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Walking Difficulties in MS

Posted on March 26, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Victoria Menard

Walking impairment is one of the most common symptoms of multiple sclerosis (MS). Many people with MS experience difficulties with ambulation (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 relies 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 longer distances and as a person becomes more fatigued and unstable.

If you notice that you are having trouble walking, 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 walking problems 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 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 Do Gait Difficulties in MS Look and Feel 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:

  • 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 people 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 MyMSTeam 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 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 walking, and the incorrect use of assistive devices like canes and walkers. Talk to your health care provider about preventing falls, as these accidents can cause injury and worsen existing mobility problems.

What Causes Gait Difficulties in MS?

Several different factors may cause a person with multiple sclerosis 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), or 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 a person to experience 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 Problems

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

Ampyra (dalfampridine) 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 doctor about your options.

Assistive Devices

Many people with walking difficulties use assistive devices to help support their mobility. According to the National Multiple Sclerosis Society, studies suggest that half of people with relapsing-remitting MS (RRMS) require some form of walking assistance within 15 years of their diagnosis.

There are many types of assistive devices for people with MS. Mobility aids, such as canes, wheelchairs, and walkers, can 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 to determine the appropriate exercises to increase your muscle strength 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, avoid 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, as opposed to reaching for walls or furniture for support.

Find Your Team

MyMSTeam is the social network for people with MS and their loved ones. Here, more than 165,000 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.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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