Foot drop following epidural

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My wife gave birth to our second baby girl a couple of weeks ago, all lovely and healthy, good stuff. Trouble is she has been left with a floppy left foot.

She is basically unable to dorsiflex the foot and has adopted a forefoot strike pattern to her gait that's casuing muscle fatigue further up the chain. She's also fallen up the stairs a few times, funny but not ideal when carrying a new baby.

The obvious culprit is the insertion of a not inconsiderably sized needle into the lumbar spine (not sure what level exactly) that has casued some kind of injury to the sciatic nerve bundle resulting in a loss of function of the common peroneal nerve?

The GP is aware and looking into what can be done, if anything. I really can't see it being anything you can "fix" as such and it should just improve over time.

I just wondered if any of you learned folk had any opinions/thoughts on it?

 

My wires a P & O she sees a few of these patients.

The obvious answer is the needle, but she who must be obeyed wonders if it from pressure on the back of the leg when in the stirrups.

A basic dorsial asssit device is the advice from her and hope for best.

 

Ps congratulations :drinks

 

CONGRATS!

It is, unfortunately, a well documented complication of epidurals: http://scholar.google.com.au/scholar?q=epidural foot drop

 

Congratulations

Not massively uncommon, I'm afraid.

Hope for the best as far as return of motor function is concerned but it will be a long process if it does come back.

Plenty of lightweight temporary devices can be used in the initial period just to make her safe

http://www.ossurwebshop.co.uk/ankle-foot/foot-up/prod_86.html

If it turns out to be long term, a SAFO might be worth investing in

http://www.dorset-ortho.com/orthotics/orthotic-products/safo/

Hope this helps

Robin

 

My 32 year old son had a similar thing with surgery for a herniated disc. The symptoms are just as you described with your wife. They damaged the nerve during the surgery and it has taken about three months to become reasonably functional and the surgeon predicts another four months for the symptoms to clear.
The surgeon seemed fairly certain that it would clear and so far he has been proved right. I can sympathise with you because it is very worrying, gut wrenching even, and the thought that this might be permanent looms.
I hope it works out as well as it has for your wife as it has for my son. Just keep believing it will clear in time and keep her spirits up.

 

Many thanks for the well wishes all

The GP arranged for to be seen by an anaesthetist in the labour ward and she went yesterday. She was not impressed.

The chap essentially said to her "this is NOT because of the epidural but all part of the birthing process....there is nothing we can do." My wife said he was very defensive from the outset and although she explained that she wasn't there to blame anyone, simply to see if there were any treatment options, he remained dismissive and sent her back to the GP. Given the evidence suggesting this is a common side effect and she perfect function prior to giving birth I think he needs a slap and some further training on his bedside manner.

On a related note, at the time of the epidural no informed consent was sought as such. It was a case of the anaesthetist saying to her “do you want me to go through the risks of the procedure, or just do it?”. Given she was 16hrs into a screaming labour she said “just do it!!!”. Our 1st daughter came out in exactly the same way with no problems afterward by the way.

Anyway, I’ve reassured her that is should come back over time, nerves are notoriously slow to heal, and to get back in touch with the GP pronto and ask for a referral to the orthotics dept. in the mean time I know of a local orthotist shop and I might see if he’s got something I can buy today.

 

You should have no problem contacting Ossur UK and purchasing a foot up yourself as a podiatrist. You can pay over the phone by credit card and they will deliver the next day. All you need is an ankle circumference. If you need a size, measure the circ just above the malleoli and let me know I will give you the size.

There are also various ways that you can use the foot up with lace, velcro and slip on shoes so PM me if you need advice

I have no financial interest in Ossur. I am an orthotist and the best short term product is the foot up for weight, cosmesis and effective function

Robin

 

Just to echo RP's above comments, I have had some great results with the Foot Up from Ossur.

I usually measure the ankle circumference, tell the patient what size they need, then show them the webpage, forward it to them via email, and ask them to order it themselves as soon as they get home. They get it much quicker and can start using it asap. Best £50 a lot of people with foot drop will ever spend.

 

I have encountered a patient in the past who had a transient foot drop following pregnancy, no epidural was involved. This lady squatted a lot during her pregnancy, that placed excess pressure on the CPNerve, and 2º foot drop, that did resolve after about 4-6 weeks (from memory).

Just a thought!

Sure you can mail order AFO's but Im sure an orthotists would ensure appropriate Px and fitting of an AFO if required.