FOOT DROP: WHAT TO DO IN THE ED?
• First, establish course of disease, is it chronic or acute?
• Chronic (~90% of cases):
• Bilateral more common than Unilateral
• Most likely doesn’t need an extensive work-up while in ED
• Important for neurology follow-up for
• Acute (~10% of cases):
• Unilateral more common than Bilateral
• Most common ACUTE causes to rule out:
1) Stroke
2) Lumbar space occupying pathology
3) Traumatic injury
4) Compartment syndrome
5) TOXIC (lead, arsenic, mercury)
6) Infection: Guillain Barre, Syphilis, HIV
• Must do advanced imaging to rule out UMN, LMN and muscle levels
1) MRI brain w/wo, MRI lumbar spine
2) XR of extremity
3) CBC, Chem 8, ESR, CRP, CPK, Lactate, Aldolase, ANA, LDH, TSH, HIV, B12, RPR, lead
4) Consider mercury/arsenic if concern
• Neurology consult for acute foot drop
• Can’t walk, must monitor, PT consult