Treating Foot Drop in Multiple Sclerosis Patients

Understanding Foot Drop in Multiple Sclerosis

Foot drop is a common mobility issue affecting many individuals with multiple sclerosis (MS). It refers to difficulty lifting the front part of the foot due to muscle weakness or paralysis. This can make walking challenging and lead to tripping or falls.

What Causes Foot Drop in MS

Foot drop in MS occurs when nerve signaling from the brain to the muscles in the foot is disrupted. MS damages myelin, the protective covering surrounding nerves, interfering with transmission of nerve signals. When signals from the brain can't reach the muscles properly, it leads to weakness or paralysis.

Specifically in foot drop, it is the nerves controlling the muscles that lift the foot up, known as dorsiflexors, that lose proper nerve stimulation. As a result, these muscles weaken and it becomes difficult or impossible to lift the toes and foot adequately when walking.

Symptoms of MS-Related Foot Drop

The main sign of foot drop in MS is difficulty lifting the front part of the foot when walking or running. This can cause:

• Dragging the foot along the ground
• Tripping, stumbling or falling
• Walking with a "slapping" gait
• Feeling like you are lifting your hip excessively high to avoid dragging your foot

Foot drop can occur in one foot or both feet simultaneously. It can come and go with MS relapses or progress slowly over time as neurological damage accumulates.

Treating Foot Drop to Improve Walking

While MS foot drop can't be cured, various treatment options exist to aid walking ability and reduce fall risk. Treatment choices depend on severity and typically utilize a combination approach tailored to each patient.

Physical Therapy

Most MS foot drop treatment starts with physical therapy focused on gait training and strengthening leg musculature. This involves exercises like:

• Ankle stretches and range-of-motion movements
• Toe curls and dorsiflexion exercises using resistance bands
• Standing calf raises
• Balance training

If foot drop is only intermittent, this training can essentially "reteach" the neuromuscular system to lift the foot correctly again. In severe cases, it improves leg strength best as possible to support use of assistive devices.

Orthotic Devices for Foot Support

Custom ankle-foot orthotics (AFOs) are often used in conjunction with physical therapy for foot drop. These brace the ankle and foot to keep it steady in the proper position for efficient walking ability.

Plastic or composite AFOs provide rigid support, while flexible carbon fiber allows some movement. Fastening the AFO tightly is crucial for effectiveness and preventing tripping risk. Many styles exist such as:

• Posterior leaf spring AFO - plastic plate behind calf
• Dorsiflex assist - elastic straps attached to shoe
• Rigid stirrup - plastic U shape below foot

These devices require proper individualized fitting from an orthotist. They can provide support when foot drop is intermittent or boost physical therapy when it is chronic.

Functional Electrical Stimulation for Nerve Activation

Functional electrical stimulation (FES) is another option complementing leg braces and training. Small electrodes are placed on the skin of the affected leg just below the knee. A small, portable stimulator unit then transmits electrical signals to the nerves that activate muscles controlling foot lift.

This stimulation essentially replaces the missing nerve signals from the brain so that the leg muscles contract. The electrodes can be worn for hours a day, re-activating dorsiflexion whenever the foot drops. Professionals program the specific stimulation pattern needed for restored motion.

Some FES systems feature sensors in the shoe that trigger stimulation only when you attempt to take a step. This allows more normal ankle movement at rest.

Surgical Interventions in Severe Cases

For those with chronic foot drop that does not improve with conservative treatment, surgical procedures may help stabilize foot positioning. This typically involves transferring a tendon to literally replace the function of weakened dorsiflexors.

In tibialis posterior tendon transfer, the tendon controlling foot arch support is re-routed and connected to a foot lift muscle. This allows the transfer tendon to take over dorsiflexion upon contraction.

For those already using an AFO brace, surgery can be performed to fuse the ankle into the 90 degree position. This prevents drop foot since the ankle can't flex beyond this fixed point. This limits some mobility but provides support without a brace.

Complementary Lifestyle Approaches

Medical interventions should be accompanied by daily lifestyle changes to support safe mobility with MS foot drop.

Appropriate Footwear

Choosing proper footwear reduces fall risk outside the home. Features to look for include:

• High tops reaching above the ankle
• Firm heel counters for rear stability
• Cushioned midsoles absorbing impact
• Textured soles with traction

Orthopedic shoes can provide medical-grade support as well. Their snug fit works with braces and custom inserts.

Home and Workplace Adaptations

Modifying your environment helps prevent falls and improve function:

• Install railings on stairs or ramps
• Ensure sufficient lighting in hallways and rooms
• Use non-slip bathmats and grab bars in bathroom
• Remove loose rugs or cables from floors
• Consider workplace accommodations like reduced walking

These simple changes remove tripping hazards protecting you at home.

Mobility Aid Options

Canes, walkers, or wheelchairs assist foot drop mobility and balance issues. Using support aids prevents excessive fatigue and likelihood of falls when out and about. Consult a physical therapist to determine appropriate mobility equipment for your individual deficits and challenges.

The Takeaway

Foot drop arising from MS-related nerve damage can seriously impact mobility and quality of life. But utilizing available treatment approaches provides both short and long term ways to manage this challenging symptom. From AFO bracing to active movement therapies and surgical solutions, regaining strength, stability and function is possible.

Combining customized medical care, assistive equipment, and home/lifestyle adaptations allows you to stay as active and confident in your movement ability as possible. Support from clinicians guiding treatment and family/friends reinforcing adaptations is also invaluable.

While MS progression varies, prioritizing safe mobility through foot drop treatments can help you walk more worry free no matter the underlying changes occurring.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.