Electrophysiological diagnostic spectrum among patients referred with suspected foot drop: a tertiary clinical neurophysiology laboratory experience

Aims: This study aimed to evaluate the electrophysiological diagnostic distribution and possible anatomical levels responsible for foot drop in patients referred with a preliminary diagnosis of foot drop. Methods: A retrospective analysis was conducted on 81 patients referred to the clinical neurophysiology laboratory of a tertiary center between January 2024 and September 2025. All patients underwent standard nerve conduction studies and needle electromyography. Cases were classified into electrophysiological diagnostic groups based on combined clinical and electrophysiological findings. Descriptive statistics were performed, and the three most frequent diagnostic groups were compared using Fisher's exact test and one-way analysis of variance. Results: Of the 81 patients, 50 were male (61.7%) and 31 were female (38.3%). The mean age was 52.8±15.9 years. Nine patients had normal electrodiagnostic studies; the remaining patients had either localizing abnormalities or non-normal findings of variable diagnostic relevance. The most frequent diagnosis was lumbosacral radiculopathy (n=22, 27.2%), followed by polyneuropathy (n=19, 23.5%), peroneal neuropathy (n=16, 19.8%), and normal electrophysiological findings (n=9, 11.1%). Bilateral involvement was observed in 23 cases (28.4%) and was most common in the polyneuropathy group (15/19, 79.0%; p<0.001). Conclusion: Foot drop is a heterogeneous condition that cannot be attributed solely to common peroneal nerve lesions. In this series, peroneal neuropathy accounted for only about one-fifth of cases, whereas lumbosacral radiculopathy and polyneuropathy were more frequent diagnostic categories. Targeted electrodiagnostic evaluation may facilitate anatomical localization and differential diagnosis in patients referred with suspected foot drop.