To evaluate whether postoperative corticosteroid therapy is associated with improved motor recovery among patients presenting with postoperative foot drop.

Postoperative foot drop is a rare but serious complication of orthopedic surgery and many patients have incomplete recovery. The role of corticosteroids in facilitating neurologic recovery remains uncertain, with limited systematic evidence.

We conducted a retrospective cohort study at a single center that included 25 patients (non-steroid - 13, steroid - 12). Demographic, surgical, and neurologic data, including serial dorsiflexion strength and electrodiagnostic findings, were obtained from the medical record. The primary endpoint was change in dorsiflexion strength (MRC scale) from diagnosis to last follow-up. Secondary endpoints included time to recovery, overall clinical resolution, the proportion achieving clinically significant recovery (ΔMRC ≥ 2) and joint infection.

Median age was 71 years (IQR 63–76); 68% female; BMI 29.7 (25.7–32.9); median procedure duration 96 minutes (88–123); tourniquet time 73 minutes (56–90.5). Median change in dorsiflexion was 4.00 (0.50–4.50) overall, 4.00 (0.50–4.50) in the non-steroid group, and 3.00 (0.50–4.75) in the steroid group. The median difference between the groups was not statistically significant. Median time to recovery was 565 days (370–908) overall with no statistically significant difference between the groups. Clinically significant recovery occurred in 64% overall (69.2% non-steroid vs 58.3% steroid; p = 0.688). No joint infections were observed.

Corticosteroid therapy was not associated with a statistically or clinically significant improvement in dorsiflexion recovery in this small cohort. The effect size was small with wide uncertainty, reflecting limited power and heterogeneity of recovery trajectories. These results suggest no clear therapeutic advantage to steroids but more research is needed. Larger retrospective and prospectively designed studies integrating electrodiagnostic predictors and causal adjustment methods are warranted to define the role of corticosteroids in postoperative foot drop recovery.