Foot Drop: Causes, Management, and Physiotherapy Solutions

As a physiotherapist running Physio at Home, I often see patients struggling with foot drop, a condition that makes lifting the front part of the foot difficult, leading to challenges in walking and increased fall risk. Foot drop can stem from various causes and significantly impact daily life, but with the right management, mobility and independence can improve. In this blog post, I’ll explore the causes of foot drop—including diabetes, nerve compression, and stroke—along with medical management, orthotics, physiotherapy exercises, and the role of walking aids. I’ll also discuss how foot drop affects gait and share practical advice for patients and carers, grounded in evidence-based research.

What Is Foot Drop and How Does It Affect Gait?

Foot drop is the inability to lift the forefoot due to weakness or paralysis of the dorsiflexor muscles (e.g., tibialis anterior) in the front of the lower leg. This leads to difficulty clearing the foot during the swing phase of walking, often causing the toes to drag or catch on the ground. To compensate, individuals may adopt a high-stepping gait (also called steppage gait), where they lift their knee and hip excessively to avoid tripping. Other gait changes include:

• Foot slap: The foot hits the ground hard due to uncontrolled plantar flexion.

• Circumduction: Swinging the leg in a semicircular motion to clear the foot.

• Increased fall risk: Weakness and instability make tripping more likely.

These gait changes can strain the hips, knees, and back, leading to fatigue and potential injuries. At Physio at Home, we work to address these challenges through targeted interventions.

Potential Causes of Foot Drop

Foot drop is a symptom of an underlying issue affecting the nerves, muscles, or brain. Common causes include:

• Diabetes: Diabetic neuropathy, caused by prolonged high blood sugar, damages peripheral nerves, including the peroneal nerve, which controls foot lifting. This can lead to numbness, weakness, and foot drop.

• Nerve Compression: The peroneal nerve, running along the outside of the knee and shin, can be compressed due to prolonged leg crossing, tight casts, or injuries (e.g., knee dislocation, fibula fracture). Compression disrupts nerve signals to the dorsiflexors.

• Stroke: A stroke can cause hemiplegia (weakness on one side of the body), affecting the brain’s motor control of the leg muscles. This often results in foot drop, accompanied by spasticity or hyperreflexia.

• Neurological Conditions: Conditions like multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Charcot-Marie-Tooth disease, or cerebral palsy can impair nerve or muscle function, leading to foot drop.

• Trauma or Injury: Fractures (e.g., ankle, fibula), knee injuries, or sciatic nerve damage from pelvic trauma can injure the peroneal nerve.

• Muscular Disorders: Muscular dystrophy or polio can weaken dorsiflexor muscles, causing foot drop.

• Other Causes: Spinal cord injuries, tumors, or prolonged bed rest can also contribute.

Each cause requires specific management, but physiotherapy and orthotics play a key role in most cases.

Medical Management of Foot Drop

Medical management focuses on addressing the underlying cause and improving function. Options include:

• Medications:

  • Diabetes: Controlling blood sugar with insulin or oral medications can slow neuropathy progression and improve nerve function.

  • Neuropathic Pain: Medications like gabapentin or pregabalin may relieve pain associated with nerve damage.

  • Spasticity (Post-Stroke): Baclofen or tizanidine can reduce muscle tightness. Botulinum toxin (Botox) injections may target spastic muscles.

• Surgical Interventions:

  • Nerve Decompression: Surgery to relieve peroneal nerve compression (e.g., from a herniated disc) can restore function.

  • Tendon Transfer: For permanent foot drop, transferring a tendon (e.g., posterior tibial) can improve dorsiflexion.

  • Ankle Fusion: In severe cases, fusing the ankle at 90° stabilizes the joint.

• Specialist Referrals: Neurologists, orthotists, or physiatrists may be involved for diagnostics (e.g., nerve conduction studies, EMG) or orthotic fitting.

Medical management should be tailored by a healthcare provider, often in collaboration with a physiotherapist.

Orthotics for Foot Drop

Orthotics stabilize the ankle and foot, improving gait and reducing fall risk. Two effective options are:

• Ankle-Foot Orthosis (AFO): A rigid or flexible brace that holds the foot in a neutral position, preventing dragging during the swing phase. AFOs, like those from Ossur (e.g., Ossur AFO Dynamic), provide stability and support heel strike. They can be custom-made or off-the-shelf.

• Orliman Foot Up: A lightweight, dynamic orthosis with an ankle cuff and elastic straps that lift the foot. It’s discreet, fits in most shoes, and promotes a natural gait. Learn more at Orliman Foot Up.

Benefits of Orthotics:

• Prevent toe dragging and tripping.

• Reduce compensatory movements (e.g., high-stepping gait).

• Support muscle recovery by maintaining proper alignment.

An orthotist can ensure proper fitting, and at Physio at Home, we guide patients on using orthotics effectively.

Physiotherapy’s Role and Exercises for Foot Drop

Physiotherapy is essential for improving strength, mobility, and gait in foot drop patients. At Physio at Home, we assess muscle strength, range of motion, and gait to create personalized plans. Key goals include:

• Strengthening dorsiflexor muscles (tibialis anterior, extensor digitorum longus).

• Improving ankle flexibility and reducing stiffness.

• Enhancing balance and proprioception to prevent falls.

Recommended Exercises

The following exercises can be done at home under a physiotherapist’s guidance. Always consult a professional before starting, and stop if pain occurs.

Exercise	Description	Reps/Sets	Benefits
Ankle Pumps	Sit with legs extended. Point toes down (plantar flexion), then pull them up (dorsiflexion).	2–3 sets of 15–20 reps	Improves dorsiflexion and circulation.
Toe Raises	Stand, holding a chair for balance. Lift toes and forefoot off the ground, keeping heels down.	2–3 sets of 10–15 reps	Strengthens tibialis anterior.
Calf Raises	Stand, holding a chair. Rise onto toes, hold for 2 seconds, then lower heels.	2–3 sets of 15–20 reps	Supports ankle stability and push-off.
Resistance Band Dorsiflexion	Sit with a resistance band around the forefoot. Pull toes toward you against band resistance.	2–3 sets of 10–15 reps	Builds dorsiflexor strength.
Ankle Eversion/Inversion	Sit with foot flat. Lift outer edge of foot, then inner edge, slowly.	2–3 sets of 10 reps each	Improves ankle mobility and stability.

Tips for Exercises:

• Perform 5 days a week, starting slowly and increasing intensity as strength improves.

• Use a mirror to check form and ensure smooth movements.

• Combine with stretching (e.g., calf stretches) to prevent tightness.

Other Physiotherapy Interventions:

• Gait Training: Using parallel bars or a gait belt to practice walking with proper heel strike.

• Functional Electrical Stimulation (FES): Electrical impulses stimulate the peroneal nerve to improve dorsiflexion.

• Manual Therapy: Massage or joint mobilization to reduce stiffness.

• Balance Training: Single-leg stands or balance boards to enhance stability.

A 2013 study in Neurorehabilitation and Neural Repair found that FES combined with physiotherapy improved walking speed and gait in stroke patients with foot drop, highlighting the value of integrated care.

Walking Aids and Their Role

Walking aids enhance safety and independence for foot drop patients, especially those with severe weakness or balance issues. Common options include:

• Sticks: Provide support for mild instability, reducing fall risk.

• Walkers: Offer greater stability for patients with significant weakness or neurological conditions.

• Crutches: Used post-surgery to avoid weight-bearing on the affected leg.

  
  

Impact on Gait:

• Aids reduce the need for compensatory movements like high-stepping gait, allowing a more natural stride.

• They distribute weight, easing strain on overworked hip and knee muscles.

• Proper training by a physiotherapist ensures safe use and optimal gait mechanics.

At Physio at Home, we assess patients to recommend the right aid and provide gait training to maximize mobility.

Additional Advice for Patients and Carers

Living with foot drop requires a holistic approach. Here are practical tips:

• Safety:

  • Remove tripping hazards (e.g., rugs) and ensure good lighting.

  • Wear supportive, non-slip shoes to enhance stability.

  • Inspect feet regularly, especially in diabetes, to prevent sores or infections.

• Carer Support:

  • Learn safe transfer techniques from a physiotherapist to assist with walking or standing.

  • Encourage daily exercises and provide verbal cues for motivation.

  • Monitor for signs of pain or fatigue and report to healthcare providers.

• Lifestyle Adjustments:

  • Maintain a healthy weight to reduce nerve compression risk.

  • Avoid prolonged leg crossing or kneeling to prevent peroneal nerve irritation.

  • Stay active within limits to prevent muscle atrophy.

• Emotional Well-Being:

  • Join support groups for neurological conditions (e.g., MS or stroke) to connect with others.

  • Celebrate small progress, like improved dorsiflexion, to stay motivated.

A 2014 study in Diabetic Foot and Exercise Therapy showed that 10–12 weeks of home-based exercises improved ankle mobility in diabetic neuropathy patients, underscoring the importance of consistency.

How Physio at Home Can Help

Foot drop can be challenging, but with expert care, you can regain confidence and mobility. At Physio at Home, we bring personalized physiotherapy to your doorstep, offering assessments, tailored exercise programs, gait training, and caregiver support. Whether you’re managing diabetes, recovering from a stroke, or dealing with nerve compression, we’re here to help.