Drop Foot Overview

Drop foot (also known as foot drop) is a condition where it becomes difficult to lift the front part of your foot (the toes and forefoot). This can cause the foot to drag on the ground when you walk. To avoid tripping, you might find yourself lifting your knee higher than usual with each step, almost like climbing stairs, so that your toes clear the floor. Because of these adjustments, your walking pattern (gait) can change — often causing the foot to slap down onto the ground with each step. Drop foot itself is not a disease, but rather a symptom of an underlying problem with the nerves or muscles that lift the foot. It can affect one foot or both (usually one side is affected) and may be temporary or long-term, depending on the cause. While it can be alarming to experience, there are treatments available to improve your walking and safety.

Drop Foot Symptoms and Diagnosis

Signs and symptoms of drop foot can include:

• Difficulty lifting the front of the foot: You may be unable to point your toes upward or have trouble clearing the ground when walking.

• Frequent tripping or dragging of toes: The toes catch on the floor, leading to stumbles or falls, especially on uneven surfaces or stairs.

• High-stepping or swinging gait: To compensate, many people raise their leg higher than normal in a “steppage gait,” or swing the affected leg in a wide arc to avoid dragging the toes.

• Foot hanging limp: The foot may tilt downward or outward when lifted, sometimes making it hard to put your heel down first when stepping. This limp position can also make climbing stairs or inclines difficult.

• Numbness or tingling: If a nerve issue is causing the foot drop, you might feel numbness or a pins-and-needles sensation in the shin, foot, or toes.

Usually, drop foot affects one side (one foot) unless there is a more widespread nerve or muscle condition. In addition to observing your walking pattern, a specialist will perform a physical exam to check the strength of your foot and leg muscles and your reflexes. Diagnosis may also involve tests to find the root cause of your drop foot. These can include nerve conduction studies (to see how well your nerves are working) or imaging like an MRI scan of your lower back or leg to look for a pinched nerve or other issues. Identifying the exact cause is important so that treatment can be targeted appropriately.

Drop Foot Causes

Drop foot happens because the muscles that lift the foot (in the shin area) are weak or paralyzed. There are several possible causes for this muscle weakness:

• Nerve injury or compression in the leg: The most common cause is an issue with the peroneal nerve (a branch of the sciatic nerve) which runs down the leg and controls the foot-lifting muscles. This nerve can be compressed or damaged by injuries (like knee or leg fractures), surgery around the knee or hip, or even by habitually crossing your legs or kneeling, which puts pressure on the nerve.

• Pinched nerve in the spine: A slipped disc or spinal stenosis in the lower back can pinch the nerves that eventually travel to the foot, leading to weakness in the foot and ankle. In this case, you might have back pain or sciatica as well.

• Muscle or nerve disorders: Certain medical conditions can lead to drop foot. For example, muscular dystrophy (an inherited muscle disease) can cause progressive weakness, including in the foot-lifting muscles. Peripheral neuropathy, such as nerve damage from diabetes, can also weaken the foot muscles.

• Brain or spinal cord conditions: Since the command to lift your foot starts in the brain, any condition affecting the brain or spinal cord can cause drop foot. Stroke is a common example — someone who has had a stroke might have weakness in the foot and ankle. Other neurological conditions like multiple sclerosis or a spinal cord injury can also lead to drop foot.

Sometimes, drop foot can develop after events like hip or knee replacement surgery if a nerve gets stretched or compressed during the procedure. In rare cases, tumors or cysts pressing on nerves, or exposure to toxins, can cause foot drop – but these are uncommon causes.

If you notice that your foot is dragging or you’re frequently tripping, it’s important to consult a specialist. They will determine why you have drop foot. Treating the underlying cause is key: for instance, relieving a pinched nerve or managing a medical condition. An MRI or nerve test, as mentioned, may be used to pinpoint the cause so the correct treatment can be planned.

Drop Foot Treatment and Prevention

Treatment for drop foot focuses on improving your ability to walk safely and addressing the cause of the problem. In many cases, conservative (non-surgical) treatments can significantly help. Common treatments and management strategies include:

• Ankle-Foot Orthosis (AFO): This is a lightweight brace or splint that you wear on your lower leg and foot. An AFO holds your foot in a proper position (at a 90-degree angle) as you walk, so your toes don’t droop down. It helps prevent tripping and can make your gait more natural. AFOs are usually custom-fitted and can be worn inside a normal shoe. Using a brace can immediately improve safety and confidence while walking.

• Physical therapy and exercises: A physiotherapist can teach you exercises to strengthen any functioning muscles in your lower leg and improve your gait. Even if the nerves are weak, therapy helps train other muscles to compensate and keeps your joints flexible. Therapists may also work on your balance and show you how to walk with the brace. Regular exercises and stretching can prevent stiffness in the ankle and foot.

• Functional Electrical Stimulation (FES): In some cases, a device can be used to stimulate the nerves in your leg with small electrical impulses. With FES, a small pad or cuff placed below the knee sends signals to the peroneal nerve at the right time as you walk, causing your foot to lift at the appropriate moment. This can be an alternative to a brace for certain patients, and it can improve walking by activating the muscles electronically. Not everyone is a candidate for FES, but your specialist will determine if it’s appropriate for you.

• Treating the underlying cause: It’s important to address whatever is causing the foot drop. For example, if diabetes has led to nerve damage, better blood sugar control and medications for neuropathy may help prevent further nerve injury. If a pinched nerve in the lower back is the cause, treatments like physiotherapy, injections, or surgery on the spine might be needed to relieve pressure. In the case of a nerve compression at the knee (for instance, by a cyst or tight tissue band), a surgical release of that nerve could be considered. By fixing the root problem when possible, the drop foot can improve or at least be prevented from worsening.

In addition to these treatments, some preventive tips can make daily life safer if you have drop foot. Your specialist may recommend wearing shoes with a supportive heel and ankle (high-top shoes or boots, for example) for stability. Simple home modifications like removing loose rugs or clutter, and using night lights, can reduce the risk of tripping. Until your foot drop is adequately treated, using a walking aid (cane or walker) might be advised for short periods, especially if you feel unsteady. All of these measures are meant to keep you mobile and safe.

Most people will start with these conservative treatments. Often, an AFO brace combined with therapy is enough to greatly improve walking. In some cases, if the nerve is going to heal on its own (for example, after a nerve injury from surgery or an accident), these supportive treatments will help you in the interim. Your doctor will monitor your progress over weeks or months. If there is no improvement or the foot drop is long-standing and severe, then surgical options may be discussed to restore movement.

Drop Foot Surgery

When drop foot does not improve sufficiently with braces or therapy, or when there is a correctable anatomical problem, surgery can be considered. The goal of surgery is to either fix the cause of the foot drop or to improve the ability of your foot to lift. The exact surgical approach will depend on the cause of your drop foot and how much function you have in the leg. Mr Hester will discuss the specific surgical plan with you, depending on the cause and severity of your drop foot.

Tendon transfer surgery: This is a common surgical treatment for chronic drop foot, especially when the nerve itself won’t recover. A tendon transfer involves re-routing a working tendon from one of your stronger foot/ankle muscles to the position of the weakened muscles. In other words, a tendon that still has good function is moved and attached to the top of the foot to help do the work of lifting the foot. For example, one of the tendons that normally moves your foot inward (the tibialis posterior tendon, located around the inner side of the ankle) can be transferred to the top of the foot. After this transfer, when that muscle contracts, it will lift the front of the foot. You will essentially retrain the muscle to perform a new function. Tendon transfer surgery for drop foot is typically done under general anesthesia. The surgeon makes one or more incisions in the leg/ankle to detach and reattach the tendon. Pins or screws may be used to secure the tendon in its new position until it heals in place. This procedure restores active upward movement of the foot, improving your ability to walk and reducing the need for a brace.

• Other procedures if needed: In certain cases, additional procedures might be done along with a tendon transfer to optimize your foot’s position. For instance, if your Achilles tendon (at the back of the heel) is very tight from the time spent with a dropped foot, the surgeon might do a small lengthening of the calf muscle or Achilles tendon (gastrocnemius recession) to allow the foot to flex upward more easily. If there are deformities in the foot or ankle joint, sometimes a fusion surgery (joining bones together) or other corrective bony procedure is done, but these are only in specific situations. Your surgeon will tailor the plan to your needs, ensuring the best chance of a stable, functional foot.

Surgery for drop foot is usually considered only after less invasive treatments, and if the condition is significantly affecting your life. The procedures above aim to improve your walking ability and quality of life. As mentioned, Mr Hester will explain which (if any) surgery is appropriate in your case. He will take into account factors like how long you’ve had drop foot, whether nerves are showing any recovery, and your overall health and activity level. Any questions or concerns you have about the surgery will be discussed in detail so you feel informed and reassured before proceeding.

Drop Foot Surgery Recovery

Recovery from drop foot surgery requires some patience, but with proper care and rehabilitation you can achieve a much improved walking function.

Immediately after surgery, your foot and ankle will be placed in a temporary back slab cast to protect the surgical site. This allows for swelling while maintaining the foot in a safe, neutral position. At your 2-week follow-up, the back slab will be removed, the wound checked, and you will then be placed into a lightweight full cast, which will stay on for a further 4 weeks, completing a total of 6 weeks in a cast.

During the cast period, you will be non-weight-bearing or partially weight-bearing, depending on the surgical details and healing progress. It is important to keep the cast dry and elevated when possible, especially in the first few weeks, to minimise swelling and reduce the risk of complications.

At 6 weeks post-op, the cast is removed and you will transition into a surgical walking boot, which allows more flexibility while continuing to protect the foot. This boot is usually worn for 4 to 6 weeks, with gradual progression to full weight-bearing.

After this phase, you will begin the transition into supportive footwear, typically with a medial arch support to offload the midfoot and help optimise foot alignment and function.

Physiotherapy plays a key role during this period, focusing on regaining strength, mobility, and retraining your walking pattern. Recovery continues over the following months, with progressive improvement in function.