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

Foot drop describes difficulty lifting the front of the foot sufficiently during the swing phase of walking. In Multiple Sclerosis this may be related to weakness, altered muscle control, spasticity, fatigue or a combination of factors, so treatment should be based on assessment rather than the label alone.

How foot drop can affect walking

Reduced foot clearance can lead to toe catching, compensatory hip or knee movement, slower walking and greater concentration during each step. It may also increase the energy cost of walking, which is particularly relevant when MS fatigue is already present.

Physiotherapy assessment

A physiotherapist may look at ankle movement and strength, hip and knee control, muscle tone, balance, walking speed, foot clearance and how performance changes with fatigue. This helps identify whether the main rehabilitation target is isolated ankle control, broader leg strength, gait strategy, balance, endurance or equipment.

Exercises that may be considered

Depending on the assessment, rehabilitation may include ankle dorsiflexion work, supported heel walking, step-over or foot-clearance drills, marching, strengthening around the hip and knee, calf work, balance practice and repeated walking tasks. Some people will need seated or supported versions, while others can progress to loaded or gym-based strengthening.

Walking strategy and fatigue

Foot clearance can deteriorate as fatigue increases. It may be useful to compare walking at the beginning and end of an activity, plan rest points and use an aid if it improves safety or reduces the energy cost of walking. The aim is not to avoid all fatigue but to recognise when movement quality is becoming unsafe or inefficient.

Orthoses and functional electrical stimulation

An ankle-foot orthosis can support the foot and ankle mechanically. Functional electrical stimulation, often shortened to FES, uses electrical stimulation timed with walking to assist movement in suitable cases. These options need individual assessment and are not interchangeable for everyone.

MS Trust's foot drop information describes physiotherapy, orthoses and FES among the options that may be considered after assessment.

When foot drop changes suddenly

A new or clear worsening in foot drop should not automatically be treated as a simple strength problem. If it represents a new neurological change or is associated with other new symptoms, contact your MS nurse or appropriate medical team for advice.

Related MS physiotherapy resources

Multiple Sclerosis Physiotherapy & Exercise Resource Centre includes related sections on balance, fatigue and walking.

When to seek individual advice

MS is variable and exercise needs to be adapted to the individual. New or worsening neurological symptoms, a suspected relapse, repeated falls, sudden changes in walking or significant new weakness should be discussed with your MS nurse, neurologist, GP or other appropriate healthcare professional. A physiotherapist can assess movement, strength, balance and mobility and tailor rehabilitation to your needs.

Explore the complete MS guide

The Complete Multiple Sclerosis Physiotherapy & Rehabilitation Guide is a 353-page digital resource with 91 progressive exercises, video demonstrations and detailed sections on fatigue, strength, balance, walking, foot drop, spasticity, relapse recovery, wheelchair and seated rehabilitation, gym exercise and self-management.