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Foot drop (weakness of the tibialis anterior muscle) can be caused by lesions to the common peroneal nerve or L5 nerve root.
Cause | Clinical Features | Tests | Management |
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Peroneal nerve injury | Weakness in foot dorsiflexion, numbness over the dorsum of the foot | EMG, nerve conduction studies, MRI to assess nerve or compressive lesions | Physiotherapy, orthotics (ankle-foot orthosis), surgical decompression if compressive |
L5 radiculopathy | Pain radiating down the leg, weakness in foot inversion and dorsiflexion | MRI lumbar spine, nerve conduction studies | Conservative (physiotherapy, pain management), surgery if refractory to conservative treatment |
Charcot-Marie-Tooth disease | Progressive weakness and wasting in the legs, high arched foot, foot drop | Genetic testing, EMG, nerve biopsy | Physiotherapy, orthotics, genetic counseling |
Stroke | Sudden onset of foot drop, along with other neurological deficits | CT or MRI brain | Rehabilitation, physiotherapy, management of stroke risk factors (e.g., antiplatelets, anticoagulation) |
Multiple sclerosis | Foot drop, spasticity, other neurological signs | MRI brain and spine, lumbar puncture | Immunomodulatory therapies, physiotherapy, symptomatic management |
Motor neuron disease (e.g., ALS) | Progressive weakness in the legs, muscle atrophy, fasciculations | EMG, nerve conduction studies, clinical diagnosis | Multidisciplinary approach, supportive care, respiratory support as needed |
Diabetic neuropathy | Foot drop with numbness, tingling, or burning sensation in the legs | Nerve conduction studies, HbA1c to assess diabetes control | Diabetes control, physiotherapy, orthotics, medications for neuropathic pain |
Trauma (e.g., fracture, hip surgery) | Acute onset foot drop following trauma or surgery | X-rays, MRI, nerve conduction studies | Early physiotherapy, surgical repair if nerve damage is identified |