Foot Drop: Causes, Symptoms & How Physiotherapy Can Help

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre    

Foot drop is a condition that makes it difficult to lift the front of the foot when walking. It can cause the toes to catch on the ground, changes in walking pattern, and an increased risk of tripping or falling.  

What Is Foot Drop? 

Foot drop refers to difficulty or inability to lift the front of the foot upward toward the shin, a movement called ankle dorsiflexion. 

Because the foot cannot clear the ground normally during walking, people with foot drop may compensate by lifting the knee and hip higher than usual. This can create a characteristic walking pattern called a steppage gait. Foot drop can affect one or both feet and may develop suddenly or gradually depending on its underlying cause.  

Importantly, foot drop is a symptom rather than a condition itself. Finding the underlying cause is an important part of treatment.  

What Causes Foot Drop? 

Foot drop can occur when there is a problem anywhere along the nervous system responsible for controlling the muscles that lift the foot. Common causes include: 

Peroneal/Fibular nerve injury 

The common peroneal/fibular nerve travels around the outside of the knee near the fibular head before dividing into branches that control muscles involved in ankle and foot movement. Compression or injury to this nerve can weaken the muscles responsible for dorsiflexion. 

Lumbar nerve-root compression 

Compression of a nerve root in the lower back (particularly the L5 nerve root) can cause weakness in the muscles that lift the foot. Conditions such as a herniated disc or spinal stenosis can sometimes contribute to this type of nerve compression. 

Neurological conditions 

Foot drop can also occur as a result of conditions affecting the brain, spinal cord, peripheral nerves, or muscles. Depending on the cause, foot drop may occur alongside other neurological symptoms. 

Injury or surgery 

Nerve damage can sometimes occur following: 

• Knee or lower-leg injuries 

• Fractures or dislocations 

• Direct nerve trauma 

• Certain surgical procedures 

Because there are many potential causes, a proper medical assessment is important when foot drop develops.  

What Are the Symptoms of Foot Drop? 

The most obvious symptom is difficulty lifting the front of the foot. 

You may notice: 

• Difficulty walking normally 

• Toes catching on the ground 

• Tripping more frequently 

• Difficulty walking on your heels 

• Weakness when lifting the foot or toes 

• A high-stepping walking pattern 

• Numbness or altered sensation on part of the lower leg or foot 

• Difficulty climbing stairs 

• Changes in balance 

Some people also experience pain, particularly when foot drop is related to a nerve problem originating in the lower back. 

How Does Foot Drop Affect Walking? 

When the foot cannot be lifted normally, it may not clear the ground during the swing phase of walking. 

The body may compensate by: 

• Lifting the knee higher 

• Bending the hip more 

• Swinging the leg outward 

• Changing the way the foot contacts the ground 

These compensations can make walking less efficient and may increase the risk of tripping and falling.  

A physiotherapist can assess your walking pattern and identify which compensations may be affecting your mobility. 

How Is Foot Drop Treated? 

Treatment depends heavily on the underlying cause and severity of the foot drop. 

Depending on the cause, management may include: 

• Treating nerve compression or injury 

• Physiotherapy 

• Strengthening and motor retraining 

• Gait rehabilitation 

• An ankle-foot orthosis (AFO) 

• Functional electrical stimulation 

• Medication when appropriate 

• Surgery in selected cases 

How Can Physiotherapy Help Foot Drop? 

Physiotherapy can play an important role in improving mobility, strength, balance, and walking safety for people with foot drop. 

Your physiotherapist will first consider your underlying diagnosis, strength, sensation, walking pattern, balance, and functional goals. 

1. Strengthening 

Exercises may target muscles that remain active and can safely be strengthened. 

Depending on the cause, this may include: 

• Ankle dorsiflexors 

• Calf muscles 

• Hip muscles 

• Knee muscles 

• Core muscles 

The goal is to maximize available strength and improve your ability to control the affected leg. 

2. Motor Retraining 

When weakness is related to nerve injury or neurological disease, physiotherapy may use repetitive movement practice and motor retraining to help you make the most of the available muscle activation. 

Treatment is individualized based on the source and severity of the neurological impairment. 

3. Gait Training 

Gait rehabilitation can help you learn safer and more efficient ways to walk. 

Your physiotherapist may work on: 

• Foot clearance 

• Step length 

• Walking speed 

• Weight shifting 

• Stair negotiation 

• Turning 

• Walking on different surfaces 

The goal is to reduce compensatory movements where possible and improve walking safety. 

4. Balance Training 

Because foot drop can increase the risk of tripping and falling, balance training is often an important part of rehabilitation. 

Exercises may include: 

• Single-leg balance 

• Weight shifting 

• Dynamic balance 

• Stepping exercises 

• Obstacle negotiation 

• Functional balance activities 

5. Ankle-Foot Orthoses 

An ankle-foot orthosis (AFO) is a brace that supports the foot and ankle. 

An AFO may help position the foot more appropriately during walking, improve foot clearance, and reduce the risk of tripping. 

Systematic-review evidence on surgical management of foot drop also identifies AFOs as an important conservative option for people with significant foot drop. (Stewart et al., 2022) 

A physiotherapist or orthotist can help determine whether an AFO may be appropriate for you. 

6. Functional Electrical Stimulation 

Functional electrical stimulation (FES) uses electrical stimulation to activate nerves and muscles involved in lifting the foot during walking. 

FES systems can be used as an assistive or rehabilitation strategy in some people with foot drop, particularly when the appropriate nerve and muscle pathways remain responsive. 

A 2024 systematic review examined the technology and control strategies used in FES systems designed to assist and rehabilitate foot drop. Whether FES is appropriate depends on the underlying cause of the foot drop and the individual's neurological and muscular function. 

Looking for Foot Drop Physiotherapy in Waterloo? 

Contact Waterloo Sports Medicine Centre to learn how physiotherapy can help improve your walking, mobility, safety, and independence!