A common problem for which patients consult neurologists like me is foot drop. As the name says, they have foot drop and hence are unable to dorsiflex their foot. As a result they are likely to catch their foot on the ground while walking and thus are prone to falls and this brings them to medical attention. Foot drop should be differentiated from frail foot. In foot drop, patients are unable to dorsiflex their foot while those who have a frail foot are unable to dorsiflex as well as unable to planter flex the foot (that is they are unable to pull their foot up or push down their foot as when you press down on a gas pedal).
Foot drop might occur suddenly (acutely) or may be more insidious and the causes for both vary. Before we discuss the causes of foot drop, it is helpful to know a little about the relevant anatomy. The muscle which helps to dorsiflex the foot is called tibialis anterior and it is supplied by a nerve called the peroneal nerve. The peroneal nerve is a branch of the sciatic nerve. The sciatic nerve is formed by the lower lumbar and sacral nerve roots and forms a part of the lumbosacral plexus. The peroneal nerve in the knee area is quite superficial as it cross the neck of the fibula (fibula is one of the bones in the lower leg along with the larger tibia). As the nerve is superficial it is prone to compression across the neck of the fibula.
So lets now discuss some of the common causes of foot drop. If suppose you suffer a fracture across the neck of the fibula, or have a gun shot wound to that area, or during knee surgery the peroneal nerve is accidently transected, you shall develop a foot drop. In all of the above the cause is injury to the peroneal nerve.
But peroneal compression may also occur due to other more subtle causes. One of the most common causes of foot drop is habitual leg crossing. This is most commonly seen in obese persons or in diabetics who lose weight. After weight loss they can cross their legs more easily and may develop a foot drop. Why does this occur you may ask? Well the answer is simple, as I told you before the peroneal nerve is quite superficial and hence prone to compression. When you cross your leg, the nerve may get pinched against the other knee and if you do not relieve the pressure soon, you can develop a foot drop. A common scenario is that the person is sitting with his legs crossed on a long flight, or might have fallen asleep with his leg pressed against the side rails of the bed (this is common in hospitalized patients in the intensive care unit or also when patients are undergoing surgery in the OR), they wake up and find they have a foot drop. The good news is that the prognosis for this type of compression injury to the peroneal nerve is rather good. Once the pressure is released, these patients usually make a full recovery over a few days to weeks and their foot drop goes away.
They can though be other more proximal causes of foot drop. You can have compression or injury to the sciatic nerve or to the lumbosacral plexus (remember I told you, that the peroneal nerve is a branch of the sciatic nerve). Compression of the sciatic nerve may at times be due to a tumor or mass in the pelvis or in the thigh or knee area.
Lower lumbar disc herniation may also result in a drop foot. This is commonly seen in L5 disc herniation. Patients usually present with radicular pain radiating down the leg, though sometimes this may be absent.
Diagnosis and management of foot drop: the diagnosis of foot drop is clinical and depending upon your examination findings, your doctor may or may not order other tests to confirm at what level is the problem. He may order a nerve conduction study and an EMG (needle study, electromyogram) to check for the the sciatic and peroneal nerves. If warranted an MRI of the lower back and of the plexus may be done.
The treatment depends upon the cause. If the foot drop is because of habitual leg crossing, then all what may be needed is to advise the patient not to cross his legs. The recovery is spontaneous. If a mass is the cause then well depending upon what it is, the treatment varies. Patients usually need a ankle foot orthosis or a foot drop splint. This splints the foot up and prevents fall.
I hope this is helpful to some of you.
Nitin Sethi, MD
184 thoughts on “Foot drop: making sense of its causes”
I suffered a L5 disc prolapse in December 2007. Before my operation i noticed i was suffering from foot drop. after the op my foot did not recover but has improved can you help with a prognosis for recovery or any other info that may help
did you recover from the foot drop?
a L5 radiculopathy due to a herniated disc is an important cause of foot drop. I am not sure about the kind of surgical intervention you underwent. Was it just a disectomy or was there spinal fusion done too. If the nerve root was just pinched, your recovery should be complete. However if the nerve root was crushed, the recovery may be delayed and at times incomplete. I would advise you to follow up with your doctor. Physical therapy is the key and I would be aggressive about it.
Nitin Sethi, MD
Six months ago I was diagnosed with Compressive Sciatic Neuropathy which caused foot drop. EMG and MRI studies have been conducted and I was told that I have to wait at least six months to see any signs of recovery. Now six months have passed and I don’t see any recovery so I was wondering if you could tell me if it’s posible that this condition can become permanent or if I still have a chance to recover. They told me that nerve suture surgery is not an option because the nerves were crushed.
Could you give me your opinion? This condition is affecting my life so much and I’m desperate to find some answers, I’m afraid to keewp waiting doing nothing about it…Thanks!
Dr sethi, My son was in ATV acicdent on mother Day. and the sixteen hundred pound fliped on top of him. causeing a bolt to go into the back of his calf. The doctor went into his leg and sliced it open from one hole above calf and to the one on the very back of the calf. The doctor said he went into the calf and cleanded away stuff away from the nerve. He said the bolt was one mm away from my sons blood vesale. The doctor came out and told us that it didn’t do any nerve damage and the nerve wasn’t cut at all. that the blood flow was good. Well now its been two weeks and my son still can’t flex his foot up, but he can flex down. He had a hemotomia on the side of his leg just above the the knee. Well now since my son still can’t move his foot up and is unable to stretch his knee all the way out. The doctor is saying he may never regain his foot to flex agian w\o having to wear a brace. He said the other day when I took my son in for a follow up that it can take upto months if he ever regains his flexing back and some of his feeling above the knee. He has a numb like feeling to it. He only can feel pressure to it. PLease tell me if you think I should take him to a Nero surgeon or a Nero.. Or a Sport Medciane doctor>? The Orto surgeon is’nt even putting him thru PT. I ask him if we will do it later on and he said no that is was just a wast of money when I can do the PT myself. All he is having me to do is flex his foot up and down three times a day and bending his knee a few times a day. PLEASE HELP!!!! Its been two weeks since this nightmare took place and my son is only 22years old. Could it be a problem some wheres else in his leg that is causeing the drop foot? Please tell me what I should do. :(((
thank you for writing in to me. At times it is difficult to prognosticate but I agree with you that time is of essence especially when it comes to potential traumatic nerve injuries. Getting a second opinion never hurts and you may request your doctor for that. I would advice consulting either an orthopedic surgeon or a physician who does sports medicine. I wish him my best luck.
Nitin K Sethi, MD
If they say I am showing signs of improvement does this mean I should get 100 percent back?
Hi Dr.Sethi,I seem to have developed a spontaneous unilateral foot drop on my left side. I have had no injuries and I’m not diabetic. I have R.A.(affecting my hands) and have been prescribed a low dose of Prednisone for the past month. I seem to have noticed a vague sense of fatigue in my left lower leg and foot about 2 weeks ago. I thought it was related to my habit of crossing my legs. Also,I’m an RN.and in my sixth month of alcohol addiction recovery.Can you shed some light ? Thank you. Happy new year to you.
Thank you Michelle and Happy New Year 2009 to you too. While there are numerous causes of foot drop some innocuous and some not so, your history suggests that you have compression neuropathy of the peroneal nerve. As you may know compression neuropathies and pressure palsies (nerve damage due to pressure) such as foot drop and wrist drop occur commonly in diabetics. They are also more commonly seen in people who consume alcohol in excess. This is likely due to multifactorial causes: alcohol acts as a neurotoxin especially when consumed in excess over a long period of time. Also people who drink alcohol in excess usually have marginal diets devoid of vitamins which are needed for healthy nerves. It is possible that your past history of alcohol consumption may have contributed to your foot drop. That and the fact that you have Rheumatoid Arthritis maintained on low dose steroids.
My advise to you would be simple. If this indeed is a compression neuropathy, the natural history is one of spontaneous resolution and improvement. Spontaneous improvement occurs over 2-3 weeks and all you have to do is wear a splint so that you do not trip when you walk. I would also advise you to supplement your diet with at least 2 tabs of a good multivitamin per day (Centrum silver may be a reasonable choice). Physical therapy always helps and should be initiated early rather than late.
If the recovery is delayed or poor, then usually 2 weeks after the index event (the time when you first noticed the foot drop), a nerve conduction study may be carried out (NCV/EMG study). This tells us about the extent of nerve damage and the site of nerve compression and thus aids in prognostication purposes.
My advise to you would be to consult a neurologist whose interest includes neuromuscular disorders. Depending upon your history and clinical examination he may or may not order a NCV/EMG study. Also he would be able to determine the etiology of your spontaneous foot drop. One last word, avoid alcohol completely till your foot drop recovers. Also abstain from smoking. Both act as neurotoxins and potentially may delay spontaneous recovery of nerve function.
Feel free to write again if you have any other questions.
Nitin Sethi, MD
Thank you for writing in to me Mr. Christen. Wishing you good health in the years ahead.
Nitin Sethi, MD
Dear Dr.Sethi, Thank you for your response to my questions regarding foot drop.( Dec.31) It was very helpful to me. Unfortunately, I can’t pursue a neuro. workup until I have health insurance,which hopefully will be very soon. I appreciate your professional,intelligent replies to your readers here. I’d like to pose another question to you for any thoughts you may have on this. Do you see any relationship to childhood vaccinations and the onset of autoimmune disorders ? Is is true that the numbers of individuals being treated for many of these disorders have been dramatically on the rise ? Thank you again for your compassionate attention.
You are very welcome Michelle. I hope you are able to see a neurologist soon. As for your question about a possible link between childhood vaccinations and auto-immune diseases, this has been looked at closely by the medical community. We know that acute disseminated encephalomyelitis (ADEM) (a type of demyelinating disease which in all probability has an autoimmune basis) may occur in some individuals after vaccination. There are other anecdoctal reports of diseases like Guillain Barre Syndrome (GBS), a demyelinating disease of the peripheral nervous system occuring after hepatitis B vaccination. I want to stress that these are idiosyncratic reactions (meaning there is no good explanation why the vaccination triggers off the autoimmune destructive cascade in some people and hence there is no way of predicting beforehand who these people may be so as to avoid vaccinating them).
The vaccines on the market today have undergone thorough safety studies, they safe lives and protect against some potentially deadly diseases. I feel the press coverage on this has been a little biased focusing only on the vaccines potential risk of causing some autoimmune diseases. In the U.S.A a lot of media coverage has been towards the potential role if any they play in causing autistic spectrum disorder. None of the studies has confirmed that such an association exists but parents are justifiably scared and at times do not vaccinate their children thus exposing them to potentially deadly diseases like measles.
Nitin Sethi, MD
You are very welcome Michelle, it is always a pleasure to hear from you. Stay healthy Michelle.
Nitin Sethi, MD
Dear Dr. Sath,
In late October I fell unconscious on a hard floor for a number of hours. I was diagnosed with compartment syndrome and underwent fascioctomy in my forearm and calf. Currently, I am suffering with a Volkman contracture in my left hand and a severe foot drop in my left foot. Today, I went for my first EMG. The consultant advised that the damage to my nerve was around my hip / buttock area (I was on my side when I came around). I do not know what the prognosis is for this type of injury causing foot drop, and it will be at least six weeks before I get referred to a neurologist. I am worried that as 3 months have passed and no dorsiflexion can be achieved that it may not return at all. I am currently managing with an AFO and attending regular physion sessions. Thank you in advance.
thank you for writing in. I understand your concern well. The nerve conduction and EMG study actually shall be of great well in prognosticating purposes. If it shows evidence of nerve degeneration and changes in the muscles supplied, that would imply that the prognosis is guarded (meaning that recovery may be slow and at times incomplete). On the other hand it may show evidence of nerve regeneration which usually translates into clinical recovery. So I feel a well performed NCV/EMG study shall help immensely.
In the meantime, my advise would be to continue with good and intense physical therapy and follow up with a neurologist.
Nitin Sethi, MD
i want to know about late recovery of dorsiflexors in G.B. Syndrome. i know few cases in which very good recovery has occured in all muscle of persons suffering from G.B. Syndrome but no recovery took place in dorsiflexors despite regular physiotherapy. why.
Dear Mr. Mahmood,
Patient’s with GBS usually do make a full recovery. Some though don’t and are left behind with varying degree of motor deficits. The dorsiflexors of the foot are involved early and sometimes the nerve involvement is severe. We refer to this as axonal degeneration (the axons of the nerves degenerate). Normally in GBS there is only demyelination (the myelin gets stripped off the nerves). Pure demyelinating forms of GBS usually show a full recovery but if there is secondary axonal degeration the recovery may remain incomplete. A nerve conduction study (NCV) shall aid in identifying if axonal degeneration has occured and thus help in prognostication purposes.
Nitin Sethi, MD
I am wondering what would be a high mm pressure in the lower leg that would indicate the necessity for fasciotomies? Is there a way to determine how long CS has been present based on the mm level/reading of the pressure test? Thanks.
Thank you for writing in. The need for a fasciotomy is a clinical decision made at the bedside. One can measure the pressure but also has to take into account the presence/ absence of distal pulsations and other such variables. The pressure per se does not correlate with the duration of the pathophysiological process.
Nitin Sethi, MD
Dear Dr.Sethi, My husband has a foot drop on the left leg. He started limping about a year ago, but even before he had pain and crums in the leg. He went to see an acupunturist, who took out most of the pain and the crums too. He’s just seen a neurologist, who’s done some tests, but said he can’t confirm anything at the moment, it could be a damaged root nerve, – though he never had any accident – or it can be motor neuron disease. He has to go back in 3 months time to repeat the test and to get another MRI. (the first MRI didn’t show anything, but it wasn’t looked at by a neurologist, only by a rheumatologist)
He seems about the same since the last few month, and he just got that brace which helps him in walking.
But am terrified that it could be a motor neuron disease, and I just wish there was something that could exclude this. Could it be a nerve damage without an accident? Thanks
thank you for writing in. Foot drop can have many causes ranging from relatively benign ones like a radiculopathy or neuropathy (damage to a nerve root or the nerve itself either due to trauma, herniated disk or compression) to more serious ones such as motor neuron disease.
Get the opinion of a neurologist. He or she shall be able to rule out motor neuron disease relatively easily. I wish your husband my very best.
Nitin Sethi, MD
I am 23 years old and underwent gastric bypass surgery on December 1st, 2008. I have since lost 96 pounds and counting. A few weeks ago, I began to have numbness/tingling in my calves and feet, but I thought nothing of it and dismissed it to a nerve trying to heal from my surgery. But last Friday, I began having trouble walking. I noticed that I was picking my right leg up higher. Then I began falling. I went to the er and the er Dr. got me an appt with a neurologist that day – who diagnosed me with drop foot. He did an emg (didn’t find out much info from that) and then ordered an MRI and Lumbar Punture. I looked up my symptoms online and found something called Slimmers Paralysis. It fits me perfect, but my Dr. has not said anything about it. But after reading your blog, I know now that it could very possibly be from crossing my legs. I was crossing my legs ALL the time. So, if I stop, my drop foot could possibly just go away on its own without surgical intervention? Please help me as I am desperate for answers. This has been devistating to me. I am a very healthy person and this just doesn’t make sense. Thank you for taking time to read this.
thank you for writing in. It is most likely that you have a compression neurapraxia (meaning that you compressed your peroneal nerve and that has led to a foot drop). The most likely cause in your case is the rapid weight loss making your nerves more prone to compression. The good news is that, compression neurapraxia has a benign course and nerve recovery is complete over a few weeks.
I would do the simple things. Wear a splint for the foot drop. Ask your doctor to check you for common vitamin deficiencies such as Vitamin B1, Vitamin B6 and Vitamin B12. If you are deficient in any of these, I would advise supplementation.
I wish you my best. Feel free to write in again.
Nitin Sethi, MD
Dear Dr. Sethi,
First I would like to thank you for the information that you provide in your blog. I have been trying to research my condition (foot drop) but have been unsuccessful at finding more information other that what it is.
I had surgery about 6 weeks ago and due to compression on the peroneal nerve at the fibula head I have foot drop. Its been six weeks. I saw a neurologist and I am doing physical therapy 2X a week and I wear an AFO. I am getting frustrated and scared because I see no improvement.
My doctors tell me not to worry and that it will get better, however they don’t seem to be concerned and I wouldn’t be either if I saw that I was getting better.
Please let me know what else I can do to recover.
Thank you for writing in. You do not mention why you had the surgery and what kind of surgery it was. The rate/speed of recovery of the peroneal nerve depends upon the mechanism of injury to the nerve. if you have compression neurapraxia (meaning that the nerve was compressed but the axons are intact), then the nerve usually recovers quickly and the recovery is complete. If on the other hand the injury is either an axonotmesis (the axons are damaged) or neuronotmesis (the whole nerve is completely cut in two) the recovery is slow and it may be incomplete.
A nerve conduction study and electromyogram (NCV/EMG) study shall help in determing what kind of injury you have suffered and shall also help in prognostication.
Nitin Sethi, MD
Hi there, great info!
I have had foot drop for about 3 weeks now with my right leg/foot. A nerve conductor study last week showed peroneal nerve damage and the Doctor said it was from crossing my legs. I am getting a brace this week and have stopped crossing my legs. He said the damage wasn’t terribly bad and hopefully will correct itself. Since I have not been crossing my legs, I have seen no improvement. It’s been about a week. He wanted to see me one more time at the end of this week, just to poke me again and make sure.
My question is, should I be satisfied with that answer? Should I move on and request an MRI or something just to be sure?
thank you for writing in. Yes I think you should be satisfied with the answer. The rate of recovery varies depending upon the mechanism of the injury. Read my answer to Sylvia’s question above. I would repeat the NCV/EMG only if the nerve is not recovering within an appropriate time frame.
Nitin Sethi, MD
Hi Dr. Sethi,
Thank you for replying so quickly. The type of surgery I had was a vaginal procedure that had nothing to do with my foot. The surgery took longer than expected and the stirrups pressed against my nerve.
Its me again. I have had and MRI, EMG, Lumbar Punture, X-Rays, and blood work and everything has come back fine. My Dr. has no idea why I have drop foot and Neuropathy. Is there not a way he can see if I have a compressed nerve? I am getting so desperate. I can’t sleep at night because of the pain in my feet and I see no improvement. My Neurologist told me that we are not going to do anymore tests – that we are just going to wait it out and see what happens within the upcoming months. He said that my age (23) and the fact that I am very healthy otherwise, is a good indication that I will make a full recovery. Should I get a second opinion? He did an EMG and all he told me was that my muscles were good and that he didn’t get a good reading from my nerves because of inflamation. I am sorry to both you again, I am just scared to death. Thank you!!
if the foot drop is due to peroneal nerve compression at the fibular head then most of the tests shall come back “normal”. Patients usually make a spontaneous recovery over a few weeks time. I would advise you to avoid potential neurotoxins such as smoking and alcohol. Take a good diet and one tab of multivitamin per day and of course physical therapy should continue.
Nitin Sethi, MD
I posted awhile back about my problem with foot drop. I have since had a nerve conductor test which found that I have damage on the outside of my knee that pinpointed between above and below the knee. This is from crossing my legs! I have had an office job for 20 years and it finally took it’s toll. I got fitted for a custom brace with springs at the ankle that keeps my foot at a degree where it won’t drop. I can walk normally although it’s kind of a pain in the butt.
He said it would probably take about 4 months or so to correct (or never), but I needed to stop crossing my legs. The nerve grows back very slowly he said and I probably would wake up one day and the problem will be gone. But the brace is good because it corrects the foot from tending to bend inward, which could eventually become a permanent problem.
It has been almost 2 months and I can now move my toes slightly upwards which is promising. I could not do that before no matter how hard I tried.
My suggestion is to get a nerve test, (not fun), then a brace, it really helps. Good Luck!
thank you for the feedback. I am glad you are improving slowly but steadily.
Nitin Sethi, MD
I am so pleased to have found these questions and your answers 🙂
I have suudenly developed foot drop and saw my GP who has referred me to a neurologist but I can’t get in to see him for four months. I have been tripping myself up and now lift my foot higher to avoid same – what type of splint would you suggest I notice that my foot has started to turn inward. Would a podiatrist or physio be able to help me – I you think four months is an awfully long time doing nothing
thank you for writing in. I am glad you found the information useful. Physical therapy is very important and I shall recommend it without hesitation. Usually an Ankle Foot Orthosis/Foot Drop Splint is prescribed. This keeps the foot in dorsiflexion and prevents you from tripping or catching your toe on the ground as you walk.
I wish you a speedy recovery.
Nitin Sethi, MD
Thank you again for the useful information. I do feel much better about my condition. I only have one more question (I think). : ) Is it common to have Neuropathy pain when you have foot drop? I have tingling/numbness/pain in both feet 24 hours a day. I was wondering if that too would go away on its own. Thanks for your time.
Thank you Candace for writing in again. The neuropathic symptoms which you describe should resolve as your nerve recovers. You mention that you have these symptoms in both feet. That makes me wonder whether you have a foot drop (peroneal nerve palsy) superimposed on an underlying neuropathy. My advise would be to bring this to the attention of your treating doctor. Some basic tests can rule out most metabolic and nutritional causes of neuropathy.
Nitin Sethi, MD
You are very welcome Sallie, I wish you a speedy recovery.
Nitin Sethi, MD
Doctor, My name is Ty Holsey from Texas. On April 23rd I suffered the worst injury I have ever faced. I tore my ACL, PCL, ligaments and cartilage in my knee playing basketball. I did this by dislocating my knee. As a result of that I now have drop foot. I just recently received surgery for this which was May 28th 2009. It has been almost two weeks now since surgery and over a month since my injury. My doctor told me my nerves are bruised and it will take several weeks and possibly months before I can move my foot again if at all. I was heartbroken by that information. I have not received a splint yet, I’m supposed to go back to the doctor June 15th to get my staples removed from my knee and to get a prescription for rehab. I have numbness in my big toe and across my foot, however, the numbness does not go all the way up my leg like I hear some other people saying. Is there any kind of encouragement you can give me? I have been praying so much for this to heal and I pray it will. What is your opinion?
thank you for writing in. I am sorry to hear what you are going through. It must be indeed tough. Hope is always there. The recovery from the foot drop depends upon the kind of injury sustained by the peroneal nerve. If the nerve was completely transected (cut through and through) then recovery is usually slow and may be incomplete. On the other hand if the nerve was merely compressed/ stunned, it usually recovers though as your doctor told you it may take weeks to months. A good quality NERVE CONDUCTION STUDY may aid in prognostication purposes.
I would encourage aggressive rehab therapy once the staples are removed. The journey may be long but if you work hard enough, the recovery may be excellent.
Nitin Sethi, MD
I have a question regarding my situation,
after my surgery on my lower back (L5) the outcome resulted in a foot drop.( Before surgery i had a lot of pain, curled toes and numbness.) Three months after my surgery my foot condition has not improved and i still foot drop have no mobility in my foot. How can I know if my sciatic nerve was pinched or crushed and if there is any hope for improvement of my condition?
thank you for writing in. A well performed nerve conduction study and electromyogram (NCV/EMG) shall aid in prognostication purposes. It shall help your physician in identifying the degree of nerve damage as well as recovery. I wish you my best.
Nitin Sethi, MD
Hi Dr. Sethi,
I sustained a right dislocated knee injury on April 19th that has resulted in foot drop. Although the torn ligaments seemed to have healed appropriately, the peroneal nerve injury is still pervasive. I had a NCV/EMG done at 6 weeks post injury and another one at 14 weeks (two days ago) post injury. Both are showing a flat line on peroneal nerve activity below the knee. I have not recovered any motor function for dorsiflexion, but I have had some reduction in the numbness and some sensation recovery, especially up my leg. In the last two weeks, I have begun to feel a deep itching under the numbness that I’m hoping is indicative of healing. I can spread my toes, though the movement appears downward in motion lacking any pull upward or outward. I have been in physical therapy 3 times a week, and in addition, have been receiving deep tissue laser therapy and electro muscular stimulation regularly since just a couple weeks after the injury. Diet wise, I have been eating a balanced diet with vitamins and taking a separate B-vitamin supplement. My doctors have now referred me to a plastic surgeon who specializes in nerve grafting. After my initial appointment with her, she asked for the second nerve conduction study, wants to wait 6 weeks, repeat the study again, and decide on surgery after that. From what I’ve learned about this condition, a 1st degree nerve injury can be ruled out due to the fact that there has been no recovery in 3 months. Apparently it is still possible that I have a 2nd degree injury of the nerve fibers themselves that could eventually result in full recovery, but the doctor adminstering the nerve conduction studies feels that this injury is of the more severe 4th (scarring) or 5th (complete transection) degree that I have been told only has a chance of recovering with a grafting. (I am also aware of the subjective chances of recovery from a grafting.) Since we are dealing with the critical time window of recovery for the finite lifespan of the motor end-plates, my questions to you surround the projected path of treatment that I am currently pursuing. In an earlier posting here, you suggested that a complete transection could heal. Is this possible without a grafting? Is there another treatment or course of action that could facilitate the peroneal nerve recovery that I could pursue? I would also value your opinion on my current condition.
I also want to add that I have had MRI’s done of my lower back, knee, lower leg, and a ankle/foot. These show plenty of edema due to dennervation, but aside from the back MRI, do not show anything that could be negatively effecting the recovery of the nerve. The lower back MRI does show a disc protrusion of 2mm that is against the L5 nerve. I am not experiencing any problems with the nerve from here down to the knee. Before the injury, I was feeling some pain in my buttocks, but it had not really progressed significantly past that. Now the constant doses of Neurontin are alleviating all of that discomfort. In order to make sure this protrusion is not effecting the recovery of the nerve below the knee, my doctor has scheduled me for a steroid epidural next week.
I would greatly appreciate any words you have for me concerning this.
thank you for writing in. You ask me for my opinion. Unfortunately I am unable to render one since I have not examined you, nor had the benefit to interpret your MRI scans and nerve condution studies. Complete transection of the nerve is always tricky when it comes to prognosticating patient about the extent and time course of recovery. If the nerve was transected through and through, then it may not recover unless nerve grafting was done and that too within a critical window period as you rightfully point out yourself.
I would not muddy the waters here by giving a half baked opinion. Follow up with your doctors and the surgeon and let them guide the work-up and treatment further.
Nitin Sethi, MD
Dear Dr. Sethi,
I had a total hip replacement on May 12, 2009 which resulted in a foot drop. I am now 3 months post op. My surgeon at my 6 week visit told me not to worry about it and said that I would recover within 3-4 months but he felt it would be sooner. I had an EMG test with the following results “There apprears to be a complete block in conduction of the right peroneal nerve. This is probably at or above the fibular head with marked denvervation in peroneal innervated muscles.” The neurologist said “it was too soon to tell about recovery”. Since that test the numbness is gradually going away and I can move toes and foot down, side to side . I walk with a cane and I have not tripped yet although I am very careful. I am due to go to my surgeon next week to see if he still thinks I will recover. I feel my foot, if the numbness goes away, will recover even if it is not fully. Maybe that isn’t possible. I would appreciate your opinion.
no you did nothing wrong. I apologize I have a little slow in answering all my blog comments.
Nitin Sethi, MD
Dear Dr. Sethi:
Thanks for your response.
I had a follow up visit with my doctor last week at my 3 month pre op visit and he still feels my foot drop will recover. He told me that there were procedures they could do but he wanted to wait to see if my foot recovered on its own before putting me through another surgery to correct it. I have an appointment with him in 3 months and he will decide then. I am disappointed and confused as to what to do.
thank you for writing in and again I apologize for my delayed reply. Your EMG/ NCV report unfortunately does not appear very promising. I am especially disturbed by the marked denervation which has been noted in the peroneal innervated muscles. You may still recover and the nerve may regenerate. The EMG report mentions a complete block in conduction. At times a good quality MRI ( special scan done to look at the nerve itself) might reveal more about its status.
Your prognosis though remains guarded and I am not certain whether the recovery shall be complete and over what time frame. Please feel free to write in again.
Nitin Sethi, MD
Dear Dr Sethi,
Two months ago I had THR with a spinal block. Upon the spinal wearing off my right foot and leg from the knee down remained numb and I was left with foot drop.
Physical Therapy and a NEMS stimulator are not helping. The pins and needles feeling is lessening but still have tingling in my toes, top of my foot in certain positions. I have to constantly wear an AFO to walk or drive but it is very uncomfortable. The Surgeon thought my foot would come back by now but no improvement. If anything it seems worse.
What could have caused this? I was fine prior to the surgery. Is there any hope of my foot coming back? What can I do? I do not wear a brace at night and have tried Nuerontin to no avail.
Thank you, Lynne
Thank you, Lynee
thank you for writing in. Foot drop can occur as a complication of total hip replacement surgery. The cause of the foot drop is usually pressure/ stretching of the fibers of the sciatic nerve. This can occur during the surgery itself or may occur due to the way the hip/limb was positioned during the surgical procedure. If the injury is a simple neurapraxia (pressure on the nerve), the nerve usually recovers fully in due course of time. Since two months have passed since your total hip replacement surgery and your foot drop persists it would be advisable that a nerve conduction study (NCV) be carried out. A good nerve conduction and electomyography (EMG) study shall give useful prognostic information namely to what extent is the nerve damaged and is the nerve regenerating? Also nowdays a high quality MRI scan can actually image the sciatic nerve itself.
The best person to guide you forward shall be your orthopedic surgeon and primary care physician. I wish you my very best.
Nitin Sethi, MD
Dear Dr Sethi,
Your page is very helpful. Please could I ask your advice. My wife gave birth to our second daughter a few days ago. This was a normal delivery lasting about 12 hours and she had an epidural.
She had been suffering from moderate to severe back pains for 1 week before delivery.
The labour was without complication and the epidural worked very well, my wife felt the epidural had more of an effect on the left side, as her leg felt more dense. Also her left leg was warmer than the right during the epidural
Unfortunately she has developed a complete foot drop on her left side which she noticed immediately after birth. She originally had reduced sensation over L4/L5/S1 and slight S2 dermatomes with a completely absent ankle jerk reflex. She also had a very cold left leg compared to the right after the eidural had worn off, but with good DP and PT pulses. She was able to flex the toes and had 3/5 power on plantarflexion. She had 5/5 power on knee extension but only 3/5 on knee flexion.
She was reviewed by a consultant anaesthetist who felt this was not a cause of the epidural and she arranged an urgent MR scan of the lumbar spine, this did not show any disc pathology/epidural haematoma/nerve root compression.
My wife was then reviewed by a neurologist who felt the cause of the foot drop was the babies head compressing the lumbar-sacral plexus (the head was lying low in the pelvis for about the last three hours of labour). No instrumentation was used. She ws not in the lithotomy position for more than 1 hour and has no signs of compression over the fibular head The neurologist ordered a MR scan of the pelvis on a non urgent basis for completeness and suggested nerve conduction studies between 10 days and three weeks.
Over the past 48 hours my wife has regained full sensation in the L4 dermatome and complains of hypersensitivity in L5/S1. She has a slight flicker of movement over EHL if she really concentrates trying to extend her toes, but still has complete motor loss on dorsiflexion with an absent ankle reflex.
I have ordered her a foot-up splint today to help her mobilise.
Please could you tell me if you have come across a presentation like this before and with my wife showing some signs of hypersensitivity how long do you feel this may take to resolve.
Thankyou in advance for your help, this really is a very informative and helpful blog
thank you for writing in and congratulations to you and your wife. Your wife’s clinical presentation has been well documented in the medical literature. We may never find out the cause of her foot drop–whether it was the prolonged labor, whether it was compression on the lumbo-sacral plexus by the baby’s head or whether it was the epidural).
The good news is that her foot drop should improve on its own. That is the natural history of this type of clinical presentation. I would agree with her neurologist and hold off on the EMG/NCV study currently–the study shall not show evidence of nerve root/ nerve/ plexus compression prior to 2-3 weeks of injury and hence needs to be done only if the recovery is delayed or incomplete.
The foot splint is well advised and so is physical therapy.
Nitin Sethi, MD
Dear Dr Sethi,
Thankyou for your reply. Over the past week we have seen marked improvement in the footdrop. My wife can now dorsiflex around 10 degrees and has near normal sensation, though she is still lacking i terms of power.
What is interesting though is that my wife had a MR scan of her pelvis today. The consultant radiologist has reported this and there is a fracture of the left sacral ala. The fracture is complete but undisplaced and appears to be in he region of the lumbo-sacral trunk. I believe this is extremely rare in labour, have you ever come accross this presentation.
My wife was complaining of severe back pains for 1 week prior to her labour and continues to do so.
We are glad we now have a definate cause for her symptoms and are hopeful she will make a full recovery.
thank you for the update on your wife. That indeed is not so common and I personally have not come across such a presentation. Maybe it was the prolonged labor? The good news is that she continues to make a rapid recovery. Might make sense to check her for osteoporosis at some point in time, though I doubt that is the culprit.
Give her my best.
Nitin Sethi, MD
I’m 53 On 8-31-09 I had hip resurfacing done. (arthritis)
I was told that my Pelvis sustained a hairline fracture and that I would not be able to put much weight on my newly repaired hip for 6-8 weeks. Several hours later I noticed that I had only very limited areas with feeling in my left foot beginning mid way between my knee and foot, and I couldn’t move my foot or toes.
The next day I began experiencing shooting. stabbing pains in that area PLUS up to mid thigh..I was told that was good.
Now 2 weeks later I’m taking 300 mg Neurotin 2 times a day and it helps.
My Dr. keeps telling me that everything will be fine shortly and tends to minimize the entire problem..he blamed my fracture on Osteoperosis and that I smoked (years ago and lightly) yet my bone density scan was normal and I’m having a new one done on Friday.
Would you agree that things will return to pre-op shape? Or should I get real?
I have a question. My bofriend woke up Friday and was not able to move his right foot or walk. He went to the hospital and they said that he had foot drop. He sprained that ankle about 3 years ago and always had some pain there but nothing that affected his walking. Is this something that can go away? We are calling tomorrow to schedule something with the neurologist, Please let me know what this can be from- he has no problems with his back or anything like that. Thank you so much for your help- we are just very freaked out and scared about this,
Paragraph 4… Yes, finally an understanding! Thanks for this.
Drop foot is a huge burden. I recently lost 110 lbs with the help of gastric bypass surgery. Out of nowhere I began crossing my legs like the president does when sitting for an interview. I never crossed my legs like this even when I was a skinny kid. The truth is, it was quite comfortable. Plus I could! My right foot will not lift up at all. I can press down, move it to the inside at about 80% of normal, and outside at about 50%. This is all on my right foot. No pain, never has been. But lifting my foot… no way. Its like its not even my foot.
I am now done crossing my legs. As of tonight. Thanks again for nailing this. Great site.
thank you for writing in. I am glad you found the answer. By the way you have a great sense of humor. Yes enough crossing the legs!!!
Nitin Sethi, MD
Question for you….I recently underwent bilateral hip replacement (Dec 09). A week after the surgery I began physical therapy in an acute care facility. I seemed to be progressing well, when out of nowhere I started having sciatic pain. The pain started in my back, went through the piriformis area, down the back of my leg, then branched off into the peroneal area (right front muscle compartment), spreading across the top of my foot (not the toe) and also into my ankle area.
I’m wondering if something could have happened during my surgery to cause this condition, or during therapy? The doc’s scalpel wasn’t anywhere this area of my back, so I am a bit confused as to what happened. I suppose it’s possible that I was tossed around a bit during the surgery or as a result of moving my anesthetized body from gurney to bed….just guessing.
At any rate, I had an EMG today and my rehab med doc confirmed I have a pinced nerve in the L5/S1/S2 area. I’m seeing a neurologist next week get another opinion.
I would be curious to know your opinion on this. Do you think I can recover without surgery?
thank you for writing in. Your symptoms (the distribution/ radiation of pain) suggest a L5-S1 radiculopathy and this was indeed confirmed by the EMG/ NCV study. As to whether you can recover without surgery, that question can best be answered after determining what is the cause of the radiculopathy. Do you have a L5 herniated disk? Where exactly is the nerve getting pinched/ compressed.
My personal opinion with radiculopathies is that most recover with physical therapy. I am quite conservative when it comes to surgery. Your pain shall respond to neuropathic pain medications such as gabapentin (Neurontin), pregabalin (Lyrica) and so forth.
Follow up with the neurologist. He shall be the best person to guide your care forward.
Nitin Sethi, MD
Hi, Nitin Sethi, MD
Thank you for writing about foot drop. I think I suffer from it and I found out about it two days ago when I was about to walk. At first I thought someone had played me a trick by altering my shoes, sadly that was not the case.
I think the foot drop is because of habitual leg crossing because I’ve been sitting still way too much the last couple of months (studies). And I’ve been sloppy with my food intake. So I wouldn’t be surprised if I’ve vitamin deficiency too.
I went to my local hospital but the doctor (an intern) seemed to be a bit unfamiliar with the problem. He examined my foot and told me to come back if it hadn’t resolved in 3-6 months and gave me a phone number to a physiotherapist. He didn’t tell if I could do anything to enhance the healing. So now I’m following your tip about taking multivitamins and I’ve also started taking long walks twice a day as well as stretching.
3-6 months seems as a long time but I suppose that’s normal healing time for a 20 year old male then.
Anyway, thank you very much for taking away some of my anxiousness. I truly appreciate what you wrote.
thank you for writing in to me and I am glad you found the website and blog useful. There are many causes of foot drop and hence seeing a doctor at some point of time is advisable. Habitual leg crossing can be one cause of foot drop and I have seen this many times mostly in thinly built individuals. I once had a patient who developed a foot drop after having kept his leg crossed all the way during a cross Atlantic flight. My advise to you would be to first not keep your legs crossed for long time. When you sleep at night (and if you have a habit of sleeing on your side) a soft pillow between the two legs is advisable. See a physical therapist, the sooner you start physical therapy the better it shall be. Also take a good nutritious diet and avoid smoking and alcohol. I wish you a speedy recovery.
Nitin Sethi, MD
thank you for writing in again. I wish you a speedy recovery and yes please do leave a message and let me know how things worked out with you.
Nitin Sethi, MD
thank you for writing back. I am glad you have fully recovered. Thank you also for your kind words. It helps me feel this is all worthwhile. Stay healthy!
Nitin Sethi, MD
Dear Dr. Sethi,
Thank you very mcuh for being so kind and generous to so many people. I developed foot drop about 4 months ago on my left foot. I love ballroom dancing. some of these dances need very strenous foot work, i,e, one need to raise the whole body with the toes of one foot frequently. Oneday, while dancing, someone hit sthe outer part of left leg just below the knee with his knee. I felt some pain but keep dancing for 2 weeks while I was pratising one tango move which use my left knee and heel to move my body to the righy for more than one hour. I started to notise I walk as if I had a shorter left leg.There was no pain. I did not think I was serious. I saw my doctor. He said it was foot drop, and no more. He try to book a neurologist for me, got appiontment on Jan13, 2011. So I went on the net to try to learn things about this drop foot. I don’t find any experts in Canada. So i went for accupuncture with electric stimilaton for 3 months with no noiceable improvement. To make things worse, I went dancing 1 month ago. after that, I found my foot a little worsen. Now i no only unable to dance but have a some problem walking. Please tell me what is my chance for a full recovery. I am now very say and worried, because, wihout dancing, life is pretty boring for me. I am now 59 years old, don’t drink nor smoke. I take good vitamins daily, including 2 b50.
Thanking you for your attention and wish to receive your reply,
Dear Dr, Sethi,
I am a firefighter and a builder and have
sustained a recent injury slipping on the ice
two weeks ago.
I have recently renewed my insurance, and so I will
see an MD for the first time with this injury in four days
(the next available appointment.)
I have been in varying degrees of pain, and from reading the descriptions
of peroneal nerve injury, it seems to be what I
am experiencing. I now have foot drop
on the injured leg. I am hoping that the time frame that has elapsed
isn’t a problem and that it will be soon that the doctor can get
the tesing needed for medical diagnosis. Is there any advise you can give
with regards to the next few days until I see the doctor?
I have no back pain; the areas of pain currently are the
outside of the leg below the knee, and the buttocks region somewhat.
Should I not walk on it?
I have sustained other injuries; this one has me worried.
I will follow doctors orders, but meanwhile, what should I do?
Thanks for allaying our fears.
thank you for writing in to me. I have not examined you, so my advise comes with significant limitations. Seeing a doctor at the earliest is of course my foremost advise. In the interim period, it may be advisable to keep pressure off the injured leg. Avoid sleeping with the injured leg in a dependent position (meaning do not sleep with the injured leg pressing into the bed frame). Since you have a foot drop you are prone to tripping and falling. So please ambulate with caution. Also if pain is not a significant issue you may attempt some limited range of motion exercises. Take 1 to 2 tablets of a multivitamin every day too.
Please do see a doctor at the earliest. He shall be the best person to advise you on further course of action. I wish you my very best.
Nitin Sethi, MD
Hello Dr. Sethi,
My 21 year old son was involved in a severe auto accident this past November and suffered, among other things, a left femur broken into three pieces and several pelvic fractures on both sides.
His left leg was in traction for three days with the traction rod through his left calf area prior to surgery to insert a rod in his femur. During those three days in traction he maintained muscle control of his foot and toes as well as sensation.
After the surgery to insert the femur rod in the left leg he still had some movement and sensation but they were somewhat less due to much pain and swelling of the whole leg.
He also had two screws inserted into his RIGHT sacro-pelvic bone in the back towards the spine a couple days later.
The surgeons reported both surgeries went well with no complications and good placement of the rod and screws (specifically that the screws did not impinge on any spinal/lumbar nerve pathways.)
He also had stable left ankle fracture of a pretty straight-forward nature and was put in an ortho boot for stability after his surgeries. The boot was left on continuously for the month that he was in hospital recovering.
Slowly, over the course of days and weeks he lost muscle control and some sensation in his left foot and toes.
He is now 5 months post-op and in physical therapy. He has progressed from wheelchair to walker to crutches and now is able to walk without assistance, tho his gait needs work due to a slightly turned in left leg.
He still can not lift his left foot and can only move his toes a slight bit. He has sensation in most of his left foot, with the exception of his big toe and his heel.
His left calf has quite marked muscle wasting from the prolonged period of non-use following his surgeries, hospital and home recovery coupled with the immobilizing of his leg in the ortho-boot.
He has recently been fitted with a custom molded AFO for the left foot/calf which helps him to walk more confidently and has allowed him to stop using the heavy and awkward large black ortho-boot.
However, I am concerned about his prognosis for recovery of use of the left foot. He is very timid about his recovery and it has taken longer than I had expected.
He also had very severe neuropathic pain in his left calf and foot beginning about a week and a half after the leg and pelvis surgeries and lasting until a month or so after he came home from hospital (so approx. 6 weeks after surgery). He has been on 900 mg. Gabapentin 3 X a day for nerve pain since it started. The pain was not well controlled at first. He was, and still continues on, morphine for pain also, although he’s been able to taper off to a much lower dose over the last couple months.
The neuropathic pain improved in his calf first and then his foot, though the foot still has bouts of sharp sudden pains in various places on it. It is much improved however from the screaming pain he was in when in the hospital and after he first came home.
I am hoping and assuming from his symptoms and the fact that he still had muscle control and sensation in the foot after his surgeries but lost them slowly, that he suffered a “bruising” or compression of a nerve during his femur reconstruction surgery, rather than a complete severing.
If that were the case, how long might it be before he were able to see some return of function and what can he do to assist in the healing process?
I have told him I thought it would be a good idea to try and walk briefly a couple times a day without the AFO brace on so that his ankle would be flexed during the walking, keeping aware, of course, of his foot’s position while walking and taking good care not to trip. He is very reluctant to do anything without the AFO on, but I worry that his constant reliance on this aid will hold him back.
I also wonder if there is any way to exercise the back of the calf muscle without the ability to lift his foot? His left calf muscle is terribly atrophied and I am worried he may become permanently disabled in the left leg if he lets it go too long.
He is in physical therapy twice a week and does well while there, but I have a very hard time getting him to do anything “above and beyond” while at home in between sessions.
He will see his orthopaedic surgeon for another follow-up at the end of this month and we are thinking of asking him about the possiblity of a nerve study. Is it too soon for that at this point? Do we need to give his leg and nerves more time to try and heal?
Any help or advice would be much appreciated. Thanks for taking the time to read my very long post !!
Really need some advice/information. About 5-6 weeks ago i started noticing that my left foot felt funny, tingling and numb, and i was also experiencing some problems walking but i couldn’t quite pinpoint it and thought it would go away. I started to realise that i couldn’t dorsiflex my left foot, it felt numb and tingly on the top of my foot and to half way up the shin. After spending a few days trying to exercise my foot i regained some minimal dorsiflexion (about half capacity compared to my normal right leg) I have no pain and minimal discomfort (the bones on the top of my foot and around my ankle are starting to ache as i constantly try and flex my muscles/toes to improve action). I have been told by my GP that i have drop foot, which i’d already suspected, but i can’t get an appointment for another 7 weeks with an orthapaedic consultant and i am starting to really stress myself out reading so much on the internet that it might be ALS/MS or some serious underlying condition. I’m mid-twenties, female and was totally free of health issues until this incident. I don’t know whether I should push my doctor for an earlier referral – i have no other symptoms and can get about but walking is becoming tiring and upsetting. The condition has not deteriorated but nor has it improved much – I was praying that it was simply a transient problem but after 6 weeks i’m not so sure. I haven’t suffered any discernible trauma or injury (except i remember carrying a heavy bag and wearing heels for a few hours which made my foot hurt prior to these symptoms). Please if you can offer any info/assurances that it is common to have something like this out of the blue, it would be much appreciated.
thank you for writing in to me. You say you are in your mid-twenties so first let me reassure you. More than likely you do not have anything serious such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Let us first discuss ALS since that is a scary disease indeed. ALS does at times start off with an innocuous foot drop but you are not in the right age group for it. Usually ALS is a disease which strikes people in their fifth or sixth decade of life. Familial ALS begins at a younger age but here the history is of multiple family members having ALS at a young age.
Now let us come to MS. MS can have myriad clinical presentations. While it can present with foot drop it is usually not a common presentation. More common presentation of MS in a young lady like you is an attack of optic neuritis (sudden loss/blurring of vision in one eye along with pain) or an incomplete transverse myelitis (TM). Patients with TM depending upon the level of involvement of the spinal cord (usually it is in the cervical cord) may present with weakness in the legs, numbness, loss of bladder control, problems with gait and balance.
So most likely you have a foot drop due to either peroneal nerve palsy or sciatic nerve palsy. Now you deny any trauma. At times the cause of peroneal nerve palsy can be “subtle” such as repeated crossing and uncrossing of the legs (in thin persons), falling asleep with the outer aspect of the knee (near the head of the fibula) pressing against something hard such as a bed railing and so forth or something pressing on the sciatic nerve (as it exits the pelvis) or at the level of the fibular head (peroneal nerve) . Rapid changes in body weight may make a person predisposed to compression palsies of various peripheral nerves. This is especially common in people who have marginal diets, alcoholic and diabetics.
My advice to you though would be to follow up with you GP. He/ she shall be the best person to guide the workup forward. I hope I have been able to offer you some useful advice.
Nitin Sethi, MD
Dear Dr Sethi,
Thank you for the quick response. I did have a nerve test done today with both the electrical current and needle tests. All they could conclude was that I had Siatic nerve damage and it was too early to provide a prognosis other than to wait. The Dr. was unable to provide any idea if the nerve was regenerating.
I follow up with my Ortho Surgeon in 3 weeks. Is there anything I can further ask him? Do you know of any other braces other than the cumbersome plastic molded one I have? The Nerve Test Dr said it could take a year or two if at all for my foot to recover =(
Again thank you, Lynne
You are very welcome Lynne. I am surprised. Since you are two months out (of the surgery) I was expecting the nerve conduction study and EMG to be more revealing. My advice to you remains unchanged. Keep in regular follow up with your doctors. They may consider repeating the NCV/ EMG study down the line. Put in a lot of effort into physical therapy. Maintain a good nutritious diet and supplement it with multivitamins and Vitamin E and B12. Avoid alcohol intake and smoking since that shall delay nerve recovery. Again I send you my very best.
Nitin Sethi, MD
Hi doctor..Im not sure if you still monitor this page but figured I’d give it a try..I developed foot drop around a year n a half ago from rhabdo caused by an overdose unfortunately..I had fallen out in a kneeling position for approx 6 hours cutting all circ to my legs..I currently have the simple brace that drops down behind my ankle n candles my foot from underneath..I exercise it as much as possible though its hard b/ the rhabdo destroyed most of the muscle in my right leg as well..I was told I’d probably never walk again and being 25 year old young woman I could not accep5 that and went to P.T. 5 days a week until I was in a walker..to crutches..to now a cane..I’ve baffled most doctors b/ when they performed an emg they found all my nerves tested were only firing one signal and my foot drop nerve wasn’t firing at all..no one has since dared try and give me any type of time frame to full recovery if any..I’ve already resigned to the fact that it’ll never be the same as before but I’m curious if you have any insight as to a time frame..can I regain the ability to flex my ankle?..as a result of the muscled weakness my ankle is almost like floating in there..and has rolled rather significantly over the months..I currently do the exercises learned in P.T. and use my treadmill everyday along with an abdoer twist I recently purchased to help my core strength to improve my balance and balance recovery..I hope you do still monitor this because it would be nice to have some type of idea time wise ya know..thank you in advance if you do get this
thank you for writing in. It is indeed tough to prognosticate on the time frame of recovery. Your doctor based on tests such as nerve conduction velocity (NCV) and electromyography (EMG) of the involved muscles shall be in the best position to answer that question. The above two tests help us in determining the extent of damage to the nerve (whether it was just compressed or whether it was crushed/cut completely) and also show us early signs of recovery which may not be clinically apparent.
I wish you my very best. Continue with the physical therapy which your doctor advised.
Nitin Sethi, MD
It is possible that persons may require prescription medications or have to undergo physical therapy in order to control sciatica’s painful effects. Surgery or injection therapy may be necessary in some cases. Magnetic Resonance neurography (MRN) is capable of generating a detailed image of virtually any nerve in the body. MRN can accurately image the sciatic nerve, and also shows that medical experts can diagnose and treat sciatic pain that is not caused by a herniated or damaged disc.
thank you for your comments.
Nitin Sethi, MD
dear Dr Sethi…. i am 17 .i had a sciatic nerve injury due to gunshot in my right upper thigh,due to which i was unable to lift my foot.I also had a burn injury under my right foot for which i was adviced bed rest so i used to jump on my left leg for going to washroom or other rooms .Although i have a lot of improvement in my foot drop in the past 2 months,but there is lot of muscle loss in my right calf muscle.Is this because of foot drop or bed rest?
Will i be able to walk after my bed rest.?also i do physiotherapy everyday.
Dear Dr. I had a 3rd revision of a total hip with a cage put in. i have a rare bone disease ( Englemann’s) and the rt. side of my pelvis was not great nd the angle was not as good as the Left side (I have bilateral total hips and knees with no problems on the lt. side). I had foot drop right after surgery with terrible edema and horrible nerve pain off and on. My surgeon said the sciatic nerve was located and spared. He seems confident my foot will come back but it has been 1yr. and 3 1/2 months since surgery. and I have some feeling on either side of my heel and along my arch but can’t lift my foot and the top and bottom front part is mostly numb.
I asked for a NCS and had that today. The nerve pain became almost unbearable 3 months ago and the Dr. said my foot was waking up. I was on painkillers. Iam now off of them completely ( used anodyne and the Rebuilder) but I am scared about whether my foot is going to come back. Can you provide any helpful comments ?Thanks, Marcia
It has been almost 6 months since my THR. No improvement in the foot drop. My Calf is mostly numb along with the top and side of my foot. I can not move the toes or foot up or turn the ankle to the right side. Physical therapy said there was nothing they could do after they rehabbed the hip.
The only sensation I have is the “buzzing” if the foot is dangling or not in a brace. I can not imagine being tied to this cumbersome painful AFO the rest of my life and getting depressed over the lack of things I can no longer do. Nerve tests were useless as all they told me was there was nerve damage. I have a follow up with my surgeon in a few weeks. Is there something further I can request be done? Thanks so much,
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Nitin Sethi, MD
This is a little long, but I promise to make it as brief as possible. I had an MIS tlif L4-S1 spinal fusion on June 21. After surgery, it became apparent that I had mild foot drop in my left leg (I had no problems in that leg prior to surgery) and increased nerve pain in my right leg. I have no pain in the drop foot leg, but my right foot feels as if I have a severe sunburn on the right side and on all the toes. The bottom of that foot has a similar feeling. I’m taking Lyrica which helps some.
As you can understand, I am more concerned about the drop foot. I can pull the toes towards me a little bit, but it slaps the ground when I walk. I’m also unable to walk on that heel. An EMG was performed which showed problems in both legs/feet involving the L5 nerve root. There is no damage to the peroneal nerve. The neurologist who performed the test said that I might be looking at a 24 month recovery period with a limited amount of function return. My surgeon says that he never came clse to the L5 nerve root and is unable to pinpoint exactly when the damage occurred. However, he said that the doctor who performed the EMG was not aware of the whole picture and is completely wrong concerning the recovery time and quality. He thinks that my nerve was “stunned” and will “wake up” during the 2-6 month period following my surgery. He believes that I will get 100% of the function I had prior to surgey back by the time the 6 month period is over.
Since it has now been just over 8 weeks since my surgery, I’m anxiously waiting for the signs to begin to manifest themselves. If the prognosis is accurate, I know that it will be a week to week change, but just what should I be looking for? I have numb areas on the lower outside of my left calf and up my foot to the big and second toe. I’ve been doing PT and exercising at home.
Do you think my surgeon is correct? Have you ever heard of “stunned” nerves in a case like this? If so, what sort of recovery should I be looking for and over what period of time? I’d really appreciate any sort of opinion you can offer. Thanks for your time.
Dear Dr. Sethi
In the last four months I have had three falls. I am 56, have well controlled diabetes (last A1C was 5.5). Hypertension well controlled. No neuropathy, numbness in my feet or legs. Fell this weekend, walking on a flat surface. My left foot dropped, caught my toe and fell hard enough to crack ribs and leave some nasty bruising. No dizzyness at all. Occasional left hand tremor in first two fingers which resolves after rest, not enough to interfere in doing things.
I do have moderate to severe arthritis at L5, and severe arthritis c-4 to c-5-c-6 ad c-7.
Suggestions? I take calcium, magnesium and zinc and bone density testing is normal. Earlier this year I had severe anemia which resolved after 14 transfusions of iron and my last hemoglobin was 13.
To whoever: I wrote back in July of this year and thought I would receive some answer or comments, nada! Has anyone with footdrop from surgery on a hip or knee who has been told recovery will take 3 months to 2 years had this happen? The only devices that can help are apparently for central nervous system conditions not surgical trauma. I have had relief from nerve pain and have numbness and periodic swelling and have had PT and annodyne therapy and have used the rebuilder tens unit. I still cannot raise my foot or toes but have a more connected sense of my foot to my leg. I have a little more feeling in parts of my foot. It has been 1 year and 8 months. My surgeon still insists my foot is waking up with some recent strange pains of several weeks duration.
Comments from anyone if not the doctor, please! Thank you.
Marcia, I was told 6 weeks, then 3 months, 6 months, a yr, now maybe 2 yrs. It has been one yr now and no change. Mine is from something related to the THR so the devices won’t help About all I can do is wait. I am glad you are starting to regain some feeling! Dr Sethi used to be on here frequently replying. Not sure if anyone is monitoring this site at all anymore. Good luck and keep us posted!
Lynne, I was told it could take anywhere from 3 months to 2years. Are you doing physical therapy? What do the letters stand for that you said your condition was caused by? The Anodyne machine is not for foot drop caused by a central nervous system condition like the Bioness thing in case you thought that was what it was. Thanks for the good thoughts. Same to you. No, I think the Doctor is not monitoring this. Perhaps those of us with this condition from various causes can help each other by reporting what we find and try. I am no satisfied to just accept this as something that can’t be helped. Will report back as I find out anymore.
Marcia and Ranelle, thanks for the replies. THR-Total Hip Replacement, sorry. They say Siatic Nerve Damage but can’t say how it happened or what the extent of the damage. I have went to PT a couple of times, all they do is give me some leg strengthening exercises and send me on my way. No one cares about gait training etc. I have a collection of braces-none comfortable and most cause knee pain from leaning on the opposite side. I guess I would feel better if I thought there was a chance at the 2 yr mark I would see an improvement. Help from others seems to be the best, no one really seems to know much about what to do. Most of my pain is the “buzzing/numbness” that is 1000x worse than when your foot falls asleep. Lately I am getting a lot of foot cramps at night. I wear a boot to keep it from dropping all night………….Please stay in touch!
Hi Lynne, You had an incompetent PT!!! They should have been doing range of motion with your foot and streeching your leg as well as trying a tens unit for pain and using a muscle stimulater to see if that would help to get the nerve or muscle to show signs of moving. And yes the Anodyne machine is definately something you should try. Please google it on the net. Also google foot drop braces and look at some of the ankle styles then you could show those to your doctor or a brace maker in your city. You all stay in touch as well.
Thank you for your comment Marcia.
Nitin Sethi, MD
thank you for writing in to https://braindiseases.wordpress.com. Rigorous and structured physical therapy (structured to your particular condition) is highly advised and should continue. Your doctor shall be the best person with respect to prognostication. Like I have stated in my post and in some of the comments, prognostication (with respect to recovery and the time frame of recovery) is at times difficult. If the nerve itself is in continuity then usually the outcome is favorable. A good nerve conduction study and/or EMG study at times gives useful information about the state of the nerve and the muscles that it innervates. Your doctor and physical therapist shall be the best person to talk about this too.
Nitin Sethi, MD
Thank you for the update Ranelle.
Nitin Sethi, MD
thank you for your thoughts. I am still monitoring this post and shall update the post when anything interesting comes to my attention.
Nitin Sethi, MD
very much here and I just answered your question. Keep in touch and remain strong.
Nitin Sethi, MD
Dear Dr Sethi.i had a motorcycle accident 10 months ago now which resulted in a large bruise and swelling on the back of my leg approximatly 8″ above the back of the knee.the foot can press downwards and now there has been some improvement ie the foot can move side to side a little and the big toe can move slightly,the calf muscle has wasted away….do u think that the leg will recover in time or am i stuck like this for life…….thanks
Thank you for writing in. You ask a very valid question but I am afraid I cannot answer it with the little information I have about your condition. Prognosis after nerve injury depends upon a number of factors such as the extent of the injury: was the nerve completely transected or was it simply compressed? As you can imagine the possibility of complete recovery of nerve function is poor after complete nerve transection. On the other hand if the nerve is simply compressed then recovery does occur as the pressure on the nerve subsides. One way to answer your question would be to get a good quality nerve conduction study. That and a high quality MRI scan may help determine how badly is the nerve damaged and whether there are any signs of nerve regeneration. Physical therapy always helps and should continue under the supervision of a doctor. Taking a good diet, multivitamins and avoiding alcohol and smoking shall also promote nerve healing. My best wishes to you John.
Dear Dr.Sethi, I just asked for a comment (# 94) above John’s. I had two needle conduction studies 6 months apart and the Dr. who read them said there was not much change ( nerve had regenerated to my knee) but I have not had an MRI. Also what type of PT would be helpful? I have had regular strength training and hobbling on a platform walker. My surgeon says to forget what the Dr. said who did the needle studies that the nerve is coming back. I still have strange pains and swelling. I would greatly appreciate any comments you might have. The Op report said the nerve was located and spared. It was stretched when the Dr. put in a cage which lengthened my leg.
I had a total hip replacement in August 2011 and on waking had no feeling or use of my lower leg. This rapidly changed (over a few hours) to pain worse that I ever thought possible. I was diagnosed with foot drop and taken back into surgery 24 hours later to try and shorten my leg to release the nerve. This was unsuccessful and I then got a Staph infection which required futher surgery to clean out everything in the operation sight. This seemed to further aggrevate the pain.
I am now taking amytriptaline, pregablin,.slow release tramadol and oral morphine if required to try and control the pain in my lower leg and especially my foot all of which is touch sensitive.
I have no dorsal flexion at all and very limited plantar flexion with various different sensations from numbness, pins and needles, shooting pains, burning in my foot and leg.
I have had nerve conduction studies done and a EMG tests which showed no response and no sign of regrowth.
Any advice would be great.
I had terrible pain after waking from a revision of a total hip and had foot drop. I still have a partially numb calf and can’t raise my foot or toes and surgery was 3-16-2010. I have tried various pain killers and finally got off all of it by using an Anodyne machine and a rebuilder machine. I think thee Anodyne helped more than anything. Google it on the internet. My physical therapist had me walk with an afo brace on (uncomfortable) and she streched my leg and had me do leg exercises. I had the needle tests done too. No re generation shown but my surgeon is still hopeful I am currently having some more discomfort ( nothing like before) from swelling from sitting all the time. Am using a foot pillow from relax the back and having my husband wrap each leg with an ace bandage while I elevate my legs for an hour. Getting ready to investigate a new exercise machine called a cardio strider by inspire fitness to exercise my leg. Push,Pedal Pull has them or look on the web. Good luck.
Six months ago I was diagnosed with Compressive Sciatic Neuropathy which caused foot drop. EMG and MRI studies have been conducted and after that doctors told me that I have to wait at least six months to see any signs of recovery. Now six months have passed and I don’t see any recovery so I was wondering if you could tell me if it’s posible that this condition can become permanent or if I still have a chance of recovery. They told me that nerve suture surgery is not an option because the nerves were crushed.
Could you give me your opinion? This condition is affecting my life so much and I’m desperate to find some answers, I’m afraid to keep waiting doing nothing about it…Thanks!
First allow me to thank you for sharing your valuable time and knowledge with us in on this blog. There is very little info about what to expect in foot drop recovery because there are so many causes that the text and web speak in very general terms. Back in Sept 2011, I suffered a hard fall onto both my knees. I had a great deal of swelling and bruising to both knees, but E.R. X-Rays showed no fractures. Also felt sharp intense pain in low back radiating to my buttocks. A week later I noticed I was slapping the floor with my left foot and I tripped and fell over my left foot several times. I saw the Doctor two weeks later and by that time I could not dorsiflex or invert my left foot at all and I could not lift my big toe. Plantarflex and eversion were fine, but I could not heel walk on my left foot at all and had to use crutches and an AFO to avoid tripping. Prior to the MRI, the Doctor said it was peroneal palsy and the function would return in a few months to a year. After the MRI and EMG & Nerve Conduction he said it was an L5 disc herniation, which pressed on the left L5 root nerve and caused radiculopathy. I had positive leg raise on effected and non effected legs with electrical shooting pain from my back to the outside of my left calf across the top of my left foot and ending in my big toe. I did meds and Physical Therapy for three months, but NO function returned and odd pins and needles electric pain worsening on low back, left buttock, left leg and foot and become unbearable. Due to severe foot drop neurosurgeon did left side L4 L5 S1 decompression surgery with L5 S1 disectomy, hemilaminectony, NO fusion. I am 45 days post op. The back pain is better and no more shooting pain with leg raises, but the electrical pain from the left knee to my left foot and toe is just as bad and worse of all no return of foot dorsiflextion or inversion. I have also developed gluteus medius weakness and my entire left leg rotates outward when I walk. I can hold it straight for 15 to 20 steps then it gets extremely tired and rotates outward. Also I tend not to wear the AFO brace because the contact with my leg and foot causes aggravation of the electrical pain. I cant stand anything touching it at night (not even bedsheets) so I prop it up on a stool that is the same hieght as my bed. I take LYRICA, SOMA and just started on TOPAMAX which help the pain, but not with function. Doctor noticed color is different from right leg and foot and temperature is 4 degrees colder so now she thinks it may be CRPS. I do physical therapy exercises for weak left gluteus medius and electric stimulation for left foot drop tibialis muscle. Finaly my questions are; 1) If and when I regain function, does it happen gradually or does it just go from not working at all to a twitch or weak movement 2/5 3/5 4/5 or will I wake up after the nerve regenerates and be 5/5 strength? 2) Will I be able to dorsiflex, invert and lift my big toe at the same time or will one begin to recover before the other? 3) Is it only the 5 mm root nerve that was pressed on that needs to regenerate or does it need to regenerate from my back all the way down to my toe before function returns? The L5 root nerve was only pressed by the herniated disk NOT crushed. Not knowing what pattern of recovery to expect makes this very difficult. I have not been able to find any info on L5 foot drop recovery. Please Help. Thank you very much sir.
First allow me to thank you for sharing your valuable time and knowledge with us in on this blog. There is very little info about what to expect in foot drop recovery because there are so many causes that the text and web speak in very general terms. Back in Sept 2011, I suffered a hard fall onto both my knees. I had a great deal of swelling and bruising to both knees, but E.R. X-Rays showed no fractures. Also felt sharp intense pain in low back radiating to my buttocks. A week later I noticed I was slapping the floor with my left foot and I tripped and fell over my left foot several times. I saw the Doctor two weeks later and by that time I could not dorsiflex or invert my left foot at all and I could not lift my big toe. Plantarflex and eversion were fine, but I could not heel walk on my left foot at all and had to use crutches and an AFO to avoid tripping. Prior to the MRI, the Doctor said it was peroneal palsy and the function would return in a few months to a year. After the MRI and EMG & Nerve Conduction he said it was an L5 disc herniation, which pressed on the left L5 root nerve and caused radiculopathy. (NO evidence of peroneal palsy on EMG or nerve conduction test). I had positive leg raise on effected and non effected legs with electrical shooting pain from my back to the outside of my left calf across the top of my left foot and ending in my big toe. I did meds and Physical Therapy for three months, but NO function returned and odd pins and needles electric pain worsening on low back, left buttock, left leg and foot and become unbearable. Due to severe foot drop neurosurgeon did left side L4 L5 S1 decompression surgery with L5 S1 disectomy, hemilaminectony, NO fusion. I am 45 days post op. The back pain is better and no more shooting pain with leg raises, but the electrical pain from the left knee to my left foot and toe is just as bad and worse of all no return of foot dorsiflextion or inversion. I have also developed gluteus medius weakness and my entire left leg rotates outward when I walk. I can hold it straight for 15 to 20 steps then it gets extremely tired and rotates outward. Also I tend not to wear the AFO brace because the contact with my leg and foot causes aggravation of the electrical pain. I cant stand anything touching it at night (not even bedsheets) so I prop it up on a stool that is the same hieght as my bed. I take LYRICA, SOMA and just started on TOPAMAX which help the pain, but not with function. Doctor noticed color is different from right leg and foot and temperature is 4 degrees colder so now she thinks it may be CRPS. I do physical therapy exercises for weak left gluteus medius and electric stimulation for left foot drop tibialis muscle. Finaly my questions are; 1) If and when I regain function, does it happen gradually or does it just go from not working at all to a twitch or weak movement 2/5 3/5 4/5 or will I wake up after the nerve regenerates and be 5/5 strength? 2) Will I be able to dorsiflex, invert and lift my big toe at the same time or will one begin to recover before the other? 3) Is it only the 5 mm root nerve that was pressed on that needs to regenerate or does it need to regenerate from my back all the way down to my toe before function returns? The L5 root nerve was only pressed by the herniated disk NOT crushed. Not knowing what pattern of recovery to expect makes this very difficult. I have not been able to find any info on L5 foot drop recovery. Please Help. Thank you very much sir.
I apologize for my ignorance, I have never posted a question on a glog and it’s very difficult to concentrate or even stay awake because my post surgery medications cause a lot of sedation. About a week or two ago I posted several questions regarding post surgery foot drop recovery caused by L5 root nerve compression. I saw my questions posted as Comment 99 on the blog with a comment under it that read “Waiting for Moderation” but I don’t know what that means. A few days later my questions and all of Comment 99 disappeared from the blog. Can someone please help me with some guidance on how to post my questions here so that Doctor Sethi can help me with a response. I truly appreciate any help. Thank you. I suspect I may need to join or become a member of this blog or website but I have no idea how to do that. Thanks again.
Dr. Sethi, I see from recent comments that you are still answering questions on this site. Would you please answer a question for me. I have asked some before and have gotten no response. My surgeon said in the op report that the sciatic nerve was located and spared ( which i take to mean he did not cut it ). It has now been 2 yrs. since surgery this month. I have some numbness and various uncomfortable to at times painful feelings. in my foot and clear up my leg. Do you think my foot drop still has any hope of recovery? I cannot lift my foot or toes and the EMG ( needle test ) only showed the nerve had not returned past my knee. Thank you very much for your time.
Dear Dr Sethi, thank you for your replies above and good to know you are still here 🙂
Marcia-your case sounds a lot like mine except 1 yr after the surgery so now they tell me maybe in another yr. The 2nd nerve test I had done showed no change. The nerve is not healed past the kneww. I am not sure why if the surgery was at the hip the damage is only from the knee down which is where all my numbness starts. I do have a TENS machine but they never really did much at explaining how to use it. I went to two different PT places both about the same-used the shock machine-no results, did some stretching and strengthening and sent me on my way. I am having a lot of pain in the hip opposite of the foot drop from the way I walk I assume. I have 3 different AFO and they are all bulky, cut in to my foot and uncomfortable to wear. Not to mention finding shoes is a nightmare. I have done a lot of googling. Tried a few things but they did not work with the severity of my foot drop. My foot is constantly buzzing if I let it hang there without an AFO while sitting, trying to sleep etc. What a nightmare. I am grateful for this forum-more info here than anyplace else. Is there a way we can privately communicate with other posters?
Marcia, did you have an MRI? I have seen that suggested but when I asked my Surgeon he said there was nothing it would show and had me have another nerve test that showed nothing. Best of luck to all and keep the info coming!
Lynne, I have not had an MRI. I have had 2 needle nerve tests. They showed the same as yours. i would have no problem with you contacting me by email directly (firstname.lastname@example.org). I have two very uncomfortable AFO braces and I saw a picture of an ankle one that looked more bearable and may check into that. I have felt some pretty frequent stinging in my arch and big toe since Sun. and clear down my leg. I believe I have developed more feeling in the side of my foot and can now raise my heel up and down. Surgery was 2 years on this Friday. Wouldn’t it be something to have the feeling return on the anniversary date! By the way, Thanks Dr. Sethi for letting us know you are still there! I taake it there is a lot even you don’t know.
thank you for your reply. I am glad to hear from you. Yes I am very much here and try to update the blog as and when time permits. Sure there is a lot that I do not know. As a doctor I have learnt to be humble and listen to my patients because frequently they turn out to be my best teachers.
Nitin Sethi, MD
Dear Dr. Sethi, Thank you for your reply. I am always pleased to hear a Dr. being humble in the fact that they don’t know everything about a condition and to let patients know that. As a patient myself and a licensed clinical social worker in private practice I know how destructive it can be to have someone in an authority position pronounce that a condition is hopeless when no one can really say that with certainty. I appreciate the fact that my own surgeon has been very open ended with questions I have had about when this whole thing will come to an end one way or another. I recently thought I was just not going to progress any further and yet I have begun to sting more and more feeling has returned. Still can’t raise my foot but who knows. In the meantime I continue to search for answers and to listen to my body and to try things on my own. You just can’t sit and wait for one Dr. to come up with all the answers to something as complex as foot drop cases. Again, thank you for your honesty. Perhaps that will give other folks the courage to question their medical care when a doctor is being too certain and their gut is telling them it doesn’t feel right.
I am glad that you are so willing to share your story and help others on the way. Maybe Marcia shall read this and get in touch with you personally.
Nitin Sethi, MD
Hmmm.. very interesting. I was diagnosed with a ruptured disc years ago, but most of the time, it does not bother me. About a month ago, I started experiencing severe lower back pain radiating down the buttocks and into the legs. I went to the doctor, and they said there was little they could do. After about a week, the pain went away, and I have been pain free since, however as the pain subsided, I started getting numbness on the top of my right foot up along the outer edge of my leg to just below the knee. I assumed it was a symptom of the ruptured disc putting pressure on the spinal nerves. Soon I started to notice that when I walked, my right foot slapped down, and try as I might, I could not control it.
So sounds like it is due to the ruptured disc right? Possibly, maybe even probably, but there is something else I have not disclosed. Although I am not diabetic, I have lost 30 pounds in the last two months brought on by the stress of going through a divorce. I am in IT, and I sit at a desk all day long. Lately, I have noticed myself crossing my legs a lot which is something I have never done to this extent. Most of the day, I have my legs crossed, and I can’t seem to break the habit. Today, after experiencing the symptoms of foot drop for a few days with no sign of it going away, I went to the doctor. I explained all my history. Minus the crossed leg portion, and he was convinced I needed surgery or it would probably be permanent and has scheduled me for an MRI which is to be followed by a surgical consult.
After he scared the day lights out of me, I told him about the crossed legs issue, and asked if this was possible. He said no, it would be to uncomfortable, and I would not do it if it were causing an issue. In fact, he really acted condescending as if that was the stupidest thing he had ever heard. He shut me up but, I wasn’t completely buying it, and that is how I can across this site. I am really hoping the doctor was wrong.
I am glad you found the post knowledgeable. Foot drop can have various causes and one of the common cause is a herniated disk which pinches the nerve that helps to dorsiflex the foot. A MRI scan of the lumbosacral spine shall help identify a herniated disk. The decision whether surgery is needed to do a discectomy and decompress the nerve is one which has to be made after due consideration of a lot of factors. Would a conservative approach (physical therapy) help? How severe is the foot drop? How acute is the foot drop? All these questions need to be considered. Your doctor shall be the best person to guide you forward.
As I have stated in my post there are other causes of foot drop. Habitual leg crossing especially in thin individuals or those who have lost considerable weight in the recent past is one of them. I send you my best.
Nitin Sethi, MD
Dear Dr. Sethi,
I developed a foot drop which the doctor said was due to me loosing padding around my nerve due to weight loss and then falling when playing squash and bruising the nerve. It is healing but I am worried it could happen again and be worse this time.
My question is will this padding return to mind my nerve if I put on weight or is there anything I can do to protect my nerves. I worked hard to loose the weight and the idea that this could cause more problems is alarming to me. Also how do people who are thin all their life protect this nerve?
Dear Dr. Sethi,
Like many of the people on your blog, I’d like to thank you for sharing so much information and alleviating my anxiety associated with a recent onset of foot drop. I am a 33 yo CF (and nursing student!) currently under medical care of an oncology group after undergoing treatment for Ewing’s Sarcoma ’09-’10 and Acute Myologenous Leukemia (AML) ’11-’12. I had exposure to Vincristine during Ewing’s treatment without any immediate side effects. I have had severe sensory neuropathy in my arms and legs since chemo for AML (7&3). I do not get any relief from gabapentin, however, Lyrica seemed to help prior to chemo immediately preceding my bone marrow transplant (allo peripheral stem cell infusion). Otherwise, I’ve adapted and have decent motor control of my extremities.
Beyond the post transplant medication regimen, I also have additional and continuing medication for a disseminated fuserium infection which arose during severe immunocompromisation while hospitalized for 7&3. It presented with subcutaneous nodules and osteomyelitis in my left toe. I have bad luck with toes, evidently! The medications include infusion of Voriconazole, Ambisome, and oral Posaconazole. My sensory neuropathy increased on the former two infusions, but appears to be static on the oral medication. I have had severe and repeated spasms of my calf muscles in both legs, but primarily my right typically upon waking from nighttime sleep. This has occurred since Ewing’s treatment in ’09. Ive never been able to get a specific treatment or even etiology for these spasms.
I experienced foot drop approximately one week ago with partial movement of my lateral toes on my right foot. I experienced a decrease of motor control for a few days where it appeared to be complete dorsiflexion parasthsia of my right big toe. I now seem able to dorsiflex my toe very slightly. I have the ability to invert my foot, but eversion is approx 50% of normal ROM.
I am assuming that this is primarily caused by crossing my legs frequently and differently than I used to. I lost 50 lbs quickly during AML treatment and have significant loss of fat and muscle due to the hospitalizations. I’ve been crossing my legs a lot because it was finally comfortable, but I noticed deep tenderness on the lateral side of my right leg after repeated “offenses”. I may have experienced earlier signs, but my legs are mostly numb to the knee. I also think that the tightness in my calves contributes to the fatigue and weakness in my tibialis anterior. I expect that I’ll experience a slow but steady recovery as I avoid bad behavior of leg crossing, but if after a few weeks it hasn’t relieved itself I’ll probably get an EMG. I have previous EMG records for comparison. Steppage is not my favorite gait!
My concern is outside of stretching, exercises, and potentially an ABO; should I be thinking about the other factors (like my history) that might be related or contributing? My oncology NP & MD didn’t seem too concerned about the issue, but it’s understandable with it being early after onset and attributable to a behavioral pattern. When should I consider imaging if this doesn’t resolve itself?
thank you for writing in to me. As has been my policy when I answer questions on this blog while I cannot and should not comment on your particular case, I can give you a few pointers to help guide you. As always your current physicians are the people who you should defer all questions to. A couple of things may be going on. You may be suffering from a chemotherapy induced neuropathy (sensory as well as motor) and on top of these already compromised nerves you might have developed a foot drop (the crossing and uncrossing of the legs may have contributed to this though one cannot be sure). The spasms may be sign of the neuropathy.
You said you have had nerve conduction studies before. It shall be good to compare your current conduction velocities, CMAPs and SNAPs with a study which was done in the past. That shall be useful information. Lyrica is a good drug for neuropathic pain. The treatment of neuropathy is avoiding (if possible) the toxic chemotherapeutic drug in the future. You should also eat a healthy diet and supplement it with vitamin supplements. Physical therapy should continue. Again talk to your doctors. They shall advice you further.
Nitin K Sethi, MD
Dear doctor. I was doing some work in my back yard, just soldering some wires back together. I was sitting cross legged on the ground for about 20-25 minutes. I don’t cross my legs that often, but this was the easiest position to perform the task.
After I finished I got up and just thought my foot was asleep. That was 4 days ago and based on what I have read I have foot-drop. What would be the recovery time for this type of injury? I have been told by a physiotherapist that I should ice it but I have not seen much information about that on the internet. Is it just time that will heal? I am going to go to the doctor this week if it does not start to feel better. Thanks.
if the nerve is simply compressed (compression neurapraxia) it should recover. A few things which you can do: take 1-2 tablets of multivitamin per day, do not drink alcohol or smoke till recovery is complete. If the weakness/ foot drop persists bring it to the attention of your doctor as you have already decided to do. My best to you.
Nitin K Sethi, MD
Dear Dr. Sethi,
I was recently working under my house in a confined space that required me to be in a squatting position on and off for a period of about 4 hours. The next morning I experienced numbness and I had no movement in the toes on my left foot. In addition, I could not raise my foot toward the ceiling at all. It was like the foot was not even there. Two weeks have passed and I have been stretching, taking OTC medications (Aspirin/Ibprof), and using a portable stem machine. I can now move the toes and lift the foot toward the ceiling, however, “heel walking” is still not posssible with the left foot. I found this website — and I appreciate you and the information that you are providing to people with this condition. I have an appointment next week with a neurologist — does it sound like this will eventually return to noarmal and is there anything else I should be doing? Again, thank you very much for the time you spend answering our questions! J
A week ago I removed the grass from my garden soil, crouching. After 3 hours grass-removal work, I found I had difficulty in dorsiflexing my both feet. At the beginning I had thought the muscle controlling dorsiflexion of feet must have been too tired to do the job and I should have recovered one day or two. But a week later, the symptom was not gone and there is little improvement. Then I realized I may have feet drop. Beside the drop feet, now sometimes when I keep sitting for half an hour or longer, I will have a little numb and cool feeling at the back of my upper and lower legs. Do you think my feet drop was simply caused by the compression of the peroneal nerve? or May even worse by hurting my sciatic nerve or even lumbosacral plexus due to the long-lasting crouching posture? It’s been a week with little improvement. Do you think it will fully recover itself or I need to get neurologist attention? Is there any rehabilitation exercise to help it heal?
Like others on this blog, I too am seeking knowledge that does not always seem readily available. My 61 yr old husband had hip replacement and woke up with foot drop. It has been 4 weeks since the surgery with no improvement. We are waiting until the 6 week mark to have the EMB and nerve conductor test. If for some reason the foot drop does not improve, we will deal with it; however, the issue of neuropathy, the tingling, burning and knotted up feeling in his foot is torture. He is on Neurtoin (600mg/3 times a day) and also hydrocodone. There is a certain amount of depression at this point. He had an injection into L4 and L5 for what was said to be a slight buldge in the disc. Pain doctor did not believe it had anything to do with foot drop. Is there anything that can be done for the pain caused at this point? Thank you for your time!
foot drop is usually painless so I am not sure why your husband has pain, burning and tingling. Is this just in one foot (the one with foot drop) or is it bilateral (neuropathy)? You say he received an epidural steroid injection so I assume his doctors felt that the pain was radiating into his leg from the back (pinched nerve). My advice would be to remain in follow up with his current doctors. Maybe you can request a neurological consultation. Good luck.
Nitin K Sethi, MD
Thank you Ranelle for your feedback.
Nitin K Sethi, MD
My husband was given the epidural prior to surgery and we have suspicions it may have something to do with the foot drop and terrible pain he has in the foot (the same leg the replacement was on). We are 6 weeks after surgery and wonder how long we should wait for emg and nerve conduction test. He is dependent on neurotin and hydrocodone for neuropathy (guess that is what the tormenting pain is labeled). Surgeon hasn’t really given much info since he has really never had this severe a case of foot drop and neuropathy. I would appreciate any advice. Thank you
Dear Dr. Sethi, I am currently experiencing foot drop after delivery s baby with epidural June 5, 2012. Baby didn’t wait for the scheduled csection. Husband took me to the hospital early that morning, I delivered him vbac. With epidural. I just couldn’t take the pain anymore at almost 9 cm. all was great, it was beautiful. Until the next morning, i almost fell. My calf and foot were numb. I cant dorsiflex . Some of the numbness has worn off except for my foot and calf, the top of my foot. Nuero doc came in asked questions and had me do some exercises, while still on the hospital. He said my prognosis was good. But wants to see me in 3 weeks. He said it was caused by sciatic nerve compression and should go away on its own. I want an mri or something, I would like to see an orthopedic doc, I don’t want to sit around and wait. I’m so scared. As of today, I can walk up and down stairs unassisted, but I do still have to lift my leg. Have you ever seen a foot drop caused by sciatic nerve compression? I can’t help but wonder if the epidural has caused this. Any insight would be much valued. Mariana
congratulations to you and your husband. Yes foot drop after sciatic nerve compression is quite commonly reported especially if the labor is prolonged and hard. I too share the neurologist’s opinion and feel that this should recover shortly. Keep in touch with the neurologist till the recovery is complete.
Nitin K Sethi, MD
Thank you for your reply. I went to a 2nd nuerologist for a second opinion. As you may recall, the first neurologist had stated that my drop foot was caused by sciatic nerve compression during vaginal delivery. The 2nd neurologist seems to think that it is peroneal nerve entrapment that is causing the foot drop. I am now overwhelmed with the difference between the two doctors. The 2nd neurologist has had an MRI ordered and I am scheduled for the EMG in a couple of weeks. I am still able to walk up and down the stairs unassisted. I can still move all my toes including the big toe. The toes do come up slightly. The numbness over my foot is still present as is the numbness to the outside of my leg. I am confused as to why neither doctor sent me home a print out of information to include exercises. I have learned more about the different causes of foot drop through your posts. Is there a reason why the two doctors had such different opinions? Would you recommend that I see an orthopedic for evaluation of my spine as well? As always I thank you for your feedback.
I have had foot drop for over a year and a half onset after total hip replacement and no improvement. I have had two nerve tests done that provided little info. I am interested in the MRI but my surgeon says it won’t be able to tell any more. Should I get a referral to a Neurologist? Is it too late to do anything to correct this? I give up hope of the foot ever returning to normal. I have the same numbness expressed above. Thank you.
I had my lower saphenous vein lasered in 2008 for painful calf varicosities. Immediately afterward, I had some superficial numbness on the lateral aspect of my foot that gradually disappeared or rather, became unnoticeable. The varicosities have returned and the saphenous vein is now bulging behind the knee. However, I now have problems with an extremely tight hamstring on the same leg and am noticing that when I run, my foot turns inward when I pick up my leg and occasionally I will drag my toes, especially when I start getting tired. Obviously, something is not right, but am not sure where to go next for help with this. Any thoughts?
Your history intrigues me Susan. You should consult either a vascular surgeon or a good orthopedics. Good luck.
Nitin K Sethi, MD
Hello Dr ,
My wife had left Foot Drop recenlty ( march 12) and undergone the nerve decompression surgery near neck of fibula. She recoverd well after that and now doing her exercises and all properly . Sudddently Similar problem started in Right foor as well . It started with a numbness and unable to lift the bottam part of her foot ( around 50 % ). So we again consulted doctor and conducted Nerve conduction and confirmed it similar block happening in her right leg as well . What is the best way of treatment now ? Now the foot is not dropped fully , how ever she had numbness and strain while trying to lift the leg
you should speak to your wife’s doctor why she is having repeated nerve compression (compression neurapraxia) in different peripheral nerves. There are a few conditions which present with liability to pressure palsies. These should be looked for and systematically excluded.
Nitin K Sethi, MD
Thank you for this article and all of your answers to people’s questions. After spending a day on my knees helping a friend lay a floor, I experienced foot drop slightly in my left foot and more seriously on my right. Your post and comments have the best information online that I’ve found.
It’s been about 20 hours since I noticed the symptoms, and they already are much better on the left and somewhat better on the right. I’ve taken Alleve, multivitamins and additional b-complex supplements, and have iced both knees. I have a standing appointment with my PT for later in the week for unrelated issues, and I’ll talk about this with him.
For cases like mine, where there’s an obvious cause for compression of the peroneal nerve, it’s clear from your comments that multivitamins are important. What do you recommend for the following:
— B-Complex supplements (I’ve seen this on other sites) and, if so, what dosage
I haven’t found answers to these questions anywhere online.
Again, thank you very much.
I am hoping that by the time you read my reply, you shall be back to good health. Now to answer your questions. There is no consensus on your much multivitamin to take. I usually advice my patients to take at least 2 tabs of multivitamin (containing all the B complex group of vitamins) per day. I advice them not to drink or smoke till nerve recovery is complete. I advice them to sleep on a soft bed and keep the pressure off the “pinched” nerve. Avoid crossing and uncrossing their legs. I also refer them to physical therapy since a brace at times is helpful especially if they are at risk for falls due to their foot drop. There is no role of anti-inflammatory drugs and ice though they may provide symptomatic relief if the patient is in pain.
Nitin K Sethi, MD
Hello Dr.Sethi. I had lower back surgery 4 months ago and during the surgery, I ended up with Compartment Syndrome in both of my thighs and had to have fasciotomies in both thighs. I also have foot drop in my right foot and severe nerve pain in the same foot and neither has gotten any better. I am currently on Lyrica for the nerve pain. My first question is will the foot drop go away on it’s own and my second question is what actually caused it…the back surgery or the compartment syndrome?
thank you for your questions. I cannot answer if and when the foot drop shall go away. Your doctor who has examined you shall be the best person to direct that question to since he likely is aware of the mechanism of the injury. At times with the help of serial nerve conduction studies (NCV) one can determine if the nerve is recovering and this helps in prognostication. Your second question what caused the foot drop also can only be answered by first determining at what site the nerve damage occurred.
Nitin K Sethi, MD
A couple weeks ago I noticed that my right foot was slapping a bit when I walked. I thought nothing of it and a week later I noticed that I couldn’t lift my big toe as high as my left one. When I push down on my right big toe there is very little resistence. I have no numbness and a small amount of main. Could this be the start of foot drop? Does foot drop usually progress this slowly?
foot drop can be acute (sudden in onset) or more chronic in evolution depending on the cause. There are many differential diagnoses which come to mind and these have to be systematically ruled out. If your foot drop is still there, my advice would be to consult a doctor and let him guide the work-up further.
Nitin K Sethi, MD
Dear Dr. Sethi and everyone who has shared on this site,
Thank you so much for this site and your thoughtful comments. When you have a problem like this, it is good to know you aren’t alone and there is hope! I beleive that I have foot drop because I “hurt” perneal nerve near my knee. I fell asleep in a truck in an awkward position on my leg, and when went to get out of the truck, my whole foot was “asleep.” When I stepped to the ground, my “asleep” foot gave out and I fell to the ground. I am not sure if I damaged my nerve while in the awkward position for too long or if it was due to hitting my knee on the ground when I fell. My foot does not feel like it is asleep, I just cannot move it upward and it is a little bit numb on top and a little bit up my ankle. That happened12 days ago and there is no sign of improvement. I have been to the Orthopedic clinic and the doctor said to give it time. I am hoping for a fast recovery! This is sort of a depressing ailment. From the sounds of it, recovery takes quite a while. I am still a little unsure that people actually do recover.
glad you have found the website helpful. Yes the majority of patients make a complete recovery from foot drop if the cause is “simple” compression neurapraxia. You need to give yourself some rest. Keep the pressure off the affected site. Wearing loose clothing, eat a healthy diet and do not smoke or drink till the recovery is complete. I wish you good health.
Nitin K Sethi, MD
Hi Heather, I found this site when I got a foot drop caused by either a fall when playing squash or ‘slimmers paralysis’ – loosing weight to fast and then compression of the nerve from crossing my legs too long on a flight (2 doctors had two different opinions). I didn’t experience too much pain just an inability to move my foot up and it dragged on the ground when I walked. The neurologist who I saw said it was a severe foot drop. I am happy to say after about 6 months my foot drop is healed. I am back playing squash and there is just a very minimal difference between the flexibility of my two feet (if you weren’t looking for it, you wouldn’t see it). I rested a lot and took B Complex vitamins and tried to eat a healthy diet which I think helped.
Basically foot drop cause my compression does heal – it doesn’t happen overnight but it happens. Rest it – don’t cross your legs or wear tight boots or anything around the knee. I was very scared when I didn’t see a difference immediately but give it time.
all good advice. I thank you for sharing it. Continue to play squash. I used to play squash when I was in Delhi, India and love the game. Miss it here in NYC.
Nitin K Sethi, MD
Hi Dr. Sethi,
Your blog is very informative and its great to see your personal involvement with so many users regarding something you are passionate about. My friend has had back pain resulting from a L4-L5 herniated disc issues for several years. She periodically gets epidurals but has recently been much better. Occasional pain but for the most part she’s been going to the gym and been pretty active without any major complaints. Just yesterday, she gradually experienced pain throughout the day until it was unbearable and she was barely able to walk at night. Today, it’s gotten worse where she cannot wiggle her toes, move her toes up or down, and can only sightly have her foot move at the ankle area. She has no sensations from the knee down and unbearable pain when pressure is applied to that foot (left foot). The area of her slipped disc is very painful as well. This happened out of nowhere and we are concerned. She’s been in and out of the ER countless times and they always discharge her with pain meds. Being that this time there is an issue with her foot (which has not happened before) we are not sure whether going to the ER will prove useful. She is skipping that option and has to go into work tomorrow. If she is experiencing foot drop, how serious can it get and what is the time frame we have before we need to react on it? Her regular doctor who treats her and knows her condition is out of state. Can this numbness result in anything else if we try to stretch and mobilize for the next few days? Should we be concerned that this is something other than her herniated discs? Thanks again for this venue.
thank you for writing in. I cannot comment on your friend’s case since I have not see her MRI scan myself and neither have I examined her. More than likely it is still her old disc issues “acting up”. In medical terms we refer to it as acute on chronic lumbar radiculopathy (meaning there is a chronic disc disease resulting in radicular pain–pain that radiates down the nerve such as sciatica. Superimposed on this chronic condition is as acute condition). If she does have “actual” weakness (or foot drop)–actual meaning real weakness and not that she is unable to move her foot due to pain–then yes I would advice that you should get it checked as soon as possible.
Good luck and keep me posted.
Nitin K Sethi, MD
Hello again. It has been 18 months since my THR and onset of foot drop with no improvement. The Nerve conduction tests have been done twice now a yr apart and no improvement. I dont seem to be getting any answers from my Dr. I asked for an MRI and they said that would not show any more than the nerve tests. Is there any hope for my foot ever recovering? They say the nerve damage is up by my hip but the numbness is only from the knee down. I am tired of AFOs and not being able to walk without wearing one. I also have the continued “buzzing” like my foot is asleep times 1000 if I am sitting letting my foot “drop” without an afo. Thank you for all the valuable information shared here. I dont understand why this happened if the nerve does not show any signs of being cut etc.
It seems that most Doctors will try to sweep this under the rug..denial seems to be the best defense..
Your nerve injury may recover over the next year or so..It’s been 3 years for me without much change.
600mg Neurotin 4X daily helps the pins and needles..
Take a look at a carbon fiber AFO..it fits in my regular tennis shoes..
Hope this helps
Hi Lynne Yes the person who suggested the carbon fiber AFO is much better. It is light as a feather and still takes a wearing in period but you will walk much better.
HI, thanks for the replies. I have 2 carbon fiber AFOs. One has a bulky cuff that goes around my calf. The problem is the bar that comes up your foot/leg that cuts in to my ankle. I am so sick of being stuck in a shoe all day to accommodate the AFO and being limited to oversized athletic shoes. The best AFO I have ( I wish we could post pics) is one the Ortho Tech custom made. It has joints at the ankle that allow my foot to bend on steps etc. It is shorter-strapping around the ankle and will fit in a few more shoes. Looks more like a sport ankle brace. I do occasionally use the Neuroitn at night . I have an appointment in a week with the Surgeon and was wondering if there is anything I can for such as a referral for different testing/drs etc? Thanks again!
I would take both braces back in and ask the person to try and make them more comfortable. Don’t give up and your comfort. Sounds like you need to take more of your meds at least for now. I would ask your doctor what he would do if it was him at this point.
My daughter is 6 years now and had mutiple extosis, due to the tumor below the knee damaged the nerve she got foot drop. the mass is removed and she had physco theraphy for 1 1/2 year. Now last 6 months I have stopped teraphy as she is not willing to do so. She can move her foot both sides and fingers upwards but not the ankle. Her first EMG did not come up positive as she did not cooperate, she was just 4 1/2 years then. Currently she is wearing AFO. without AFO also she do not have any issue with walking or running, cycling or playing. Only she has to lift her knee little bit higher.
Please let me know if this has any solution, will this grew with time as she will grow or will recover as her muscels will grow stronger with age.
thank you for your question and I understand your concerns. Unfortunately I cannot prognosticate on your daughter’s future recovery since I have not examined her. You should follow up with her surgeon.
Nitin K Sethi, MD
Hello Dr – My mother got a foot drop almost 5 months back. She has consulted number of doctors in India and all the tests are normal. Doctors are not giving any medicines and saying that dfoot drop is due to weakness. I understand that it would be hard for you to take a precise call, but is foot drop due to weakness repairable ? Thanks in advance.
Dr Sethi, I had nerve decompression surgery on July 29th, 2012. I was having pain in my left leg with a burning in the calf and thigh. I had numb and tingling sensation for a couple of months in my left foot prior to surgery and loss of strength in the foot. This followed by foot drop. I feel my surgery, a lumbar laminectomy at L4/L5 was successful since all of the real pain is gone. The only residual effect is the foot drop with my big toe and the next toe and the top of my left foot numb and tingling. I was told to wait and see how it does over time, maybe as long as 6 months or possibly longer. I am a very active 62 year old and a little impatient. I know nerves are hard to fix. And that they may not fix. I was told my nerve was compressed not crushed. I have seen things like Vitamin B and R Alpha Lipoic Acid that seem to help with diabetic neuropathy.I may not have neuropathy as diagnosed but the symptoms are there and we can not call it peripheral neuropathy until the nerve has had a chance to heal. Are the supplements I mentioned good for this? I have done much reading and it seems they do have a positive effect on Diabetic Neuropathy. What about my problem? What are the chances of my nerves healing and going back to normal. Thank you for your time and consideration.
My complaint rarely evolves to foot-drop anymore as the initial signs that I have been compressing the peroneal nerve are numbness on the lateral and underside of the foot after squatting for any significant period of time. I’ve heard this described a Strawberry Picker’s Palsy. My fitness regimen has me use squatting as a more biomechanically friendly way of reaching objects on the ground and it has helped me regain the sort of external rotation in the hips common to children at an age of 47. The numbness is a concern though and I am trying to make a cost-benefit decision as to whether enjoying the increased ROM, stability and mobility and is worth the cost of some sensation loss and, in extremes dorsiflexion. Is the condition always reversible with rest (as it has been since my 20s) or is there a risk of permanent loss of function from prolonged squat resting?
Good morning sir, I was involved in a car accident in which I sustained injury to the pelvis. I also noticed I couldn’t move my toes and foot. Gradually movement returned to my toes and foot but I can only dorsiflex. I was told by the doctor that I will undergo partial hip replacement. Though I m yet to do the operation. After few weeks at the hospital I could nt bend my knee properly. So doc, after my broken pelvis s restored, will I gain full use of my knee and foot?
Dear Dr. Sethi,
I was developing foot drop and it was progressively getting worse. i took it upon myself to figure out that I had peroneal nerve compression due to an exceedingly tight calf. I had surgery to decompress the nerve at the fibular head and the deep peroneal. The foot drop got worse and just had gastrocnemius recession done. I am hoping this fixes thefoot drop, The frustratng part is that I’m told there is no nerve damage, it is all muscular!!! What do you think? I just had tye gastro done 3 days ago.
Hi Dr. Sethi,
I am a 64 year old male who has recently had a sudden loss of movement in my left foot. I fell in mid October 2012 and landed on my left side (buttocks). I had bruising but no pain. I then went about 1 month without any issues and around November 19th, 2012 I started to notice a loss of movement in my left foot. Corresponding to that same timeframe, I had two severe leg cramps in my left calf muscle. After those cramps, my left foot condition quickly worsened and since early December 2012 I have been unable to use my left foot. I have full movement in the hip and knee. I have no pain. I still have sensation in my left foot, but have no movement… cannot flex toes, pull foot up, or do circles with my ankles. I have had a history of crossing my legs. I recently had an x-ray on my lower back/hips and all was good and had an MRI and it showed some deterioration in my L2/L3 vertebrae, but nothing as far as muscle, ligament or nerve damage. My GP is at a loss for what to do next and the waiting list to get into a neurologist in my area is 6-7 months. I now have to walk with the assistance of a cane. Please help. It should also be noted I was diagnosed at treated for esophageal cancer in 2011. Currently, I have no recurrence. My treatment plan included chemotherapy, which concluded in January 2012. Thank you for every bit to advice and help you can give.
Dear Dr Sethi
I have recently developed foot drop in my left foot I am 42 yr male, physically fit, take regular exercise like 30-forty pushups and stretching etc. I have never touched alcohol or smoked. I take good nutritious diet with fruits. I do not sit cross legged for long. . One month ago, I sustained a minor injury due to a fall from a wall. The fall caused severe back ache which subsided one the orthopedics expert told me to lie down, bring my feet closer and life the back upwards hold it for 5 seconds and let it come back to the ground slowly. I did it ten times religiously for 14 days thrice a day. I went to the park and hung myself upside down swing my body for 2 mins for two days . About 90 % of the pain subsided. Eight days ago, I felt the foot slap in my left foot, I was advised to see a neuro surgeon, I went to him at once. He diagnosed it to be a foot drop. An MRI was done for the lower back and then done again as the doctor wanted some “contrast” to see some thing in my lower back clearly. As soon as the report was out, he doctor advised me to undergo surgery as it was the only alternative.
Current problem: Numbness in part of left heel and the area upto the left thumb. I can flex the foot down but not upwards..I can not stand or walk for more than 5 minutes.
My MRI Report reads:
The study reveals evidence of a well defined rounded altered signal intensity lesion involving left seural foramina/lateral canal region at L3-4 level extending inferiorly posterior to superior end plate of L4 vertebra involving left exiting L3 nerve root . The lesion shows peripheral rim enhancement following administration contrast with central non enhancing component. The lesion measures approximately 8.8 x 5.8 mm. The lesion demonstrates iso-dense signal on T1 and T2w images.
MR findings reveal Lumbar spondylotic and disc degeenrative changes associated with:
* Iso-intense rim enhancing lesion in left neural foramina/leteral canal region at L3-4 level compression left exiting L3 nerve root. Imaging findings are favour of herniated nucleus pulposus with peripheral granulation tissue representing scar with other less likely differential of nerve sheath tumor.
* Mid left far lateral disc bulge at L3-4 level with superimposed fissuring indenting ventral thecal sac encroaching inferior aspect of left neural foramina which along facetal joint arthropathy and ligamentum flavum hypertrophy is causing severe left foramina stenosis and left sided compressive radiculopathy.
* Broad based posterior disc bulge with mild postero-central disc protrusion at L4-5 level mildly indenting ventral thecal sac encroaching inferior aspect of bilateral neural foramina which along with facetal joint arthopathy and ligamentum flavum hypertrophy is causing moderate to severe bilateral neural foramina stenosis and consequent bilateral compressive radiculopathy.
Sir, Kindly advise if it can be cured with physiotherapy. Where should I consult- pl advise a neuro expert. I am at Palwal a small town close to Faridabad and about 60 kms from Delhi.
Hi Nitin, a quick question – my apologies if you’ve already discussed/covered this… I have a confirmed 16mm L4/L5 herniation with possible sequestration. Initially I had severe pass out type pain come on after rising in bed one morning, with foot drop, lateral numbness – at one point a large part of my foot, and not just outermost laterally along my left foot with decreased sensation to the 1/4 lowest lateral aspect of my leg. I have seen a neurosurgeon right after the incident and he thought it best to manage it conservatively and basically just watch it. It’s been three months now and my left leg has atrophied where my calf is considerably smaller than right, as is glute and hamstring. The first few weeks made it difficult to walk much at all as I had sacral spasms when attempting to. I didn’t walk as much as I think I should have; however, I can now tolerate walking several kms – albeit with a limp and very noticeable leg weakness. My question is, with normal use, if the L5 nerve is no longer impinged, is it possible that it would still atrophy? I was considering perhaps if it weren’t innervated for a period of time, unless it was given isolated specific exercises, it might not naturally re-innervate? Or, my fear is, the L5 nerve is still impinged. I’ve been able to walk several km’s for weeks now, and have done fairly regular walking – I used to easily handle 14kms+ including hiking, now my leg is exhausted after few km but tolerable. Have you seen cases where there was no longer impingement but still saw progression of deficits – in muscle stimulation (with subsequent continued atrophy)? I haven’t been doing physio or going to the gym at all but will be trying that now. Thanks so much!
First and foremost, thank you so much for you post on foot drop. It is informative and easily accessible. I was hoping you might be able to answer a more specific question for me regarding resolution of symptoms.
About a year and a half ago, I was involved in a very serious motorcycle accident that required extensive hip surgery (SI joint fixation and ORIF to correct multiple acetabulum fractures). During this surgery, my sciatic nerve was stretched and damaged, causing immediate and total foot drop in my right foot. During the first week, I suffered severe neurological pain (treated with some degree of success with varying doses of Neurontin). Over the first year, I had no change in range of motion, but over the first few months the neurological pain ceased. The outside of my shin felt like pins and needles to the touch, and the top of my foot felt completely numb.
Quite spontaneously this evening, I noticed a small amount of abnormal movement in my foot. Although I cannot be sure if this has been slowly developing without notice or actually a spontaneous return of perineal function, I definitely have a sudden change here. Emanating from somewhere along the top of my foot, I have regained roughly 1-2 inches of dorsiflexion capable of overcoming mild resistance pressure. In addition, the top of my foot feels cooler than the rest of my leg. I can generate slight pins and needles with vigorous brushing over the top of my foot, and the outside of my shin feels much more normal until closer to my foot.
As I have never been followed by a neurologist, and I have not been in contact with my treating orthopedist in many months, I do not know where to go from here. Is there a possibility that my foot drop will completely resolve? What are my chances? Is there anything I can do to facilitate recovery?
I know it has been a long time since this post was originally made, and I am grateful for any input you might be able to offer. Even if this is all I ever get, this has been an incredible gift. Thank you!
I gave birth naturally three weeks ago, and during labor “lost my foot” as I put it then. The drop foot was total for about a week, and since then has begun to slowly improve. I can now lift my foot about an inch and a half and wiggle my toes. 🙂 Walking is still difficult, though I’m getting more confident in dealing with it as time goes by. I still cannot walk around with my baby, for fear I’ll trip over my own toes!
Do you have any idea how long it will take for full recovery? I can’t wait!
Thanks for this wealth of information. I’m 30y/o male with a desk job, and unconsciously have been sitting with my legs crossed for most of that time (hours at a clip.) Sometimes they are even double crossed, where my foot comes back around the ankle of the leg that is supporting the crossed on. My legs are skinny, and I mean skinny enough that most people say something when I am getting fitted for a suit or wearing shorts.
So where I’m at now. The other night I got up from a long day of work (with some getting up and down) and was getting ready to go out when I noticed my foot was experiencing foot drop and a mild struggle in the shin muscle to prevent it. Not to the extent where it won’t dorsiflex at all, but to an extent where it was at about 2/3 capacity. It improved as the night went on, but now the changes (two days later) are much more minimal.
I thank you for this site, because if it wasn’t for knowing that my leg crossing could be the root of my problem, I would have begun to assume it was something more insidious that I was going through. My age + the leg I cross + the sudden onset + how I sit makes a lot of sense right now. Now I’m just worried about how long the repair will take organically.
Any insight to home remedies? Would it be safe to say that I compressed my nerve?
I underwent my third discechtomy operation just 21 days ago
I had the 1st bet L 4,5 then 3 years later bet L5,S1
And 6 years later between L4,5 again but in this last
Time it progressed rather quickly and I developed
Drop foot 5 days prior to surgery and it is still there
My neurosurgeon said it’ll probably be back but
His face wasn’t very optimistic
I try to be positive but I have a question what does
Vigorous physical therapy include? Because so far
My neurosurgeon only recommends dorsi and plantar flexion
Excercises with eversion and inversion while asleep and my therapist
Disagrees and wants to stimulate the nerve Electrically
Sorry because I live in a country that lacks defenite differentiation
Between specialties . Can u tell me what to do?
My footdrop first started with intense neuropathy. I first noticed after iwas forced to drive my manual gear car a couple of times. This was 3 months after the onset of np. The np made me lose about 15kgs so fast. Before that I had been very active and used to walk long distances, jog and dance a lot. Now the np pain and resulting muscle wastage have just turned me into an almost vegetative state. I use a crutch evrywhere and has no balance. I have noticed that taking a multivit has helped somehow with the pain and am now able to sleep. But the footdrop is still there and its making me depressed and almost suicidal. Pls help. What do I do?!!
Moses, many of us suffer with this condition from different causes…see a doctor to get advice for which type of specialist is available in your area and also ask for a referral to a physical therapist to see what they can do to help. There are meds to help with the nerve pain, swelling etc. Maybe the good doctor will have some good advise for you as well.
Good luck and hang in there,
Thank you as always for your comments and advice Marcia. Hope you are healthy and happy.
Nitin K Sethi, MD
I’m a biomedical engineer currently developing a stimulation brace to assist patients experiencing foot drop. Basically the brace stimulates the common peroneal nerve to achieve dorsiflexion muscles contraction. I’m expecting the system to have much more efficiency than basic passive orthosis.
I would like to know your opinion concerning such a system. Would advise it for rehabilitation? If you would, to what degree of foot drop would you advise it?
Joseph, I have foot drop secondary to a revision of my right hip joint with a cage which traumatized the nerve. So far the only stimulation devices I have heard of are for folks who have a CNS type of foot drop…will your devise work for people like me with trauma to the nerve ( not cut ) due to surgery ? Please respond and if so I would be interested in a clinical trial when that might come about.
i may sound a bit off the track but I would like to share with you that I too had this problem of Foot Drop in Nov 2012 and I met three experts who by way of Accupressure and little physiotherapy healed it and my foot turned normal by the end of Jan 2013. I suggest that the patients with similar problem approach a good Accupressure specialist. In case there be any patient from India, I would be glad to share the address where this treatment is available.
Thank you for your feedback Anil.
Nitin K Sethi, MD
I would be interested in what your accupressure and phisiotherapy consisted of…..I wonder if accupuncture would help as well?
I was recently working on my knees a lot and when I went to sleep one night I woke up with foot drop the doctor said it was due to compression and said it would heal in the next couple of week it has healed to about half the strength and has made no more improvement. When I have searched the web for answers a lot were multiple sclerosis. Could I have this? I am only 20 what are the chances it could be this?
Luke, multiple sclerosis can present in many fashions. I personally have never seen a patient of multiple sclerosis who presented with foot drop as his first and only symptom.I would advice you to bring your concerns to the attention of your primary care physician/ doctor. A good examination and history shall help allay your concerns and fears.
Nitin K Sethi, MD
Im at a total loss.. I have an unusual foot drop, where my left foot will turn inward at the ankle. It only starts after 30 or so steps, but will kick in sooner if I walk too fast. If I stop and rest for just a bit, Im allowed another 20 or so normal steps. I have a full AFO which helps. (I couldn’t work without it). But at times the AFO doesn’t help at all, as its not a downward problem, but a sideways problem. Ive had a total workup with a neuromuscular MD, with 4 MRI’s (brain, spinal chord, left leg, peroneal nerve), and 4 EMG’s. Everything was normal. I do have some varicose veins on my left leg, but the vascular surgeon said they wouldn’t cause my limp. I wonder if the EMGs were normal because my problem is delayed?? I am 57 years old, and am in very good health otherwise. Im not overweight, and my lab values are fine. There is no numbing, or tingling, or pain of any kind. Ive had no injuries or surgeries. I used to walk miles and miles for exercise, and now can’t even manage a parking lot, and there isn’t any reason!!! All of the MDs are stumped, and I seem the only person on the planet with this problem. Have you ever heard of such a thing?? Thank you for your help.
Thank you for writing in to me Sharon. Your case intrigues me too. I have only one suggestion–have any of your doctors investigated you for dystonia? You may like to bring this up with your doctor. Please feel free to write it again. I wish you the best.
Nitin K Sethi, MD
I’ve a frequent leg crosser (I’m 16, female) and yesterday I noticed my right foot bangs louder on the ground when I walk, the slight numbness, how I can’t lift my foot all the way (I can toes and a bit off the ground it still feels restricted) and of course, the way I have to lift my leg when I walk so I don’t trip. Please help Dr Sethi. I’ve never had any serious medical problems and I’m really worried. Will it go away on its own? Should I stop crossing my legs?
Thank you, Dr. Sethi, for the wonderful website that you keep up on so well!!
I posted on this site a little over a year ago because I was experiencing foot drop that I believed was due to a pinched/damaged nerve near my knee after being in an awkward position for an extended time. I am happy to say that it only took a few months for me to fully recover! I took a vitamin B complex, took care of myself, and, by accident, got Ultrasound therapy! I would like to think that is what significantly helped me. It was performed by a chiropractor. I went to him for another issue with my hip and puzzled him when I told him about my foot drop. He performed Ultrasound therapy, focusing on my knee area. I do not know for sure if that is what cured it, but I believe that it truly helped me have a speedy recovery! I went in about once a week for the therapy for about three months and seemed to recover in no time. I don’t want to steer anyone in the wrong direction if this is a bad thing, but at the same time, I want to share what (seemed to) work for me!! Good luck everyone!
Heather, it is such a pleasure to hear from you again and I am happy that you are well. Thank you for your comments.
Nitin K Sethi, MD
So, Docter do you thi k it is possi le this ultrasound thraphy helped the foot drop?
Can occasional foot drop be caused by autism, ADHD, and/or dyspraxia? It’s happened maybe 0-4 times a year for as long as I can remember, probably less often now then when I was a kid. It usually happens when I’m in a hurry and focused more on where I’m going in the abstract sense more than I’m paying attention to where I’m literally walking.
I am suffering from foot drop from atleast 3 weaks .. One day i was having fever from 2 days nd when i got up in morning i found it difficult to walk in left leg … Then we reffered to dr. He provided medicines nd asked for physiotheraphy but aftet some days when stimulator was applied my foot does’nt move then i reffered another dr . he asked that its that viral of fever nd physiotherapist asked for test … My ncv and emg reports are normal my muslea are also weak when i stand from lying on bed there sounds some voice in joints of hand progress is there but my foot bears less weight i am 16yrs old so i need advice that how much time it will take i think its due to internal weakness my knee also sometimes when put weight get bend suddenly but nw that’s stoped i also has been injected 5injections of meco 1000 please advice me what to do i am doing exercises regularly adviced by my. Physiotherapist please advice me what to do….. I shall ve thank full to u
I am suffering from foot drop help
Hi , 3 months back i had an accident and i broke both Fibula and Tibia of my right leg , i also had undergone right hip surgery as it was dislocated. Now i m not able to move my right foot and don have sensation on the right part of my leg (Below Knee ), but i feel tinglings in my foot and some times it pains. I just wanted to know if it is a good sign and if it is recoverable .
I’m under a neurologist and have been for the last year or so. My problems started with my left hand/arm. My two end fingers started curling over and I had terrible pins and needles all the time. I also have a lot of muscle wastage in my hand and arm.
Four months ago I was in the bath and went to get out and couldn’t move my left foot. My partner helped me out. I ended up in a & e as I couldn’t move my foot / toes and had excruciating pins and needle pain. I got admitted and had a lumbar puncture as guillan barre was suspected.
I have had numerous tests including MRI of spine which showed nothing. EMG/nerve conduction studies on my left side which show nerve and muscle damage but no cause of it. Blood tests all normal apart from slight raised inflammation. Lumbar puncture which was clear.
My neurologist is at a loss as to what’s causing my problems. My left leg is so thin compared to the right leg and all the muscle has gone. I’ve still got foot drop and have done for 4 months now. My fingers are still curled too.
I’ve beeh started on gabapentin which is working wonders for the nerve pain. I have also been on a course of steroids which made no difference.
My neurologist has now requested a brain MRI and he’s refereed me to his colleague for a second opinion (also a consultant neurologist ).
Have you come across anything like this befire?? My neurologist mentioned it could be psycological??? I was upset at this comment as I am of sound mind and don’t understand how I could caste this to happen to myself. ?? He said it happens sub consciously. I think this is a cop out as he can’t find out what’s causing this.
I’m at the end of my tether now and just want some answers.
I have been sufferring from foot drop. I have undergone stimulation process bt it doesn’t work. Nw am gng to marry.. Is there are any chances of inheriting this to my children?? Please help me on this…
Hi I’ve had foot drop for nearly 4 weeks had an mri scan which showed L5 root entrapment with marked foot drop 1/5,,,,, seen a physiotherapist consultant she said my foot drop won’t go without surgery and referred me to a spinal surgeon still waiting for an appointment to see what they say,,, don’t get that much pain in my back unless I do abit to much,, I get twinges still shooting down my leg,, can’t lift foot or move from side to side can move 3 toes abit can’t bend them, leg is weak,, just wondering if any one can tell me what to expect,, had back ache for 4 days before foot drop that’s when I had pain in buttock leg and foot within few hours developed foot drop,, thanks
Hi I’ve had foot drop for nearly 4 weeks had an mri scan which showed L5 root entrapment with marked foot drop 1/5,,,,, seen a physiotherapist consultant she said my foot drop won’t go without surgery and referred me to a spinal surgeon still waiting for an appointment to see what they say,,, don’t get that much pain in my back unless I do abit to much,, I get twinges still shooting down my leg,, can’t lift foot or move from side to side can move 3 toes abit can’t bend them, leg is weak,, just wondering if any one can tell me what to expect,, I had backache for 4 days when I had pain in buttock leg and foot within few hours had foot drop been the same since,, thanks
Hi I’ve had foot drop for nearly 4 weeks had an mri scan which showed L5 root entrapment with marked foot drop 1/5,,,,, seen a physiotherapist consultant she said my foot drop won’t go without surgery and referred me to a spinal surgeon still waiting for an appointment,,, don’t get that much pain in my back unless I do abit to much,, I get twinges still shooting down my leg,, can’t lift foot or move from side to side can move 3 toes abit can’t bend them, leg is weak,, just wondering if any one can tell me what to expect,, many thanks
Dr. Sethl. I had hip replacement a month ago-I had and epirdurl for the operation. When the operation was over I had severe pain down both legs and left foot.I coud not bring my foot back.My doctor said I had drop foot, I had never heard of this. Before the operation I inform my doctor and the anitesiest that I had a buldge disk in my L4 and for them to be carefull with the way they handled me.No one informed me of the side effects of the hip surgery or the epirdural. Do you know what caused this, because I still have the droped foot.
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