Paresis of the left or right foot is a symptom of many diseases of the nervous system. The Yusupov Hospital has created the necessary conditions for the treatment of patients with sagging feet:
- modern methods are used to determine the cause of foot paresis;
- individual approach to choosing a treatment regimen;
- the use of modern medicines that are effective and have a minimal range of side effects;
- innovative methods of physical rehabilitation.
The team of rehabilitation clinic specialists (physical therapy instructors, physiotherapists, massage therapists, reflexologists) works harmoniously and coordinates their actions. Professors and doctors of the highest category at a meeting of the expert council discuss severe cases of the disease and collectively make decisions regarding further tactics for managing patients with foot paresis. Psychologists, using the latest psychological techniques, restore the patient’s mental balance, help to gain confidence in recovery and actively participate in the treatment process.
What is foot paresis
Foot paresis is a complete or partial loss of muscle strength in the foot. The leg seems to drag along the ground, since the patient is unable to lift the front part of the foot. Such disorders are provoked by neurological diseases. As a result, the patient cannot walk normally. If we examine the lower arch, there is a strong bend that does not allow the patient to lower his leg normally to the surface.
One or both limbs are affected by pathology. The disease can develop at any age. This condition is called “foot paralysis.”
Why does paraparesis occur?
Traumatic injuries
The causes of paraparesis are fractures, fracture-dislocations, partial and complete dislocations of the vertebrae, ruptures of the capsular-ligamentous apparatus and intervertebral discs in the thoracic and lumbar spine. Sometimes the disorder is provoked by spinal bruises due to high-energy impacts. The time of onset of disorders, severity and prognosis are determined by the nature of the spinal cord lesion:
- Injury.
Upon admission, complete paralysis due to spinal shock is detected. Sometimes there is an incomplete loss of spinal functions. Subsequently, functions are gradually restored. Organic lesions cause residual neurological symptoms. - Compression.
Acute compression develops at the time of injury and is associated with displacement of the vertebrae or their fragments. Delayed compression myelopathy is formed with instability, secondary displacement of bone fragments, increasing edema, hemorrhages, and hematoma formation. - Anatomical break
. Complete damage to the spinal cord is observed with intense traumatic effects and significant displacement of hard structures. It is the most unfavorable in terms of prognosis; lost functions are not restored. - Other
. Paraparesis can be provoked by damage to a large vessel of the spinal cord, compression, rupture, bruise or hemorrhage into the nerve roots.
Sudden loss of spinal functions is accompanied by the development of flaccid paraparesis, loss of sensitivity, and dysfunction of the rectum and bladder. Subsequently, flaccid paraparesis is transformed into spastic paraparesis with convulsive muscle contractions below the level of the lesion, the formation of pathological reflexes, and a tendency to form contractures.
Paraparesis
Nontraumatic compressive myelopathy
Compression of non-traumatic origin often develops subacutely or chronically. It is detected in the following pathologies:
- Spinal cord tumors.
Characterized by a slow progression of symptoms with further subacute decompensation. Paraparesis can occur with benign and primary malignant neoplasia, metastasis of tumors in other locations. - Purulent abscesses.
They are formed under the dura mater, more often formed with osteomyelitis, spinal tuberculosis, and sometimes as a result of open injuries and operations. - Spondylogenic compression.
A subacute course of myelopathy is typical for a ruptured intervertebral hernia. With osteochondrosis, changes increase gradually and are caused by pressure from osteophytes or hernia fragments, protrusion of the fibrous ring. In spondylolisthesis, disorders are caused by “slipping” of the vertebra.
Spinal circulatory disorders
Spinal stroke occurs suddenly. Acute circulatory disorders in the thoracic region are manifested by lower spastic paraparesis (weakness in the legs, increased muscle tone), urinary retention, sensory disorders, and disappearance of abdominal reflexes.
With ischemia or hemorrhage in the lumbar area, flaccid paraparesis of the proximal legs is observed while maintaining muscle strength in the distal parts of the lower extremities. Increased Achilles reflexes and disappearance of knee reflexes, urinary retention, and sensory disturbances are detected. With transient circulatory disorders, symptoms increase gradually.
Hereditary diseases
The phenomena of paraparesis are detected in the following hereditary pathologies:
- Adrenoleukodystrophy.
Caused by the accumulation of certain fatty acids. Lower paraparesis accompanies such forms of the disease as adrenomyeloneuropathy and symptomatic adrenoleukodystrophy. - Machado-Joseph disease.
Type 1 of this spinocerebellar ataxia manifests itself with spastic lower paraparesis, which is further complemented by weakness of the upper limbs, paresis of the pharyngeal muscles and oculomotor nerves with the development of dysarthria, dysphagia, and ophthalmoplegia. - Krabbe disease.
Paraparesis is characteristic of juvenile and adult forms of glycolipidosis. Combined with hemianopsia, visual agnosia, difficulties with voluntary movements. - Refsum's disease.
Initially, flaccid paresis of the distal parts of the lower extremities is observed. Later, hand weakness, cerebellar ataxia, hearing and vision impairment occur.
Congenital anomalies
Meningomyelocele is an extension of spinal tissue beyond the spinal canal. Formed in utero and detected at birth. It is manifested by the presence of a hernia-like protrusion in the lumbar region. Neurological disorders progress as the child grows. With damage below L4 in severe cases, paraparesis is determined, above L3 - complete paraplegia.
The spinal dermal sinus is most often localized at the level of the lumbar or lumbosacral region. There is significant variability in symptoms - from asymptomatic to increasing neurological disorders, including flaccid paraparesis, muscle atrophy, hyporeflexia, hypoesthesia and pelvic function disorders. With tethered spinal cord syndrome, the changes worsen.
Degenerative diseases
Paraparesis is detected in such degenerative lesions of the nervous system as:
- Amyotrophic lateral sclerosis.
In ALS with cervical onset, an asymmetrical flaccid upper paraparesis develops at the initial stage. Lower spastic paraparesis is formed, which is also asymmetrical in nature. Subsequently, the clinical picture is complemented by bulbar and pseudobulbar syndromes. - Multiple sclerosis.
Paresis is considered the leading manifestation of this demyelinating pathology. Spastic lower paraparesis is most often observed, tetraparesis is less common. Cerebellar symptoms and hyperkinesis are detected. - Opticomyelitis.
The autoimmune disease usually debuts with optic neuritis, which is subsequently accompanied by signs of myelitis: tetraparesis or lower paraparesis, ataxia, sensory disorders, pelvic dysfunction. Less commonly, optic neuritis is preceded by myelitis.
Syringomyelia
The formation of cavities in the spinal cord is congenital or provoked by traumatic injuries or infectious diseases. In most cases, syringomyelia affects sensory neurons, which is accompanied by the appearance of zones of loss of sensitivity and neurotrophic disorders. When the cavities spread to the anterior horns, the development of lower paraparesis is observed.
Infectious diseases
Paraparesis is determined by a number of neuroinfections, which include:
- Neurosyphilis.
Muscle weakness in the lower extremities is detected with meningovascular neurosyphilis, meningomyelitis, and gummas at the base of the brain. - Lyme disease.
Tick-borne borreliosis is accompanied by paresis at the stage of dissemination. There are pulsating headaches, lacrimation, neuralgia, myalgia, photophobia, and increased fatigue. - Spinal tuberculous meningitis.
A rare form of damage to the meninges, which manifests itself as girdle pain, pelvic disorders, mono- or paraparesis.
Other possible symptoms of foot drop:
- tingling, numbness and mild pain in the foot due to damage to the sciatic nerve;
- disturbances in the flexion of the foot and its toes;
- difficulty climbing stairs;
- loss of sensitivity on the sole and in the area of the outer edge of the foot;
- atrophy of the leg muscles due to intervertebral hernia or spinal cord injury.
Foot paresis requires immediate treatment. Otherwise, the person will lose the ability to move independently and an irreversible foot deformity will develop.
Paresis: symptoms and treatment
Paresis is a symptom whose manifestation is associated with pathologies in the body, such as a tumor of the brain or spinal cord, stroke, encephalitis, poliomyelitis, as well as processes that cause the destruction of the protein responsible for the transmission of nerve impulses. Paresis can be a consequence of encephalitis, multiple sclerosis, traumatic brain injury and spinal injury.
Paresis can be central (at the level of the brain and spinal cord) and peripheral (at the level of peripheral nerves). Central paresis is characterized by increased tone of the affected muscles. Peripheral paresis develops in the group of muscles associated with the damaged nerve and is expressed in muscle weakness and involuntary muscle twitching.
Paresis can affect either one side of the body (paresis of an arm and a leg on one side), or both limbs (arms or legs at the same time, for example, paresis/paraparesis of the lower extremities), or one arm or leg (paresis of an arm or paresis of a leg). Most often, patients are faced with the manifestation of hemiparesis - paresis of one half of the body. With hemiparesis, the patient is concerned about decreased skin sensitivity, muscle soreness and swelling, weakness, impaired flexion and extension of the joint, tremor, unsteadiness of gait, and uncoordinated movements. Right-sided hemiparesis occurs in patients much more often than left-sided hemiparesis. Such patients often have difficulty reading, writing, and counting.
In patients after a laryngeal injury, surgery on the neck organs (thyroid gland, carotid artery, cervical spine), or with cancer, laryngeal paresis may occur - a temporary impairment of the mobility of the laryngeal muscles. This diagnosis is established for patients with a disease duration of up to 6 months. The clinical recommendations of the Ministry of Health say that it is possible to restore the mobility of the laryngeal muscles in a period of several months to two years.
Facial nerve paresis may occur after a stroke. With paresis, the following is observed: drooping of the corner of the mouth, impaired swallowing, limited eyebrow mobility, inability to completely close the eye, impaired facial expression. According to WHO, damage to the facial nerve ranks second in frequency among diseases of the peripheral nervous system. Paresis of facial muscles leads not only to cosmetic defects and painful experiences for the patient, but also to impaired swallowing and chewing functions, impaired pronunciation and even loss of vision (if neuroparalytic keratitis is detected).
Complications of foot paresis
Moving in this way causes great inconvenience to a person, increasing the load on the hips. If the disease is not treated, degenerative changes will only increase. Due to incorrect positioning of the legs, foot deformation develops. At the initial stage, it will not be difficult to return it to an anatomically correct state. But a protracted process leads to irreversible changes.
At the first signs of the disease, you should seek help from a neurologist. He will be able to accurately identify the cause of “foot paralysis.” Elimination of the provoking factor will lead to the cure of foot paresis (intervertebral hernia, consequences of injury), since this disease is not independent.
In severe cases of the disease, paralysis develops and the person loses the ability to move independently.
Diagnosis of foot paralysis
It is impossible to make a diagnosis on your own, much less identify the cause of foot paresis. The specialists of the Noosphere clinic will help with this. Only a comprehensive diagnosis will be able to accurately identify the provoking factor of “cauda equina.” It is important, before visiting a specialist, to remember how long ago the foot stopped moving normally, the front part of the foot, which was in anticipation of this problem. The following methods are used to carry out diagnostics:
- MRI. Magnetic resonance imaging
- Ultrasound examination (ultrasound)
- Electrocardiogram (ECG)
- Laboratory research
Diagnostics
In patients with foot paresis, during a standard neurological examination, an initial diagnosis is established based on complaints and anamnesis. The diagnosis is helped by a muscle strength test, which evaluates forward flexion of the foot, measured on a 5-point scale. Foot mobility in points: 0 points for paralysis, and 5 points for full mobility, i.e. in the absence of paresis.
When diagnosing, methods such as:
- MRI - magnetic resonance imaging;
- MRN—magnetic resonance neurography;
- CT - computed tomography;
- EMG - electromyogram;
- EEG – electroencephalography;
- Lab tests.
The methods are used to obtain information about disorders in nerves and tissues surrounding them.
The peroneal nerve is responsible for the muscles of the legs, with dorsiflexion of the ankle, and is also responsible for the innervation of muscles that rotate the ankle outward.
The tibial nerve innervates the muscles responsible for plantar flexion. With paresis, these muscles are tense.
Paresis of the foot can sometimes be accompanied by paresthesia in the lower leg.
The final diagnosis is made by a doctor based on the results of research, obtaining comprehensive information about damage to the nerves and tissues surrounding them. The doctor prescribes the optimal course of treatment for equine foot after determining the cause of this pathology. A conservative method using drug treatment for paresis will help restore nerve impulses and improve tissue trophism.
Causes of equine foot
Foot paresis can be caused by various reasons:
- intervertebral hernia in the lumbar region;
- neuromuscular disease;
- damage to the peroneal nerve - chemical or mechanical;
- damage to the sciatic nerve as a result of a car accident, injury, careless actions, adverse medical interventions;
- lesions in the lumbosacral plexus;
- damage to the L5 nerve root;
- diabetic neuropathy;
- cauda equina syndrome, which occurs when nerve roots are compressed in the spinal canal;
- tumor lesion of the spinal cord;
- spinal cord damage due to poliomyelitis;
- rare brain damage caused by stroke, tumor or transient ischemic stroke;
- genetic pathology - hereditary neural amyotrophy and hereditary neuropathy;
- side effects of drugs or alcohol;
- multiple sclerosis.
Treatment of foot paresis
Foot paresis can be treated in two ways - surgery and conservative therapy. In many ways, the choice of technique is influenced by the reasons that caused the disease and the degree of deformation of the foot. The Noosphere clinic uses only conservative treatment methods.
An individual course of therapy is selected for each patient, based on the examination results and the patient’s condition. A full course of recovery takes up to 1.5 months. The procedure schedule is 2-3 times a week. The general treatment regimen includes the following therapeutic procedures:
- Resonance wave UHF therapy
Resonance wave therapy is a method of therapeutic effects on the aquatic environment of the body with low-intensity, high-frequency electromagnetic waves.
- Fermatron injections
Fermatron intra-articular injections are an effective method of treating various diseases of the musculoskeletal system by introducing a drug (chondroprotector) into the affected joint.
- Rehabilitation on the Thera-Band exercise machine
Treatment of the spine and joints using the Thera-Band simulator will restore limb mobility in a short period of time without expensive treatment in specialized sanatoriums.
- Block of joints and spine
Joint blockade is a type of drug treatment of the spine and joints aimed at relieving acute pain, inflammation and muscle spasms.
- Drug treatment
Drug treatment of joints and spine at the Noosphere clinic is used in a wide range and in combination with physiotherapy. Intra-articular injections, blockades and droppers.
Treatment of foot paresis at the Noosphere clinic (St. Petersburg) involves the return of normal muscle tone, restoration of the anatomically correct position of the leg and general improvement of the body. As a result, metabolic processes and blood circulation improve.
To consolidate the positive results of treatment, the patient is recommended to undergo a course of rehabilitation exercises. Within a year after completing the course, the patient can visit the clinic’s specialists free of charge. To get rid of horse foot forever, you need to strictly follow all the recommendations of the doctors at the Noosphere clinic.