From the Research
The workup for bilateral foot drop should begin with a thorough neurological examination to determine the pattern and severity of weakness, followed by nerve conduction studies and electromyography, as well as MRI of the lumbosacral spine to rule out central causes like spinal stenosis or disc herniation affecting L4-L5 nerve roots, as suggested by the most recent study 1. The initial evaluation should include:
- Nerve conduction studies and electromyography to differentiate between peripheral neuropathy, lumbar radiculopathy, and other causes
- MRI of the lumbosacral spine to rule out central causes like spinal stenosis or disc herniation affecting L4-L5 nerve roots
- Laboratory tests, including:
- Complete blood count
- Comprehensive metabolic panel
- HbA1c
- Vitamin B12 levels
- Thyroid function tests
- Inflammatory markers like ESR and CRP Additional testing may include:
- Heavy metal screening
- Vasculitis panel
- Cerebrospinal fluid analysis if autoimmune or inflammatory causes are suspected Unlike unilateral foot drop, bilateral presentation more commonly suggests systemic conditions such as polyneuropathy (diabetic, alcoholic, or nutritional), Guillain-Barré syndrome, or hereditary neuropathies rather than localized compression, as noted in 2 and 3. During the diagnostic process, supportive measures should include:
- Ankle-foot orthoses to prevent falls and maintain mobility
- Physical therapy to prevent muscle atrophy
- Pain management if neuropathic pain is present The underlying cause determines treatment, ranging from glycemic control in diabetes to immunomodulatory therapy in autoimmune conditions or surgical decompression if structural causes are identified, as discussed in 4 and 5.