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

What Is Foot Drop?

Foot drop is the inability to lift the front of the foot during walking, causing the toes to drag on the ground. Affected individuals compensate with a high-stepping gait pattern (steppage gait) or hip hiking — both of which increase energy expenditure and fall risk. Foot drop is a symptom, not a diagnosis — the underlying cause determines treatment and prognosis.

Causes of Foot Drop

The anterior compartment muscles that dorsiflex the foot are powered by the deep peroneal nerve, a branch of the common peroneal nerve. Anything disrupting this nerve pathway — from the brain through the spinal cord, nerve roots, and peripheral nerve to the muscle — can cause foot drop. Common causes include: common peroneal nerve compression at the fibular head (from leg crossing, cast pressure, or weight loss), lumbar disc herniation at L4-L5 compressing the L4 or L5 nerve roots, stroke or brain injury affecting the motor cortex, multiple sclerosis, Charcot-Marie-Tooth disease, and direct peroneal nerve injury from hip or knee replacement surgery or trauma.

Diagnosis

Identifying the cause is essential to selecting treatment. Electromyography (EMG) and nerve conduction studies localize the lesion to the peripheral nerve, nerve root, or central nervous system. MRI of the lumbar spine rules out compressive disc or tumor pathology. Brain MRI evaluates for central causes. Neurological examination guides the work-up sequence.

Orthotic Management: AFOs

Ankle-foot orthoses (AFOs) are the cornerstone of functional management for foot drop regardless of cause. A posterior leaf spring AFO holds the ankle at neutral dorsiflexion during the swing phase, eliminating toe drag and reducing fall risk. Custom-molded AFOs better accommodate foot shape irregularities than prefabricated options. Dynamic AFOs with carbon fiber leaf springs provide more natural push-off assistance during gait. Proper footwear fitting over AFOs requires accommodating the device — our team assists patients in finding appropriate footwear for their orthotic.

Surgical and Rehabilitative Options

When foot drop results from a compressive lesion, surgical decompression of the nerve may restore function. Tendon transfer surgery — redirecting functional tendons to provide dorsiflexion — restores active foot lifting in cases where nerve recovery is unlikely. Electrical stimulation devices that activate the peroneal nerve during the swing phase of gait (functional electrical stimulation) provide dynamic correction as an alternative to static AFOs. Physical therapy maximizes gait efficiency with the existing function and compensatory strategies. Balance Foot & Ankle in Howell and Bloomfield Township provides AFO prescription, fitting, and surgical evaluation for foot drop patients in coordination with neurology and physical medicine specialists.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

📅 Book Online
📞 (810) 206-1402

Foot Drop Affecting Your Walking? Expert Diagnosis and Treatment

Foot drop makes it difficult to lift the front of your foot, causing tripping and an abnormal gait. Dr. Tom Biernacki identifies the underlying cause — whether nerve, muscle, or spinal — and provides bracing, therapy, and surgical options to restore function.

Learn About Nerve and Muscle Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Stewart JD. Foot drop: where, why and what to do? Practical Neurology. 2008;8(3):158-169.
2. Aprile I, et al. Peroneal neuropathy: predisposing factors, diagnosis and treatment. Neurological Sciences. 2015;36(6):911-917.
3. Carolus AE, et al. The interdisciplinary management of foot drop. Deutsches Arzteblatt International. 2019;116(20):347-354.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

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.