Drop foot

Foot drop is a symptom of an underlying issue that makes it difficult to raise the front part of the foot. Presentation includes:

• Dragging of toes and tripping
• Slapping foot
• High stepping gait.

The most common cause of painless drop foot (with no history of radiculopathy) is peroneal neuropathy.

• Detailed history
• Neurological examination
• Differentiate neurological or spinal cause
• Consider metabolic cause.

New onset undiagnosed foot drop should not be referred to MSK Service.

• New onset foot drop associated with trauma (knee, spine, pelvis) should be referred urgently to Orthopaedic surgeons via on-call/OAU.
• Foot drop associated with radiculopathy – refer urgently to Orthopaedics on SCI gateway.
• Patients with acute bilateral foot drop, one sided foot drop with fasciculations, or more widespread neuropathy should be referred urgently to Neurology via SCI gateway.

• Bloods to assess for metabolic causes.
• FBC, U&E, LFT, Bone Profile, B12, folate, glucose, HbA1c, thyroid function, serum electrophoresis, urine electrophoresis (Bence-Jones)
• Consider referral to orthotics for ankle foot orthosis (AFO)
• Educate patient about the condition- advise to avoid leg crossing/prolonged squatting or kneeling, safety net for progressive signs.
• Advise on appropriate exercises – passive movements to maintain range; active assisted or active if possible.

New onset undiagnosed foot drop pathway.

This pathway is also available in PDF format.