Drop foot


  • Drop foot is the weakness of the dorsiflexion muscles in the foot
  • The extent of the deficit depends on three factors: location, severity and duration of the injury
  • The most common cause of the drop foot is peroneal nerve neuropathy a problem often related to compression at the neck of the fibula at knee level where the nerve is superficial with minor tissue support



  • common peroneal nerve damage
  • Superficial peroneal nerve damage
  • Deep peroneal nerve damage


  • L5 root radiculopathy
  • Sciatic nerve neuropathy
  • Anterior horn cell lesions
  • Cauda Equina Compression


  • Muscle dystrophy
  • hip arthroplasty that could result in sciatic nerve injury


Medical conditions:

  • DM
  • Vitamine B12 deficiency
  • chemotherapy
  • Alcohol misuse


  • History of habitual or prolonged squatting or kneeling
  • History of knee brace or recent cast
  • Recent weight loss (Slimmer’s palsy)
  • Overstretching of peroneal leg, usually happens after ankle strain or prolonged leg or ankle stretch
  • History of DM
  • History of alcohol abuse
  • Recent surgeries


  • Inspect legs for swelling, redness and other signs of trauma
  • Examine the lower and upper extremities for fasciculation, this would suggest extensive neurological problems such as motor neuron disease
  • Test the gait and balance: taking high steps is a sign of severe weakness of dorsiflexion muscles
  • Heels and toes walking exam: difficulty walking on the heel is a sign of Peroneal n. damage
  • Assess dorsiflexion muscle strength for peroneal nerve damage
  • Assess plantar flexion and inversion for tibial nerve function
  • Assess hip abduction for L5 root damage. Weakness of hip joint abduction on physical exam may differentiate
  • Check knee and Achilles’ tendon reflexes and plantar responses
  • Palpate the common peroneal nerve for local tenderness. Conducte Tinel’s sign for ‘pins and needles” in the nerve distribution

Lab Work Up

  • CBC for anemia
  • Vitamin B.12 level


  • Electromyography
  • Nerve conduction


  • Immediate neurologist referral if the problem is acute and bilateral
  • Surgeon or orthopedic referral in case of compartment syndrome
  • Education on avoidance from leg crossing, squatting and kneeling if the compression of the nerve at the knee is a potential cause
  • Physical therapy if needed
  • Recommend shoes with ankle support to prevent ankle sprain
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