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

Understanding Foot Drop

Foot drop — also called drop foot — is a condition in which the muscles that lift the front part of the foot (dorsiflexors) are weakened or paralyzed, making it difficult or impossible to raise the foot and toes. Walking with foot drop requires compensatory strategies: high-stepping gait (exaggerating hip flexion to clear the foot), circumduction (swinging the leg outward), or hip hiking — all of which are mechanically inefficient and increase fall risk.

Foot drop is not a diagnosis itself but a symptom of underlying neurological, musculoskeletal, or systemic disease. Identifying and treating the underlying cause is always the priority.

Common Causes of Foot Drop

The common peroneal nerve (also called the fibular nerve) supplies the muscles that dorsiflex and evert the foot. Compression, injury, or disruption of this nerve — at any point from the lumbar spine to the lateral knee — produces foot drop. Common causes include lumbar disc herniation or spinal stenosis at L4-L5 (compressing the L5 nerve root), common peroneal nerve compression at the fibular head (from leg crossing, prolonged squatting, or tight casting), stroke affecting the motor cortex, multiple sclerosis, Charcot-Marie-Tooth disease, and peroneal nerve injury during hip or knee replacement surgery.

Traumatic peroneal nerve injury from knee dislocation, fibular fracture, or laceration produces immediate foot drop. Diabetic mononeuropathy can selectively affect the peroneal nerve. Less common causes include brain tumors, ALS, and spinal cord injury.

Podiatric Evaluation and Management

While the neurological or orthopedic cause of foot drop must be addressed by the appropriate specialist, podiatrists play an important role in the functional management of foot drop — improving ambulation safety, preventing secondary foot deformities, and reducing fall risk. Our evaluation assesses gait pattern, ankle and toe dorsiflexor strength, presence of contracture, and foot alignment.

Ankle-Foot Orthoses (AFOs): The Podiatric Cornerstone of Foot Drop Management

An ankle-foot orthosis — a plastic or carbon fiber brace worn inside the shoe — holds the foot in a neutral or slightly dorsiflexed position, preventing the foot from dragging and restoring more normal gait mechanics. Custom-fabricated AFOs are molded to the individual’s foot and provide the best fit. Prefabricated AFOs offer immediate availability at lower cost. The choice of AFO design (rigid, hinged, posterior leaf spring) depends on the degree of weakness, spasticity, and functional demands.

Surgical Options for Foot Drop

When foot drop results from surgically correctable nerve compression (peroneal nerve entrapment at the fibular head, lumbar disc herniation), decompression surgery can restore function. Tendon transfer surgery — typically transferring the tibialis posterior tendon from the medial to the dorsal foot — creates active dorsiflexion in patients with permanent peroneal nerve dysfunction. This procedure is most appropriate when the foot drop has been present for 12–18 months without neurological recovery. Peroneal nerve stimulators (functional electrical stimulation devices) provide another option for motivated patients with partial nerve function.

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When to See a Podiatrist for Foot Drop

Foot drop from nerve injury, stroke, or spinal conditions requires prompt evaluation to determine the cause and best treatment path. At Balance Foot & Ankle, Dr. Tom Biernacki provides comprehensive neurological foot assessments, custom AFO bracing, and surgical consultation for peroneal nerve decompression.

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Clinical References

1. Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-169.
2. Aprile I, Caliandro P, La Torre G, et al. Multicenter study of peroneal mononeuropathy: clinical, neurophysiologic, and quality of life assessment. J Peripher Nerv Syst. 2005;10(3):259-268.
3. Mont MA, Dellon AL, Chen F, et al. The operative treatment of peroneal nerve palsy. J Bone Joint Surg Am. 1996;78(6):863-869.

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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.