Friday 20 April 2018

A case of foot drop and over 70s card

Ask the GP...

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Our GP answers questions on a muscular weakness and applying for the over 70s car.

Question: I had hip surgery last year. There was damage to a nerve and now I have foot drop. I have had physiotherapy but I still have pain and tingling. Will this go away?

Dr Nina replies: Foot drop is a muscular weakness or paralysis that makes it difficult to lift the front part of the foot and toes. This results in a person dragging the foot along the ground. Many compensate by lifting the upper part of the leg when walking to allow the foot to clear the ground. The foot may then slap back down as it returns from the exaggerated step. This condition can be temporary or permanent.

There are a number of causes. Muscular weakness due to muscular dystrophy or polio can cause this. Nerve damage is the more common cause. This may be due to injury to a nerve during hip or knee surgery or due to pressure on a nerve in the lower spine. Conditions such as diabetes can also result in nerve damage. More central brain and spinal for problems such as motor neurone disease, and multiple sclerosis may also cause foot drop.

The nerve that has been damaged is the peroneal nerve. This is a branch of the sciatic nerve which many people are familiar with.

If foot drop occurs directly after surgery the case may be obvious. In other cases you may require X-rays, CT scans or MRI scans to ascertain the cause. Nerve specific tests such as electromyography (EMG) can help localise the cause.

Foot drop may be permanent or temporary. Physiotherapy is started early to try and restore muscle function. In more prolonged cases a special brace which supports the foot and holds it in the correct position may be recommended. This is called an ankle foot orthosis. Shoes that lace or have Velcro need to be worn with these in order to help keep the brace in place.

Electric nerve stimulation involves placing a sensor in the shoe and electrode son the skin. These are attached to a battery powered stimulator worn on the body. This sends an impulse to the muscles telling them to contract when the heel leaved the ground. These need specialist review. Thirdly surgery may be an option for some. This may involve the transfer of a tendon form other muscles or fusion of the bones in the ankle.

Nerves may have a motor and sensory function.The pain and tingling are symptoms associated with sensation in a nerve and are due to damage of the sensory part of the nerve while the foot drop is damage to the motor part.

Unfortunately the damage may never fully resolve. It is important to continue physiotherapy. Make sure your environment is de cluttered to reduce the risk of falls. If t!he pain persists there are some medications that can dampen down nerve impulses.

Question: I am over 70 and would like to apply for my free GP visit card. Is the process complicated? What information do I need to give? Will my wife need to complete a separate application?

Dr Nina replies: As of August 5 this year all of those over 70 who are ordinarily resident in Ireland are entitled to a GP visit card. This card covers visits and services provided by your GP. Unfortunately it does not cover other services, such as physiotherapy and counselling, or expenses such as prescriptions.If your spouse is also over 70 they are entitled to a card. If they are under 70 they will only be entitled if they meet the income guidelines for under 70's. These have not changed.

You can apply on-line at or in paper form. Forms are available at your local health centre or they can be downloaded from the HSE site. Each person can select their GP of choice. If a husband and wife would like different GPs this is entirely possible. If you apply on line you will simply complete 2 separate applications. The paper form has two separate acceptance boxes allowing different GPs to stamp each one.

The application process is very straightforward. You need to have your PPS number and then also complete details such as your name, address and date of birth. You then nominate your GP of choice. The easiest way to do this on line is type your doctor's name into the appropriate box and they should pop up in the search. You do not need to supply any other personal or financial details for the GP visit card application.

If your GP is not partaking in the scheme, or if you would simply like to change doctors, you can select any doctor of choice. Once you have received your card number you are covered to attend the practice you registered with.

I am over 70 and would like to apply for my free GP visit card. Is the process complicated? What information do I need to give? Will my wife need to complete a separate application?

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