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Paediatric Drop Foot

Foot drop is a musculoskeletal disorder that affects the lower limb. It is characterised by weakness in the ankles or an inability to flex the ankle joint. Foot drop can be bilateral (both sides) or unilateral (one side) and can be permanent or temporary depending on the cause. This condition can be resolved early through podiatric intervention.

What Causes Foot Drop in Children?

The causes of foot drop can vary in terms of severity and permanence. In most cases, the appearance of this condition can usually be attributed to a neurodegenerative disorder that occurred in childbirth or during the early days of life.

The most common neurodegenerative disorders that can cause foot drop are:

  • Cerebral palsy (CP)

    This neurological condition causes motor and movement disabilities and can vary in levels of severity. Although it is the most common motor neurone disorder in children, it tends to affect more boys than girls. This condition can be:

    • Congenital: Abnormal brain development or damage to the developing brain occurs during pregnancy because of birth defects such as being too small or premature, being a twin, or other complications.
    • Acquired: Brain damage occurs after the first 28 days of life, usually due to an infection or head injury.

    Cerebral palsy can present in many ways, with the most common form being spastic cerebral palsy. The affected child will present with stiffness and rigidity in the body, awkward movements, and walking difficulties. The affected body parts; bones, muscles, joints, and tendons, can also differ between individuals and face declining mobility over time depending on the severity of the condition.

  • Paediatric stroke

    Strokes in children can happen suddenly and are typically caused by an injury to a blood vessel in the brain, leading to injury in the surrounding brain tissue. Strokes can be categorised into two forms; acute trauma causing bleeding into the brain (haemorrhagic), or an insufficient supply of blood due to a blockage (ischemic).

    Common symptoms include weakness or diminished movement on one side of the body and decreased muscle tone in infants. These can also appear as trouble with balancing and walking or sudden lethargy. Paediatric strokes are considered rare and are often misdiagnosed or undiagnosed.

  • Spina bifida

    Spina bifida is a condition that affects the spine due to a neural tube defect. One such condition, known as myelomeningocele, is the most serious type of spina bifida and occurs when the spinal cord and canal do not form or fail to close. A particular physical characteristic of this condition is a protruding sac of fluid from the child’s back. This growth traps and damages part of the spinal cord and nerves, causing moderate to severe disabilities. These may include a loss of feeling, a lack of function in the lower limbs, and a high incidence of foot deformities. Spina bifida is usually diagnosed intrauterine through prenatal testing or after the baby is born.

What Are The Symptoms of Foot Drop in Children?

Foot drop can be very difficult to identify especially with babies and young toddlers who haven’t started to walk. Their movements should be monitored closely.
Early signs of foot drop in babies include:

  • Weakness or an inability to flex the foot and ankle
  • No resistance when changing

Foot drop can be easier to identify in older toddlers and children as the symptoms are more noticeable. Some common symptoms include:

  • Bending the knee more than normal during motion to help with ground clearance of the foot (steppage gait)
  • Hiking the hip higher on one side
  • Inability to lift the toes or forefoot
  • Decreased muscle strength
  • Regular tripping and falling
  • Limping
  • Inability to retain footwear on the foot
  • Lack of physical cooperation from your child when putting on socks and shoes
  • Toe walking
  • Pointed toe position
  • Toes dragging on the floor while walking
  • Depleted functional mobility
  • Developmental delays in standing and climbing milestones

How Can Podiatry Help My Child’s Foot Drop?

Your child’s developmental history, birth complications, medical history, and milestones will be thoroughly assessed during the initial consultation to determine the diagnosis and its severity. If your child’s deformity is severe, prompt intervention must be taken to rectify and increase the efficiency of their gait.

Depending on the type of foot drop, your podiatrist may recommend the following:

  • Fitting your child with rigid/dynamic braces, splints, and/or orthotics to assist in movement
  • Stretching exercises
  • Using therapy to improve muscular function and provide nerve stimulation
  • Regular follow-ups to assist with the guided development and growth of your child
  • Tailored advice and education on the diagnosis

Podiatrists at East Coast Podiatry are highly experienced in handling complex paediatric cases. Parents who suspect the presence of foot drop in their children should seek a podiatrist’s professional opinion as soon as possible.

Frequently Asked Questions

Parents should start to become concerned when they notice their child trip over their feet constantly or display weakness and poor balance on one side when learning to crawl and walk. During the ‘toddler’ phase, babies with foot drop will struggle to stand independently, and walking will be delayed when compared to similarly aged children. Differences in muscle strength, tone, and coordination from the norm can be the first signs of a neuromuscular deficit.

If your child has any of the above symptoms or any other concerning presentations of musculoskeletal abnormalities, visit your podiatrist for an expert opinion and further guidance as soon as possible.

No. The complete resolution of foot drop depends on the severity and permanence of the underlying condition. If the underlying cause is attributed to a mild condition, foot drop can show signs of improvement or even be resolved entirely. However, improvements to this condition will only happen if the proper intervention methods are made and followed through with. A consultation with a foot specialist or paediatric podiatrist will help determine the best course of action.

No, if broken in properly. Orthotic devices used for paediatric foot drop are specifically designed and customised to each child’s foot and biomechanical structure. There are little to no problems when starting to wear the devices and they should be comfortable for children. Your podiatrist will guide parents through the acclimatisation process to reduce the possibility of initial overuse, irritation, or any other adverse reactions.

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