Walking impairment is one of the most common symptoms of multiple sclerosis (MS). Many people with MS experience difficulties with walking, as well as their gait (walking pattern). These problems may cause a person to walk unsteadily, trip or stumble, and feel less confident in their ability to move around.

The way a person walks depends on many factors, including muscle coordination and the cooperation between different parts of their nervous, musculoskeletal, and cardiorespiratory (heart and lung) systems. Research has found that people with MS have a higher level of gait variability (changes in pattern or speed) than the general population. Changes in stride can cause difficulties with walking, especially over long distances and as a person becomes more fatigued and unstable.

If you notice that you’re having MS walking problems, talk to your health care provider or neurologist. They can help determine whether your difficulty is related to MS, as walking problems may have a different cause. Your doctor will also be able to recommend ways to manage these issues and help you stay as mobile as possible.

Common Gait Problems in MS

People with MS may experience different types of gait abnormalities. Two of the most common gait patterns are known as steppage gait and spastic gait.

Steppage Gait

Steppage gait (also known as neuropathic gait) is characterized by drop foot — an MS symptom in which the front part of the foot drops and does not lift up correctly with the rest of the leg while walking. In a person with drop foot, the toes point downward and may drag or scrape on the ground while walking.

Spastic Gait

Spastic gait is common in people who experience spasticity — a symptom seen in MS that causes involuntary muscle spasms or stiffness. In people with spastic gait, the leg on the side of the body most affected by spasticity is stiff and drags in a semicircular motion.

What Does MS Gait Look Like?

Like other MS symptoms, gait impairments can vary significantly from person to person. Not everyone will experience the same problems when walking. Some may notice changes in the way they walk, whereas others may notice changes in their walking speed or step length.

Some of the most commonly reported walking difficulties in MS include:

• Difficulty walking downstairs
• Taking slower, shorter steps
• Feeling unsteady while walking or turning
• Tripping or stumbling
• Feeling heaviness in the legs when stepping forward
• Experiencing weakness in the legs when placing weight on them
• Difficulty placing the foot firmly on the ground
• Reaching for support from walls, furniture, or other people

Some MyMSTeam members find that these difficulties may be accompanied by pain. One member shared that their legs were hurting while having trouble walking and another experienced pain in their knee joints.

Other members are surprised by how quickly their walking problems develop. “I can’t believe that five months ago, I wasn’t too bad — no walking aids or having trouble walking,” said one member. Now, this member wrote, “I’m a totally different person.”

Some, on the other hand, find that their walking difficulties develop slowly over time. As another member shared, “The walking issues are one of those things that I noticed, only to realize it’s been happening for a while, and I don’t know when it started.”

Emotional Impact

These walking difficulties may cause a person with MS to lose confidence in their mobility. Concerns about falling or people mistaking the symptoms for drunkenness in public can sometimes lead to social isolation and other emotional challenges.

As one member wrote, “Difficulty walking stresses me out like you wouldn’t believe.” Another member shared that the toughest thing for them has been coming to terms with their changing abilities: “I’m finding it difficult to get my head around being more disabled.”

Many people living with MS complain about difficulty with walking long distances such as when they are at an airport or in a train station.

Fall Risks From Walking Difficulties

Falling is a substantial concern for people with walking problems. Research has found that people with MS are at higher risk of falling and sustaining injuries from falls. Additionally, people with MS tend to fall while performing basic daily activities, such as bathing, cooking, or walking in crowded areas.

Several factors increase the risk of falls in people with MS, including poor balance, slowed gait speed, and the incorrect use of assistive devices like canes and walkers. Talk to your clinicians about preventing falls, as these accidents can cause injury and worsen existing mobility problems.

What Causes Gait Difficulties in MS?

Several factors may cause a person with MS to have difficulty walking:

• Problems with nerve signals
• Spasticity
• Balance issues
• Sensory problems
• Muscle weakness
• Fatigue
• Visual and cognitive problems

Problems With Nerve Signals

Walking is a complex process that relies on the coordination of multiple body systems, including the central nervous system (CNS) — the brain and spinal cord. In people with MS, the immune system mistakenly attacks cells in the myelin, which is the protective sheath surrounding the nerves in the CNS. The immune attack results in areas of damage known as MS plaques or lesions. Damage to the myelin can interrupt the signals between the CNS and the muscles involved in walking, causing gait dysfunction.

Spasticity

Spasticity is a common symptom of MS. Involuntary muscle tightness or spasming can cause a person to have difficulty walking — as one MyMSTeam member wrote, “I’m having trouble walking. My legs are tightening up.”

Balance Issues

Research suggests that as many as 4 in 5 people with MS have some degree of ataxia, the lack of voluntary coordination of muscle movements. Ataxia can cause balance problems and result in an unsteady gait that may resemble clumsiness or drunkenness.

Sensory Problems

MS may cause abnormal sensations, including numbness. Severe numbness in the feet may make a person unable to feel the floor or the position of their feet, which can cause problems with walking.

Muscle Weakness

Weakness in the leg muscles can cause a person to feel like their legs are Jell-o and unable to support their weight while walking.

Fatigue

Many people with MS find that their walking problems worsen when fatigued. Fatigue can also limit stamina and cause falls in people with MS. As one member shared, “I’m having trouble walking today and fell a couple of times. It gets frustrating, but after I get some well-needed rest, I will be better tomorrow.”

Visual and Cognitive Deficits

People with MS commonly experience cognitive changes, including difficulties with information processing and visual perception, which can make walking difficult.

Managing and Treating Gait Difficulties in MS

Let your health care provider know as soon as you notice any difficulties with walking or balance. There are many ways of managing gait problems, from medication and physical therapy to exercise and assistive devices. Together, these approaches may help you regain your balance, increase your mobility, and help you remain confident while moving.

Medications

If you have walking problems with MS, your health care provider may recommend a medication to help improve your symptoms.

Ampyra

Dalfampridine (Ampyra) is an oral medication approved by the U.S. Food and Drug Administration to improve walking in people with MS. This medication works to improve the conduction of nerve signals in nerve fibers when the protective coating (myelin) has been damaged by MS.

Other Medications

MyMSTeam members report taking several other medications to help improve their walking abilities. “If your nerves are acting up like mine do,” wrote one, “I have two different medications that help: gabapentin and diclofenac.” One member found that taking gabapentin daily “helps a little” with their walking difficulties. Talk to your clinician about your options.

Assistive Devices

Many people with walking difficulties use assistive devices to help support their walking ability and gait speed. According to the National Multiple Sclerosis Society, studies suggest that half of the people with relapsing-remitting MS require some form of walking aid within 15 years of their diagnosis.

There are many different types of assistive devices for people with MS. Mobility aids such as canes, wheelchairs, and walkers can help support movement and prevent falls. People whose walking problems are caused by numbness may benefit from using a cane, walker, or Canadian crutch (a crutch that includes an arm cuff and handle). These devices help compensate for numbness by carrying sensations from the ground through the device into the hand and arm.

Supportive braces and orthotics can help control the position and movement of the body and reduce pain while walking. Drop foot, in particular, may be managed using a brace known as an ankle-foot orthotic.

Exercise and Physical Therapy

Experts have advised that even a small amount of exercise can help improve walking difficulties when performed regularly (at least five days a week). A physical therapist can work with you on gait analysis to determine the appropriate exercises to increase your muscle strength, range of motion, and improve your walking problems.

MyMSTeam members also note that pushing yourself too far with exercise may do more harm than good. As one member wrote, “I started walking on a treadmill and overdid it.” This member found that they were “stuck between exercising to build strength and finding it difficult to walk afterward.” They decided to start bringing a cane to the gym in case of unsteadiness after exercising.

Fall Prevention

Fall prevention is one of the most important things to keep in mind if you experience walking problems. Aside from discussing solutions with your health care provider, the National Multiple Sclerosis Society recommends reducing your risk of falling by:

• Wearing safe, low-heeled shoes
• Being conscious of where you are walking (for example, avoiding freshly washed floors)
• Increasing safety at home by keeping areas where you walk clear of cords, loose carpets, or other objects

Installing assistive devices like grab bars throughout your home can also help make daily movement safer and improve your quality of life.

Sometimes, people with MS focus on what they can’t do. Talk with your doctor to figure out the right tools to help you build confidence, regain your ability to get around, and stay as mobile as possible.

Find Your Team

MyMSTeam is the social network for people with MS and their loved ones. Here, more than 194,000 members come together to discuss life with multiple sclerosis. Members frequently discuss walking difficulties and other symptoms of MS.

Have you experienced walking problems with multiple sclerosis? Share your stories or advice in the comments below or by posting on MyMSTeam.