Can Multiple Sclerosis Cause Foot Drop?

Yes. Multiple sclerosis can cause foot drop by disrupting the nerve signals travelling between the brain, spinal cord and muscles that control the foot.

A person may find it difficult to:

• Lift the front of the foot
• Lift the toes
• Keep the foot level as the leg swings forwards
• Control the foot as it reaches the ground

This may cause:

• The toes to drag
• The shoe to scuff the floor
• Foot slap
• A high-stepping walking pattern
• The leg to swing outwards
• Trips or falls
• Greater walking effort
• Faster fatigue

The MS Trust describes foot drop as a recognised symptom of MS caused by disruption in the nerve pathway between the legs and brain. The altered signals prevent the foot from lifting to the correct angle at the correct stage of walking.

What Is Multiple Sclerosis?

Multiple sclerosis, usually shortened to MS, is a neurological condition affecting the brain and spinal cord.

It can interrupt the transmission of messages through the central nervous system and produce a wide range of symptoms.

Common symptoms include:

• Fatigue
• Numbness or tingling
• Balance or coordination problems
• Muscle cramps and spasms
• Stiffness
• Visual problems
• Bladder difficulties
• Problems with memory or concentration

Symptoms vary considerably from one person to another. They may come and go through relapses and remissions or gradually worsen over time, depending on the type and pattern of MS.

How Does MS Cause Foot Drop?

Walking requires accurately timed messages between the:

1. Brain
2. Spinal cord
3. Peripheral nerves
4. Muscles of the hip, knee, ankle and foot

In MS, damage within the brain or spinal cord can interrupt or delay these messages.

The muscles responsible for lifting the ankle may then:

• Contract too weakly
• Contract too late
• Tire quickly
• Work against stiff or overactive opposing muscles
• Fail to coordinate with the rest of the leg

As the leg swings forwards, the front of the foot may remain pointed down rather than lifting clear of the floor.

The MS Trust explains that MS foot drop is caused by ankle weakness or disruption in the nerve pathway to and from the brain, producing poor coordination between the leg and ankle during walking.

Is MS Foot Drop a Peripheral Nerve Problem?

Usually, no.

MS is a central neurological condition, meaning the main damage is within the:

• Brain
• Spinal cord

This differs from foot drop caused by damage to the common peroneal nerve near the outside of the knee.

MS-related foot drop

The signal is disrupted within the central nervous system.

Peroneal nerve foot drop

The signal is affected within a peripheral nerve in the leg.

Both can cause difficulty lifting the foot, but the wider symptoms, treatment options and suitability for functional electrical stimulation may differ.

A person with MS can still develop an unrelated:

• Trapped peroneal nerve
• Slipped disc
• Peripheral neuropathy
• Injury

New symptoms should therefore not automatically be attributed to existing MS.

What Does MS Foot Drop Look Like?

Possible signs include:

• The toes brushing the floor
• The front of the shoe wearing down
• The foot slapping after the heel lands
• Raising the knee higher than usual
• Swinging the leg around in an arc
• Lifting one side of the pelvis
• Taking shorter steps
• Walking more slowly
• Looking down continuously
• Difficulty with stairs
• Difficulty crossing thresholds
• Greater problems on uneven ground
• Worsening control later in the day

The MS Trust notes that people may lift the leg higher to clear the toes, but this uses additional energy and can increase fatigue and unsteadiness.

Why Does the Leg Swing Outwards?

Swinging the leg outwards is a common compensation for reduced toe clearance.

Instead of lifting the foot sufficiently, the person moves the entire leg around the side.

This may help the toes avoid the floor, but it can:

• Use more energy
• Slow walking
• Affect balance
• Increase hip movement
• Contribute to back or hip discomfort
• Become harder to maintain when tired

An AFO or FES system may reduce this compensation where it successfully improves foot clearance.

What Is Foot Slap?

Foot slap occurs when the heel lands but the muscles cannot control the forefoot as it lowers.

The front of the shoe may strike the floor rapidly and audibly.

In MS, this can result from:

• Dorsiflexor weakness
• Poor coordination
• Fatigue
• Altered muscle tone
• Delayed nerve signals

A support that only lifts the toes during the swing phase may not provide the same control after heel contact as a structured AFO designed to resist plantarflexion.

Is MS Foot Drop Always Caused by Weak Ankle Muscles?

No.

Foot catching in MS is often more complicated than isolated weakness at the ankle.

Other contributing factors can include:

• Weak hip flexors
• Weak knee flexors
• Reduced knee movement
• Spasticity
• Ankle stiffness
• Poor coordination
• Reduced sensation
• Balance impairment
• Fatigue
• Tremor or ataxia
• Pain
• Fear of falling

The MS Trust advises that what is described as foot drop may involve several subtle symptoms rather than isolated dorsiflexor weakness. Establishing the actual cause is important because an AFO may help true ankle weakness but may not solve foot catching caused mainly by weakness higher in the leg.

Can Weakness at the Hip Look Like Foot Drop?

Yes.

A person needs enough hip and knee movement to shorten the leg and clear the foot during the swing phase.

If the hip cannot lift the thigh sufficiently, the toes may catch even when some ankle movement remains.

Signs that the issue involves more than the ankle may include:

• Difficulty lifting the whole leg
• The knee remaining relatively straight
• Dragging from the hip
• Difficulty stepping onto a kerb
• Trouble bringing the leg into a car or bed
• Toe catching despite an AFO lifting the ankle

A neurological physiotherapist can assess each part of the walking pattern.

Can Knee Weakness Contribute?

Yes.

The knee normally bends while the leg swings forwards.

Reduced knee bending can leave the leg effectively too long, increasing the chance that the toes will catch.

Knee weakness can also cause:

• Buckling
• Difficulty standing
• Reduced control on stairs
• Compensatory knee locking
• Greater reliance on a walking aid

A simple textile foot-lifting support may improve the ankle without correcting a substantial knee problem.

What Is Flaccid Foot Drop in MS?

Flaccid foot drop means the main problem is reduced muscle activation and weakness rather than strong stiffness or spasticity.

The foot may:

• Hang down
• Remain relatively flexible
• Offer little resistance when moved
• Respond to an upward textile traction system
• Slap as it reaches the ground

A soft dynamic support such as StepUp® may be considered where the presentation is:

• Flaccid
• Flexible
• Relatively stable from side to side
• Not complicated by severe knee instability

The StepUp® product is currently indicated for flaccid foot drop, swing-phase dorsiflexion weakness and neurological presentations including multiple sclerosis.

What Is Spastic Foot Drop in MS?

Spasticity is involuntary muscle stiffness caused by disruption of the neurological pathways controlling movement.

The ankle and foot may be pulled:

• Downwards
• Inwards
• Into toe curling
• Into a stiff position

The movement may become stronger when the person is:

• Tired
• Walking quickly
• Anxious
• In pain
• Experiencing an infection
• Cold
• Moving over a difficult surface

MS can cause weakness and stiffness within the same leg. In some people, a degree of stiffness may even contribute to standing, so treatment must be individual rather than simply attempting to remove all muscle tone.

Can a Soft Foot Drop Support Control Spasticity?

Not necessarily.

A textile brace mainly provides an upward pull.

It may not safely control:

• Strong plantarflexion
• Significant inward rotation
• Severe ankle instability
• A fixed position
• Sudden spasms
• Major knee involvement

Signs that a soft support is being overpowered include:

• The cuff being pulled down
• The foot remaining pointed
• The support rotating
• The foot landing on its outer edge
• Extreme strap tension being required
• The heel lifting
• Continued toe dragging

Do not attempt to overpower spasticity by tightening every strap.

A more structured or custom-made AFO may be required.

Can the Foot Turn Inwards?

Yes.

Inward movement may occur because of:

• Spasticity
• Muscle imbalance
• Weakness of outward-turning muscles
• Reduced ankle control
• Fixed deformity

The person may:

• Walk on the outside edge of the foot
• Roll the ankle
• Develop pressure around the ankle
• Feel unstable
• Catch the outer edge of the shoe

StepUp® can provide mild mediolateral assistance through its strapping system, but it should not be treated as equivalent to the structural containment of every plastic or custom AFO.

Strong inversion needs professional assessment.

Can MS Cause Toe Curling?

Yes.

Toe curling may result from:

• Spasticity
• Muscle overactivity
• Effort during walking
• Foot position
• An unsuitable shoe
• The foot sliding forwards

The toes may:

• Curl beneath the foot
• Press into the shoe
• Develop callus or pressure
• Make standing less stable
• Become painful

Increasing the upward traction on a foot-drop support will not necessarily correct toe curling.

A review may be needed of:

• Spasticity
• Footwear
• AFO design
• Toe position
• Skin
• Ankle range

Can the Ankle Become Stiff?

Yes.

Stiffness may develop through:

• Spasticity
• Reduced movement
• Tight calf muscles
• Achilles shortening
• Long-term positioning
• Contracture

The ankle may no longer move easily into the position required for a standard brace.

Signs include:

• The heel lifting
• Difficulty placing the foot flat
• Pressure at the front of the ankle
• A gap beneath the heel
• The knee moving backwards
• Toes being pushed forwards

Do not force a stiff ankle into a standard AFO.

A custom device, resting splint, stretching programme or spasticity treatment may be required.

Can MS Foot Drop Vary During the Day?

Yes.

MS symptoms can fluctuate because of:

• Fatigue
• Heat
• Activity
• Stress
• Pain
• Sleep
• Infection
• Medication effects
• Muscle stiffness

Someone may walk relatively well during the morning but begin catching the toes later in the day.

This can make foot drop difficult to assess during a brief clinical appointment.

Tell the clinician:

• When the foot begins dragging
• How far you can walk before it worsens
• Whether heat affects it
• Whether rest improves it
• Whether the problem changes outdoors
• Whether it is worse during a suspected relapse

Why Does Fatigue Make Foot Drop Worse?

MS-related fatigue can reduce:

• Muscle activation
• Coordination
• concentration
• balance
• ability to compensate

A high-stepping or outward-swinging gait also consumes additional energy, creating a cycle in which:

1. Foot drop makes walking harder.
2. Compensatory movement uses more energy.
3. Fatigue increases.
4. Toe clearance becomes worse.

The MS Trust notes that compensating for foot drop can tire the legs more quickly and increase wobbliness and fatigue.

NICE recommends discussing energy conservation, priorities, lifestyle and appropriate exercise when managing MS-related fatigue.

Can Heat Make Foot Drop Worse?

Yes, for some people.

Heat may temporarily make established MS symptoms more noticeable.

This may happen during:

• Hot weather
• A hot bath or shower
• Exercise
• A warm workplace
• Fever
• An overheated room

The person may notice:

• Greater weakness
• Increased toe dragging
• Worse balance
• More fatigue
• Reduced walking distance

NICE advises that MS-related fatigue may be triggered by heat as well as physical, emotional and biological stress. NHS MS guidance also notes that symptoms worsened by heat generally improve again once the person cools down.

Temporary worsening from heat does not automatically mean a new relapse.

Can Cold Make Foot Drop Worse?

Some people find that cold increases:

• Stiffness
• Spasticity
• Pain
• Difficulty initiating movement

Cold weather may also add practical problems such as:

• Slippery surfaces
• Heavy footwear
• Bulky clothing
• Reduced sensation

The response is individual.

Use footwear that remains secure and compatible with the brace without becoming excessively heavy or tight.

Can an Infection Make Foot Drop Worse?

Yes.

An infection can temporarily worsen established MS symptoms.

Common triggers can include:

• Urinary tract infection
• Chest infection
• Cold or flu
• Stomach infection
• Fever

This temporary worsening is sometimes called a pseudo-relapse or pseudo-exacerbation.

The MS Trust explains that infection can increase existing symptoms temporarily and that symptoms may begin improving as the infection is treated or resolves.

Contact your healthcare team if walking suddenly deteriorates, particularly if you also have:

• Fever
• Urinary symptoms
• Cough
• Feeling generally unwell
• Confusion
• Increased spasms

What Is an MS Relapse?

A relapse involves new neurological symptoms or a significant worsening of previous symptoms.

NICE defines a relapse as symptoms that:

• Last for more than 24 hours
• Occur after a stable period of at least one month
• Are not explained by infection or another cause

Relapses should be assessed by a healthcare professional with expertise in MS. Not every relapse requires steroid treatment, but a relapse affecting ordinary tasks may benefit from prompt management.

Is Worsening Foot Drop Always a Relapse?

No.

Foot drop may temporarily worsen because of:

• Heat
• Infection
• Fatigue
• Stress
• Poor sleep
• Pain
• Overactivity
• Medication
• An unsuitable or worn brace

It may also worsen because of:

• Gradual MS progression
• A new relapse
• A trapped peripheral nerve
• A slipped disc
• Another neurological condition
• Reduced fitness
• A fall or injury

Contact your MS team rather than attempting to diagnose the cause yourself.

Could Sudden Foot Drop Be a Stroke Instead?

Yes.

Someone with MS can still have a stroke.

Call 999 if weakness occurs suddenly with:

• Facial drooping
• Arm weakness
• Speech difficulty
• Sudden vision loss or blurring
• Severe sudden balance or coordination problems
• Confusion
• Sudden unexplained collapse

The NHS advises emergency assessment for these symptoms because they may indicate a stroke rather than MS.

Do not wait to see whether the weakness settles.

Can MS Affect Both Feet?

Yes.

MS can affect:

• One leg
• Both legs
• Different parts of each leg
• One side more than the other

Someone may have:

• Foot drop on one side
• Weakness in both legs
• Different levels of spasticity
• Different sensory changes
• Different AFO requirements

Do not assume that both legs need the same brace or size.

Each limb should be assessed independently.

Can Foot Drop Be an Early MS Symptom?

It can be one of the symptoms that leads someone to seek medical assessment, but foot drop alone does not diagnose MS.

MS can produce many symptoms, including:

• Numbness
• Visual disturbance
• Weakness
• Balance problems
• Spasms
• Fatigue
• Bladder changes

These symptoms can also be caused by many other conditions.

The NHS advises seeing a GP when MS symptoms are suspected. Diagnosis requires neurological assessment and may involve examination, MRI, blood tests and other investigations; there is no single test that independently diagnoses MS.

How Is MS-Related Foot Drop Assessed?

The assessment may consider:

• Ankle dorsiflexion strength
• Toe movement
• Passive ankle range
• Muscle tone
• Spasticity
• Foot alignment
• Knee control
• Hip strength
• Sensation
• Balance
• Coordination
• Fatigue
• Walking distance
• Falls
• Footwear
• Ability to fit a device
• Goals and daily activities

The clinician should observe more than a few steps.

The problem may be more obvious:

• After repeated walking
• On stairs
• Outdoors
• When turning
• When carrying something
• Later in the day
• When the person is warm or fatigued

Who Can Help?

The healthcare team may include:

• MS nurse
• Neurologist
• Neurological physiotherapist
• Orthotist
• Occupational therapist
• Rehabilitation consultant
• Podiatrist
• Specialist FES service

MS nurse or neurologist

May assess:

• Relapse
• Disease progression
• Medication
• Spasticity
• Other neurological changes

Physiotherapist

May assess:

• Strength
• Muscle tone
• Walking
• Balance
• Fatigue
• Exercise
• Falls
• FES suitability

Orthotist

May assess:

• AFO design
• Foot and ankle alignment
• Knee effect
• Fit
• Footwear
• Skin
• Ability to apply the support

Occupational therapist

May help with:

• Dressing
• Work
• Fatigue management
• Home mobility
• Bathroom safety
• Daily routines

Can Physiotherapy Help?

Yes.

Physiotherapy may address:

• Ankle activation
• Hip and knee strength
• Balance
• coordination
• Walking technique
• Stairs
• Endurance
• Falls risk
• Spasticity
• Use of an AFO
• Use of a walking aid

The programme should be adapted to:

• Fatigue
• Heat sensitivity
• Pain
• Muscle tone
• Balance
• Relapse status
• Other MS symptoms

NICE advises that aerobic, resistance and balance exercises may help MS-related fatigue and recommends individualised support rather than assuming that fatigue should prevent physical activity.

Can Exercise Cure MS Foot Drop?

No.

Exercise can help improve or maintain:

• Strength
• Mobility
• balance
• endurance
• confidence
• flexibility

It cannot repair all neurological damage or guarantee that normal ankle control will return.

A person should not repeatedly exercise the ankle to exhaustion in the belief that more effort will overcome disrupted nerve signals.

Exercise quality and consistency are more important than forcing a weak movement.

Can an AFO Help?

Yes.

An AFO may assist by:

• Lifting the forefoot
• Improving toe clearance
• Reducing foot slap
• Stabilising the ankle
• Controlling foot alignment
• Influencing knee movement
• Reducing compensatory high stepping
• Making foot placement more consistent

An AFO does not:

• Treat MS itself
• Repair neurological pathways
• Remove fatigue
• Restore sensation
• Prevent every fall
• Suit every walking problem

The MS Trust confirms that AFOs can hold the foot and ankle in a more suitable position during walking and should be measured or prescribed by an orthotist where clinically appropriate.

Which Type of AFO Is Best for MS?

There is no single best AFO for everyone with MS.

Possible options include:

• Textile foot drop supports
• Flexible plastic leaf-spring AFOs
• Reinforced AFOs
• Carbon AFOs
• Hinged AFOs
• Solid AFOs
• Ground-reaction AFOs
• Custom-made AFOs
• Resting splints

The correct device depends on whether the main problem is:

• Flaccid weakness
• Spasticity
• Ankle stiffness
• Foot rotation
• Knee instability
• Fatigue
• Reduced sensation
• Difficulty fitting the brace
• A combination of several problems

When Might StepUp® Be Suitable?

StepUp® may be considered where:

• Foot drop is flaccid
• The ankle remains flexible
• Toe-clearance assistance is required
• Side-to-side instability is mild
• A low-profile support is preferred
• Use with or without footwear is useful
• A latex-free textile device is required
• The wearer can fit and monitor the straps

Its current features include:

• Soft textile construction
• Adjustable touch-close fastenings
• Dynamic foot lift
• Anti-slip silicone beading
• A calf band
• Mild mediolateral assistance
• Use with or without footwear
• Small, Medium, Large and Universal sizes
• Latex-free construction

Its stated indications include flaccid foot drop and neurological weakness associated with multiple sclerosis.

When Might StepUp® Be Unsuitable?

It may not provide enough control where there is:

• Significant spasticity
• A fixed ankle position
• Strong inward or outward foot movement
• Major heel movement
• Significant knee collapse
• Strong knee hyperextension
• Severe balance impairment
• Active skin damage
• A foot shape that cannot be accommodated

A soft device should not be selected solely because it looks less restrictive.

The brace must provide enough support for the actual walking problem.

Can StepUp® Be Worn Without Shoes?

Yes, the current StepUp® design is intended for use with or without footwear.

Shoeless use does not mean that it is safe on every surface.

Take care on:

• Smooth laminate
• Polished wood
• Wet tiles
• Loose rugs
• Thick carpet
• Stairs
• Uneven thresholds

Someone with reduced sensation may still need enclosed footwear to protect the foot from:

• Cuts
• Heat
• Sharp objects
• Pressure
• Impact

Does StepUp® Control the Knee?

Its primary function is dynamic foot lift, with mild additional stability through its strapping system.

It is not a substitute for an AFO selected specifically to provide substantial control of:

• Knee collapse
• Knee hyperextension
• Major stance-phase instability

If the knee is unstable, the complete leg should be assessed.

When Is a Plastic AFO More Appropriate?

A structured plastic AFO may provide:

• More consistent plantarflexion resistance
• Greater heel control
• More ankle stability
• A physical footplate
• Greater influence on knee position

It may be preferable when:

• A textile support stretches or moves
• The foot still drags
• The heel repeatedly lifts
• More structural control is required
• Fatigue causes the soft support to become insufficient

A more enclosed or custom-made AFO may be needed where the foot turns strongly or the ankle is fixed.

When Is a Carbon AFO Considered?

A carbon AFO may offer:

• Lightweight structural support
• A slim profile
• Consistent dorsiflexion assistance
• Dynamic energy return
• Mild side-to-side control, depending on design

It must still suit:

• Ankle range
• Knee control
• Foot shape
• Body weight
• Footwear
• Muscle tone

Carbon is not automatically better for MS.

A dynamic response can be helpful for one person and too stiff or unsuitable for another.

When Is a Custom-Made AFO Needed?

A custom device may be considered when:

• Standard sizing does not fit
• The foot has changed shape
• The ankle is fixed
• Spasticity is substantial
• The foot turns strongly
• The knee needs a precise mechanical effect
• Pressure relief is required
• Sensation is significantly reduced
• Several suitable stock braces have failed

Custom-made does not automatically mean more effective.

It meets a more individual need that cannot be managed reliably with a standard product.

Can a Resting Splint Help?

A resting or night splint may be used when the goal is to:

• Maintain ankle position
• Manage calf or Achilles tightness
• Reduce prolonged downward positioning
• Support a contracture-management programme

It is different from a walking AFO.

The MS Trust notes that positional ankle splints may be used overnight where tightness or contracture around the ankle needs to be managed.

Do not walk in a resting splint unless it is specifically designed for weight-bearing.

Can Functional Electrical Stimulation Help?

Potentially.

FES uses timed electrical pulses to activate the common peroneal nerve and muscles that lift the foot.

MS is a central neurological cause of foot drop and is among the conditions for which FES may be considered.

NICE explains that FES can be used for upper motor neurone foot drop associated with MS and works by stimulating the common peroneal nerve through surface or implanted electrodes.

A specialist assessment is needed to determine whether:

• The nerve and muscles respond
• The ankle has sufficient movement
• The movement produced is useful
• Electrode placement is manageable
• The skin tolerates the device
• Walking improves
• The person can operate the equipment

Is FES Better Than an AFO for MS?

Neither is universally better.

Potential AFO advantages

• Passive mechanical support
• No batteries
• No electrodes
• Greater structural ankle control
• Potential knee influence
• Several soft and rigid designs

Potential FES advantages

• Active muscle contraction
• More ankle freedom
• Less material inside the shoe
• A dynamic lifting movement
• Settings that can be adjusted

Research in people with MS has compared AFO and FES treatment, but individual response, walking speed, fatigue, comfort and everyday usability remain important. The MS Trust recognises both as established approaches for managing MS-related foot drop.

Read our guide: AFO vs Functional Electrical Stimulation: Which Is Better for Foot Drop?

Can Someone Use Both?

Possibly.

A person might use:

• FES for selected walking
• A structured AFO on uneven ground
• A textile brace for shorter journeys
• An AFO when the FES equipment cannot be used
• A resting splint at night

This should be planned with the clinical team because each device can produce a different:

• Ankle movement
• Knee effect
• Walking pattern
• Footwear requirement

Do not combine FES and an AFO on the same leg without specialist advice.

Can an AFO Reduce Fatigue?

It may reduce some of the additional effort caused by foot drop.

By improving toe clearance, it may reduce the need to:

• Lift the knee excessively
• Swing the leg outwards
• Watch the floor continuously
• Take repeated corrective steps

However, an unsuitable AFO can increase fatigue if it:

• Is too stiff
• Is too heavy
• Causes pain
• Alters the knee badly
• Requires unsuitable footwear
• Restricts useful movement

The brace should be reviewed over a realistic walking distance rather than only during the first few steps.

Can a Brace Be Used Only When Tired?

Possibly.

Some people need support mainly:

• Later in the day
• On longer walks
• During travel
• On uneven ground
• At work
• When symptoms are worse

Others require it for all standing and walking.

The MS Trust notes that orthoses do not necessarily need to be worn continuously; use can depend on the activity and functional need.

Do not wait until the toes are already repeatedly catching before fitting a brace if fatigue-related foot drop is predictable.

Can an AFO Be Worn All Day?

Possibly, when it:

• Has been introduced gradually
• Fits correctly
• Remains comfortable
• Does not create persistent skin pressure
• Continues improving walking
• Is appropriate for the activity

Check the skin before and after use.

Stop and seek advice if the brace causes:

• Pain
• Persistent redness
• Blistering
• Broken skin
• Numbness
• Swelling
• Colour changes
• Increasing instability

MS-related altered sensation may mean pressure is not felt normally.

Does Reduced Sensation Affect AFO Use?

Yes.

A person may not feel:

• A tight strap
• Rubbing
• A folded sock
• A blister
• A foreign object inside the shoe
• Excessive heat
• Skin breakdown

Inspect:

• Calf
• Ankle
• Heel
• Achilles area
• Top of the foot
• Sides of the foot
• Sole
• Toes

Use good lighting, a mirror or help from another person where needed.

Can Poor Balance Continue Even if the Foot Lifts Better?

Yes.

MS can affect balance through:

• Reduced sensation
• Poor coordination
• Dizziness
• Visual problems
• Weakness
• Spasticity
• Fatigue
• Tremor

An AFO may improve foot placement without correcting every cause of imbalance.

The person may still need:

• A walking stick
• Crutches
• A frame
• Balance rehabilitation
• Environmental changes
• Falls assessment

Does an AFO Prevent Falls?

No brace can guarantee that someone will not fall.

An AFO may improve one important factor by reducing toe dragging or improving ankle stability.

Falls may still result from:

• Poor balance
• Knee weakness
• Reduced sensation
• Dizziness
• Visual problems
• Fatigue
• Medication
• Environmental hazards
• Poorly fitted footwear

The home and walking environment should also be considered.

Which Footwear Is Best?

Suitable footwear should normally have:

• An enclosed heel
• An enclosed toe
• Adjustable laces or touch-close fastening
• Adequate width
• Adequate depth
• A stable sole
• Reliable grip
• Sufficient room for the support

The MS Trust recommends well-fitting adjustable footwear and advises that lace-up or touch-close shoes may remain more secure than loose slip-ons. Heavy footwear may also increase muscular fatigue.

Can Heavy Shoes Make Foot Drop Worse?

They may make the leg feel harder to move.

A heavy shoe can increase the effort required to:

• Lift the foot
• Bend the knee
• Advance the leg

Choose footwear that is:

• Supportive
• Secure
• Appropriately lightweight
• Compatible with the brace

Extremely lightweight footwear is not helpful if it lacks grip, heel support or adequate space.

Can You Walk Barefoot?

It depends on:

• Sensation
• Balance
• Floor surface
• Ankle stability
• Whether the support is designed for shoeless use

A StepUp® support can be configured without footwear, but this does not provide the same protection as an enclosed shoe.

Barefoot or shoeless walking may be unsuitable where there is:

• Reduced sensation
• Poor balance
• An unstable ankle
• Sharp objects
• Hot flooring
• Wet flooring
• Significant foot deformity

Can You Use Stairs?

Possibly, but stairs require:

• Toe clearance
• Hip and knee strength
• Balance
• Accurate foot placement
• Controlled lowering
• A secure handrail

Fatigue may make stairs more difficult later in the day.

Practise an appropriate technique with a physiotherapist where:

• The toes catch
• The knee gives way
• Balance is poor
• Both legs are affected
• A new brace has changed ankle movement

Can You Walk Long Distances?

Some people can, but distance should be planned around:

• Fatigue
• Heat
• Toe clearance
• Balance
• Skin
• Brace fit
• Rest points
• Terrain
• Access to transport

A support that works for a short indoor walk may become less effective as:

• Elastic stretches
• Muscles fatigue
• Spasticity changes
• The cuff moves
• The wearer becomes hot

Increase distance gradually and review the device if control deteriorates predictably.

Can You Exercise?

Yes, many people with MS can benefit from appropriately selected physical activity.

NICE advises that aerobic, resistance and balance exercises may help with MS-related fatigue. Exercise should be personalised according to mobility, balance, heat sensitivity and other symptoms.

Possible activities include:

• Walking
• Cycling
• Seated exercise
• Strength training
• Balance training
• Swimming where safe
• Yoga
• Pilates

Stop and seek advice if exercise causes:

• Unsafe toe catching
• Repeated falls
• A persistent neurological change
• Severe pain
• Skin damage from the brace
• Symptoms that do not settle after rest or cooling

Should You Avoid Exercise Because Heat Worsens Symptoms?

Not necessarily.

Possible strategies include:

• Exercising in a cooler environment
• Choosing a cooler time of day
• Taking regular breaks
• Using fans or air conditioning
• Drinking fluids according to medical advice
• Avoiding very hot showers immediately beforehand
• Reducing intensity during warm conditions

Temporary heat-related worsening often improves after cooling. A new change that persists should still be discussed with the MS team.

Can You Drive With MS Foot Drop?

Driving safety depends on more than the diagnosis.

Consider:

• Which foot is affected
• Strength
• Sensation
• Coordination
• Reaction time
• Fatigue
• Vision
• Medication
• The AFO’s effect on ankle movement

Do not drive if you cannot reliably:

• Move between pedals
• Apply the brake firmly
• Release the accelerator
• Judge pedal pressure
• Prevent the brace or shoe catching

Check the applicable DVLA and insurance requirements and obtain a specialist driving assessment when control is uncertain.

Can MS Foot Drop Affect Work?

It may affect jobs involving:

• Prolonged walking
• Standing
• Stairs
• Uneven ground
• Driving
• Ladders
• Heavy footwear
• Heat
• Carrying loads

Possible adjustments may include:

• More seated work
• Rest breaks
• Flexible hours
• A cooler environment
• Reduced walking distances
• Accessible parking
• A suitable workstation
• Alternative duties
• AFO-compatible safety footwear

An occupational therapist or occupational-health service may help identify practical adjustments.

How Should StepUp® Be Fitted?

Follow the supplied instructions and any professional fitting demonstration.

A general fitting process may include:

1. Sit on a stable chair.
2. Open the calf and foot components.
3. Position the calf band at the recommended height.
4. Make sure the silicone grip lies smoothly.
5. Position the foot component without twists.
6. Fasten each touch-close strap securely.
7. Apply moderate lifting tension.
8. Put on compatible footwear where being used.
9. Stand with suitable support.
10. Test the brace over a short, clear route.

The brace should:

• Assist toe clearance
• Remain centred
• Avoid pulling the foot strongly sideways
• Avoid excessive compression
• Remain stable as the person walks

Why Might StepUp® Slip?

Possible causes include:

• Incorrect size
• Incorrect calf position
• Loose fastening
• Damp skin or fabric
• Worn silicone grip
• Excessive traction tension
• Strong spasticity
• Significant foot rotation
• A change in leg size

Sit down and refit it safely.

Do not keep tightening the support when the underlying problem may be:

• Wrong sizing
• Inadequate control
• A worn component
• A change in symptoms

Why Might the Toes Still Catch?

Possible causes include:

• Insufficient support tension
• Brace movement
• Fatigue
• Increased spasticity
• Ankle stiffness
• Weakness at the hip or knee
• Poor balance
• Unsuitable footwear
• A support that is too flexible

Do not assume that maximum strap tension will solve every case.

A different AFO or broader neurological-physiotherapy assessment may be required.

What if the Foot Is Pulled Sideways?

Stop and obtain advice if the support causes or fails to control:

• Strong inversion
• Strong eversion
• Ankle rolling
• Landing on the outer foot edge
• Pressure over an ankle bone

A more structured brace may be necessary.

When Should the Brace Be Reviewed?

Arrange review if:

• Toe catching continues
• Walking distance reduces
• The support slips
• The foot turns
• The heel moves
• The knee gives way
• The knee hyperextends
• Spasticity changes
• The ankle becomes stiffer
• Skin marks persist
• Sensation changes
• The brace becomes difficult to fit
• Symptoms change during a relapse
• The support becomes worn
• Daily activities change

Take:

• The brace
• Normal socks
• Everyday footwear
• Walking aid
• Details of falls
• Photographs of pressure marks
• Notes about when symptoms worsen

Can MS Foot Drop Improve?

It may improve, remain stable or change over time.

Improvement may occur through:

• Recovery after a relapse
• Rehabilitation
• Better symptom management
• Improved fitness
• A more appropriate brace
• FES
• Management of spasticity
• Treatment of infection or another temporary trigger

Some people continue to require long-term assistance.

The NHS confirms that MS affects everyone differently and that treatment may need to change over time according to symptoms and the type of MS.

Can an AFO Prevent the Leg From Recovering?

No.

An appropriately selected AFO supports function while it is worn.

It may allow the person to:

• Practise more steps
• Reduce compensatory movement
• Walk more safely
• Conserve energy
• Participate in work or rehabilitation

The physiotherapist may also prescribe controlled activity without the brace where this is safe and relevant.

Do not stop using a support solely because of a general belief that a brace makes muscles weaker.

Can an AFO Cure MS Foot Drop?

No.

An AFO assists or controls the position of the foot.

It does not:

• Cure multiple sclerosis
• Repair damage in the brain or spinal cord
• Eliminate fatigue
• Restore sensation
• Guarantee normal walking
• Prevent future relapses

MS treatment may also involve:

• Disease-modifying therapies
• Relapse management
• Physiotherapy
• Spasticity management
• Fatigue management
• FES
• Mobility aids
• Occupational therapy
• Symptom-specific medication

The AFO addresses mobility rather than the underlying disease process.

Simple MS Foot-Drop Checklist

Ask your MS team or rehabilitation professional for assessment if you notice:

• Toe dragging
• Foot slap
• High stepping
• The leg swinging outwards
• Difficulty on stairs
• Worsening control with fatigue
• Heat-related deterioration
• The foot turning inwards
• Increased spasticity
• Ankle stiffness
• Knee instability
• Repeated trips
• Reduced walking distance
• Skin pressure from an existing brace
• A significant change from your usual symptoms

Before wearing a brace:

• Check the skin
• Check the product
• Check the straps
• Use the correct size and side
• Remove twists
• Use suitable footwear
• Fit the brace while seated
• Test it over a short distance
• Use a walking aid where prescribed

After use:

• Remove it while seated
• Inspect the skin
• Check for swelling
• Check for worn components
• Record any repeated problems

When Should You Contact the MS Team?

Contact your MS nurse, neurologist or GP when:

• New symptoms last more than 24 hours
• Established weakness becomes substantially worse
• Daily activities become more difficult
• Walking changes suddenly
• You begin falling
• You suspect a relapse
• Infection may be worsening symptoms
• A current AFO or FES system is no longer effective
• Spasticity or ankle stiffness has changed

Do not start leftover steroid medication without assessment.

The clinical team needs to distinguish between:

• Relapse
• Infection
• Heat-related worsening
• Fatigue
• Progression
• Another neurological condition

When Is It an Emergency?

Call 999 for sudden:

• Facial weakness
• Arm weakness
• Speech difficulty
• Loss or blurring of vision
• Severe loss of balance or coordination
• Sudden one-sided weakness
• Confusion
• Collapse

These may be signs of a stroke, even in someone already diagnosed with MS.

Seek urgent medical assessment for:

• Rapidly worsening weakness in both legs
• New inability to stand
• Severe back pain with new leg weakness
• Numbness around the genitals or buttocks
• Changes in bladder or bowel control
• A hot, swollen or painful leg
• A serious injury caused by a fall

A brace should never be used to delay assessment of a major new neurological change.