Battling Foot Drop With Functional Electrical Stimulation
Last updated: June 2023
A while back, I wrote about a pretty common issue that plagues many people who suffer from multiple sclerosis: foot drop. In my overview of the issue, I touched on a few of the ways to improve it. One of those methods is referred to as Functional Electrical Stimulation (FES). Well, I recently had a friend begin to use an FES unit to combat her foot drop, so I thought I’d do a deeper dive on it, as well as get her thoughts, now that she’s been using it for a few weeks.
What is MS foot drop?
First, a little reminder about foot drop. A fairly common symptom of MS, foot drop occurs during the process of walking because one of the nerves that our brain uses to communicate with muscles in our foot has been damaged by the demyelination of MS. These signals that our brain is subconsciously sending to our legs and feet to make the act of walking happen either don’t get there at all or are delayed because of the damaged nerves. Our brain says “lift your foot” but it fails to lift. Many times, all of the other commands our brain sent out to make us walk managed to get there successfully though. So with everything in motion, except that one foot, we often end up dragging our one foot or even falling because everything else is in motion. You can see how this can be a real, even dangerous, problem.1
Functional Electrical Stimulation
One method used to combat foot drop is the use of a Functional Electrical Stimulation (FES) device. Consisting of a control box, electrodes, and a battery, it is typically worn on the problem leg, below the knee. The device sends low-level electrical signals to the nerve that tells the leg muscles to move the foot. It is essentially taking over for the damaged nerve and forcing a signal to those muscles that are required. When calibrated correctly, the control box of the device will know when you are lifting your leg to move and when your foot is back on the ground. This calibration is important and can take some time to get right.2
While I do suffer from foot drop, unlike most things I discuss here, I have no firsthand knowledge of using an FES device. So, I spoke to someone who does, my friend Ann, who recently began using an FES device, a Bioness L300 Go model. Below are my questions and her answers.
Seeking out the FES device
What led you to seek out a functional electrical stimulation device?
Ann: I currently experience intermittent hyperextension of the left knee, which seemed to be caused by weakened quad muscles and/or hamstrings. I had seen an advertisement in 2016 and while I didn't have these issues back then, I decided to follow the lead and try it out, knowing the progression of my MS could make this device important in the future. Back then, it involved a sensor placed in sneakers (the type of compatible footwear was limited).
Bioness L300 Go
Ann: Now, I’m the elated owner of the Bioness L300 Go model, thigh cuff, and calf component. As predicted three years ago, my walking did get increasingly affected, particularly when fatigued by distance. Today’s model is Bluetooth controlled, and it predicts and adapts to your gait needs. No more sensors and wires! It is now multi-directional and even has a bicycle setting. For my job, I am on my feet and this device enables me to get through those last hours of my shift and saves me a lot of energy that would otherwise be exerted trying to compensate. I also don't have to use a cane, so I have both hands free to do my job in retail cosmetics.
Improvements using the FES
Have you noticed an improvement in your issues since using it?
Ann: When you first receive the device, there is a training protocol that you follow for the first couple of weeks to get your muscles used to being assisted, without overtaxing them. I felt like, very shortly after starting, different muscles were starting to pick up the messages, and my general gait improved. My compensatory pain in my right hip had also lessened significantly.
Negatives to using the FES
Have there been any negatives?
Ann: The blaring negative is the cost to a patient, and the reluctance or refusal of insurance companies to help. They often consider multiple sclerosis "unrehabilitatable" and would rather limit coverage to conditions like strokes. For me, it was more an issue of continued functionality in my daily life and work (and perhaps avoiding a hip replacement down the line.) I received some assistance from the MS Foundation and started saving early, predicting its usefulness. Another negative could be that it is a bit complicated involving the saturation of electrodes to properly ensure electricity is conducted properly. The company representatives at Bioness are good about providing calibration/demonstrations for the device, but that only goes so far.
Ann: I would say any patient that has been properly fitted by Bioness should have follow-up physical therapy as directed by their physician to get maximum benefit.
Do you recommend an FES device?
Ann: I do, for very specific people, like most with this disease, it’s highly individual.
A huge thanks to my friend Ann for answering my questions; this is one of those things I’ve heard about and understand, but have never gotten to experience firsthand. It sounds like the device has been incredibly helpful for her (which is what really made me want to write this). Unfortunately, it sounds like it can be a bit expensive and a bit of a hassle, particularly if you are dealing with the healthcare landscape in the United States. There are still other ways to battle foot drop though, like braces and physical therapy.1 For some though, those methods won’t work, and an FES device will be the best option.
There are different options to combat foot drop
Whether foot drop is an issue for you or not, I think an important takeaway is that there are always options out there. I think it’s also pretty great to see that while we keep getting new medications and making progress on that front, there are other areas, in science and technology, being explored to help those with multiple sclerosis.
Thanks so much for reading and always feel free to share!
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