1640 - A Tale of Two Nerves: Bilateral Foot Drop with Separate Neurological Pathologies

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MD

Miguel DeMarzo, III, DO

Resident Physician (PGY-1)
Baylor University Medical Center - Baylor Institute for Rehabilitation
Arlington, Texas, United States

Co-Author(s)

NK

Nimah Khan, n/a

Medical Student
Texas Tech Health Sciences Center El Paso
Plano, Texas, United States

Presenting Author(s)

AA

Amir Akhavan, BS

Medical Student
TCU School of Medicine
Fort Worth, Texas, United States

Co-Author(s)

OS

Omar Selod, DO

Physician
PMR Fort Worth
Fort Worth, Texas, United States

Submitter(s)

MD

Miguel DeMarzo, III, DO

Baylor University Medical Center - Baylor Institute for Rehabilitation
Arlington, Texas, United States

Case Diagnosis: Concurrent Bilateral Foot Drop Due to Multifactorial Etiologies (Right Radiculopathy and Left Peroneal Neuropathy)

Case Description: A 69 year old female presented with right-sided foot drop for two weeks. The patient emphasized predominant symptoms on the right side and unaware of left sided deficits. Physical examination demonstrated decreased sensation to light touch to the right L5 distribution, 4/5 strength in ankle dorsiflexion and 3/5 on great toe extension bilaterally but worse on the right, bilateral 0/4 S1 reflexes, and a steppage gait observed. MRI studies demonstrated severe bilateral neural foraminal narrowing at L4/5 and L5/S1, and a hyperintense peroneal nerve at the fibular head. Initial management included recommendation to wear an ankle-foot orthosis (AFO) and scheduled an electrodiagnostic (EDX) study for one week later. Upon follow up, nerve conduction study (NCS) was significant for a right peroneal neuropathy at the fibular head. Electromyography (EMG) of the right lower extremity was normal, but remarkable for a left L4 & L5 radiculopathy.

Discussions: This case underscores the diagnostic complexity inherent in evaluating foot drop, especially when bilateral involvement arises from separate etiologies. Foot drop commonly originates from either radiculopathy or peripheral neuropathy; however, simultaneous occurrence from distinct pathologies is rare and diagnostically challenging. This case highlights the importance of obtaining EDX study in a timely manner and in the evaluation of foot drop as it may indicate multifactorial etiologies.

Conclusions: Clinicians must remain vigilant for multifactorial causes in cases presenting as unilateral foot drop, as contralateral involvement may be subtle or asymptomatic initially. A comprehensive electrodiagnostic workup, complemented by imaging, was essential for accurately distinguishing between overlapping conditions to guide appropriate management.