Foot Drop as a complication of critical illness: a retrospective analysis

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Background: Foot drop (FD) is commonly encountered in critical care patients, however, the exact pathophysiology and incidence remains unknown. Design: Retrospective single-center study. Objectives: We aim to describe the incidence of FD in long lie critically ill patients and propose a protocol to enhance early screening in this population. Methods: Between 1st of January 2020 and 31 December 2022, we screened all patients with a prolonged ICU stay of seven days or more for the presence of clinical FD, using a Medical Research Council foot dorsiflexion score of less than two. In this group, an ICU physician reviewed medical charts to assess clinical and electrodiagnostic (EDX) signs of peroneal neuropathy. Outcome measures: We screened for risk factors such as severity of illness, duration of ICU and hospital stay and organ failure. Results: 57 out of 879 long lie ICU patients had clinical FD, of which 26 had EDX confirmed peroneal neuropathy. Compared to the group without FD, patients with clinical FD had significantly higher APACHE III scores (77.5 versus 72, p < 0.05), ICU length of stay (30 versus 13.6 days, p < 0.05) and hospital length of stay (58.4 days versus 27.3 days, p < 0.05). Furthermore, more patients had received mechanical ventilation (89% versus 62%, p < 0.05) and duration of mechanical ventilation was longer (19 versus 10 days, p < 0.05). Also renal failure (54% versus 22%, p < 0.05), need for renal replacement therapy (33% versus 10%, p < 0.05) and duration of renal replacement therapy (13 days versus 7 days, p < 0.05) was higher in the FD group. Extra-Corporeal Membrane Oxygenation (ECMO) was more prevalent in the FD group (14% versus 2.5%, p < 0.05); duration of ECMO run however was similar in both groups (11.4 days versus 11 days, p = 0.9). Conclusions: FD is common and associated with a higher degree of organ failure most likely both as cause and effect. Early screening by means of MRC foot dorsiflexion and EDX testing in patients with prolonged ICU stay is essential to avoid delay in treatment and revalidation.

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