Managing Foot Drop in MS

Foot drop causes difficulty lifting the toes. It can lead to a walking pattern that can add to fatigue and muscle imbalances, cause falls, and more. Numerous treatment options are available.

When foot drop steps into your life, putting one foot in front of the other becomes really difficult.

Foot drop can occur in people with multiple sclerosis (MS). It can affect mobility, the ability to complete daily routines, and how we interact with the world around us.

MS foot drop (also called drop foot) refers to difficulty flexing and lifting the front part of the foot. This causes the toes to contact the ground first instead of second in the typical heel-toe gait. It occurs due to weakness or paralysis of the muscles that lift the foot.

Foot drop makes it challenging to climb stairs or walk on uneven surfaces, like jagged pavement, grassy areas, or tilted floors.

There’s not much data on how many people with MS have foot drop. But we do know that among the estimated 31% of people with MS who have trouble walking, foot drop is the most common symptom.

It can appear one day as a temporary flare and then disappear, but it may also progress into a constant foot lag and limp.

For me, foot drop is a frequent visitor whenever temperatures get hot. On steamy summer days, I keep my cane in my bag for when foot drop inevitably creeps up on me.

Everyone’s foot drop is different. It can occur at any stage of the disease.

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What causes MS foot drop?

MS foot drop can occur due to damage to the nerves in the lumbar spine and the peroneal nerve. The peroneal nerve activates the dorsiflexor muscles at the front of the ankle, which lift the foot.

In MS, the immune system mistakenly attacks myelin, the protective covering of nerve fibers, leading to disruptions in nerve signaling.

Other conditions, such as stroke, brain or spinal cord injury, cerebral palsy, or even compression of a single nerve, can also cause foot drop. So can muscle spasticity, another common symptom of MS.

What does it look like when someone with MS foot drop walks?

When a person with foot drop walks, it often looks like they are climbing stairs. That’s because they lift their leg higher than usual, typically with a lot of hip and knee movement, to compensate for the inability to lift their foot separately.

This effort to maneuver the leg requires lots of exhaustive effort, which may develop into secondary symptoms like fatigue and pain.

Another common gait issue with MS foot drop is foot slap. This is when the affected foot uncontrollably smacks the floor with every step. Foot slap is less obvious visually, but the foot can be heard striking the ground.

What are the early signs of foot drop?

Tripping or stumbling while walking, difficulty lifting the front of the foot, and dragging the toes are some early signs of MS foot drop.

Other clues you may notice include a decrease in muscle mass and tone of the calves and foot muscles as well as a loss of sensation.

You may also notice a change in your gait, like lifting your leg at the knee before stepping or swinging your leg to the side when walking.

Recognizing early signs and seeking treatment can help prevent further complications and improve mobility.

What are the complications of MS foot drop?

Over time, altered walking habits create muscular strain and place pressure on bones and joints throughout the body, like the hips and knees. This can lead to issues with posture, balance, joint pain, and difficulty performing some movements or activities.

Ankle weakness and a decrease in muscle strength can also lead to:

• balance issues
• spasticity
• altered foot sensation
• foot deformations

The physical exertion that walking with foot drop requires can cause emotional stress and added fatigue. Some people may experience depression when MS symptoms or mobility issues worsen.

Personally, I’ve experienced stress related to my MS foot drop when I worry that my wobbly gait may be perceived as evidence of drunkenness or drug use.

Driving even causes me anxiety because of the mistrust I have in my own feet to press on the car’s foot pedals with enough speed and force. Even a traffic stop makes me uneasy; my foot drop wouldn’t permit me to perform common sobriety tests if requested.

Dealing with MS foot drop isn’t easy.

How is MS foot drop treated?

Several treatment options are available for managing MS foot drop. Treatment depends on the severity of the symptom and its effects on daily activities. Here are some common options:

Assistive devices

Canes, braces, walkers, wheelchairs, and scooters are excellent tools when you need support to move around more easily.

Another option is an ankle-foot orthosis (AFO), a brace worn on the lower leg and foot for stability. It helps lift the forefoot during walking, reducing the risk of tripping.

AFOs come in various designs, including rigid and flexible options, and can be customized to fit individual needs.

Functional electrical stimulation (FES)

FES uses low level electrical impulses to stimulate the peroneal nerve, which activates the muscles responsible for foot movement. FES devices are typically worn as a cuff below the knee.

You can program it to synchronize with your walking pattern.

Physical therapy

Physical therapy aims to improve strength, flexibility, and coordination. A physical therapist (PT) can work with you to develop a personalized exercise program targeting the muscles involved in foot movement.

I’ve found that supervised strength conditioning has given me more physical control of my body as I get stronger and, ultimately, a greater sense of confidence in walking.

Medications

In cases when spasticity contributes to foot drop, a doctor may prescribe injections of botulinum toxin, known more commonly as Botox. These shots are injected into the calf to relax the muscle and support its function, reduce pain, and increase range of motion. This may provide temporary relief for up to 3–4 months.

Surgical interventions

In severe cases of foot drop that do not respond to traditional treatments, surgical interventions, such as nerve decompression or tendon transfer, may be considered. These procedures aim to restore function and improve foot control.

FAQs

Is foot drop permanent?

The intensity and duration of foot drop varies in people with MS. In some cases, MS foot drop may improve or resolve over time, especially during periods of remission.

However, for others, especially those with progressive forms of MS, foot drop may persist or worsen over time. Treatment options and interventions can help manage foot drop and improve mobility.

Do you get foot drop in one foot or both?

MS foot drop can occur in one or both feet, depending on the extent of nerve damage. While many people with MS experience foot drop on one side initially, It’s not uncommon to develop it on both feet over time.

What happens if foot drop is left untreated?

If foot drop is left untreated, you may be at greater risk of falls and have more trouble in your daily activities.

Caring for declining foot function as soon as you notice it can help avoid long-term effects on your overall health.

Can I do anything at home to improve my MS foot drop?

While it’s important to consult a healthcare professional for a personalized treatment plan, you can try some exercises and strategies at home to help improve mobility.

MS foot drop exercises focus on strengthening the muscles involved in foot movement and maintaining flexibility.

After learning the exercises from a PT, I had more confidence when I started doing them at home independently. Using assistive devices may also provide support and enhance walking ability.

The takeaway

MS foot drop can be a scary symptom to confront as this illness progresses. However, with proper management and treatment, people can experience improved walking ability and overall quality of life.

It’s crucial to work closely with healthcare professionals, like physical therapists, to develop a personalized treatment plan that addresses your specific needs and goals.

Remember, you are not alone. Many resources and supports are available to help you feel more in control of your body.