Foot drop

Foot drop (drop foot) is where it's difficult to lift or move your foot and toes. It usually affects 1 foot and can affect the way you walk.

Causes of foot drop

The most common cause of foot drop is an injury to a nerve that runs down your leg and controls the muscles that lift your foot.

This can be caused by:

• sports injuries
• a slipped disc in the spine
• crossing your legs, kneeling or squatting for long periods of time
• problems with your nerves (peripheral neuropathy) caused by diabetes
• hip or knee replacement surgery
• not moving for a long time (for example, if you're staying in hospital)

Foot drop can get better with treatment, or on its own. But sometimes it can be permanent.

Less common causes of foot drop include:

• inherited conditions like Charcot-Marie-Tooth disease
• muscle weakness caused by muscular dystrophy, spinal muscular atrophy or motor neurone disease
• damage to the brain or spinal cord caused by cerebral palsy, Parkinson's disease, multiple sclerosis (MS) or a stroke

Diagnosing foot drop

If you have foot drop, a GP will examine your leg and foot, and look at the way you walk.

Your GP may refer you to a specialist to find out what's causing your dropped foot.

You may need to have imaging tests, such as an x-ray, ultrasound scan, CT scan or MRI scan.

You may need nerve conduction tests to help find where the affected nerve is damaged.

Sometimes you'll have an electromyography at the same time. This is where your doctor inserts electrodes into your muscle fibres to record their electrical activity.

Treatment for foot drop

How foot drop is treated depends on what's causing it and how long you have had it for. Sometimes it can get better on its own.

Common treatments for foot drop include:

• physiotherapy to strengthen or stretch the muscles in your leg and foot
• braces, splints or shoe inserts to help hold the foot in position
• a small device that's put in your body and uses electrical signals to help your nerves work (electrical nerve stimulation) - especially if you've had a stroke or have multiple sclerosis
• spine surgery - if your foot drop is because of nerve compression in your spine

If you have permanent loss of movement from foot drop, you may have surgery to fuse the ankle and foot joints, or repair or graft the nerve.

Things you can do if you have foot drop

There's a higher risk of tripping and falling if you have a foot drop.

But there are some simple changes you can make to help avoid this.

You can also do things to help stabilise your foot and improve your walking ability.

These could include:

• wearing an ankle-foot brace or splint to hold your foot in a normal position
• physiotherapy to strengthen your foot, ankle and lower leg muscles
• electrical nerve stimulation - in some cases it can help lift the foot
• surgery

Ankle-foot brace or splint

You can wear an ankle-foot brace or splint on the lower part of your leg to help control your ankle and foot.

It holds your foot and ankle in a straightened position to improve your walking.

If your GP thinks a brace or splint will help, they'll refer you for an assessment with an orthotist. An orthotist is a specialist who measures and prescribes braces and splints.

Your footwear will need to fit around the brace or splint.

Wear shoes with laces or adjustable fastenings. They're easy to adjust around the brace or splint. Shoes with a removable inlay are also useful because they provide extra room.

You can wear a close-fitting sock between your skin and the brace to help prevent rubbing.

Avoid wearing high-heeled shoes.

If you need a brace or splint, you must break it in slowly. When it's broken in, wear it as much as possible while walking. It'll help you walk better and keep you stable.

Electrical nerve stimulation

In some cases, an electrical stimulation device can help improve walking ability. It can help you walk faster, with less effort and more confidence.

An electrical stimulation device is a control box with batteries and electrode patches.

You put the electrode patches on your skin. Put one near the nerve supplying the muscle and the other over the centre of the muscle.

Leads connect the electrodes to the control box. This is about the size of a pack of cards. You can wear it on a belt, on a cuff around your leg or keep it in a pocket.

The device produces electrical impulses that stimulate the nerves to contract (shorten) the affected muscles.

The device is triggered by a sensor in your shoe. It activates every time your heel leaves the ground as you walk.

If your GP or consultant thinks you'll benefit from using an electrical stimulation device, they'll refer you to an orthopaedic foot and ankle surgeon.

After an assessment, the surgeon may refer you to a specialist unit to try the device and check that it's suitable for you.

For long-term use, you may have an operation to implant the electrodes under your skin. You'll have the procedure under general anaesthetic. Your surgeon places the electrodes over the affected nerve.

Electrical stimulation can treat people with foot drop caused by damage to the brain or spinal cord.

This is only an option when:

• the person understands what's involved and agrees to the treatment
• the results of the procedure are closely monitored

Surgery

Surgery may be an option in severe or long-term cases of foot drop with permanent movement loss from muscle paralysis.

The procedure usually involves moving a tendon from the stronger leg muscles to the muscle that usually pulls your ankle upwards.

Another type of surgery involves fusing (joining) the foot or ankle bones to help stabilise the ankle.

Talk to your GP or specialist if you're thinking about having surgery for foot drop.

They'll give you information about the procedures and discuss the benefits and risks.