Foot drop

Definition

Foot drop, sometimes called drop foot, is a general term for difficulty lifting the front part of the foot. If you have foot drop, you may drag the front of your foot on the ground when you walk.

Foot drop isn't a disease. Rather, foot drop is a sign of an underlying neurological, muscular or anatomical problem.

Sometimes foot drop is temporary. In other cases, foot drop is permanent. If you have foot drop, you may need to wear a brace on your ankle and foot to hold your foot in a normal position.

Symptoms

Signs and symptoms of foot drop may include:

• Difficulty lifting the front part of your foot, which is sometimes the only sign of foot drop
• Dragging your foot on the floor as you walk
• Slapping your foot down onto the floor with each step you take
• Raising your thigh when you walk, as if you were climbing stairs (steppage gait)
• Pain, weakness or numbness in the foot

Foot drop typically affects only one foot. Depending on the underlying cause, however, it's possible for both feet to be affected.

When to see a doctor
If you can't lift your foot or you drag your foot when you walk, consult your doctor.

Causes

Foot drop is caused by weakness or paralysis of the muscles below the knee involved in lifting the front part of the foot. The underlying causes of foot drop are varied. Often, neurological, muscular and anatomical problems overlap.

Specific foot drop causes may include:

• Muscle or nerve damage. An injury to the muscles that control the ankle and toes can cause foot drop. Sometimes nerve damage — from an injury to the nerves in the lower spine or leg to the long-term nerve damage of diabetes (neuropathy) — causes foot drop. In other cases, nerve damage occurs during hip or knee replacement surgery. Pressure to the nerve on the outside of the shinbone just below the knee (peroneal or fibular nerve), as you might experience if you sit with your legs crossed for too long, can trigger temporary foot drop.
• Muscle or nerve disorders. Various forms of muscular dystrophy, an inherited disease that causes progressive muscle weakness, may contribute to foot drop. Various forms of compartment syndrome, a condition characterized by the compression of nerves and blood vessels within an enclosed space, may have the same effect.
• Central nervous system disorders. Disorders that affect the spinal cord or brain — such as amyotrophic lateral sclerosis (ALS), multiple sclerosis or stroke — may cause foot drop.

Peroneal nerve

Peroneal nerve

The peroneal nerve is on the outside of the fibula just below the knee. Pressure to the peroneal nerve, as you might experience if you sit with your legs crossed for too long, can trigger temporary ...

Preparing for your appointment

You're likely to start by seeing your family doctor or regular health care provider. Depending on the suspected cause of foot drop, you may be referred to a doctor who specializes in brain and nerve disorders (neurologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Take note of key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor. Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together.

For foot drop, some basic questions to ask your doctor include:

• What's causing my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• Can my condition be treated?
• What treatment do you recommend?
• Are there alternatives to the primary approach that you're suggesting?
• Do you have any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions anytime you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• When did you first notice symptoms?
• Are your symptoms present all the time, or do they come and go?
• Does anything seem to make your symptoms better?
• Does anything seem to make your symptoms worse?
• Do you notice any weakness in your legs?
• Does your foot slap the floor when you walk?
• Do you have numbness or tingling in your foot or leg?
• Do you have a history of diabetes?
• Do you have any other muscle weakness?

Tests and diagnosis

Foot drop is usually diagnosed during a physical exam. Be prepared to describe how the problem began, as well as any other signs or symptoms you're experiencing. In some cases, additional testing is recommended:

• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of certain parts of the body.
• Electromyography (EMG) and nerve conduction studies. These tests measure electrical activity in the muscles and nerves.

Treatments and drugs

Treatment for foot drop depends on the underlying cause. If the underlying cause is successfully treated, foot drop may improve or even disappear. If the underlying cause can't be treated, foot drop may be permanent.

Specific treatment for foot drop may include:

• Braces or splints. A brace on your ankle and foot or splint that fits into your shoe can help hold your foot in a normal position.
• Physical therapy. Exercises that strengthen your leg muscles and help you maintain the range of motion in your knee and ankle may improve gait problems associated with drop foot.
• Nerve stimulation. Sometimes stimulating the nerve that lifts the foot when you step (peroneal nerve) improves foot drop, especially in the case of foot drop caused by a stroke. In some cases, a small, battery-operated electrical stimulator is strapped to the leg just below the knee. In other cases, the stimulator is implanted in the leg.
• Surgery. In cases where foot drop is permanent, surgery that fuses ankle or foot bones or that transfers tendons to stronger leg muscles may be helpful to improve walking difficulties.

The goal of any type of treatment for foot drop is to help you maximize your mobility and independence.