Written by James Roland | Published on May 21, 2014
Medically Reviewed by Kenneth R. Hirsch, MD on May 21, 2014
Drop Foot: Causes, Treatments, and More
Foot drop, or drop foot, is a common symptom of multiple sclerosis (MS). It’s a difficulty in lifting the front part of the foot, which can make walking challenging. People with this symptom tend to walk by lifting the knee as though they were walking up stairs. Other muscle- and nerve-related symptoms of MS can compound the challenges presented by this condition.
Fortunately, there are many treatment options, ranging from braces to physical therapy to surgery. They may not completely restore a normal gait, but they can often reduce the symptoms significantly and making walking easier.
The MS Connection
Because MS disrupts communication between the brain and the body, nerve-related problems are common. Feelings of numbness or tingling in the extremities are often the earliest signs of MS.
Nervous system problems can develop into more serious complications. Foot drop may be the result of a peroneal nerve injury. People with MS may also experience peroneal muscle weakness that causes foot drop. The muscle runs down the outer leg and connects to the foot. The peroneal nerve is a branch of the sciatic nerve, which starts in the lower back and runs down the leg. But other muscles in one or both legs can become weak due to MS as well, causing you to feel unstable on your feet.
Foot drop-related walking problems can be made worse by other symptoms of MS. Numbness in the feet can become so severe that someone with MS may have difficulty feeling the floor or knowing exactly where their feet are in relation to the floor. This condition is called sensory ataxia. Ataxia is a muscle control problem that prevents the coordination of movement.
Many symptoms of MS can cause difficulty walking. The general sense of fatigue that accompanies MS causes leg muscles to simply become tired, and tightness or spasms in the leg muscles can add to walking problems. Even without foot drop, walking can be a challenge for people with MS.
While MS is a common cause of foot drop, the gait-related problem is also associated with other conditions. These include amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), muscular dystrophy, and stroke.
Foot drop can also be caused by injuries to nerves that control the muscles that lift the foot. The affected nerves may be in the knee or in the lower spine, and can have a range of causes. Hip or knee replacement surgery and diabetes can sometimes cause foot drop. And nerve damage in the eye, which can result in pain when moving the eye or even vision loss, can cause general difficulty walking. Other causes include nerve compression or a herniated disc.
Your Treatment Options
Foot drop treatments depend primarily on the cause of the condition and the extent of the disability. Treating a herniated disc, for example, may eliminate foot drop. But spinal surgery may not solve the problem for people with MS.
A variety of orthotics, like braces and splints, are available. Some are worn in the shoes, while others are worn around the ankle or near the knee. One widely used device is called an ankle foot orthosis (AFO). This helps keep the foot at a 90-degree angle to the lower leg to support it. While it can help improve your gait, it can also be a hassle, and may require a larger shoe to accommodate the brace. An AFO may also become uncomfortable if worn for long periods of time.
Electrical stimulation of the peroneal muscle while walking can also help reduce the symptoms of foot drop. Small devices worn near the knee respond to the movement of the leg and send mild electrical stimuli to the muscle to help it move properly.
Physical therapy can also help. A variety of exercises can strengthen the leg muscles and improve flexibility. Working with a physical therapist with a knowledge of MS and foot drop would be especially helpful.
If orthotics or physical therapy don’t sufficiently manage the condition, there are several surgical solutions that may help. A healthy tendon from another part of the body can be grafted onto the leg and foot. Nerve grafting is also an option. A healthy nerve is taken from somewhere else in the body and placed in the leg so that it can better stimulate the peroneal muscle.
Another type of surgery fuses the foot and ankle to remove the burden from the peroneal muscle. However, this procedure reduces the flexibility of the ankle.
All surgeries carry risks, so it’s important that you talk to your doctor about all your treatment options. If you’re going to have an operation, be sure to understand the risks, benefits, and long-term results of your choice.
Living with Foot Drop
Walking with foot drop can make you self-conscious and wear you out. But like some other MS symptoms, it can often be managed successfully. Foot drop doesn’t have to be endured without help. Talking with your doctor and being ready to work with a physical therapist are two of the best steps you can take to treat foot drop.