Rehabilitation interventions for foot drop in neuromuscular disease

  • Review
  • Intervention

Authors


Abstract

Background

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases.

Objectives

To conduct a systematic review of randomised trials of treatment for footdrop resulting from neuromuscular disease.

Search strategy

We searched the Cochrane Neuromuscular Disease Group Trials Register (July 2005), MEDLINE (January 1966 to July 2005), EMBASE (January 1980 to July 2005), AMED (January 1985 to July 2005) and CINAHL databases (January 1982 to July 2005).

Selection criteria

Randomised and quasi-randomised trials of physical, orthotic and surgical treatments for footdrop resulting from lower motor neuron or muscle disease and related contractures were included. People with primary joint disease were excluded. Interventions included a 'wait and see' approach, physiotherapy, orthotics, surgery and pharmacological therapy. The primary outcome measure was ability to walk whilst secondary outcome measures included dorsiflexor torque and strength, measures of 'activity' and 'participation' and adverse effects.

Data collection and analysis

Methodological quality was evaluated by two authors using the van Tulder criteria. Three studies with altogether 139 participants were included in the review. Heterogeneity of the studies precluded pooling the data.

Main results

Early surgery did not significantly affect walking speed in a trial including 20 children with Duchenne muscular dystrophy. After one year, the mean difference (MD) of the 28 feet walking time was 0.00 seconds (95% confidence interval (CI) -0.83 to 0.83) and the MD of the 150 feet walking time was -2.88 seconds, (95% CI -8.18 to 2.42). In a trial with altogether 26 participants with Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy), long-term strength training significantly increased walking speed on a 6 metre timed walk (MD -0.70 seconds, 95% CI -1.17 to -0.23) but not on a 50 metre timed walk (MD -1.9 seconds, 95% CI -4.09 to 0.29). In a trial of a 24-week strength training programme in 28 participants with myotonic dystrophy, there was no significant change in walking speed on either a 6 or 50 metre walk.

Authors' conclusions

Using the primary outcome of ability to walk, only one study demonstrated a positive effect and that was an exercise programme for people with Charcot-Marie-Tooth disease. Surgery was not significantly effective in children with Duchenne muscular dystrophy. More evidence generated by methodologically sound trials is required.

Plain language summary

Rehabilitation for foot drop (weakness or muscle shortening (contracture) at the ankle joint)

Foot drop is the term commonly used to describe weakness or contracture of the muscles at the ankle joint. It may arise from many neuromuscular diseases. Interventions might include a 'wait and see' approach, physiotherapy, orthotics (appliances), surgery or drug therapy. The review identified three randomised controlled trials which met the criteria for inclusion in the review, involving 139 participants in total. In one trial involving people with Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy, exercise had a significant beneficial effect on walking ability. A trial of surgery on the Achilles tendon in boys with Duchenne muscular dystrophy had no significant effect on walking ability. Data from a third trial of exercise in people with facioscapulohumeral muscular dystrophy showed no positive effect on ankle strength. Further randomised controlled trials are needed.

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