Practice 10-Minute Consultation

Foot drop

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1736 (Published 27 April 2015) Cite this as: BMJ 2015;350:h1736
  1. Femke Stevens, junior doctor1,
  2. Nico J Weerkamp, neurologist2,
  3. Jochen W L Cals, general practitioner and assistant professor1
  1. 1Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, Netherlands
  2. 2Bronovo Hospital, The Hague, Netherlands
  1. Correspondence to: J Cals j.cals{at}maastrichtuniversity.nl
  • Accepted 16 March 2015

The bottom line

  • Consider isolated peroneal neuropathy as the most likely cause of foot drop in patients with weakness of foot dorsiflexion and eversion; sensory loss of the anterolateral aspect of the lower leg and the foot dorsum; normal reflexes; no pain swelling, or erythema of the leg; and no other neurological features

  • Offer conservative treatment in unilateral foot drop caused by isolated peroneal neuropathy, but refer patients with acute bilateral foot drop, one sided foot drop with fasciculations, or more widespread neuropathy to a neurologist

A 42 year old healthy female yoga instructor consults with frequent stumbling and numbness of the upper side of her left foot. She has no pain or other symptoms.

What you should cover

Foot drop (weakness of the dorsiflexion muscles in the foot) is common, causes difficulty in walking, and greatly increases risk of falling. Spontaneous unilateral foot drop usually has a peripheral cause. The lesion can be in the L5 nerve root, sciatic nerve, common peroneal nerve, deep peroneal nerve, or superficial peroneal nerve (figure). The extent of the sensory or motor deficit depends on the location (or level), severity, and duration of the injury or compression.1

Sites of pathology of the lower extremity that can lead to foot drop. (1) L5 nerve root: weakness of hip abduction (gluteal muscles) and pain and sensory loss in the side of the thigh and lower leg, including the dorsum of the foot and toes I-III, in addition to features in items 4 and 5. (2) Sciatic nerve: pain in the back of the thigh and calf, in addition to any of the …

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