
The prognosis of dorsiflexion weakness depends on its cause. If the nerve has only been damaged by pressure for a short period of time, the foot palsy regresses spontaneously in many cases. The nerve fibers recover and the foot lift muscle can resume its function.
If, on the other hand, the nerve is completely severed or irreversibly damaged in the area of the spinal cord, the symptoms usually persist. The symptoms can be alleviated somewhat through physiotherapeutic measures. Aids such as orthoses (splints) also make everyday life easier for patients.
What degree of disability is a palsy of the foot?
The degree of disability is determined by the pension office on the basis of a medical report. A limitation in everyday life is decisive for the classification in the degree of disability.
A degree of disability (GdB) of 30 is estimated for a slight palsy of the foot. However, this also depends on the cause of the paresis. If there is also a spinal disease, the patient can be classified higher. Whether the patient also receives the mark G also depends on the extent of the restriction caused by the foot dorsiflexion paresis. This can be assumed if a distance of two kilometers cannot be covered on foot without harming yourself and others.