How to Keep Walking With MS Foot Drop

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 — starting at about $5,000 or more — 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, which causes 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 — the disc or other mass can be removed. But an MS lesion is a different problem and cannot be fixed with surgery,” she says.

A Foot Drop Success Story

David Altman, a personal trainer in Littleton, Colorado, 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 5-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 an FES 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 FES device, Altman says strength training and other exercises enable him to live successfully with MS.