Foot drop

The bottom line Consider isolated peroneal neuropathy as the most likely cause of foot drop in patients with weakness of foot dorsiflexion and eversion; sensory loss of the anterolateral aspect of the lower leg and the foot dorsum; normal reflexes; no pain swelling, or erythema of the leg; and no other neurological features Offer conservative treatment in unilateral foot drop caused by isolated peroneal neuropathy, but refer patients with acute bilateral foot drop, one sided foot drop with fasciculations, or more widespread neuropathy to a neurologist A 42 year old healthy female yoga instructor consults with frequent stumbling and numbness of the upper side of her left foot. Central causes (such as cerebral ischaemia), anterior horn cell diseases, cauda equina compression, and muscle dystrophy are rare and usually produce other symptoms. 2 Medical history Because external pressure is the most common cause of peroneal neuropathy, ask about habitual leg crossing, habitual or prolonged squatting or kneeling (may be work related), confinement to bed, use of leg brace or recent plaster cast below the knee, use of leg positioning or leg supports during recent surgery, or other causes of compression at the fibular neck.