This common MS complication can make walking difficult. Here’s what you can do to stay active and mobile.
By Regina Boyle WheelerMedically Reviewed by Jason Paul Chua, MD, PhD
Reviewed: November 2, 2021
Some people with multiple sclerosis develop foot drop (sometimes called “drop foot”), a weakness in the ankle and foot muscles that makes it hard to flex the ankle and walk with a normal heel-toe pattern, according to the National Multiple Sclerosis Society (NMSS). When you have foot drop, your toes touch the ground before your heel, which can cause you to trip or lose your balance. But a variety of treatment options can improve your ability to walk and help you stay active and independent.
In addition, spasticity, or MS-induced tightness in the calf muscle, can contribute to the toes’ pointing downward, making it even more difficult for the muscles to lift the foot, says Mandy Rohrig, a physical therapist and the senior programs consultant for Can Do MS.
When you walk with foot drop, you may catch your toes on the ground and trip because you can’t lift the toes out of the way when swinging the foot during a step, explains Michelle Fabian, MD, an associate professor of neurology at Mount Sinai Hospital in New York City.
“To avoid tripping, [people with foot drop] may lift their hip up higher than normal, leading to a walking appearance called a steppage gait — they might appear to be going up a step,” Dr. Fabian adds.
Walking differently to compensate for foot drop takes a lot of energy and may tire you even more quickly, making you more prone to falls, says Rohrig.
Even in people who have MS, foot drop can sometimes be caused by something other than MS, like a pinched nerve, Fabian says.
When foot drop is due to MS, it can occur as a new or recurring symptom during a relapse, or it can be a consequence of MS progression, she explains.
When an MS relapse causes foot drop, it’s likely to get better over time, often after a course of steroids. But when foot drop occurs in someone with progressive MS, the weakness may stay the same or slowly get worse, adds Fabian.
Treating MS-Related Foot Drop
Treatment for foot drop can greatly improve mobility and make walking less tiring. Treatment options include the following:
Physical therapy Physical therapy can help improve strength and stiffness for people who have foot drop, notes the NMSS. According to Rohrig, your physical therapist will identify whether weakness, spasticity, or both are causing the foot drop, and will then prescribe specific exercises for you. The therapist will also determine how foot drop is impacting your functioning and will investigate whether an assistive device might help you get around better.
Braces A brace called an ankle foot orthosis (AFO) is commonly recommended to help manage foot drop, adds the NMSS. The brace, typically made of plastic, is worn around the lower leg and foot. Most AFO braces hold the ankle and foot in a fixed position, but some have a hinge that allows the ankle to move.
There are various types of AFO braces. Some fit inside regular shoes; for others, you’ll need to wear an extra-deep shoe. A physical therapist can help you select the best one for your needs.
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Functional electrical stimulation (FES) FES involves the application of a mild electrical stimulus to a muscle in order to help it move better, according to the NMSS. In some cases, when MS causes nerve damage, the muscle no longer receives the correct message from the central nervous system. FES typically involves a wearable device that delivers an electrical current to stimulate the peroneal nerve just below the knee and therefore the muscle needed to lift the front of the foot, Rohrig explains. The stimulation is timed to lift the foot during the swing phase of walking to prevent it from dropping or dragging.
There are two FES devices that can help alleviate foot drop: WalkAide from Innovative Neurotronics and NESS L300 from Bioness, notes the NMSS. They are both relatively small and battery powered, and you typically wear them the whole time you are walking around. On the plus side, many people find FES devices easier to wear and more convenient than an AFO. But they are also much more expensive — about $5,000 to $6,000 — and typically not covered by insurance.
While FES devices have been shown to help improve walking speed, they won’t help everyone with foot drop. A rehabilitation specialist with experience in MS can help you choose the right assistive device for you.
Surgery Surgery is not an option for foot drop that’s caused by MS because the nerve injury originates in the spinal cord “and is causing a disruption to the pathway that lifts the foot,” Fabian says. “Other conditions, such as a herniated disk or compressed nerve, might be fixed by surgery as there is something pressing on the pathway — then the disc or other mass can be removed. But an MS lesion is a different problem and cannot be fixed with surgery.”
A Foot Drop Success Story
David Altman, a personal trainer in Denver, was diagnosed with MS in the 1970s as a college student. In 2005, he developed foot drop on his right side. Altman, an avid runner, noticed he wasn’t able to complete his usual five-mile runs.
“I could run one way, but I limped all the way back,” he recalls. “Then it progressed to where I couldn’t run a step.”
Altman was originally fit with an AFO, but couldn’t bring himself to put it on because it made him feel self-conscious. He spent four years limping until he was fit with a functional electrical stimulation device, which he says changed his life — so much that he agreed to film a documentary for the maker of his specific device, the Bioness L300.
In addition to the functional electrical stimulation device, Altman says strength training and other exercises enable him to live successfully with MS.