Can drop foot be fixed? Causes, bracing, surgery and timing

Your toes catch on the floor. Your foot slaps down with each step. Drop foot, also called foot drop, means the muscles that lift the front of your foot are weak. A brace can hold the foot up, but surgery can go after the cause.

Can drop foot be fixed?

Often, yes. The signal that lifts your foot travels from the brain, down the spine and through the leg. A problem at any point can cause drop foot, and finding that point comes first. An operation is a reasonable option whenever the nerve has a realistic chance of recovering, one review says.^[2] Surgery can release a trapped nerve, reroute a working nerve, or move a working tendon to lift the foot.^[5]

When can nerve decompression fix drop foot?

Nerve decompression is surgery that releases tight tissue pressing on a nerve. In a pooled analysis of 368 people, typical strength rose from 1 to 5 on a 0 to 5 scale, and 53.9% reached full strength. Serious complications were uncommon.^[1] After traumatic peroneal nerve injuries, 81.4% of people who had a release could at least lift the foot against gravity.^[6] In one series, 69% of people with foot drop no longer had it after surgery.^[4]

The authors of one review say anyone with a bothersome drop foot and a suspected pinched peroneal nerve should hear about this option, which they say carries little risk.^[2] Surgery is also considered when other care has failed, or for a mass, a cut nerve or severe changes on nerve tests.^[5] Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, performs nerve decompression for appropriate patients.

If the back is the cause, a spine surgeon leads care. Across nine studies of 431 people with painful drop foot, 84.5% gained strength after decompression of the spine.^[9]

What are nerve and tendon transfers for drop foot?

When a nerve can’t recover, or a release didn’t work, working parts can be rerouted to lift the foot.^[5]

• Nerve transfer. A healthy nerve branch is redirected to the muscle that lifts the foot. Good strength returned in 58% of people with several donor branches and 43% with one.^[10] Dr. Ozturk performs nerve transfer for appropriate patients.
• Tendon transfer. A working tendon, usually the posterior tibial tendon from the inner ankle, is moved to the front of the ankle to lift the foot.^[11] Across 37 studies, function scores rose and fewer people needed a brace.^[11] In a review of peroneal nerve injuries, 81.5% could then lift the foot against gravity.^[6] After a knee dislocation, one review called it the most predictable way to regain foot lift when the palsy persists.^[3]

Our Center for Lower Extremity Surgery explains recovery after foot and ankle surgery (external site).

Why does timing matter for drop foot?

Get drop foot evaluated early, because waiting can cost you. Nerves regrow about a millimeter a day, and a muscle can’t wait forever.^[12]

• At the knee. In that series, people did significantly better when symptoms had lasted less than 12 months before surgery.^[4] In 45 people with peroneal nerve injuries, results were strongest with surgery within 5.5 to 9.5 months.^[13]
• In the back. Across six studies of 312 people, decompression within one month gave better recovery than later surgery.^[7] In pooled records of 66 people, those who had surgery within six weeks of symptoms were up to 6 times more likely to recover more.^[14] In 75 people with a disc problem, each day of delay was linked to a 0.2% lower chance of improvement.^[15]
• With muscle changes. One review treats muscle wasting from a squeezed nerve as a sign for immediate surgery, because waiting may cause permanent nerve and muscle damage.^[16]

A rough guide from the research:

• Right away. Sudden drop foot needs prompt attention. Find the cause and start a brace.
• Three to six months. Closed injuries, such as a stretch or crush, are usually watched for this long. If recovery stalls, surgical exploration is reasonable.^[16,17]
• After six months. A nerve injury that hasn’t been repaired may need a nerve transfer or tendon transfer. Permanent damage to the nerve-muscle connection has been seen as early as 12 months after injury.^[12]

A tendon transfer moves a working muscle, so it can remain an option later. In one series of 16 people, it was done an average of 26.7 months after paralysis began, with good or excellent results in 14.^[18]

Why does drop foot happen?

• The peroneal nerve near the knee. Pressure is the most common cause of trouble here.^[5] Triggers include a knee injury, a broken fibula, a tight cast, high boots and crossing your legs.^[19] Most people whose leg crossing is to blame improve when they stop.^[8]
• A cyst in the nerve. When the cause isn’t clear, a fluid-filled cyst inside the nerve is one possibility.^[20]
• The L5 nerve root in the lower back. A disc problem or other wear-and-tear changes in the spine can pinch it.^[7,15] Injury higher up, to the sciatic nerve, can weaken the same muscles.^[8]
• The brain or spinal cord, as with a stroke.^[2]

If it began after an operation, see foot drop after surgery. See also our foot drop page.

How is the cause found?

A careful exam can often show where the problem sits.^[8] We test the muscles that lift and turn the foot, map any numbness, tap along the nerve at the knee, check your back and hip, and watch how you walk.

Nerve studies, EMG and imaging, arranged with another specialist, help locate the injury, show how much damage there is and reveal what is pressing on the nerve.^[8,20]

Which brace helps you walk with drop foot?

Think of a brace as a bridge. An ankle-foot orthosis (AFO) holds the foot up, stops it from dragging, and keeps you stable when your heel lands.^[21] For a severe drop foot of any cause, it helps people walk better and more safely.^[8] That keeps you moving while the cause is treated, but a brace doesn’t repair the nerve.

What are the limits?

Not every drop foot recovers, and surgery may leave some weakness or a need for a brace. Many peroneal nerve problems recover on their own,^[4] and a 2022 review found no study comparing release with non-surgical care directly.^[22] Most surgical studies are small and not randomized, so the results above can’t be compared head to head.^[6] Nerve transfer works very well for some people and barely at all for others.^[23] After disc surgery, 15% of people in one study lost strength.^[15] Risks include infection, wound problems and a transfer that doesn’t work.^[1,23] Severe nerve damage can leave lasting disability.^[19]

Common questions

Can drop foot go away completely?

Yes, for some people, especially when weakness is partial or the cause is removed early. Others improve only partly.^[3,4]

Does common peroneal nerve injury cause foot drop?

Yes. It is one of the two most common causes.^[2] See common peroneal nerve compression.

What is a good drop foot brace for walking?

One that clears your toes, feels stable and fits your shoes and activity. Get it fitted rather than guessing.

When to see a specialist

Have drop foot checked promptly, even if it seems mild. We see patients in Lyndhurst, Paramus and Millburn.