Procedures · Peripheral Nerve & Brachial Plexus Surgery

Foot Drop

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

Foot drop is the inability to lift the foot when walking: the front of the foot hangs, so the patient trips over it or lifts the knee high to compensate. It is not a disease in itself but a sign of a problem in the nerve or muscle responsible for lifting the foot — and locating that problem precisely is the first step before any talk of treatment.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

What causes it?

The cause most relevant to peripheral nerve surgery is injury to the common peroneal nerve, which winds around the fibula bone just below the knee — an exposed position that leaves it vulnerable to compression, and to injury in fractures, wounds, and tight casts. Foot drop can also arise from injury higher up in the sciatic nerve — after accidents, surgery, or a misplaced intramuscular injection — or from nerve-root problems in the spine and other neurological conditions.

Foot drop is therefore never treated before two questions are answered: where is the problem, and is it capable of recovering?

Assessment

Assessment covers the strength of lifting the foot and toes and of the other directions of movement, examination of sensation, localisation of the injury along the nerve's course, and the history: when did the weakness begin, following what, and is it improving, stable, or worsening? Electrodiagnostic studies (nerve conduction studies and EMG) are used where needed to localise and grade the problem and to detect early reinnervation, with imaging where indicated. Ankle suppleness is also examined — a mobile joint is a precondition for the success of any later option.

Non-surgical treatment

In cases capable of spontaneous recovery — as in many compression injuries — the first plan may be observation with an ankle-foot orthosis (AFO), a brace that prevents tripping and protects the gait, together with physiotherapy that keeps the ankle supple and prevents shortening of the heel cord. The brace is both a safety measure and a compensation, and for some patients it is an appropriate permanent solution.

Nerve surgery options

When assessment points to a repairable compression or injury, nerve options are considered according to the case: decompression of the peroneal nerve, direct repair or grafting for suitable acute injuries, or nerve transfer in selected cases. These options obey the same time factor as all nerve surgery: the muscle does not wait indefinitely, and early assessment preserves the options.

Tendon transfer once paralysis is established

If it becomes clear that the nerve will not recover usefully — or the reinnervation window has passed — an effective option remains: transferring the tendon of a well-functioning muscle from the back of the leg and redirecting it to lift the foot. For many patients this gives a safer gait and freedom from the brace, or less dependence on it. It requires a supple ankle and a rehabilitation programme to retrain the brain in the new function. Tendon transfer has its own page explaining the principle in full.

Expectations and limitations

The outcome varies with the cause, its level, and the timing of treatment. Nerve recovery — where possible — is slow and unfolds over months; a tendon transfer restores useful lift but does not make the foot identical to what it was before the injury. General surgical risks include infection and wound problems, with procedure-specific risks added — such as tendon adhesion or incomplete nerve recovery. The details are discussed for each case before any decision.

Is foot drop permanent?

Not necessarily; many compression injuries improve spontaneously. What decides the matter is specialist assessment identifying the cause and its recovery potential, and follow-up that tracks improvement or its absence.

Is a brace an alternative to surgery?

The brace is an option in its own right and suits some patients permanently; it is also the safety measure during observation or rehabilitation. Weighing it against surgery is an individual decision built on the case and the patient's priorities.

When is tendon transfer considered?

When the paralysis is established and useful nerve recovery is no longer expected, with a supple ankle and a suitable donor muscle. The timing is determined by assessment and follow-up.

Medical-information notice

This is general information and does not replace consultation and examination. New or progressive foot drop deserves medical assessment without delay to establish its cause — and some of its causes lie outside the peripheral nerves and need a different diagnostic pathway.