Foot Drop in Multiple Sclerosis: Exercises, Walking and Physiotherapy Options

Foot drop describes difficulty clearing the front of the foot during walking. In Multiple Sclerosis it may contribute to toe catching, altered step length, compensatory hip or knee movement, slower walking and increased falls risk.

Why foot drop happens

Reduced ankle dorsiflexion strength is one possible contributor, but walking in MS is rarely explained by one muscle alone. Fatigue, hip weakness, stiffness, balance, sensation and coordination can all affect foot clearance.

Exercise may target more than the ankle

Ankle dorsiflexion work can be useful, but rehabilitation may also include hip flexion, knee control, calf strength, trunk control, marching, stepping and obstacle-clearance practice. The best combination depends on what is limiting the person's gait.

Practise the task of walking

Strength gains need to transfer into function. Controlled stepping, repeated foot placement, walking practice and safe changes in speed or direction can help integrate strength and coordination into gait.

Fatigue can make foot clearance worse

Some people clear the foot adequately at the start of a walk and begin catching the toes later. That pattern may require pacing, shorter walking bouts, rest breaks or a mobility aid as well as strengthening.

Orthoses and functional electrical stimulation

Where foot drop is persistent, an individual assessment may consider an ankle-foot orthosis or functional electrical stimulation. NICE has guidance on functional electrical stimulation for drop foot of central neurological origin. Suitability needs to be assessed for the individual.

Do not ignore a new change

A new or clearly worsening neurological symptom should not simply be treated as a strength problem. Contact your MS nurse or medical team for advice, particularly if the change could represent a relapse or another new neurological issue.

When to seek individual advice

MS affects people differently. New or worsening neurological symptoms, a suspected relapse, significant changes in walking or balance, repeated falls, or concerns about medication or treatment should be discussed with your MS nurse, neurologist, GP or appropriate healthcare professional. Exercise advice should be adapted to your individual symptoms and safety needs.

A structured MS physiotherapy resource

For a much larger exercise library and practical self-management guidance, see The Complete Multiple Sclerosis Physiotherapy & Rehabilitation Guide. It is a 353-page digital guide with 91 exercises ranging from bed-based and seated rehabilitation through to standing, balance, walking, strength, gym and higher-level exercise.

The guide is designed to complement, not replace, individual medical and physiotherapy care.