What Is Foot Drop? Foot Drop Causes, Exercises, and Treatment

September 27, 2022

Have you been wondering what is foot drop? It is a condition where the patient cannot lift the front of the foot when walking. With foot drop, the front of the foot and toes will drag on the ground. It can affect one or both feet and poses a safety hazard because of the increased risk of falling. Patients with foot drop will sometimes need to lift their thighs, as if ascending stairs. This side-effect is called a steppage gait.

The condition sometimes causes the foot to slap against the ground as the patient lowers their legs. It can also cause loss of sensation on top of the foot or in the toes. Foot drop is not a disease—it is a symptom of something else. Read on to learn more about foot drop, how it gets diagnosed, and the treatments available to you.

Foot Drop Causes

So, what causes foot drop? It often results from the compression of the peroneal nerve. It is part of the sciatic nerve, helping to control the movement of the lower leg, foot, and toes and providing sensation.

Developing foot drop and pathology of the peroneal nerve is usually a symptom of an underlying condition that can weaken or paralyze the muscles responsible for lifting part of your foot when walking. These conditions include:

Nerve injury
Neurological conditions
Musculoskeletal conditions
Autoimmune Disease
Anatomical issues
Activities that compress the peroneal nerve

Nerve Injury

One of the most common causes of foot drop is lumbar radiculopathy—a condition where a herniated spinal disc compresses a nerve root and leads to weakness or paralysis.

Radiculopathy in the L5 vertebrae can result in weakness, numbness, and loss of sensation in the foot.

Other factors affecting the nerve include prolonged bed rest, tight casts, and diabetes. Diabetes patients are prone to nerve and nerve compression issues, which might also result in foot drop.

Neurological Conditions

Neurological conditions affect the brain or spinal cord, potentially causing food drop. These diseases include amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome). The diseases can impair the muscles and motor neurons that work to lift the muscles of the foot.

Moreover, you could be at risk of foot drop if you experience a cerebrovascular accident (stroke). A stroke can cause hemiplegia, a type of paralysis on one side of the body, and might manifest as foot drop.

Parkinson’s Disease and Polio are two other neurological conditions that can cause foot drop.

Musculoskeletal Disorders

Musculoskeletal disorders and their subsequent treatment can be another source of foot drop.

Patients who experience traumatic injuries like knee dislocations, hip fractures, and blunt trauma often have foot drop after surgical treatment. Surgery can cause sciatic neuropathy, which might result in foot drop.

What’s more, muscular dystrophy, an inherited disease that causes paralysis, and Charcot-Marie-Tooth Disease (CMT), an inherited neuropathy disease that affects motors and nerves, can also cause foot drop.

Autoimmune Disease

In addition to neurological conditions like MS and ALS, patients with other autoimmune diseases may experience foot drop. One example is polyarteritis nodosa, a multi-organ blood vessel disease where arteries become inflamed and damaged.

Myositis is another rare autoimmune disease that affects muscles and blood vessels. It can lead to diminished reflexes and decreased muscular strength, which could result in foot drop.

Anatomical Issues

Overgrowth of bones in the spinal column can sometimes cause foot drop. Pathological growths like tumors and cysts can affect the spine or peroneal nerve in the knee.

Other Risk Factors

Any activity that compresses the peroneal nerve can cause foot drop. The following are potential risk factors:

Prolonged kneeling—common in trades like plumbing, carpentry, and agriculture—can compress the peroneal nerve.
Wearing tight, high boots
Pressure to the knee from deep sleep or a coma
Weight loss, being thin, and conditions like anorexia nervosa

Diagnosis

Now you have the answers to what is foot drop and its potential causes, you might be wondering how you can get a diagnosis.

Your provider can diagnose foot drop through a physical exam and diagnostic testing. The diagnosis will include foot drop and the underlying condition causing it.

Physical Exam

During a physical exam, your provider will have you walk across the room so they can observe if you demonstrate symptoms of foot drop. A standard musculoskeletal test typically includes a heel and toe stand, and a deep knee bend.

The provider will also check your foot and leg muscles for weakness. Muscle strength is graded on a 0-5 scale, with 5 being full strength. The tests typically include flexion and extension for the knee, dorsiflexion, eversion, and plantarflexion for the ankle, and hip flexion.

As well, a physical exam will examine if there is an absence of reflexes or any numbness and tingling. A neurosensory exam includes the use of a pinprick, which gently prods the skin with a pin to see if you can feel it.

Diagnostic Testing

There are several diagnostic tests to diagnose foot drop. These include:

X-rays—The most basic diagnostic imaging. It can identify a soft tissue or bony growth
MRI—An imaging test that uses magnetic waves to identify soft tissue pathology
CT-scan—An advanced form of x-rays that takes images from different angles
Ultrasound—A non-invasive test that uses sound waves to identify soft tissue growths or inflammation
Electromyography (EMG)—A nerve test that measures electrical activity in nerves

Foot Drop Treatments

Treatment for foot drop usually involves a mixture of treatments like orthotics, physical therapy, stretching, strengthening, and nerve stimulation. If the condition is unresponsive to this type of management, your provider may suggest surgery.

Foot drop treatment will often focus on addressing the underlying condition causing it. Often, once the underlying condition gets addressed, the foot drop will start to go away. However, if the condition shows no improvement, it could mean the foot drop is permanent.

Physical Therapy

Physical therapy (PT) is intended to address musculoskeletal disorders. If PT is recommended for your foot drop, you’ll usually work with a licensed physical therapist. You can also perform a physical therapy program on your own schedule at home.

The treatment plan focuses on stretching and strengthening exercises for your muscle and soft tissue. Your exercise regimen will center on restoring range of motion and function for your foot.

With foot drop, physical therapy will include exercises for the foot, ankle, lower leg, knee, hip, and core.

Foot Drop Exercises

Some of the most common exercises include stretching, isometric contraction, elevated toe taps, and toe curls.

Stretching involved sitting on the floor and placing a towel or band around the affected foot. Pull both ends of the towel to stretch the calf muscles.

An isometric contraction should be performed from a seated position. Use a band or strap to pull the affected foot off the ground. With the foot still raised, release the tension of the band and try to hold the foot as long as you can while keeping the muscle contracted.

For an elevated toe tap, place the heel of the affected foot on an elevated surface. Point your toes toward the ground as if you’re tapping your toes. Hold the plantarflexion position for a few seconds and then gradually raise the foot back up.

Lastly, toe curls require you to place the affected foot flat on a towel. Curl your toes inward and try to pull the towel.

Orthotics

An orthotic is a lightweight device, a sort of drop foot brace or splint. Patients wear an ankle-foot-orthosis (AFO) on the ankle and lower leg to keep the foot off the ground while walking. In addition to foot drop braces, your provider may also recommend an orthotic shoe insert.

Electrical Nerve Stimulation

With electrical nerve stimulation, a clinician will place electrodes on your lower leg. The electrodes connect to a small pack that generates electrical impulses. These impulses stimulate the nerves and help lift the leg.

Surgery

If management of your condition doesn’t yield positive results, your provider may recommend surgery. The procedure is known as a tendon transfer. It does come with potential complications, such as infections and the tendon tearing or failing to heal. Moreover, the procedure will not restore the original strength or movement.

Alternatively, surgery might be necessary to address the underlying cause of the foot drop, like a lumbar decompressive surgery, to relieve a herniated disc. Surgery can also transplant a tendon from the unaffected leg to help the muscles pull the leg with foot drop.

If the foot drop is permanent, your provider may recommend surgery to fuse the foot and ankle joint.

Conclusion

So, what is foot drop? It is a condition that means a person cannot raise their foot off the ground when walking. Foot drop is usually a sign of an underlying pathology like nerve compression or neurological conditions.

The prognosis for foot drop is good. Most patients will recover with conservative treatment once the underlying condition resolves. For severe cases or permanent foot drop, your provider may recommend surgery.