Foot drop and MS

What is foot drop?

Foot drop is a symptom of multiple sclerosis which affects walking. The front of the foot doesn’t lift up as it usually would when you walk. You might notice it slaps down on the ground, or catches on the floor. It’s sometimes an early symptom people notice, but can happen much later as well. 

Because the dropped foot doesn’t lift up, it makes trips and falls more likely. And lifting the leg extra high to compensate sometimes adds to fatigue or knock-on effects like pain in the lower back, tight muscles or balance problems. So if you notice any signs of foot drop, it’s good to seek expert advice. That could be from a physiotherapist, occupational therapist or orthotist (who specialises in things like ankle supports and insoles). 

Early signs of foot drop in MS

Early signs of foot drop in MS include: 

• You find it hard to step over small objects
• Feeling as though your feet or toes often drag 
• You lift your leg higher when you’re walking so you don’t catch your foot on the ground 
• You have to think more about walking, which makes it tiring
• Noticing you stumble or fall more often
• You notice unusual wear and tear on your shoes

What causes foot drop?

Foot drop with MS is caused by disruption to the messages in the brain and spinal cord. MS damage in the brain and spinal cord causes different symptoms, depending on the areas affected. With foot drop, the damage affects messages that control how the foot lifts up when we walk. 

Other MS symptoms can make it harder to manage a dropped foot, like numbness or unusual sensations or muscle spasms and stiffness in the leg. 

Foot drop can be caused by MS or other conditions and if it happens suddenly you should always seek medical advice from your MS team or your GP.

Treatments for foot drop

There are treatments and ways to manage foot drop that can make a big difference. If you think you might have foot drop, speak to your physiotherapist, MS team or GP to arrange an assessment. There might be neuro-physiotherapy available where you live. Neuro-physiotherapists specialise in neurological conditions including MS. 

Some people notice foot drop only happens after walking a longer distance. If you feel the distance you can comfortably walk is slowly getting shorter, seek advice from a physiotherapist. They can often help you maintain or even improve your mobility. And getting this expert help early can have most benefit.  

You might need to try a few different approaches to find what works best for you. Treatment could include exercises and physiotherapy, or orthotics and functional electrical stimulation (FES). 

Physiotherapy for MS foot drop

A physiotherapist can help with the foot drop in several ways: 

• Suggest strengthening exercises for the foot and ankle muscles
• Help manage other symptoms that might make foot drop worse, like muscle stiffness 
• Give advice about posture and movement to fix or avoid knock-on problems 
• Provide equipment or referrals for orthotics or FES (functional electrical stimulation)

If you have foot drop or wear a splint for any reason, daily stretching is important. Stretching keeps the range of movement in your ankle. A physiotherapist can give advice about this. 

You might be able to see a neuro-physiotherapist. They specialise in neurological conditions including MS. Sometimes neuro-physiotherapy is part of a neuro-rehabilitation service. But it’s not available everywhere. Ask your GP or MS team about a referral for physiotherapy. 

Read more about how physiotherapy can help with MS

Orthotics for MS foot drop 

You might get a referral to an orthotist to help with your dropped foot. They can prescribe external devices to help with movement. For example, an ankle support for foot drop that fits inside the shoe and underneath the trouser leg.

An assessment of your foot drop will recommend what works safely and well for you. There are some orthotic devices sold online, but always get advice from a healthcare professional who knows your foot drop. Using the wrong orthotic for you could cause other problems. 

Read our expert blog on how orthotics can help MS foot drop 

Functional electrical stimulation (FES)

Functional electrical stimulation (FES) is a piece of medical kit that helps people who have foot drop. The FES machine is about the size of a pack of cards and is run by a battery.

You can wear it on your belt, in your pocket or on a strap wrapped around your knee. Two wires go from it and end in patches that have electrodes in them. These stick to the lower part of your leg, beneath your knee, where the nerve is that controls your muscle.

As you walk, these electrodes are triggered to send signals to your leg muscle. This makes it tighten for a second or two, helping you lift your foot better.

This signal doesn’t hurt but you’ll get a ‘pins and needles’ feeling when the signal is triggered. Some types of FES devices don’t have wires. You wear them around your shin and the electrical signal is triggered by movement when you walk.

How can I try FES for my MS?

FES helps you walk faster, easier and with more confidence. If you want to try it, ask your MS nurse, GP, or neurologist. They can refer you on to your local FES service if there is one. There they’ll assess you to see if FES is right for you.

The NHS where you live decides if they’ll pay for you to have FES and in some places it can be hard to get. You can pay to have it privately but this costs between £3,000 and £5,000.

There are some electronic devices marketed for foot drop that are being sold online. Some are marketed as FES, others as electronic massage. Speak to your physiotherapist, MS team or GP before trying any device. A proper healthcare assessment for your foot drop can make sure it’s effective and safe for you to use.  

Living with foot drop

As well as treatments like physiotherapy, orthotics and FES, there could be things you build into your daily life to manage foot drop. For example, thinking about the kind of shoes that give you a bit of ankle support, or aren’t too heavy. There might be things that are easy to trip over that you can move at home or work. Or routes you can plan when you’re out and about that avoid lots of trip hazards.  

Read more about balance and MS