17814 Foot Drop

Overview

Foot drop (sometimes called 'drop foot') is not a disease in itself. It is a sign that something is affecting the nerves or muscles that lift the front of your foot. Normally, when you walk, a group of muscles at the front of your shin pulls your toes up so your foot clears the ground. With foot drop, that lifting action is weak or missing, so the front of the foot and toes hang down and can drag or catch on the floor. It can affect one foot or both, and it can be temporary or long-lasting depending on the cause.

Foot drop is not one of the most common problems a doctor sees, but it is well recognised. It is much more often seen in people who already have a nerve, back or brain condition, or who have had certain types of surgery or injuries.

It can affect people of any age. In adults it is most often linked to pressure or injury to a nerve in the leg, a slipped disc or narrowed space in the lower back, diabetes, or a stroke. In children it is uncommon and is usually caused by a nerve injury, a muscle condition present from birth, or a neurological condition. In older adults, falls risk and existing conditions such as diabetes or arthritis of the spine make it more likely.

Symptoms

Common symptoms

• The front of the foot and toes droop downward and are hard to lift up.
• Toes catch or drag on the floor when walking.
• A 'slapping' sound as the foot lands, because you cannot lower it gently.
• Lifting the knee higher than usual to keep the foot off the ground (this is sometimes called a 'steppage' or high-stepping walk).
• Tripping or stumbling, especially on stairs, kerbs or uneven ground.
• Numbness, tingling or a 'pins and needles' feeling on the top of the foot or outer shin.
• Weakness when trying to stand on your heels.
• Tiredness in the leg or hip from the extra effort of walking.

Symptoms in children

• Tripping or falling more than other children of the same age.
• Walking on tiptoe on one side, or an odd, uneven walk.
• Not being able to lift the foot up when asked.
• Delay in learning to walk, or walking that looks different from other children.
• In young babies, one foot that stays flopped downward and does not move much.

Symptoms in older adults

• More frequent trips and falls, sometimes with fear of falling afterwards.
• Difficulty lifting the foot when getting out of a chair or stepping off a kerb.
• Foot drop that appears alongside back pain, leg numbness, or weakness elsewhere.
• Foot drop after hip or knee replacement surgery, or after long periods of lying or sitting still.
• Skin problems on the toes or top of the foot from rubbing on shoes.

Causes

Main causes

• Pressure or injury to the peroneal nerve (the nerve that runs close to the surface around the outside of the knee) — for example from crossing your legs for a long time, kneeling, squatting, a tight plaster cast, or sitting with legs pressed against something hard.
• A trapped or irritated nerve root in the lower back, such as from a slipped disc or narrowed space around the spine (this is often called a 'pinched nerve').
• Injury to the sciatic nerve, which runs from the lower back down the leg.
• Nerve damage from diabetes (diabetic neuropathy).
• Stroke, multiple sclerosis, or other conditions affecting the brain or spinal cord.
• Conditions that damage nerves over time, such as motor neurone disease or inherited nerve conditions.
• Direct injury to the leg, knee or hip, including fractures and surgery around the knee or hip.
• Long periods of bed rest or being unable to move the legs, especially in people who are very unwell.
• Less common causes include pressure from a growth or swelling near the nerve, problems with the muscles themselves, and some rare infections.

Risk factors

• Diabetes or other conditions that can damage nerves.
• A history of back problems, slipped discs or spine surgery.
• Knee or hip surgery, or a leg injury.
• Regularly crossing your legs, kneeling or squatting for long periods.
• Being very thin or having little padding around the knee and shin.
• Long stays in hospital, bed rest, or being unconscious or unable to move for a time.
• Smoking and heavy alcohol use, which can harm nerves over time.
• A family history of inherited nerve or muscle conditions.

When to see a doctor

See a doctor urgently if:

• You notice sudden or quickly worsening foot drop.
• Foot drop comes with back pain, bladder or bowel changes, or numbness in the groin area (seek emergency care).
• You have foot drop plus weakness or numbness elsewhere, or signs of a stroke (call emergency services).
• You develop foot drop after an injury or after surgery.
• Your leg feels tight, swollen, very painful or numb.

Book a routine appointment if:

• Your foot has been dragging or catching for more than a few days.
• You are tripping more often, or your walk has changed.
• You have numbness or tingling in the foot or lower leg that is not settling.
• You have a long-term condition such as diabetes and notice new weakness in your foot.
• A child is walking oddly, tripping often, or not lifting one foot properly.

Diagnosis

A doctor will usually start by talking with you about when the problem began, what you have noticed, your medical history and your work and daily habits. They will watch you walk and check the strength of the muscles in your foot, ankle and leg, test your reflexes and feeling, and may examine your back and hips. From this they can usually tell that you have foot drop. The next step is to work out why, which sometimes needs tests.

Tests that may be done

• A full physical and neurological examination (checking strength, feeling, reflexes and how you walk).
• Blood tests, to look for causes such as diabetes, vitamin deficiencies or inflammation.
• X-rays of the lower back, knee or leg.
• MRI or CT scans, to look closely at the spine, nerves or soft tissues.
• Nerve conduction studies — small electrical pulses test how well signals travel along your nerves.
• Electromyography (EMG) — a test that uses fine needles to check how well your muscles and nerves are working.
• Ultrasound scan of the nerve or leg.
• Rarely, other tests such as a lumbar puncture (a sample of fluid from around the spine) if an inflammatory or infectious cause is suspected.

What to expect at your appointment

You may be asked to walk up and down, stand on your heels, and push against the doctor's hand with your foot. These tests are painless, though some may feel a little odd or tiring. Nerve tests can feel like small electric tingles or mild discomfort, and scans are usually quick and quiet. Results may take a few days to a couple of weeks. Sometimes the cause is obvious straight away; other times it takes a few appointments and tests to pinpoint it. Keep a note of when symptoms started and anything that makes them better or worse, as this helps your doctor.

Treatment

Treatment for foot drop has two parts: dealing with the underlying cause, and helping you walk safely and comfortably in the meantime. Which treatments suit you will depend on what is causing the problem, how long it has been there, and how much it affects your daily life. Your doctor, a physiotherapist and sometimes a specialist nerve or orthopaedic team will work together with you.

Self-care at home

• Do the exercises your physiotherapist gives you — they help keep muscles and joints flexible and may help nerve recovery.
• Wear supportive, well-fitting shoes with a good sole; avoid loose slippers or flip-flops that catch easily.
• Check your feet daily for cuts, blisters, redness or rubbing, especially if you have reduced feeling.
• Keep floors clear, use good lighting, remove loose rugs and use handrails on stairs to reduce falls.
• Avoid crossing your legs for long periods, and avoid kneeling or squatting for long stretches.
• Take breaks and change position regularly if you sit or stand for long periods.
• If you have diabetes, keep your blood sugar well controlled as advised by your care team.

Medical treatments

Treatment is tailored to the cause. Physiotherapy is the mainstay: a therapist will teach you exercises to strengthen the muscles that lift the foot, stretch tight muscles at the back of the leg, and practise a safer walking pattern. A lightweight ankle-foot orthosis — a brace or splint worn in your shoe or around the ankle — holds the foot up so you do not trip; many people find this makes a big difference. Some people benefit from electrical stimulation, where small pulses help activate the weak muscles. If the cause is a pinched nerve in the back, or a medical condition such as diabetes or inflammation, treating that condition is a key part of recovery — your doctor will discuss suitable options and any medicines, including possible side effects, with you. Podiatry can help with footwear and foot care, and occupational therapy can help you adapt your home.

When is surgery considered?

Surgery is only considered for some people, usually after other treatments have been tried or when there is a clear structural cause. Examples include releasing a nerve that is being pressed on, removing a disc or bone spur that is trapping a nerve root in the back, repairing an injured nerve, or — for long-standing foot drop that has not recovered — a tendon transfer, where a working tendon is moved to help lift the foot. Surgery is not right for everyone, and your specialist team would discuss the benefits, risks and what recovery involves before deciding together with you.

Living with this condition

Most people find a routine that works: wearing the right shoes, using a brace if it helps, doing exercises, and being a little more careful on stairs and uneven ground. Plan walks with resting points, take a torch or use your phone light at night, and consider a walking stick or trekking pole if it makes you feel steadier. Tell family or friends if you are unsteady, so they can help without fuss. Many people keep driving, working and exercising — but check with your doctor if your foot drop affects your ability to brake or react quickly, and tell your car insurer if your doctor advises it.

Lifestyle tips

• Stay as active as you safely can — regular movement helps circulation, mood and muscle strength.
• Build falls prevention into your home: grab rails, night lights, non-slip mats.
• If you smoke, getting support to stop can help your nerves and blood vessels; ask your doctor or pharmacist.
• Keep alcohol within recommended limits, as heavy drinking can damage nerves.
• Wear shoes with a firm heel and good grip; ask about specialist footwear if needed.
• Keep up with regular check-ups for any long-term condition, such as diabetes.

Diet and exercise

There is no special diet for foot drop, but eating a balanced diet helps your nerves and muscles stay as healthy as possible. Include plenty of vegetables, fruit, whole grains, beans, nuts and protein foods such as fish, eggs, beans or lean meat, and get enough calcium and vitamin D for bone health. If you have diabetes, following your agreed eating plan helps protect your nerves. For exercise, aim for a mix of gentle aerobic activity (walking, swimming, cycling, or seated exercise), stretching for the calf and ankle, and the specific strengthening exercises your physiotherapist recommends. Build up slowly and stop if you have pain — and always use your brace or support if you have been advised to.

Mental health and emotional wellbeing

It is completely normal to feel frustrated, anxious or low when your walk changes and everyday things become harder. Foot drop can affect your confidence, work and social life, and a fear of falling can make you withdraw. These feelings are common and worth mentioning to your doctor — support such as physiotherapy, counselling or a local support group can help a lot. If you ever feel overwhelmed or unsafe, do not cope alone: contact your doctor, a local mental health service, or your local emergency number if you need urgent help.

Prevention

You cannot prevent every cause of foot drop, but you can lower your risk. Avoid crossing your legs or kneeling for long periods, and move or change position regularly if you sit or stand for a long time. If you are having leg, hip or knee surgery, staff will pay attention to how your legs are positioned — tell them if you have had nerve problems before. Managing long-term conditions such as diabetes well is one of the most important protective steps. If you notice new weakness, mention it early, because early treatment gives the best chance of recovery.

Screening programmes

There is no general screening programme for foot drop. However, if you have diabetes or another condition that can affect nerves, your care team will usually check your feet and nerve function at regular appointments — this is a good chance to raise any new weakness.

Complications

If left untreated

• More frequent trips and falls, which can cause fractures, head injuries or loss of confidence.
• Tightening and shortening of the calf muscle and ankle (a contracture), which can become permanent.
• Stiffness and pain in the ankle and foot.
• Skin damage, blisters and ulcers where the foot or toes rub on shoes or the floor.
• Muscle wasting in the lower leg from not being used.
• Loss of independence, difficulty working or driving, and social isolation.
• Knock-on strain on the hip and lower back from an altered walking pattern.

Long-term outlook

The outlook varies depending on the cause, and there is good reason for hope. When foot drop is caused by pressure on a nerve — for example from crossing your legs or a tight cast — many people recover well, though nerves heal slowly, often over several months. Foot drop after a stroke or with a long-term nerve condition may be more persistent, but braces, physiotherapy and practical adjustments allow most people to keep walking, working and doing the things they enjoy. Getting assessed early, sticking with exercises and looking after your feet give you the best chance of a good outcome.

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