Foot Drop

Foot drop refers to the loss of the ability to dorsiflex, or raise the foot at the ankle, causing a floppy foot that hampers walking. Foot drop can be caused by many factors, but most often it is due to an injured peroneal nerve. When the peroneal nerve is damaged, it cannot stimulate the tibialis anterior muscle which is responsible for lifting the foot up at the ankle. Trauma or a tumor anywhere along the nerve can cause foot drop. 


There are two methods for surgically repairing the nerve available within six or so months of the injury. Some cases up to a year old can be addressed with nerve surgery. These surgeries offer recovery of voluntary movement so that the patient does not have to use an orthotic device or walk with an awkward gait. After this time frame, tendon transfers or other ankle stabilizing approaches that do not restore movement as well, but improve mobility, are available.



Nerve Transfer Surgery

Healthy nerves adjacent to the injured nerve can be bridged to the injured nerve, bypassing the area of injury.  Nerves responsible for the ability to push down the foot, for example, can be branched to also supply power to the ankle for lifting up.


Nerve Decompression Surgery

When the peroneal nerve was stretched but not torn a simple nerve decompression surgery can restore function.  Decompression refers to surgically relieving pinching of the nerve, and like a garden hose that has been unkinked, the flow of power to the muscle improves and results in return of function. 


Tendon Transfer Surgery - There is no time limit for this surgery to be performed


Transferring the Posterior tibial tendon to the tibialis anterior tendon acts as an internal splint so that an external brace should no longer be necessary.  Dr. Nath performs the transfer along with nerve decompression to improve function significantly.  


Foot Drop Nerve Surgery

  • Surgery takes 1-2 hours, and requires 1 night stay in the hospital.
  • The incision is 3-4 inches long below the knee

Top left panel – Surgical incision is made at the popliteal fossa.
Top right panel – Preoperative anatomy of the tibial and peroneal nerves (common and the branches to superficial and deep peroneal nerves).
Lower left panels – Partial transfer of superficial peroneal nerve to deep peroneal nerve. Two fascicle groups of the superficial nerve suffice to neurotize the deep peroneal distal stump.
Lower right panel – Partial transfer of tibial nerve to common peroneal nerve.

HOW TO BE EVALUATED


Time is of the essence with this type of injury, as we only have a six month window from the date of injury or onset of symptoms to optimally respond to this type of nerve damage with Dr. Nath’s specific surgeries Contact the office at 866-675-2200 to evaluated by Dr. Nath in the Houston office.  


  • Evaluation in Houston office (no charge for initial consultation)
  • Video evaluation: submit all medical records to the office with video 
  • Outreach Event evaluation for in person evaluation free of charge( must bring documentation if required for condition)


For video evaluation perform the following movements:

  • Lift both feet up 3 timesPush both feet down 3 times
  • Turn both feet inward 3 timesTurn both feet outward 3 times
  • Stand up, take 3 steps forward, and 3 steps backward. 


Visit our website for video upload: http://www.drnathbrachialplexus.com/en/files/add.php

We also need to see a recent EMG report (nerve conduction study). This testing may be done by a neurologist in your area. If you have not had an EMG performed, please refer to your primary care physician or general practitioner for a reputable Neurologist in your area. The testing should include the sciatic nerve and its muscle distribution. Please send all medical records with the EMG report to contact@drnathmedical.com.