Maybe your toes catch on the edge of the rug, or your foot slaps the floor with each step. Trouble lifting the front of your foot, called foot drop or drop foot, makes walking tiring and raises your risk of falling. A foot drop brace can help you walk more safely.
A brace is only part of the answer, though. Foot drop is a symptom, not a diagnosis. Something is affecting the nerves, muscles, spine or brain that control the foot, and that cause shapes your treatment and outlook.
What foot drop looks and feels like
The muscles along the front of your shin lift your foot as you swing your leg forward. When they weaken, you may notice:
- Toes that drag or catch, especially on stairs, curbs and carpet
- A slapping sound as your foot lands
- A high-stepping walk, or swinging your leg out to the side
- Numbness on the top of your foot or the outside of your shin
It can affect one or both feet and be mild or complete.
What causes foot drop and how it is diagnosed
The most common cause is pressure on the peroneal (fibular) nerve, which wraps around the outside of the leg just below the knee. Habitual leg crossing, long squatting or kneeling, a tight cast, major weight loss, or a knee injury or surgery can all compress or injure it.
Other causes include:
- A pinched nerve root in the lower back, often from a herniated disc or spinal stenosis
- Injury to the sciatic nerve, sometimes after hip surgery or trauma
- Stroke, multiple sclerosis, or a brain or spinal cord injury
- Nerve damage from diabetes
- Nerve and muscle diseases such as ALS or Charcot-Marie-Tooth disease
A physician checks strength, sensation and reflexes in both legs. Electromyography (EMG) and nerve conduction testing can show whether the problem lies in the nerve near the knee, a spinal nerve root or the muscle, and how severe it is. Imaging or blood tests may follow.
Types of foot drop brace
Most foot drop braces are a type of ankle-foot orthosis (AFO), which holds the foot up as you step. Common options include:
- Off-the-shelf AFOs: prefabricated plastic or carbon fiber braces that run under the foot and along the lower leg, often used for mild to moderate weakness.
- Custom-molded AFOs: made from a cast or scan of your leg, often recommended for severe weakness, an unstable ankle, swelling or reduced feeling in the foot.
- Hinged AFOs: braces with an ankle joint that allows some controlled movement.
- Soft dorsiflexion assists: an ankle cuff with an elastic strap to the shoelaces, lighter but less supportive.
- Functional electrical stimulation (FES) devices: a cuff below the knee that stimulates the nerve to lift the foot with each step. They may help some people after stroke or with multiple sclerosis, but only work when the peroneal nerve itself is healthy.
Why a professional should fit your brace
The right foot drop brace depends on your diagnosis, strength, ankle stability, skin and daily activities. A physician usually prescribes it, an orthotist fits and adjusts it, and a physical therapist helps you walk well in it. A poorly fitting brace can rub, cause pressure sores or create new walking problems.
Once you have one:
- Wear it with a roomy, supportive shoe and a long sock
- Build up wearing time gradually, as your orthotist advises
- Check your skin daily for redness or blisters, especially if you have diabetes or numbness
- Have the fit rechecked if your weight, swelling or strength changes
Treatment beyond the brace
Treating the cause comes first, such as avoiding leg crossing, managing diabetes or addressing a disc problem. Once pressure on a nerve is relieved, function often returns over weeks to months, though some nerve damage is permanent.
Physical therapy can help with:
- Strengthening the muscles that lift the foot, when some function remains
- Stretching the calf to prevent a stiff ankle
- Balance and gait training to lower your risk of falling
Depending on the cause, surgery such as nerve decompression or a tendon transfer may be an option.
Foot drop warning signs
Call 911 if foot drop or leg weakness comes on suddenly, especially with facial drooping, arm weakness, trouble speaking or confusion, which can signal a stroke. Go to an emergency department for foot drop with new loss of bladder or bowel control or numbness in the groin, or for severe pain and tight swelling in the shin after an injury.
See a doctor promptly for foot drop that develops gradually, worsening weakness, or foot drop in both feet.
Frequently asked questions
Is foot drop permanent?
It depends on the cause. Foot drop from short-term pressure on the peroneal nerve often improves over weeks to months once the pressure is removed, as the nerve slowly recovers. Foot drop from severe nerve injury, stroke or a progressive condition may be long-lasting. Your physician can explain what to expect.
How long will I need to wear a foot drop brace?
Some people need one only while a nerve recovers, often a few months; others with lasting weakness wear one long term. Your care team will recheck your strength over time and tell you when it is safe to cut back. Don't stop wearing it on your own, since tripping and falls are a real risk.
Can you drive with foot drop?
It depends on which foot is affected, how weak it is and whether you can feel the pedals. Right foot drop can make braking slower or less reliable, so talk with your doctor before driving. A driver rehabilitation specialist can assess your driving and suggest adaptive equipment, such as hand controls, if needed.
Talk with our team
Physical Medicine & Rehabilitation of NY & CT (PMR) can help find the cause of foot drop with a physiatry evaluation and nerve testing, and our physical therapists can help you walk more safely with your brace. Request an appointment and our team will contact you to schedule your visit.