Foot Drop: Symptoms, Causes, Treatments

Author: Thomas C. Weiss
Published: 2015/07/09 - Updated: 2021/08/09
Topic: Mobility Impairments - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Information regarding foot drop, a sign of an underlying muscular, neurological, or anatomical issue. Foot drop makes it hard to lift the front part of your foot, so it may drag on the floor when you walk.

Introduction

Foot drop is defined as a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. Foot drop can be caused by nerve damage alone or by muscle or spinal cord trauma, abnormal anatomy, toxins or disease. If you experience foot drop, you might drag the front of your foot on the ground when you walk. Foot drop is not a disease. Instead, foot drop is a sign of an underlying muscular, neurological, or anatomical issue. Sometimes, foot drop is temporary. In other instances, foot drop is permanent. If you have foot drop, you might need to wear a brace on your ankle and foot to hold your foot in a regular position.

Main Item

Symptoms

Foot drop makes it hard to lift the front part of your foot, so it may drag on the floor when you walk. To counter this, you might raise your thigh when you walk, as if you were climbing stairs, to help your foot to clear the floor. The gait may cause you to slap your foot onto the floor with every step you take. In some instances, the skin on top of your toes and foot might feel numb. Foot drop commonly affects only one foot. Depending upon the underlying cause; however, it is possible for both feet to be affected.

Causes of Foot Drop

Foot drop is caused by paralysis or weakness of the muscles involved with lifting the front part of the foot. The underlying causes of foot drop are varied and might include the following:

• Spinal Cord and Brain Disorders: Disorders that affect the spinal cord or brain, such as amyotrophic lateral sclerosis (ALS), stroke, or multiple sclerosis may cause foot drop.
• Nerve or Muscle Disorders: Various forms of muscular dystrophy, an inherited disease that causes progressive muscle weakness, might contribute to foot drop. Other disorders such as Charcot-Marie-Tooth disease or polio may also cause foot drop.
• Nerve Injury: The most common cause of foot drop is compression of a nerve in your leg that controls the muscles involved with lifting the foot. The nerve may also be injured during knee or hip replacement surgery, which can also cause foot drop. A nerve root injury in the spine can cause foot drop as well. People who have diabetes are more susceptible to nerve disorders, which are associated with foot drop.

Risk Factors

There is a nerve that controls the muscles that lift your foot. The nerve runs near the surface of your skin on the side of your knee closest to your hand. Activities that compress the nerve may increase your risk of foot drop. Examples of these activities may include:

• Crossing Your Legs: People who habitually cross their legs might compress the peroneal nerve on their uppermost leg.
• Wearing a Leg Cast: Plaster casts that enclose the ankle and end just below the knee may exert pressure on the peroneal nerve.
• Prolonged Kneeling: Occupations that involve prolonged kneeling or squatting, such as picking produce on a farm or laying floor tile, may result in foot drop.

Tests and Diagnosis

Foot drop is usually diagnosed during a physical examination. A doctor will want to watch you as you walk and might check some of the muscles in your leg for weakness. The doctor may also check for numbness on your shin and on the top of your toes and foot. In some instances, additional testing is recommended.

At times, foot drop is caused by an overgrowth of bone in the spinal canal, or by a cyst or tumor pressing on the nerve in the spine or knee. Imaging tests may help to pinpoint these forms of issues and may include:

• X-Rays: Plain X-rays use a low level of radiation to visualize a soft tissue mass, or a bone lesion that might be causing your symptoms.
• Computerized Tomography (CT) Scan: CT combines X-ray images taken from a number of angles to form cross-sectional views of structures within the body.
• Ultrasound: Ultrasound technology uses sound waves to create images of internal structures. It might be used to check for tumors or cysts that may be pressing on the nerve.
• Magnetic Resonance Imaging (MRI): MRI uses radio waves and a strong magnetic field to create detailed images. MRI is especially useful in visualizing soft tissue lesions that might be compressing a nerve.
• Electromyography (EMG): EMG and nerve conduction studies measure electrical activity in your nerves and muscles. The tests might be uncomfortable, although they are very useful in determining the location of the damage along the affected nerve.

Lets Look at Gait

The normal gait cycle is:

• Swing phase (SW): The period of time when the foot is not in contact with the ground. In those cases where the foot never leaves the ground (foot drag), it can be defined as the phase when all portions of the foot are in forward motion.
• Initial contact (IC): The point in the gait cycle when the foot initially makes contact with the ground; this represents the beginning of the stance phase. It is suggested that heel strike not be a term used in clinical gait analysis as in many circumstances initial contact is not made with the heel. Suggestion: Should use foot strike.
• Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this represents the end of the stance phase or beginning of the swing phase. Also referred to as foot off. Toe-off should not be used in situations where the toe is not the last part of the foot to leave the ground.

The drop foot gait cycle requires more exaggerated phases.

• Drop foot SW: If the foot in motion happens to be the affected foot, there will be greater flexion at the knee to accommodate the inability to dorsiflex. This increase in knee extension will cause a stair climbing movement.
• Drop foot IC: Initial contact of the foot that is in motion will not have normal heel-toe foot strike. Instead the foot may either slap the ground or the entire foot may be planted on the ground all at once.
• Drop foot TC: Terminal contact that is observed in patients that have drop foot is quite different. Since patients tend to have weakness in the affected foot, they may not have the ability to support their body weight. Often, a walker or cane will be used to assist in this aspect.

Gait Changes and Cognitive Disability - Alzheimer's Association - (2012-07-15).

Foot Drop Treatment Methods

Treatment for foot drop depends on the underlying cause. If the underlying cause is successfully treated, the person's foot drop may improve or disappear entirely. If the underlying cause cannot be treated, foot drop might be permanent. Specific treatment for foot drop can include the following:

• Nerve Stimulation: At times, stimulating the nerve that lifts the foot improves foot drop.
• Splints or Braces: A brace on your ankle and foot, or a splint that fits into your shoe, may help to hold your foot in a normal position.
• Surgery: Depending upon the cause and if your foot drop is fairly new, nerve surgery might be helpful. If foot drop is long-standing, a doctor might suggest surgery that fuses foot or ankle bones, or a procedure that transfers a functioning tendon to a different position.
• Physical Therapy: Exercises that strengthen your leg muscles and help you to maintain the range of motion in your ankle and knee might improve gait issues associated with foot drop. Stretching exercises are especially important to prevent the development of stiffness in your heel.

Home and Lifestyle

• Due to the fact that foot drop may increase your risk of tripping and falling, you may want to take precautions around your home.
• Keep all floors clear of clutter, avoid the use of throw rugs, and relocate electrical cords away from walkways.
• Ensure rooms and stairways are well lit, and place fluorescent tape on the top and bottom steps of stairways.

Author Credentials: Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a CNA Thomas has providing care for people with all forms of disabilities. Explore Thomas' complete biography for comprehensive insights into his background, expertise, and accomplishments.