Foot Drop: Causes, Diagnosis, and Treatment Options

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

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Foot Drop: When the Foot Cannot Lift

Foot drop — the inability to adequately lift the forefoot during the swing phase of walking — is a functionally debilitating condition that causes the foot to drag and catch on the ground, dramatically increasing fall risk and impairing gait efficiency. Foot drop is not a diagnosis itself but a symptom of underlying nerve or muscle pathology that requires systematic investigation to identify the cause and appropriate treatment. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate foot drop in collaboration with neurology to identify the specific pathology and provide appropriate orthotic and surgical management.

Causes of Foot Drop

Foot drop results from dysfunction at any level of the neurological pathway controlling ankle dorsiflexion. Common peroneal nerve injury: the most common peripheral cause — the peroneal nerve is vulnerable at the fibular head (knee level) to external compression (crossing legs, prolonged squatting, plaster cast pressure) and is injured in knee fractures and dislocations. L4-L5 radiculopathy: disc herniation at L4-5 compresses the L5 nerve root, which is the primary contributor to tibialis anterior (ankle dorsiflexor) function — the classic presentation is foot drop with low back and lateral leg pain radiating to the dorsal foot. Stroke: cerebral or brainstem stroke affecting the motor cortex or corticospinal tract produces upper motor neuron foot drop with spasticity (different from flaccid lower motor neuron drop). Other causes: Charcot-Marie-Tooth disease, multiple sclerosis, ALS, sciatic nerve injury, peroneal tumor.

Diagnosis: Localizing the Lesion

The neurological examination localizes foot drop to upper (central) or lower (peripheral) motor neuron: upper motor neuron foot drop has spasticity (increased muscle tone) and hyperreflexia; lower motor neuron foot drop has flaccidity and hyporeflexia. Electrodiagnostic testing (EMG and nerve conduction studies) localizes peripheral lesions precisely — distinguishing peroneal nerve injury at the fibular head from L5 radiculopathy, or from a more proximal sciatic neuropathy. MRI of the lumbar spine (for radiculopathy), brain (for stroke/MS), or nerve (for focal nerve tumor/compression) completes the workup based on clinical localization.

Orthotic and Surgical Management

Ankle foot orthosis (AFO): the standard functional management for foot drop from any cause — the AFO holds the ankle at 90 degrees, preventing foot drop during swing phase and improving gait safety and efficiency. Carbon fiber AFOs (lighter, more dynamic energy return) and traditional polypropylene AFOs serve different patient needs. Functional electrical stimulation (FES): peroneal nerve stimulators (Bioness L300, WalkAide) deliver timed electrical stimulation to the peroneal nerve during swing phase, activating dorsiflexors without an AFO. For permanent peroneal nerve injuries: tendon transfer (tibialis posterior transfer through the interosseous membrane to the dorsal foot) permanently restores dorsiflexion without ongoing orthotic use — appropriate for complete, non-recovering injuries. Contact Balance Foot & Ankle at (810) 206-1402 for foot drop evaluation, AFO fitting, and discussion of surgical options for appropriate candidates.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Foot Drop

Foot drop — difficulty lifting the front part of the foot — has many possible causes from nerve compression to stroke. At Balance Foot & Ankle, Dr. Tom Biernacki provides comprehensive evaluation to identify the source, custom AFO bracing for daily function, and surgical consultation for nerve decompression when appropriate.

Learn About Our Treatment Options for Foot Drop | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-169.
2. Poage C, Roth C, Scott B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg. 2016;24(1):1-10.
3. Ho B, Khan Z, Switaj PJ, et al. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration. J Orthop Surg Res. 2014;9:67.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

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Dr. Daria Gutkin, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.