From the Guidelines
Foot drop is primarily caused by nerve damage, particularly to the peroneal nerve, and conditions such as diabetes, multiple sclerosis, and stroke, which can lead to nerve damage or brain/spinal cord injury. The etiology of foot drop can be multifactorial, involving various pathways that ultimately result in the weakness or paralysis of the muscles responsible for lifting the front part of the foot.
Common Causes of Foot Drop
- Nerve damage: The peroneal nerve is particularly susceptible to injury from compression, trauma, or prolonged pressure, leading to foot drop 1.
- Conditions like diabetes: Diabetes can cause peripheral neuropathy, a type of nerve damage that can lead to foot drop, as highlighted in studies focusing on preventive foot care in diabetes 1.
- Multiple sclerosis and amyotrophic lateral sclerosis (ALS): These conditions can cause nerve damage leading to foot drop.
- Stroke: A stroke can cause brain damage that leads to foot drop.
- Physical trauma: Injuries such as knee injuries, hip or knee replacement surgery, or sports injuries can damage the peroneal nerve.
- Muscular disorders: Conditions like muscular dystrophy and polio can weaken the muscles directly, leading to foot drop.
- Certain medications: Chemotherapy drugs, for example, can cause peripheral neuropathy leading to foot drop.
Importance of Early Diagnosis and Management
Early diagnosis of foot drop is crucial as some causes are reversible if treated promptly. Management strategies may include the use of braces (ankle-foot orthosis), physical therapy, nerve stimulation, or in some cases, surgery. The goal of treatment is to improve mobility, prevent falls, and maintain quality of life. Given the potential for serious complications, particularly in individuals with underlying conditions like diabetes, regular foot examinations and education on foot care are essential, as emphasized in guidelines on the management of patients with lower extremity peripheral artery disease 1.
Preventive Measures
Preventive measures, such as regular foot examinations, patient education on self-foot examination and healthy foot behaviors, and the selection of proper footwear, are critical in managing and preventing foot drop, especially in high-risk populations like those with diabetes or peripheral artery disease 1.
From the Research
Causes of Foot Drop
The etiology of foot drop is diverse and can be attributed to various factors. Some of the common causes include:
- Traumatic damage to the common peroneal nerve due to sharp injury, gunshot wound, sciatic nerve tumor, radiculopathy, or hip replacement surgery 2
- Injury to the common peroneal nerve, which innervates ankle joint and foot extensors 3
- Sciatic nerve injury, lumbar plexopathies, L4/L5 radiculopathy, central nervous system related neuropathies (anterior horn cell disease, brain tumor) 3
- Compartment syndromes of the lower leg 3
- Anterior horn cell disease, lumbar plexopathies, L5 radiculopathy, and partial sciatic neuropathy 4
- Habitual leg crossing, which may cause peroneal neuropathy at the neck of the fibula 4
- Brain metastases, which can manifest as foot drop in rare cases 5
- Peripheral nerve injuries, stroke, neuropathies, drug toxicities, spinal stenosis, L5 sciaticas, systemic diseases such as connective tissue diseases, vasculidities, or diabetes 5
- Acute inversion sprain of the ankle, which can cause traction and compression of the common peroneal nerve 6
Specific Nerve-Related Causes
Foot drop can also be caused by specific nerve-related injuries, including:
- Peroneal nerve injury, which can occur due to trauma or surgical nerve injury 2, 6
- Sciatic nerve injury, which can cause foot drop due to damage to the nerve fibers that innervate the muscles of the lower leg 3, 5
- Lumbar plexopathies, which can cause foot drop due to damage to the nerve roots that innervate the muscles of the lower leg 3, 4
Other Causes
Other causes of foot drop include:
- Leg compartment syndromes, which can cause foot drop due to increased pressure within the muscle compartments of the lower leg 3
- Dorsiflexor injuries, which can cause foot drop due to damage to the muscles that control ankle movement 5
- Systemic diseases, such as diabetes, which can cause foot drop due to nerve damage or peripheral neuropathy 5