Foot drop

NHS Choices information about foot drop (drop foot), with links to other useful resources

Conditions that cause foot drop

Managing foot drop

Ankle-foot orthosis (AFO)



People with foot drop tend to scuff their toes along the ground, so they may lift their foot higher than usual when walking to prevent this.

Foot drop is often linked to damage or disease of the brain or spinal cord, although it may also result from injury to the nerves in the leg.

If foot drop is caused by an injury or nerve damage, recovery is often possible. However, if it's caused by a progressive neurological condition such as multiple sclerosis, foot drop will probably be a lifelong symptom to manage.

## Conditions that cause foot drop

The condition causing foot drop can be temporary or permanent. Possible causes include:

-   [multiple sclerosis](/health-library/conditions/multiple-sclerosis)
-   [stroke](/health-library/conditions/stroke)
-   [cerebral palsy](/health-library/conditions/cerebral-palsy)
-   [motor neurone disease](/health-library/conditions/motor-neurone-disease)
-   [spinal muscular atrophy](/health-library/conditions/spinal-muscular-atrophy)
-   spinal stenosis
-   [Charcot-Marie-Tooth disease](/health-library/conditions/charcot-marie-tooth-disease)
-   acquired [peripheral neuropathy](/health-library/conditions/peripheral-neuropathy)
-   damage to the nerve that passes below the knee
-   [muscular dystrophy](/health-library/conditions/muscular-dystrophy)
-   myositis

You can click on the above links for information and advice on these conditions.


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## Managing foot drop

If you have foot drop, you may find it hard to clear the affected foot from the ground. This means you are more at risk of falls and injury.

Generally, making small changes in your home, such as using non-slip rugs and mats and removing clutter, can make a big difference in helping to prevent falls. Read more about [preventing falls](/self-care/falls/#prevention).

There are also measures you can take to stabilise the foot and improve your walking ability. These include:

-   having [physiotherapy](/health-library/treatments/physiotherapy) to strengthen the foot and lower leg muscles
-   wearing an ankle-foot orthosis (lower leg brace) and shoe insert
-   using an electrical stimulation device – although this is only suitable for use if the nerves controlling muscle movement are not affected

Some of these are discussed in more detail below.


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## Ankle-foot orthosis (AFO)

An ankle-foot orthosis (AFO) is a device worn on the lower part of the leg to provide direct control of the ankle and foot. It is designed to hold your foot and ankle in a straightened position, to improve your walking.

### Referral and assessment

Assessment for an AFO should be undertaken jointly by a specialist orthotist (who assesses, measures and prescribes orthoses) and a specialist physiotherapist. Your doctor will refer you to see these health professionals.

### Wearing the device

When putting on your AFO, you should wear a close-fitting sock between your skin and the device, for comfort and to prevent rubbing.

Your heel should be firmly inserted into the AFO and the straps fastened securely. Your footwear should then be fitted around the orthosis.

Your AFO is to be worn as much as possible while walking, as it will help you walk more efficiently and keep you stable.

It is very important that you break in your AFO slowly. Begin by using your AFO for an hour the first day and increase to two hours the next day and so on until you build up to wearing it for a full day.

### Footwear

The footwear worn with your AFO is very important. Lace-ups or velcro fastenings are preferred as they give the most adjustment. The lower they open, the better. A removable inlay is useful, providing more room within the footwear.

A heel no higher than 1.5cm is recommended. Heels that are too high can tip your knee forward, causing you to become unstable.

### Care advice

Examine your skin under the orthosis every day, checking for redness or irritation (this is common). Stop wearing the AFO and contact your health professional if any redness doesn't disappear after 20-30 minutes.

Your AFO can be cleaned with a damp cloth and towel dried.

### Electrical stimulation device

An electrical stimulation device can be used to improve walking ability in certain conditions, but not all cases of foot drop. It can help you to walk faster, with less effort and with more confidence.

#### How it works

Two self-adhesive patches (electrodes) are usually placed on the skin. One is placed close to the nerve supplying the muscle and the other over the centre of the muscle. Leads connect the electrodes to a battery-operated stimulator, which is the size of a pack of cards and worn on a belt or in a pocket.

The stimulator produces electrical impulses, which stimulate the nerves to contract (shorten) the affected muscles. The stimulator is triggered by a sensor worn in the shoe. The shoe sensor activates the stimulator every time your heel leaves the ground as you walk.

#### Referral and assessment

If your doctor or consultant thinks you will benefit from this treatment, you will be referred to a specialist hospital clinic for an assessment and to try out the device.

You'll need a few sessions at the clinic to get used to using the device, and will need regular follow-up appointments as you go along.

#### Using the device

Some patients use stimulation independently every day, while others use it as part of their physiotherapy treatment. Some patients continue to use the device for many years, others only for a few months.

#### Implanting the electrodes under the skin

Sometimes, the electrodes can be implanted under your skin, which will require an operation. The electrodes are placed over the affected nerve while you are under general anaesthetic (put to sleep).

The electrodes can be connected to a portable stimulator by leads that go through the skin, or they can be completely implanted under the skin and activated by radiofrequency waves.

### Surgery to treat foot drop

Surgery may be considered for those with permanent loss of movement from muscle paralysis. This usually involves transferring a tendon from the stronger leg muscles to the muscle that should be pulling the ankle upwards.

In rare cases, the bones of the ankle joint may be fused to stabilise the ankle.

If you are considering this form of surgery, speak to your doctor or specialist about what is involved and the pros and cons of the treatment.


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References

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