Acupuncture Treatment for Foot Drop - A Case Report

Introduction:  Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg and brain/spinal disorder. Treatment with surgery, nerve stimulation or braces has limited response and potential significant side effects.

Objective: To describe the outcomes of acupuncture treatment for foot drop secondary to chronic low back pain in a single patient using a case report design.

Case History: A 75 year-old male who developed left foot drop and complained of inability to dorsiflex for four weeks. It started with deep and sharp pain in the low back that traveled into leg and foot. Pain has resolved after chiropractic treatment. Twenty years of low back pain (comes and goes) due to disc rupture incident. Still has some numbness on left leg and dorsal left foot with heaviness. Previous x-rays had shown L/S degeneration. Average pain is 2/10 currently and happens 25-50% of time. Pain has greatly decreased with chiropractic care, but gradually developed difficulty in walking. Walking is assisted with a cane. No significant past medical history or family history was reported.

Intervention: A total of six acupuncture treatments, once per week for 30 minutes each time were provided. Acupuncture points included: ST36, SP9, GB34, ST40, ST41, SP6, SJ5 left side. Additionally, Scalp acupuncture at the Motor Leg region and sensory leg region on the right side was also performed. The needling process started with application of scalp needles first, then 4 times of walking back and forth with needles stimulation in-between for 10 foot distance. This was followed by the body acupuncture at the above points. 

Outcome measures: Improvement was measured using Verbal rating of pain scale, muscle strength, ROM (Range of motion), and ability to walk.

Results: At the end of six treatments, the pain scale was down to 0/10, the ROM of ankle change from 0 to 47^o/50^o;  dorsliflexion strength increase from 0 to 4­^-/5; Big Toe dorsliflexion strength increased from 0 to 4/5; Pt could walk without cane. We hypothesize that acupuncture increased the circulation and stimulated the nerves

Conclusion: Acupuncture seems promising as a complementary medical treatment for foot drop. Clinical studies involving more cases and electrophysiological studies are necessary to investigate the effectiveness of acupuncture and understand its specific mechanism of action.