Foot drop refers to a condition where a person is unable to lift the front part of their foot to the proper angle when walking. A wide range of diseases can cause foot drop, including multiple sclerosis (MS).

Foot drop is not a disease itself, but the effect of an underlying problem. This problem may be anatomical, muscular, or neurological in origin.

Foot drop results from weakness of the peroneal muscles (which are responsible for movement) or dysfunction of the peroneal nerve (which stimulates the muscles). If an individual has foot drop, their foot may appear to hang down or drag. They may also scuff their foot on the ground when they are walking, which can result in discomfort or accidents.

Fortunately, treatments are available for foot drop, including physical therapy, self-management strategies, assistive devices, and surgery.

Foot Drop in Multiple Sclerosis

Although there are no published studies to confirm its prevalence, foot drop is a commonly observed symptom in MS.

What Does Foot Drop Look Like?

Foot drop can affect one foot (unilateral) only or both feet (bilateral).

As a result of this muscle weakness or nerve injury, people with foot drop may drag their affected foot (or feet) on the ground while walking. Others may attempt to avoid dragging by bending their knees to raise the foot higher than usual, resulting in what is called a steppage gait.

Impacts of Foot Drop

For people with foot drop, walking up stairs, curbs, and on other uneven surfaces can be quite difficult. To avoid obstacles that might make walking difficult, they may alter their walking style, usually by lifting the affected leg higher as if climbing up.

Changing your way of walking is tiring, as it requires more effort and energy. This may cause you to feel wobbly. Over time, walking this way can lead to hip and lower back pain, muscle tightness, and issues with overall balance.

These difficulties in walking can also make you more prone to falling. This can sometimes be embarrassing or frustrating — especially if people do not understand that it is caused by MS.

Foot drop can also affect your ability to perform work responsibilities. Difficulty moving around can impact your productivity and ability to perform physical tasks.

What Causes Foot Drop in Multiple Sclerosis?

Foot drop results from weakness in the ankle muscles or lack of signaling between the brain and the leg muscles. In both cases, it becomes impossible to lift your foot to the correct angle when taking a step. This causes the toes to drag or scuff on the ground.

Foot drop can worsen depending on what other MS symptoms you experience. Numbness and other abnormal foot sensations reduce sensitivity to the floor, which can cause changes in one’s walking ability and speed. Controlling your affected foot if you are experiencing MS spasms and muscle weakness can also be challenging.

Certain occupations that involve kneeling or squatting for long periods of time can also increase the risk of foot drop.

How Is Foot Drop Diagnosed?

If you are experiencing difficulties raising the front of your foot while walking, you may have foot drop. Contact your neurologist so you can determine why this might be happening.

To diagnose foot drop, a doctor will perform a physical exam. In this exam, the doctor will observe the way you walk and check the functioning of your leg muscles.

In some cases, imaging tests may also be ordered to diagnose foot drop. These can include X-rays, CT scans, or ultrasound scans.

If your foot drop is due to nerve damage, your doctor may have you take nerve conduction tests to locate the point of damage. Your doctor may also perform electromyography, a diagnostic procedure in which electrodes are inserted into the muscle fibers to record their electrical activity.

Is MS-Related Foot Drop Permanent?

Foot drop in MS can be permanent or can get better with time. There are several treatment options for foot drop. Your doctor can help you come up with the best approach for your particular needs.

How Is Foot Drop Treated?

Foot drop treatment in MS involves physical therapy, assistive devices, and self-management strategies. In some cases, surgery may be necessary.

The following treatments are commonly used in the management of foot drop.

Physical Therapy

Physical therapy can help you strengthen your leg, ankle, and foot muscles. Physical therapy can also help manage other MS symptoms that tend to worsen foot drop, including spasticity and walking-related complications.

Your physical therapist can also provide or recommend devices that can help correct your foot’s position.

Assistive Devices

There are two common types of devices used to treat foot drop: functional electrical stimulation (FES) and ankle-foot orthosis (AFO).

An FES device is typically placed on the leg or around the waist. These devices deliver electrical impulses to the nerves around the impacted muscles, promoting leg movement as you walk. It is necessary to evaluate this treatment option with a trained physiotherapist. They will help you determine if it is recommended for your specific needs.

AFO devices — which include braces or splints — are worn on the lower leg. These devices, typically made of plastic or carbon fiber, are used to place your foot and ankle in the correct position as you walk. If your doctor determines an AFO device is right for you, they may refer you to an orthoptist (a person specifically trained in fitting braces or orthotics).

Self-Management

There are various lifestyle adjustments that you can make to manage your foot drop and help other treatments work more work effectively. These include:

• Wearing the right footwear — Wear shoes that fit well, provide ankle support, and are lightweight so as not to tire out your muscles.
• Avoiding certain positions — Avoid positioning your body in ways that increase the risk of foot drop. Crossing your legs regularly can gradually lead to compression of the peroneal nerve on the upper part of the leg, and squatting or kneeling for too long can also cause foot drop.
• Taking it slowly — Practice caution when moving about. Know how to deal with obstacles in your surroundings, and avoid them if you can.
• Keeping your walkways clear — Remove potential hazards in your home — especially in high-traffic areas. That includes wires or cables that can cause trips and falls.

Surgery

Severe or long-lasting foot drop can lead to muscle paralysis, which can result in permanent difficulty with movement. Surgery can help.

Often, surgery for foot drop involves transferring muscle tendons from stronger leg muscles to the affected muscle. Another available procedure fuses the foot or ankle bones to steady the ankle. Speak with your doctor to assess whether you are a candidate for either one.

Talk With Others Who Understand

MyMSTeam is the social network for people living with multiple sclerosis and their loved ones. On MyMSTeam, more than 166,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS and foot drop? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

1. Foot Drop Information Page — National Institute of Neurological Disorders and Stroke
2. Foot Drop — Cleveland Clinic
3. Foot Drop — Mayo Clinic
4. Foot Drop — Multiple Sclerosis Trust
5. Foot Drop — National Health Service
6. How To Keep Walking With MS-Related Foot Drop — Everyday Health