Florida Foot Drop Center

Serving Patients in Jacksonville, Florida

What causes foot drop?

Paralysis of the muscles below the knee that lift the front part of the foot and cause the foot to point toward the floor at the ankle is known as foot drop. In addition to muscle weakness, often patients complain of a “numb” front or side of their leg and top of their foot. Foot drop can be caused by lumbar disc herniation (damage to a nerve root in the lumbar spine), damage to the peroneal nerve (usually near the knee) or damage to the nerve bundles in the lumbosacral plexus. The typical events that can lead to foot drop are injury to the back or leg, ankle sprain, operations around the knee or even simple repetitive activities such as crossing your legs for a prolonged period of time.

What are the non-surgical options for my foot drop?

Any patient who suspects drop foot is advised to consult with a medical professional as soon as possible to seek appropriate treatment and avoid possible complications. The first step in evaluating foot drop is to schedule an appointment with a medical or surgical specialist to evaluate your spine to determine if your muscle weakness is due to a nerve root compression. They will typically perform a history, physical examination and may order tests such as an X-ray, MRI or electrodiagnostic testing (EMG/NCS). If there is no focal abnormality causing your foot drop, your doctor may recommend a foot drop braces/splints (orthoses) and physical therapy. A foot drop brace keeps the ankle at 90 degrees to aid in keeping the toes from dragging while walking as well as to help keep the Achilles tendon from getting tight. Specialized physical therapy for foot drop may include gait training that essentially teaches the patient how to walk all over again as well as Achilles tendon stretching and muscle stimulation.

Are there surgical options for my foot drop?

If the cause of your foot drop is due to compression on the peroneal nerve, a procedure can be performed to relieve the pressure on the nerve with the goal of restoring muscle function. The common peroneal nerve is a branch of the sciatic nerve that travels from behind your knee around the neck of your fibula (the bone on the outside of your leg). After the common peroneal nerve passes the fibula it travels through several potential areas where it is vulnerable to compression prior to reaching the muscle it controls. Nerve is compression is similar to standing on a garden hose that causes the water pressure to drop to a slow trickle or even stop all together. In the case of nerve compression this decreases the signal that is traveling along the nerve to muscle, resulting in muscle weakness/paralysis or "foot drop." The tight areas of peroneal nerve compression may be released surgically through a small incision to allow the nerve to function properly and ultimately restore muscle function.

In certain instances, nerve transfers are used. A nerve transfer procedure involves taking donor nerves with less important roles and transferring them to restore a more crucial nerve function. In the case of foot drop this may involve transferring a nerve that supplies one of the several muscles that push the foot down to a nerve that will restore function allowing the muscles to now pull the foot up. As the transferred nerve must learn a new function, physical therapy is required to help retrain the mind to use this transferred nerve.

If weakness is due to nerve root compression within the lumbar spine, often a neurosurgeon or orthopedic spine surgeon can perform an operation to open the space where the nerve leaves the spine (the spinal foramen). The goal of these operations are to remove a herniated disk (microdiscectomy), open the foramen (foraminotomy), or in more complex cases, a combination of these procedures with or without a fusion, in which the bones are fixed together.

What should I expect during recovery following surgery for my foot drop?

The timing of recovery to restore function to alleviate foot drop is variable depending on the procedure you had. For peroneal nerve decompression surgery typically patients see small signs of recovery within three to six months. For nerve transfer surgery it may take up to a year to see any signs of recovery. No matter which procedure was performed, continuation of your foot drop brace and physical therapy is important. It is important to note that some patients will have persistent/permanent foot drop even with surgery and will require a tendon transfer or ankle fusion to place the foot in a more functional position.