The objective of our study was to investigate the clinical presentation of patients with acquired foot drop in Malawi; the association of intramuscular injections and quinine administration; and the association between private sector clinics. A consecutive case series of 50 paediatric patients with foot drop was identified that represented 5% of all outpatient appointments during the study period. Ninety percent of all patients had received a gluteal intramuscular injection of quinine, of which 58% were treated in private clinics. This study presents the first description of the aetiology of acquired foot drop in Malawi and suggests that gluteal intramuscular injection of quinine is the leading cause.