Spontaneous Recovery of Complete Foot Drop in Case of Lumbar Disk Herniation: Catcher in the Rye?

Background: Foot drop is defined as inability to dorsiflex the foot at the ankle joint. Although a well-documented entity with a myriad of causes along the neuraxis, starting from parasagittal intracranial pathologies to peripheral nerve lesions, treatment has always remained uniform (i.e., elimination of the causative pathology. A conservative approach with complete recovery has never been documented with video evidence).

Case Description: A 74-year-old female presented with dorsiflexion weakness of the left ankle secondary to a prolapsed disk at the L4-5 level. The duration of the foot drop was short (3 days). She was planned for surgery but kept under close observation considering the consistent recovery of the symptoms. To our astonishment she had rapid pain relief in the next 5 days. Motor power improved over 3 weeks, and she had complete recovery in 4 weeks. Video recordings were made to document the improved power at both stages.

Conclusions: Spontaneous recovery of complete foot drop is possible, and there is a role for the conservative management even with dense neurologic deficit in cases of lumbar disk herniation. Careful repeated examination is the key for conservative management before jumping to aggressive surgical intervention.