Foot drop is not a disease in itself — it is a sign that the muscles at the front of the ankle are no longer working properly. In a healthy leg these muscles lift the foot upwards (a movement called dorsiflexion) so that the toes clear the ground when you walk. When they are weak or paralysed, the front of the foot drops down and drags.

The problem almost always begins with a nerve. The common peroneal nerve, which wraps around the outer side of the knee at the top of the fibula (the outer shin bone), is the most commonly injured nerve in the lower limb. Because it sits close to the skin at this point, it is easily bruised, stretched or compressed. Damage here switches off the muscles that lift the foot and turn it outwards.

Foot drop can be temporary or permanent, and it can affect people of any age — from sports injuries in young, active patients through to nerve problems later in life. Specialist assessment by a Consultant Foot & Ankle Surgeon in London such as Mr Matthew Welck gives you the widest range of treatment options and the best chance of a full recovery.

Foot drop is one of the more frequent nerve-related problems seen in a foot and ankle clinic. Because it has so many possible causes, exact figures are hard to pin down, but nerve injuries of the lower limb are common and the peroneal nerve is the one most often affected.

In a large European study of peroneal nerve problems, around 1 in 6 cases had no obvious cause, roughly 1 in 5 followed surgery around the knee, and about 1 in 9 were caused by trauma. Weight loss, prolonged pressure on the nerve, and diabetes were other recognised triggers. In short: foot drop is common enough that it should always be taken seriously and investigated promptly.

Causes fall into three broad groups — nerve, muscle, and spine/brain. The commonest are:

Nerve causes (most common)

• Compression of the peroneal nerve at the outer knee — from crossing the legs, prolonged bed rest, tight plaster casts or a direct blow
• Trauma and sports injuries — fractures around the knee or fibula, and knee dislocations, which can stretch or tear the nerve
• Slipped disc (lumbar disc prolapse) or trapped nerve in the lower back (the L5 nerve root)
• Diabetic neuropathy and other conditions that damage nerves over time, such as Charcot–Marie–Tooth disease which is a disease that affect nerves.
• Complications of hip or knee surgery, or a nerve tumour pressing on the nerve

Muscle causes

• Rupture of the tibialis anterior tendon (the main foot-lifting tendon)
• Compartment syndrome or muscular dystrophy affecting the front-of-leg muscles

Spine and brain causes

• Stroke, multiple sclerosis, cerebral palsy or spinal cord problems that interrupt the signal to the leg

• A high-stepping “steppage” gait — lifting the knee higher than normal to stop the toes catching, as if climbing stairs
• Foot slapping — the foot slaps flat onto the floor at each step instead of landing heel-first
• Tripping and catching the toes on kerbs, carpets and uneven ground
• Weakness lifting the foot or toes, and difficulty turning the foot outwards
• Numbness or tingling over the top of the foot or outer shin
• Loss of confidence and reduced walking distance, with a higher risk of falls

If foot drop is longstanding, the foot can become fixed in a pointed-down position and skin problems or pressure sores may develop, so early review is important.

• Clinical examination — testing the strength of each muscle group and checking sensation to locate exactly where the problem lies
• Nerve conduction studies and EMG — electrical tests that show whether the nerve is compressed, recovering, or divided, and how the muscles are responding
• MRI scan — of the lower back if a slipped disc is suspected, or of the knee/nerve to find compression or a tumour
• Weight-bearing X-rays and weight-bearing CT (WBCT) — modern low-dose imaging taken while standing, used to assess the position of the foot and the health of the joints before any surgery

Many people start here, and some recover fully without an operation — especially where a nerve is bruised rather than divided.

• Treating the underlying cause — for example relieving pressure on a trapped nerve or optimising diabetes control
• An ankle-foot orthosis (AFO) — a lightweight brace worn in the shoe that holds the foot up, stops the slapping and dragging, and restores a safer, more natural walk
• Physiotherapy — to keep the ankle supple, maintain muscle strength and prevent the heel cord (Achilles) from tightening
• Functional electrical stimulation (FES) — a device that stimulates the nerve to lift the foot as you walk, helpful in some neurological cases
• Watchful waiting — where a nerve is expected to recover, a period of up to around 12 months of supported rehabilitation is often recommended before considering surgery

The right operation depends on the cause, how long the foot drop has been present, and whether the nerve can recover. The plan is always highly individualised.

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — the UK’s leading orthopaedic hospital — and Honorary Associate Clinical Professor at UCL. He is widely regarded as one of the best foot and ankle surgeons in London and North London.

His practice is dedicated exclusively to foot and ankle surgery, with specialist expertise in nerve and tendon transfer surgery, sports injuries, Achilles rupture and Achilles tear, complex reconstruction and total ankle replacement. He has authored over 50 peer-reviewed publications, holds double fellowship training, and is a pioneer of weight-bearing CT and 3D-printed patient-specific instrumentation for complex deformity.

Patients are seen across North and Central London with rapid access to MRI, WBCT, nerve testing and multidisciplinary care. Every option is discussed openly and a bespoke, individualised plan is agreed together.

If you are tripping, dragging your foot, or have been told you have foot drop, specialist assessment can make a real difference to your recovery.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon. Early expert review gives you the widest range of treatment options and the best long-term result.

Email: secretary@matthewwelck.com
Call: 07547 395 270
Website: matthewwelck.com