How does foot drop develop in patients with diabetes?

Updated: Mar 23, 2020
  • Author: James W Pritchett, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Patients with a combination of neurologic, muscular, and anatomic dysfunction typically are diabetic and develop loss of protective sensation and proprioception that leads to unperceived trauma. This is coupled with an autonomic neuropathy that results in loss of sympathetic vasoconstriction and enhanced pedal blood flow, causing demineralization and subsequent bone weakness.

Unperceived trauma, demineralization, and bone weakness culminate in destruction of the tarsal bones. This, in turn, leads to formation of a bony block at the ankle joint and foot drop. Progressive motor neuropathy is also present, in which the muscles weaken in a distal-to-proximal manner, resulting in loss of strength in the anterior compartment. The anterior muscles are overpowered by the Achilles tendon, and this leads to abnormal pronator stress at the midtarsal joint, which further encourages osseous breakdown and foot drop.

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