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Health condition · Clinically reviewed

Foot drop, why the toes catch - and how to lift the foot again.

Foot drop is a sign, not a diagnosis. Peroneal palsy, disc-related radiculopathy, stroke, MS and motor neurone disease each present with a dropped foot - and each has a different plan.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, ABN and peer-reviewed neurology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including nerve conduction studies, AFO options, FES and nerve-decompression pathways.

Key facts

Foot drop at a glance.

The essentials, in plain English - what it is, the common causes, and how it is worked up in UK neurology and orthopaedic practice.

  • What it is

    Weakness of ankle dorsiflexion and eversion - the front of the foot cannot lift, producing a slapping or high-stepping gait.

  • Most common cause

    Common peroneal (fibular) nerve compression at the fibular neck - often from crossed legs, tight casts, positional pressure or weight loss.

  • Second most common

    L5 radiculopathy from a lumbar disc herniation compressing the L5 nerve root, usually with back pain and sciatica.

  • Central causes

    Stroke, spinal cord lesions, multiple sclerosis and motor neurone disease can each present with foot drop.

  • Key investigation

    Nerve conduction studies and EMG localise the lesion and grade severity - the diagnostic backbone of foot drop.

  • Recovery

    Many peroneal palsies recover with time, orthotics and physiotherapy - specialist input decides when surgery is worthwhile.

Why this guide matters

A sign with ten causes, not one.

Foot drop can come from a compressed nerve at the knee, a slipped disc in the back, a stroke, MS, motor neurone disease, diabetes, a fracture or surgery. The plan depends entirely on which.

  • Peripheral versus central

    A peroneal nerve lesion at the knee behaves differently from a stroke. Examination and neurophysiology tell them apart.

  • Nerve conduction studies matter

    They localise the lesion, grade severity and predict recovery - the diagnostic backbone of foot drop.

  • Bracing and rehab first

    An AFO, specialist physiotherapy and, in central causes, FES restore function while the underlying cause is treated.

How the diagnosis is made

From first trip to a clear plan.

The steps a UK neurologist, orthopaedic surgeon or GP will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and timeline

    Onset, trauma, back pain, prolonged sitting, weight loss, diabetes, alcohol, medications and family history all narrow the cause.

  2. 02

    Assessing

    Motor and sensory exam

    Testing dorsiflexion, eversion, inversion, hip abduction, reflexes and sensory patterns to separate peroneal palsy from L5 radiculopathy.

  3. 03

    Assessing

    Gait and Tinel at fibular neck

    Steppage gait, heel walking and a Tinel sign over the fibular neck point to a peripheral peroneal lesion.

  4. 04

    Confirming

    Nerve conduction studies and EMG

    Specialist neurophysiology localises the lesion, distinguishes axonal from demyelinating injury and grades severity.

  5. 05

    Confirming

    Targeted imaging

    A specialist-commissioned MRI of the lumbar spine, or focused imaging of the fibular neck, depending on the clinical picture. See our guide to private MRI scans.

  6. 06

    Planning

    Bloods and selective tests

    HbA1c, full blood count, B12, heavy metals and, where relevant, genetic testing for Charcot-Marie-Tooth disease.

  7. 07

    Planning

    MDT plan

    Neurology, orthopaedics, neurosurgery, physiotherapy, occupational therapy and orthotists shape a specialist-commissioned plan.

Typical timeline: first assessment to a settled plan in a few weeks in most cases.

Symptoms

What foot drop actually feels like.

The classic mix of tripping, a slapping foot, sensory change and shin wasting - plus the features that mean it is time to escalate.

  • Dropping toes catching the floor

    Tripping on uneven ground, pavements and rugs is often the first thing people notice.

  • Steppage or high-stepping gait

    The hip and knee lift higher on the affected side to clear the toes as the foot swings through.

  • Weak dorsiflexion and eversion

    Inability to walk on the heel and difficulty turning the sole outward on the affected side.

  • Sensory loss over the dorsum of the foot

    A patchy numbness on the top of the foot and lateral lower leg with peroneal nerve lesions.

  • Back pain with radiating leg pain

    Shooting pain down the outer thigh and shin suggests L5 radiculopathy rather than a peripheral nerve lesion. See our guide to radiculopathy.

  • Wasting of the anterior compartment

    Visible thinning of the muscles on the front of the shin over weeks to months.

  • Fasciculations or progressive weakness

    Twitching muscles and creeping weakness raise concern for motor neurone disease.

  • Red flag - sudden bilateral foot drop

    Rapid onset in both feet, saddle anaesthesia or bladder change needs same-day assessment for cauda equina or cord lesions.

Causes

Ten reasons the foot drops.

Peripheral, radicular, central and muscular - the causes cluster into groups, and the pattern of weakness and sensory loss points to the right one.

  • Common peroneal nerve compression

    Trauma, crossed legs, a tight cast, prolonged bed rest, sports and significant weight loss are typical triggers at the fibular neck.

  • L5 radiculopathy

    A lumbar disc herniation compressing the L5 nerve root, usually with back pain and shooting pain down the leg.

  • Stroke or other brain lesion

    An upper motor neurone pattern with spasticity and hyperreflexia. See our stroke guide.

  • Spinal cord lesion

    Multiple sclerosis, cord tumours and cervical myelopathy can each cause foot drop with mixed signs. See multiple sclerosis.

  • Motor neurone disease

    Progressive weakness with fasciculations and wasting and no sensory loss. See motor neurone disease.

  • Peripheral neuropathy

    Diabetic, alcoholic, heavy-metal and inherited neuropathies. Charcot-Marie-Tooth is a classic - see our CMT guide.

  • Post-surgical

    Knee or hip replacement and tumour resection can stretch or injure the peroneal or sciatic nerves.

  • Chronic exertional compartment syndrome

    Exercise-induced calf pain and weakness that settles at rest - considered when nerve studies and imaging are normal.

  • Trauma - fibular fracture or knee dislocation

    A direct or stretch injury to the peroneal nerve at the fibular neck or in the popliteal fossa.

  • Muscular dystrophy

    Distal myopathies and inherited dystrophies can present with foot drop, usually with a positive family history.

Treatment

How foot drop is treated in the UK.

Treat the underlying cause first. Add an AFO and specialist physiotherapy. Consider FES for central causes, and reserve surgery for confirmed compressive lesions or persistent disabling drop.

  • Treat the underlying cause

    Decompress the peroneal nerve, treat the radiculopathy, manage the stroke, treat MS or peripheral neuropathy - the diagnosis drives the plan.

  • Ankle-foot orthosis (AFO)

    A carbon-fibre or polypropylene brace holds the foot up during gait. Fitted by a specialist orthotist. See AFO.

  • Specialist physiotherapy

    Gait training, strengthening of hip and dorsiflexors and balance work - specialist-commissioned neurorehabilitation. See our physio clinic.

  • Functional electrical stimulation (FES)

    A wearable device that stimulates the peroneal nerve during walking. Useful in central causes such as stroke and MS. See FES.

  • Peroneal nerve decompression

    Surgical release of the common peroneal nerve at the fibular neck for confirmed compressive lesions with persistent weakness.

  • Discectomy for L5 radiculopathy

    Specialist spinal surgery to relieve nerve-root compression when disc-related foot drop does not settle with time.

  • Tibialis posterior tendon transfer

    A tendon from the deep calf is rerouted to the dorsum of the foot to restore active lift. See tendon transfer.

  • Ankle arthrodesis

    Selective fusion of the ankle in a functional position for irreversible drop with painful instability - a specialist option.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

A neurologist, orthopaedic surgeon or GP who knows your case can tell you which parts apply to you. If a new foot drop is progressing, get seen the same day.

  • NICE. Sciatica (lumbar radiculopathy) - clinical knowledge summary.

  • Association of British Neurologists (ABN). Guidance on peripheral nerve disorders.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Guidance on tendon transfer and AFO prescribing.

  • British Society of Clinical Neurophysiology. Standards for nerve conduction studies and EMG.

Red flags

When foot drop needs urgent attention.

Most foot drop is worked up in the outpatient setting. These are the situations that are not - and where an emergency or urgent specialist opinion is needed.

  • Sudden bilateral foot drop

    Rapid onset in both feet with saddle numbness or bladder change points to cauda equina or a cord lesion - a same-day emergency.

  • Rapidly progressive weakness

    Weakness spreading up the leg or to the other side within days needs urgent neurology review to exclude Guillain-Barre and cord pathology.

  • Fasciculations and wasting

    Twitching muscles with wasting and no sensory loss raises concern for motor neurone disease and warrants specialist referral.

  • Post-surgical foot drop

    New drop after knee, hip or tumour surgery needs early nerve conduction studies and a surgical opinion.

  • Trauma with pulseless leg

    Knee dislocation or fibular fracture with a cold, pulseless leg is a vascular emergency alongside the nerve injury.

  • Compartment syndrome features

    Deep, out-of-proportion calf pain, tightness and worsening drop after exertion or trauma needs urgent orthopaedic review.

  • Systemic red flags

    Weight loss, night sweats or a known cancer with new foot drop warrants urgent imaging to exclude compressive metastasis.

  • Vasculitic pattern

    Painful, patchy multifocal neuropathy with rash or systemic features needs rheumatology input for suspected vasculitic neuropathy.

  • Falls and injury

    Recurrent falls from unrecognised foot drop drive fractures and head injuries - assessment should not be delayed.

Living with it

A workable condition, with the right kit and plan.

Four things make the biggest difference day to day - a proper brace, active rehab, a safer home and a scheduled recheck.

A quiet reminder

Falls are the risk that hides in plain sight.

An unaddressed foot drop trips people on stairs, kerbs and rugs. A well-fitted AFO and a home OT visit prevent fractures and head injuries.

  1. 01 Fitted

    A properly fitted AFO

    A well-fitted brace changes daily life. See a specialist orthotist rather than buying online - fit and hinge choice matter.

  2. 02 Move

    Rehabilitation is active

    Regular, specific physiotherapy for gait, hip strength and balance does more than passive stretches.

  3. 03 Home

    Small changes prevent falls

    Remove loose rugs, add stair rails, wear supportive shoes and consider a home occupational therapy visit.

  4. 04 Review

    Recheck at 3 to 6 months

    Many peroneal palsies improve over months. Repeat neurophysiology guides when to escalate to surgery.

Frequently asked

Everything we get asked about foot drop.

Quick answers on causes, recovery, bracing, FES and surgery.

  • What is foot drop?

    Foot drop is weakness of ankle dorsiflexion and eversion - the inability to lift the front of the foot. It produces a slapping foot or a high-stepping gait and can come from a peripheral nerve, a spinal nerve root, the spinal cord or the brain.

  • What is the most common cause?

    Compression of the common peroneal nerve at the fibular neck. Crossing the legs for long periods, tight casts, prolonged bed rest, significant weight loss and direct trauma to the outer knee are typical triggers.

  • Can a slipped disc cause foot drop?

    Yes. An L5 nerve-root compression from a lumbar disc herniation is the second most common cause. It usually comes with back pain and shooting pain down the leg, and needs a specialist-commissioned MRI of the lumbar spine and a spinal opinion.

  • Will it recover on its own?

    Many peroneal palsies improve over three to six months with time, an ankle-foot orthosis and specialist physiotherapy. Nerve conduction studies and EMG help predict recovery and time surgery if it is needed.

  • Do I need surgery?

    Not always. Surgery is considered when there is a confirmed compressive lesion that does not settle, a large disc herniation, a traumatic nerve division or persistent disabling drop where a tendon transfer or arthrodesis is a better answer than a lifelong brace.

  • What is FES and who is it for?

    Functional electrical stimulation is a small wearable device that stimulates the peroneal nerve during walking to lift the foot. It is most useful for central causes such as stroke and multiple sclerosis and is prescribed and set up by specialist services.

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