Clinical manifestations of foot ptosis:

The ankle joint can’t be dorsiflexion. When walking the sick foot is dragging. When lifting the side of the lower limb higher, tiptoe always touch the ground firstly. Thus, during the swinging phase of the walking cycle, the patient is unable to complete ankle-dorsiflexion and develops a characteristic foot ptosis gait.

Causes of foot ptosis:

ø Foot ptosis deformity is mainly caused by damage to the nervus peroneus communis. The common causes are as follows:

ø The anesthesia level did not disappear, the sensory function of the affected limb did not recover, and the fibula neck of the limb was compressed;    

Swelling and compression of limbs, no protective measures were taken;

ø The affected limb is caused by compression of the limb during skin traction;

ø The patient was thin and had little subcutaneous fat, and was in a forced position. The fibula neck was easily be compressed.

ø Hemiplegia patients.

Prevention of foot ptosis:

ø Strengthen education, keep the affected limb in a neutral abduction position, and avoid external rotation compression of the fibula neck.

Massage the small head of the fibula every 2-3 hours.

ø Guide patients to exercise ankle pump 20 to 30 times/time, 2 to 3 times/day.

ø To enhance the protection of the fibula neck, soft pillows can be placed under the knee joint to expose the fibula neck.

ø Paraplegic patients should use special supports, such as anti-drop foot boards.

Prevention of foot droop (paraplegic patients) :

(1) bed period: change the position every two hours , maintain the functional position of the limb, , to rely on something in lateral position, pad up the knee in hemiplegic position, in order to keep the lower limb in the functional position, to ensure that the hemiplegic side of the lower limb rotation, adjust the lower limb to maintain mild flexion in bed.

(2) limb movement: Do passive flexion and extension of the upper and lower limb joints on the paralyzed side, dorsiflexion movement of the foot joints.

Do 15 sets twice a day. In order to promote the passive movement of the paralyzed side, the automatic movement of the healthy side also does the same operation. If the passive movement is not sufficient, the healthy side can be used to drive the affected side to do passive movement.

(3) Out of bed: wheelchair riding training: after the acute phase, with the doctor's permission, start wheelchair riding training, once a day, 5 minutes a time, if the wheelchair training is stable, you can increase the times. You must keep your feet on the pedals in a wheelchair. The patient's safety must be taken into account. Patients whose neck cannot remain stable while their torso is secured with a seat belt may use a wheelchair equipped with a bed.

(4) Sitting training: For patients who can sit in wheelchairs, 2 times a day, at this time, the soles of the feet should use the pedal of the wheelchair to maintain the functional position.

(5) Walking period: when sitting in a wheelchair or on the soles of the feet for dorsiflexion training. Place 5-6 cm of sponge between plantar and ground for dorsiflexion training, 10 times for this set, 2 times a day.

Rehabilitation and nursing

(1) Walking training: encourage and guide patients to get out of bed and stand up as soon as possible. The standing activity under the bed should follow according to their respective circumstances. You can stand on the bed firstly, stand as far as possible to keep the heel contact with the ground, while doing squatting and walking exercises. Gradually increase the walking time.

(2) Rehabilitation training: first of all, start with passive exercise, do flexion and extension activities from ankle joint to interphalangeal joint, the strength of hand should be soft, from small to hard 2 times a day, 20 to 30 minutes every time, when the muscle strength of patients got grade 2 , who can be active in passive foot flexion and extension, step by step, don't try so hard. When the patient can stand, to begin with platform, until the solid ground, with feet walk not tilt. And pay attention to the gait, so that the gait in line with the physiological requirements.

(3) Keep the foot position: when the patient can only lie in bed, no matter in supine position or side position, the feet can not be suspended.

It is necessary to put soft cushion in the foot, supine side of the hip, knee flexion, and make the foot and soft cushion, so that its pedal solid. When lateral decubitus position affected side foot should pad soft pad. Cloth shoe therapy can be adopted during sleep, the affected side of the cloth shoe is vertically fixed on the patient's bed rail,

Every night before going to bed, put the foot of the affected side into the shoe and remove it from the shoe every 2-3 hours for a massage.

(4) Foot warm heat therapy: this is the use of physical action to heat up the tissue and then cool it down to promote the absorption of inflammation.

The purpose of increasing local nerve nutrition, relieving muscle spasm and reducing swelling. The specific method is to first use 38 ~ 40 degrees warm water immersion

Soak the affected foot for 8-10 minutes, then soak it in cold water at 15-20 degrees for 8-10 minutes, repeat 3 times, twice a day, for 1-2 months.

(5) Others: ankle foot orthosis, pendent orthosis, leg orthosis. In recent years, our department has adopted the method of self-made anti-spin shoes to prevent foot sagging with remarkable effect.