Functional outcomes of surgical strategies for foot drop secondary to common peroneal nerve injury: A systematic review and meta-analysis

To synthesize the available evidence on surgical strategies for foot drop secondary to common peroneal nerve (CPN) injury and evaluate functional outcomes across different reconstructive techniques. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. MEDLINE, Embase, and LILACS were searched from inception through April 11, 2026, without language restrictions. Observational studies and relevant case series evaluating surgical interventions for foot drop were included. Risk of bias was assessed using the risk of bias in non-randomized studies of interventions and the Joanna Briggs Institute checklist. A random-effects meta-analysis of proportions was performed for tendon-transfer studies. Nineteen studies met the eligibility criteria. Surgical interventions included neurolysis and nerve repair procedures, nerve transfer techniques, tendon transfer procedures, and combined surgical strategies. Tendon-transfer studies generally reported favorable functional outcomes, with approximately 70– 90% of patients achieving functional recovery. Neurolysis, nerve repair, and nerve transfer procedures showed more variable results across studies. Meta-analysis of seven tendon-transfer studies ( n = 139) demonstrated a pooled functional dorsiflexion rate of 76.4% (95% confidence interval, 67.2–83.7) with low statistical heterogeneity (I 2 = 11.6%). The certainty of evidence ranged from low to very low across intervention categories. Surgical management of foot drop secondary to CPN injury appears to be associated with meaningful functional improvement. Tendon-transfer procedures were associated with favorable and relatively consistent outcomes in the available literature; however, the predominance of observational studies and methodological limitations preclude definitive comparative conclusions regarding the superiority of any surgical strategy. Further well- designed prospective studies with standardized outcome measures are needed to strengthen the evidence base.