Diagnostic Imaging for Foot Drop

Initial Imaging

• Radiographs should be the first imaging study when evaluating foot drop, particularly to rule out bony abnormalities or trauma, as recommended by the American College of Radiology 1, 2
• Weight-bearing radiographs are preferred when possible as they may detect dynamic abnormalities not apparent on standard views, according to the American College of Radiology, with a strength of evidence not specified 3

Advanced Imaging

• CT may be useful in cases of suspected bony abnormalities compressing neural structures, as suggested by the American College of Radiology 1, 4
• Ultrasound can be valuable for dynamic evaluation of the peroneal nerve at the fibular head and for identifying space-occupying lesions, as recommended by the American College of Radiology 5
• MRI can effectively evaluate muscle denervation changes, as noted by the American College of Radiology 1, 2

Special Considerations

• In patients with diabetes and neuropathy, standard clinical tests may be less reliable, and imaging should be performed more liberally, according to the American Diabetes Association and other guidelines 6
• For suspected peroneal nerve compression at the fibular head, dynamic ultrasound during knee flexion/extension may reveal nerve subluxation not apparent on static imaging, as suggested by the American College of Radiology 5