The Ultimate Guide to Foot Drop: Learn What Causes Drop Foot and What You Can Do to Treat It
What Is Drop Foot?
The many terms used to describe drop foot do a pretty good job of explaining what it is—foot drop, slap foot, floppy foot, lazy foot syndrome, fallen foot, toe drop—you get the idea.
Foot drop, in essence, is the inability to lift the front part of the foot or toes (no dorsiflexion of the foot). This makes walking a struggle. If you stick with a “normal” walking pattern, your toes will drag along the ground as you move, tripping you up.
To avoid that, people with drop foot syndrome take on a steppage gait, where they bend their knee and lift the foot higher than they otherwise would to prevent the toes from dragging. When they bring the foot down, it slaps forward—sometimes off to the side.
Foot drop may affect one foot or both (bilateral).
For some, drop foot is permanent. But for others, it goes away. Which category you fall in will in part depend on the particular cause of foot drop, as well as how quickly you seek treatment. In the article that follows, we’ll take you through:
- some possible causes of drop foot,
- some of its related symptoms,
- how a foot drop brace can help,
- and what other modes of treatment (& surgical and non-surgical) are available.
We’ll also spend a bit of time talking about what drop foot rehabilitation might entail and even sharing some success stories.
Foot drop is not a condition in and of itself. Rather, it’s a symptom of some other, underlying problem. Determining what’s to blame can direct foot drop treatment.
Most Common: Peroneal Nerve Injury
There is a very long list of drop foot causes, but at the top of it is peroneal nerve injury. The peroneal nerve is a branch of the sciatic nerve that wraps around the knee and runs down the leg into the foot. Surprise, surprise—it’s a big player when it comes to lifting the front of your foot.
Pressure, overstretching or lesions (cuts) to the peroneal nerve can compromise your ability to flex the foot toward the sky. Some have total peroneal nerve palsy (paralysis) where they have zero ability to control dorsiflexion. For others, the impact of peripheral neuropathy (damage to the nerves outside the brain or spinal cord) is less severe.
A few examples of ways peroneal nerve damage might occur include:
- Knee replacement surgery (or some other surgery to the joint)
- Achilles tendon repair surgery
- A stroke that leaves you in a position that pressures the peroneal neve for an extended period
- Dislocated kneecap
- Fractured shin bone
- Crossing the legs or squatting for a long time
And this is by no means an all-encompassing list. While conducting research for this article, I came across a story of an individual who had gone in for heart surgery developed compartment syndrome where the pressure within the muscles climbed to dangerous levels. To relieve that, the surgeon conducted a fasciotomy where he cut into the fascia to ease that pressure. In doing so, the surgeon nicked the peroneal nerve, leaving the patient with foot drop.
There are many, many ways you can damage the peroneal nerve.
Sciatica and Foot Drop Linkage
Damage farther up the peripheral nervous system may also be to blame. Recall that the peroneal nerve is a branch of the sciatic nerve? Pinching, severing or overstretching that nerve can also result in drop foot.
Some possible scenarios that may damage the sciatic nerve, causing sciatica and/or foot drop include:
- Spinal surgery, particularly in the L4/L5 area
- Hip surgery
- Lumbar disc herniation
- Piriformis syndrome (spasm of a muscle in the buttocks region)
- Trauma to the lower back
- Bone spurs or tumors of the spine
Diabetes also increases your risk of nerve damage in the foot, as can dramatic weight loss.
Foot Drop Can Also Be Caused by Disease
Unfortunately, foot drop symptoms can also come with other diseases like ALS or MS. That list includes the following:
- Multiple sclerosis (MS)
- Amyotrophic lateral sclerosis (ALS)
- Cerebral Palsy
- Charcot-Marie-Tooth Disease
- Muscular dystrophy
- Parkinson’s disease
Other Foot Slap Causes
Exposure to toxins, weak ankles and anatomical abnormalities may also be to blame for your slap foot gait.
Having a stroke is another threat on multiple levels. When the flow of blood to the brain is cut off or restricted, it can cause damage to the nerves, including those needed to lift the foot. Plus, muscles will weaken during the recovery period when you’re not able to move much.
The most obvious sign of foot drop is clearly the struggle or inability to flex the foot toward the ceiling, which goes hand in hand with the high-knee foot drop gait to compensate.
But in the initial stages, these symptoms may be subtler. Early signs of foot drop may include frequent tripping, some issues working the pedals of your car and troubles if you try to run up staircases. You can take this foot drop test to see if this might be the cause.
Other symptoms of drop foot include pain in other areas of the body stemming from the dragging foot gait, such as in the knees, hips or low-back. You might also develop fun things like corns, calluses, bunions, etc. from flopping your foot out to the right or left.
The weakness in the foot and ankle can also throw off your balance, making you vulnerable to tripping and all the risks that entail. An injury stemming from a fall can compound the problem since you’ll lose strength and flexibility if you’re not able to use the muscles of the ankle and feet for a period.
Nerve problems in the foot can also lead to buzzing, burning or tingling sensation, though drop foot does not cause any foot pain (mercifully) for some.
Will My Drop Foot Ever Get Better?
"Can foot drop be cured? Maybe. Are there things I can do to make things better? Absolutely."
Your odds of foot nerve damage recovery will depend on how long ago the damage occurred as well as how far up the nerve path the damage occurred.
The longer you wait, the less likely efforts to repair the damage will be successful. And the higher up the nerve path the nerve is pinched or otherwise damaged, the longer the foot drop recovery time.
Generally speaking, the nerves involved in foot drop heal at a rate of roughly 1/4” per month. That means it will take much longer for a nerve damaged at the spinal level to recover versus damage to the peroneal nerve. And while that recovery process is underway, muscles can waste away (atrophy), adding to the problem.
Online communities are riddled with some amazing foot drop recovery stories where people regain some function of their foot five years after tendon transfer surgery.
But it’s important to note that in many cases, regaining full or partial function of the foot can take years, and in some cases, foot drop simply cannot be fixed.
But that doesn’t mean all hope is lost. There are many things you can do to help your case and keep foot drop from disrupting your life.
Foot Drop Treatment
There are some amazing stories out there of people who don’t let foot drop hold them back, such as a woman with permanent foot drop completing multiple marathons with the help of a foot drop brace for running—and doing so with times fast enough to qualify her for the Boston Marathon, no less!
There are many things you can do to up your odds of recovering from drop foot or simply make it less of a strain on your life by easing foot pain and enabling you to do the things you love. In the following section, we take you through some of those options.
Address the underlying problem, if possible
When a spinal nerve is compressed, a steroid injection near the nerve root in the spine can reduce inflammation that may be pressing on the nerve root. Doing so can fully or partially resolve foot drop. Or if a herniated disc is to blame, you may need surgery to repair damage and/or open space in the spine. Or when diabetes is wreaking havoc on your nervous system, getting blood sugar levels corrected can cure your floppy feet. Or getting a dislocated kneecap back in position can decompress the peroneal nerve.
You get the idea. Sometimes taking care of the causes of your foot pain is a relatively quick and effective remedy for temporary foot drop.
On the flip side, ignoring such problems can up the odds of permanent foot drop.
As I laid out in this article, flopping the foot forward as you walk is a problem on many fronts—it presents a tripping hazard, can lead to problems with the foot, and can create imbalances that result in pain in the knees, hips, etc.
These dorsiflexion assist AFOs (ankle foot orthotics) come in many styles, ranging from posterior leaf spring (PLS) AFOs made of plastic or lightweight carbon fiber to bulkier foot drop boots that can be worn at night to soft foot drop braces that can be worn even when you’re barefoot.
One of our most popular products is a soft foot drop brace that can be worn with shoes or when you’re shoeless. A common complaint with carbon fiber and plastic AFOs is that they can dig into the leg and/or foot and can’t be used with some shoes and pants due to their bulkiness.
The soft fabric of this brace won’t dig in, plus its slim, innovative design means you won’t have to size-up in terms of shoes or worry about your pants getting caught on the product. The drop-foot strap and optional shoe tongue insert turns many “normal” shoes (within reason… we’re not talking heels) into the “best” shoes for drop foot. You can even wear this dynamic AFO barefoot or with sandals.
The low-profile design also gives you more flexibility than some of the more rigid supports, which can help you maintain more muscle strength and flexibility that is so important to the function of your foot.
With that said, this sock-like item that lifts the foot is not intended for rigorous athletic activity. If you’re looking for a foot drop brace for running, you will likely need a carbon fiber ankle foot orthosis, possibly a hinged one.
Another common request is foot drop night brace that supports the foot as you sleep. Without a dorsiflexion night splint, your foot may flop to the side, straining other areas of the body and renewing the ankle and foot pain, burning and tingling associated with neuropathy.
This dorsiflexion night splint is specifically designed to support the ankle and foot at a 90-degree angle as you sleep. This foot and ankle brace is far less bulky than traditional night braces for foot drop and it features a breathable, open heel design that improves sleep quality.
You can wear it whether you’re a side, back or stomach sleeper.
And the medical-grade Velcro used to secure its highly adjustable straps is 10 times stronger than standard Velcro, so you don’t have to worry about it coming loose during the night.
If you would prefer a more traditional boot to prevent foot drop at night (or during the day), you should consider buying this drop foot brace for sleeping. The rigid shell of the brace forms an “L” that supports the foot, with cushioning making it more comfortable against the skin. The front side of the dorsiflexion boot is pretty open, with a series of straps giving you a custom fit.
This mode of keeping the foot up relies on a small electrical charge that is applied by a small device (sometimes called a TENS unit) you can wear just under the knee. That little jolt of energy from the functional electric stimulation (FES) device to the peroneal nerve can stimulate contraction of the muscles that lift the front of the foot up, allowing you to walk more naturally.
This movement means you continue to exercise the muscles and other tissues of the leg and foot, plus it reduces fatigue that might come with walking around in an orthopedic brace.
This seems like a no-brainer, right? The catch is that they come with a high price tag (around $5,000) and insurance often doesn’t pay for such devices. Plus they do not work for everyone.
Also, a TENS unit for foot drop is not a perfect solution… you will still have to think about how you walk and wait for your foot to move before taking a step. Some users also say they would prefer more support.
Before committing to nerve stimulation for foot drop treatment, it’s probably a good idea to find a clinic that does fittings for such products and try one out.
Do Regular Foot Drop Exercises and Stretches
One of the major risks of foot drop is that the muscles of your foot, ankle and leg can lose strength and flexibility the longer you are unable to use them. Over time, they may even atrophy, or waste away.
For that reason, foot and ankle strengthening and stretching exercises are an important component of drop foot treatment. Activity can also maintain and/or strengthen the mind-body connection, which is important when the nerves of the leg and foot are not firing as they should.
For some, physical therapy to strengthen weak feet and ankle muscles can improve the symptoms of foot drop by enhancing your balance, broadening your range of motion and keeping your tissues limber.
Foot physiotherapy exercises are not a quick fix. Drop foot exercises are most effective when a patient commits to doing them regularly and on a long-term basis.
Also note that simply being as active as you can be will help prevent muscles from wasting, even if you are using an AFO brace for foot drop.
7 Exercises to Strengthen Feet and Ankles You Can Do at Home
While you can and should work out a specific physical therapy regimen for foot drop with a professional, the following are a few examples of some foot drop treatment exercises to get you started:
- Seated ball lift: Sit in a chair with your feet flat on the floor. Place a small ball (e.g., a tennis ball) on the floor in front of you. Grab the ball using both your feet and slowly extend your legs to lift it. Hold for a few seconds then lower back to the ground. Repeat 10 times.
- Marble pickup: Sit in a chair with your feet flat on the floor. Put around 20 marbles in a bowl in a bowl on the floor in front of you, with an empty bowl next to it. Use the toes of your affected foot to transfer all the marbles to the empty bowl.
- Toe-to-heel rocks: Rock your weight forward to rise onto your toes and hold the position for 5 seconds. Then rock your weight backward and lift your toes off the ground and hold for five seconds. Repeat 10 times. For more of a challenge, you can do this standing on one leg. You may want to do this exercise near a wall or with a chair or counter in front of you so you can hold on for added support.
- Modified toe raises: If you’re not able to do the toe-to-heel rocks, give this one a try. In a seated position, slide your unaffected foot underneath the affected one. Use the lower foot to lift the front part of the affected foot, while keeping both heels on the ground. Repeat 10 times.
- Towel Stretch: Sit on the floor with your legs extended in front of you. Loop a towel or resistance band around the arch of your foot. Pull the towel/band toward your body so you get a good stretch. Hold for 30 seconds then release. Repeat five times.
- Ankle Eversion: Stand with your affected foot slightly in front of your other foot. Rotate your ankle/foot to lift the outer edge of your foot toward the sky, hold for a few seconds and then relax the foot back to the ground. As you do this exercise, focus on using your foot and ankle to twist the foot, rather than the leg. Repeat 10 times.
- Ankle rotations: Sit in a chair with the back supported. Raise one leg in the air and slowly rotate your foot as far inward as you can and hold the position for a few seconds. Next slowly rotate your foot outward and hold. Repeat 10 times for each leg. To make this more challenging, you can add weighted bands to your ankle.
Don’t Ignore Foot Pain… Medication and Natural Remedies Can Provide Relief
Suffering can take a toll on your overall well-being and limit your willingness to get out and enjoy a more active life that is so important to peroneal nerve damage recovery or foot drop management. For that reason, it’s important to do all that you can to stop foot drop from ruining your life.
A doctor can recommend medications to help with the nerve pain, burning, tingling, etc. And there are also some natural, homeopathy methods for treating/managing foot drop that may be worth a try.
Massage is a great way to manually stretch and work the joints and tissues of the foot and ankle, with physical therapy often incorporating this hands-on mode of care. Working these tissues via soft-tissue or deep friction massage can improve the range of motion and function of the foot and ankle.
There are also essential oils meant for relieving foot and ankle pain that may help with some of your drop foot symptoms. A few examples include:
- Black pepper
You might try soaking your feet in a mix using warm water, Epsom salts, baking sodas and a combination of these oils (listen to your seller regarding the ingredients) or creating an essential oils-infused massage oil blend.
There are also a number of surgical options to cure or address foot drop, though your success rate will depend on the underlying cause, how long it has been since the initial peroneal or sciatic nerve damage occurred, your age and health, and more.
In some cases, addressing the underlying cause, like a herniated disc, may decompress the sciatic nerve and help return function to your foot. Or if pressure on the peroneal nerve is to blame, a surgeon may be able to release a tight fascial edge, restoring function to the peroneal nerve and foot.
Tendon Transfer for Foot Drop Treatment
In some scenarios, tendon transfer surgery may improve a patient’s ability to lift up the foot. This is more likely to be an option for you if other muscles of the foot and ankle still function.
With this procedure, a tendon and some attached muscle (often the posterior tibial tendon) is taken from one area of the foot and transferred to another area to replace tissue that is no longer functioning.
After surgery, you will need to be off your feet for several weeks, including time in a cast and boot, followed by weeks of physical therapy and use of a night splint for several months.
As you can see, the recovery time for foot drop surgery is a long one. The goal of surgery is to enable you to walk without a brace. But surgery is not a guarantee that will happen, and full or partial use of an AFO for foot drop may still be necessary.
In addition, you should know that while this procedure can help, it will not be able to fully restore strength and range of motion to the foot and ankle.
Nerve Transfer for Foot Drop Treatment
Nerve transfers are another option for some. With this surgery, nerves with less important roles are transferred to the branch of the nerve used to flex the foot.
Once again, the recovery period for this procedure is a long one. Small signs of progress will occur about three to six months after the operation, but movement may take six to 12 months to return. Extensive therapy will be needed not only to train the transferred tendons to lift the foot but also to address the loss of the “donor” nerves.
Surgery to Fixate the Foot and Ankle
Another drop foot surgery option is one to fuse the ankle and foot joint so that they are well aligned, cause less pain and function better. There are various ways to do this procedure, which is known as arthrodesis.
Again, fixating the ankle and foot this is not a perfect solution, but it does provide pain relief and improves the function of the foot/ankle for some with drop foot.
A Few Tips for Living with Foot Drop
There are a few things you can do to make tripping less of a threat in the comfort of your home, such as keeping your floors clear of clutter and throw rugs. Tucking electrical cords away from walkways can also limit your risk of them tripping you up. And good lighting in rooms and stairwells can make your life a bit easier by illuminating tripping hazards.
Rushing or multi-tasking while getting from point A to point B can also up your odds of taking a tumble. So slow down and don’t try to do too much at once.
The digital age has also made support groups more readily available for those struggling with foot drop. Online blogs and forums are great resources for tips, inspiring stories and updates on innovative foot drop aids that can help make this condition less of a burden.