Rehabilitation of drop-foot with maximal isokinetic cross-training: a case report

Question: We wondered whether an unconventional intervention, the Cross-Training, could improve the performance of dorsiflexor muscles in an inveterate iatrogenic drop-foot. We investigated whether unilateral, maximal isokinetic training of the normal leg would induce, in the contralateral affected side, a worthy strength-transfer, with cortico-spinal and gait adaptations. Methods: A 59-year-old man who suffered in childhood a surgical-induced damage of the left common peroneal nerve at the head of the fibula, performed a 4-week training (16 sessions) of the normal leg, at 40°/s-angular velocity. Before and after training, the subject underwent a test-retest assessment procedure including: 1) bilateral isokinetic dynamometry of the dorsiflexors’ performance; 2) stance and gait-analysis; 3) recording of cortical and spinal drives to the affected leg, through measurement of central motor conduction time, input-output curve, cortical silent period (cSP), SICI, ICF, SICF, H-reflex, V-wave and M-wave. Results: The untrained-affected dorsiflexors showed considerable increases in strength (peak-torque: pre = 23N/m; post = 31N/m), power (pre = 14W; post = 22W) and total-work (pre = 9J; post = 22J). Ankle dorsiflexion increased from 4 to 11 degrees. Overall gait pattern was unchanged, however a better stance performance was suggested by changes in heel-to-forefoot contact-time % of stance-time (pre = 0.5%; post = 3.4%) and mean steplength (pre = 30cm; post = 34cm). An increase in cortico-spinal drive to the untrained-affected leg was revealed only by reduction of cSP duration (120%RMT: pre = 154ms; post = 144ms; 150% RMT: pre = 196ms; post = 182ms). Conclusions: Maximal isokinetic cross-training induced considerable improvements in the performance of the untrained-affected leg with a parallel increase in its cortico-spinal drive. In this report cross-training was a viable and effective rehabilitative approach to drop-foot.