MS and Foot Drop
One of the more common issues that people associate with multiple sclerosis is trouble walking. When I talk to people who don’t know a lot about the disease, that’s one thing they often bring up. They know that many folks with MS can end up limping or using a cane or even a wheelchair. Few understand why though. Today I want to tackle one of the many reasons that those of us with MS can have trouble walking: foot drop.
What is foot drop?
Foot drop (some people refer to it as “drop foot”) is a symptom where those with MS have weakness in the muscles that flex the ankle. By now, you know that in MS, the lining around our nerves gets attacked by our own immune system, so the signals from our brain to other parts of our body don’t always get to where they are going in a timely manner or at all. This “weakness” we talk about with foot drop is actually when the signal from the brain that says “lift the front part of your foot” doesn’t make it. My brain says “take a step” but my body only gets part of the instructions.
The significant impact on your day-to-day
As you might imagine, even though this is a small area to have trouble with, it’s pretty significant. Trying to walk with this condition can be incredibly hard. When someone with foot drop walks, their toes tend to catch the ground because they can’t move them out of the way. Foot drop is often one of the symptoms that leads to falls, so it can be extremely dangerous. One of the instinctive ways those of us with foot drop end up countering the problem is by trying to raise our knees higher to help our feet clear the ground. Not only does this look very awkward, but it can lead to muscle injuries and also contribute to fatigue. It may not seem it, but that’s a lot of extra and unnatural work to try to walk. That’s one reason I know that if I have to walk too much, I’m going to be extra worn out the next day.
Most people don't notice it
Foot drop is one of those symptoms that, while not invisible like cog fog or mood swings, is still only visible if you are really looking for it. If someone isn’t staring at my foot when I walk or if I’m not raising my knee or using a cane then chances are people won’t notice it. That is, until I stumble or fall. And chances are, you’ll never see the toll it takes on me from a fatigue standpoint of trying to walk around with it.
Every step can be a struggle
Foot drop is another example of why you should never question a person legally parked in a handicap space if they aren’t actually in a wheelchair. From a quick glance, they may appear fine, but every step for them may be a struggle. I know I’ve had several bad falls in parking lots because, even though I have a handicap placard, I worry about the backlash of using it because I don’t look handicapped.
Ways to help deal
Thankfully, there are some ways to help overcome foot drop or at least mitigate some of dangers that come along with it.
Seeing a physical therapist who specializes in MS can be very helpful in combating foot drop. They will often work on strengthening key muscles in your leg to aid you in walking. Many can also work on your gait, teaching you a better and more effective way to walk.
There are a variety of orthotics, splints, and braces that can be used to alleviate the problems caused by foot drop. One that is particularly common is a brace that keeps your foot at a 90-degree angle to your leg so that you don’t drag it. I’ve tried using this, and it can be helpful but can also be a bit uncomfortable.
Functional Electrical Stimulation (FES)
This is a device that you wear on your leg that sends electrical signals to the nerve that lifts the foot. Like any MS treatment, some people have great success with this and others don’t. I’ve tried it out and it was pretty effective for me. These devices can be very expensive though, and many insurance companies (like mine when I was prescribed it) won’t pay for it.
There are a few surgical treatments for foot drop that are often considered a bit extreme. Some involve trying to replace or repair the peroneal nerve. Surgery to replace the tendon near the ankle and foot can also be done. Also, in some cases, a surgery can be performed to fuse the foot to the ankle. Surgery is the least common way of combating foot drop.
Foot drop can have different causes
While there are effective ways to fight this symptom, it must be remembered that foot drop may be only part of the reason that a person with MS may have difficulty walking. Leg spasticity, problems with balance, numbness, and fatigue can all also reduce a person’s ability to walk. While these foot drop treatments can be very helpful, they don’t guarantee that an MS patient will be walking around with no issue. It’s important to talk with your neurologist and physical therapist to determine which, if any, of these options is a good fit for you.
How often do you use assistive devices to help manage your MS?