If you notice your toes catching on the ground, your foot slapping when you walk or that you have to lift your knee higher than usual to avoid tripping, these changes can be signs of foot drop.
Although foot drop affects the way your foot moves, the problem may actually start somewhere else, such as a nerve in your leg or a pinched nerve in your lower back.
This article explains what causes the condition, how doctors pinpoint where the problem is coming from and how treatment can help improve strength, balance and walking.
What Is Foot Drop?
Foot drop, also called drop foot, means it is difficult to lift the front part of your foot. The muscles that normally lift your toes and the front of your foot are weak or not working properly. It can affect one or both feet and may develop gradually or appear suddenly. Because the weakness changes the way your foot moves, it can also affect your gait, or the way you walk.
You may:
- Drag your toes or catch your foot on stairs or uneven ground
- Notice your foot slap down when walking
- Lift your knee higher than usual to keep your toes from dragging
- Have trouble walking on your heels
- Feel less steady or trip more often
Sometimes, a change in the way you walk is the first clue that something is affecting the nerves or muscles that control your foot.
What Causes Foot Drop?
Foot drop is a sign that something is affecting the nerves or muscles that control movement of the foot. The cause may be in the leg, spine, brain or another part of the nervous system.
A Nerve Problem in the Leg
The peroneal nerve, also called the fibular nerve, travels around the outside of the knee and helps control the muscles that lift the foot. Injury or pressure on this nerve can interfere with those signals.
Possible causes include an injury near the knee, certain surgeries, prolonged pressure on the nerve or keeping your legs crossed for long periods. Nerve damage related to diabetes and inherited nerve disorders, such as Charcot-Marie-Tooth disease, can also cause the condition.
A Pinched Nerve in the Spine
Nerves that branch from the lower spine help control movement and sensation in the legs and feet. A pinched or irritated nerve root in the lower back can sometimes lead to foot drop.
Possible causes include:
- A herniated disk
- Spinal stenosis, or narrowing of the spinal canal
- Spinal cord or nerve injuries
- Bone spurs
Conditions Affecting the Brain, Nerves or Muscles
Foot drop can also result from conditions that affect the brain, spinal cord, nerves or muscles. These include stroke, multiple sclerosis, cerebral palsy, ALS and muscular dystrophy. Some forms of spinal muscular atrophy and other motor nerve disorders can also cause foot drop.
What’s key here is that there are many possible causes, so finding where the problem starts is an important part of diagnosis and treatment.
Who Is Most at Risk?
People of any age can develop foot drop, but certain conditions, injuries and procedures may increase the risk:
- Older adults: More likely to develop foot drop related to lower spine problems, such as a herniated or degenerating disc, spinal stenosis or nerve compression.
- People who have had spine, hip or knee surgery: Foot drop can sometimes occur when nerves are injured or compressed during or after surgery.
- Younger adults: Injuries from motor vehicle crashes, sports and recreational activities are common causes of foot drop.
- People with nerve or neurological conditions: Conditions that affect the nerves controlling the muscles that lift the foot can also lead to foot drop.
How Is Foot Drop Diagnosed?
To determine where the problem is coming from, start with an evaluation from your healthcare provider. They may:
- Ask about your symptoms, including when they started and whether they are getting worse.
- Check muscle strength, sensation and reflexes to identify areas of weakness and determine which nerves may be involved.
- Watch you walk because changes in your gait can provide important clues.
- Order nerve tests, such as electromyography (EMG) or nerve conduction study (NCS) / nerve conduction velocity (NCV) tests. These can help determine whether the problem involves a nerve in the leg or a nerve root coming from the spine.
- Use imaging, such as an MRI when needed to look at the spine or other structures.
Together, these tests can help determine whether the problem involves a nerve in the leg, the spine or another part of the nervous system. Your doctor can then refer you to the appropriate specialist.
How Is Foot Drop Treated?
Treatment depends on what is causing the foot drop.
Physical Therapy
Physical therapy may be an important part of treatment. It can help:
- Strengthen weak muscles
- Improve balance and walking
- Maintain flexibility and range of motion
- Reduce the risk of falls
A physical therapist may also recommend exercises and strategies tailored to your specific weakness and walking needs.
Braces and Other Supports
An ankle-foot orthosis (AFO), or another type of brace, can help hold the foot in a safer position. This may make walking easier and lower the chance of tripping.
Treating the Underlying Problem
Depending on the cause, treatment may focus on relieving nerve compression, addressing a spinal condition, repairing a peripheral nerve injury or managing an underlying neurologic condition.
Surgery may be considered when a structural problem, such as a herniated disk or spinal stenosis, is putting significant pressure on a nerve and causing weakness. Procedures such as a diskectomy or spinal decompression can relieve pressure on the affected nerve.
Can Foot Drop Go Away On its Own?
Recovery can depend on the underlying cause, how severe the nerve or muscle damage is, how long the problem has been present and how well the affected nerve recovers.
Some people regain normal or near-normal strength, while others may have lasting weakness. Because every case is different, there is no single outcome that applies to everyone.
When Should You See a Doctor for Foot Drop?
It is a good idea to get evaluated if you notice:
- New difficulty lifting your foot
- Unexplained weakness
- A new change in your walking
- Frequent tripping or falling
- Numbness or tingling
- Back pain along with leg or foot weakness
- Symptoms that are getting worse
If foot or leg weakness starts suddenly — especially along with facial drooping, arm weakness, trouble speaking, severe dizziness or other sudden neurologic symptoms — seek emergency medical attention. Sudden weakness can be a sign of stroke.
Common Questions About Foot Drop
Can Foot Drop Happen Without Pain?
Yes. Foot drop can occur without pain, particularly when it is caused by a nerve problem. Some people may have weakness or difficulty lifting the foot as their main symptom, while others may also experience numbness, tingling or pain depending on the underlying cause.
Can You Walk Normally With Foot Drop?
Some people with mild foot drop may be able to walk normally or compensate for the weakness without realizing it. Others may develop changes in their gait, such as lifting the knee higher or swinging the leg outward to keep the toes from catching the ground. Treatment and supportive devices may help improve walking.
What Happens if Foot Drop Is Left Untreated?
Untreated foot drop can increase the risk of tripping and falling. Depending on the cause, ongoing weakness can also affect the way you walk and place additional strain on other muscles and joints. Getting evaluated can help identify the underlying problem and determine whether treatment is needed.
Can Foot Drop Come Back After Treatment?
It can, depending on the underlying cause. If the condition that caused the foot drop returns or a nerve becomes compressed again, symptoms may come back. New or recurring foot weakness should be evaluated to determine what is causing it.
Find the Source of Pain
Foot drop can originate in the leg, spine or nervous system. Finding the source of the weakness is key to choosing the right treatment and protecting your mobility.
At the Stony Brook Spine Institute, our multidisciplinary team of experts works together to provide seamless, patient-centered care for both children and adults. We’re committed to delivering advanced, personalized treatment through a collaborative approach that brings together specialists from across the institution, including neurosurgery, orthopedics, pain management and physiatry. Learn more or call (631) 444-BACK (2225) for an appointment.
