Palsy of the foot: Out of step

Paralysis of the anterior tibial muscle often makes walking considerably more difficult. The resulting gait disturbance is called a houndstooth, stork or stepper gait. What helps those affected on their feet

Diagnostics: During the physical examination, the doctor tests various foot reflexes

© Panthermedia / Wavebreakmedia

People affected by foot paralysis can no longer actively pull the tip of the foot upwards and lift the leg from the hip to take a step forward.

"The risk of falling is high because you get caught with the tip of your foot on the floor and stumble," says Professor Günter Seidel, chief physician at the Clinic for Neurology and Neurological Early Rehabilitation at the Asklepios Clinic North - Heidberg in Hamburg. In addition, the stepping gait leads to improper stress on the hips and the entire spine, which can become very painful over time.

Too much pressure on the nerve

The gait disorder is caused by paralysis of the anterior tibial muscle that lifts the foot. There are many reasons for that. The most common: too much pressure on the peroneal nerve - this is part of the large leg or sciatic nerve.

Causes can be injuries, lengthy bed rest or sitting cross-legged for long periods of time.

Multiple causes

The impairment can also originate from the central nervous system or from the nerve roots between the vertebral bodies - for example after a stroke or a herniated disc.

Nerve damage (polyneuropathy) in the course of longstanding diabetes also weakens or paralyzes the foot lifter. "The variety of possible causes makes it difficult for us to put the patients into numbers," says Dr. Anne Carolus from the Neurosurgical Clinic at the University Clinic Knappschaftskrankenhaus Bochum.

New therapy concept

In order to improve the advice and medical care of those affected and to bundle them in an interdisciplinary manner, the doctor founded a specialist consultation hour. There, doctors from various disciplines and physiotherapists work closely together.

The therapy concept in Bochum provides for using imaging methods to find out whether the damage has an origin that can be localized. On this basis it is then decided whether an operation to relieve pressure increases the chance that the paralysis will regress.

In some cases, for example after an accident injury, the nerves can regenerate without intervention. "The fibers sprout again, about a millimeter per day," says Seidel. This growth can be specifically promoted. "Physiotherapy with certain movements that are repeated frequently stimulates the nerve tissue."

Small measures increase the quality of life

In many cases, however, the time window for a significant improvement is already closed because the patients are late. "In less than half of those affected, the paralysis can still be remedied," says Carolus. In most cases, the suffering has lasted for months or years. "Then the nerve is usually irreversibly damaged."

However, nobody has to come to terms with the complaints and problems that arise. Even if a causal therapy is no longer possible, you can improve the quality of life and reduce the risk of injury (see box below). Small changes often help. Particularly important: remove any tripping hazards in the apartment!

That improves the gait

Individually adapted orthotics support foot movement. These are mechanical auxiliary systems that guide the tip of the foot upwards using a spring mechanism. Targeted exercise therapy increases mobility.

If the paralysis persists, surgery can help. The tendon of another foot muscle is deflected onto the back of the foot.

Eliminate uneven floors such as wavy parquet at home, glue down carpet edges and lay loose cables so that no one can trip over them.