Can You Use Stairs With Foot Drop or While Wearing an AFO?

Many people with foot drop can continue using stairs, but the activity may require more care, a handrail, an ankle-foot orthosis and an individually taught technique.

Stairs are more demanding than ordinary level walking because you need to:

• Lift the foot high enough to clear the edge of the step
• Bend the hip and knee
• Place the foot accurately
• Control the ankle
• Transfer body weight
• Maintain balance
• Control the knee while going down
• Coordinate any walking aid
• Judge the height and depth of each step

An AFO may improve the position of the foot and help the toes clear the stair, but it cannot correct every factor involved.

Someone may still have difficulty because of:

• Knee weakness
• Hip weakness
• Poor balance
• Reduced sensation
• Spasticity
• Ankle stiffness
• Fatigue
• Visual problems
• A poorly fitted brace
• Unsuitable footwear
• An unsafe staircase

The NHS recognises that foot drop creates a greater risk of tripping and recommends handrails, supportive footwear, adequate lighting and removing hazards from the home.

Why Are Stairs Difficult With Foot Drop?

When going upstairs, the toes need to rise above the front edge of the next step.

With foot drop, the ankle may remain pointed downwards as the leg moves forwards. This can cause the toes or front of the shoe to:

• Hit the stair riser
• Catch on the edge
• Scrape along the step
• Prevent the whole foot reaching the tread
• Cause the person to compensate by lifting the hip or knee higher

Going downstairs creates a different challenge.

The affected leg must:

• Move forwards without catching
• Reach the lower step accurately
• Accept or control weight
• Allow the body to descend safely

A brace may help hold the foot in a more suitable position, but descending also depends heavily on knee control, balance and confidence.

Can an AFO Make Stairs Safer?

A suitable AFO may help by:

• Improving toe clearance
• Limiting excessive downward ankle movement
• Holding the foot in a more consistent position
• Reducing unwanted side-to-side movement
• Improving the stability of the foot and ankle
• Influencing knee and hip movement during standing and walking

AFOs can support the ankle and foot and may also help control movement at the knee and hip, making standing, balance and walking easier for suitable users.

However, an AFO cannot guarantee safe stair use.

It will not automatically correct:

• Severe hip weakness
• A knee that gives way
• Poor balance
• Reduced sensation
• Visual difficulty
• Significant spasticity
• An unsafe handrail
• Loose footwear
• A stair that is unusually high, narrow or uneven

The complete movement needs to be assessed.

Should You Practise Stairs With a Physiotherapist?

Yes, particularly when:

• The foot drop is new
• You are using a new AFO
• You have recently fallen
• The toes still catch
• You need a stick or crutch
• Your knee feels unstable
• You have weakness following a stroke
• You have significant neurological symptoms
• You feel unsure which leg should lead
• Your staircase has no handrail
• You need to carry the brace or aid between floors

A physiotherapist can assess:

• Strength in both legs
• Foot placement
• Toe clearance
• Knee control
• Balance
• Handrail use
• Walking-aid position
• The most suitable stair sequence
• Whether supervision is required

NHS stair guidance commonly advises practising the technique with a physiotherapy team before relying on it independently.

Use the Handrail

A secure handrail provides an additional point of support and should be used where possible.

Before starting, check that the rail:

• Is firmly attached
• Extends far enough along the staircase
• Can be gripped securely
• Is not obstructed
• Is on the most practical side for your strength and walking aid
• Is dry and clean

Where possible, keep one hand available for the rail rather than carrying objects.

NHS foot-drop guidance specifically recommends installing handrails on stairs to reduce falls risk.

Keep the Stairs Well Lit

Poor lighting can make it harder to judge:

• The edge of each step
• The depth of the tread
• The final step
• Changes in stair colour
• Obstacles
• Whether the whole foot is placed securely

Helpful changes can include:

• Bright stair lighting
• A switch at both the top and bottom
• Contrasting stair edges
• Fluorescent markings on the first and last step
• Removing deep shadows
• Avoiding patterned flooring that hides the step edge

The NHS suggests keeping the home well lit and using fluorescent tape on the top and bottom stair where foot drop creates a falls risk.

Fit the AFO Before Approaching the Stairs

Do not attempt to adjust the support while standing on the staircase.

Before you begin, confirm that:

• The brace is the correct type and side
• The heel is fully seated where relevant
• The calf or ankle cuff is level
• Every strap lies flat
• No fastening is opening
• The footplate lies correctly
• The lifting strap is connected
• The footwear attachment is centred
• The shoe fastens securely
• The foot is not numb or painful
• The brace is not cracked or damaged

Walk several steps on level ground first.

If the brace is already moving, rubbing or failing to clear the toes on the floor, do not test it on stairs.

Wear Secure Footwear

Supportive footwear is particularly important on stairs.

Look for:

• An enclosed heel
• An enclosed toe
• Laces or adjustable touch-close fastening
• A stable sole
• Adequate grip
• The correct length
• Enough width and depth for the AFO
• A heel counter that holds the foot securely
• A sole that does not project excessively beyond the toes

Avoid:

• Backless slippers
• Loose sandals
• Oversized shoes
• Very heavy footwear
• Smooth or worn soles
• Shoes that cannot fasten over the brace
• Very thick soles that make step clearance more difficult

The NHS advises people with foot drop to wear well-fitting shoes that support the feet.

Should You Use StepUp® Without Shoes on Stairs?

The StepUp® can be used with or without footwear as part of its design. However, this does not mean that shoeless stair use is safe for every wearer.

Stairs increase the risk of:

• Slipping
• Toe catching
• Poor foot placement
• Contact pressure
• Losing balance

Supportive, non-slip footwear will normally provide a more secure surface and better foot protection.

Only use the StepUp® on stairs without shoes where this has been individually assessed as safe, taking account of:

• Floor surface
• Sensation
• Balance
• Grip
• Foot control
• Stair design
• Falls history

The anti-slip silicone elements in the StepUp® help stabilise the textile components but should not be treated as a replacement for suitable stair footwear.

Check the Whole Foot Fits on the Step

Where possible, place the whole foot securely on the stair tread.

Avoid leaving:

• The heel hanging over the edge
• Only the toes on the step
• The foot turned sideways unless specifically taught
• The outer edge unsupported
• The shoe half positioned on a narrow tread

A foot placed only partly on the step may:

• Slip backwards
• Reduce stability
• Make the knee harder to control
• Increase pressure on the front of the foot
• Cause the AFO to move

Look down briefly where needed to confirm placement, but do not remain bent forwards or stare at the feet throughout the complete staircase if this affects balance.

Should You Alternate Feet on Each Step?

Some people can use a normal alternating stair pattern, placing one foot on each successive step.

Others are safer using a step-to pattern, where both feet meet on each step before moving again.

A step-to pattern may be more suitable when:

• One leg is clearly weaker
• Balance is reduced
• The affected knee is unstable
• Toe clearance is limited
• You use a walking aid
• You are learning to use a new AFO
• Fatigue affects control
• You are recovering from illness or injury

Do not feel pressured to alternate feet simply because this appears more normal.

Safety and control are more important than speed.

Which Leg Should Lead Going Upstairs?

A commonly taught step-to technique is to lead upstairs with the stronger or unaffected leg, then bring the affected leg onto the same step.

NHS physiotherapy guidance frequently uses this sequence for people managing a weaker or operated leg.

However, this is not a universal instruction for everyone with foot drop.

The correct technique can depend on:

• Which leg has the best strength
• Knee control
• Hip strength
• Whether both legs are affected
• The side of the handrail
• Whether a stick or crutch is used
• Weight-bearing restrictions
• The effect of the AFO
• Other neurological symptoms

Use the sequence taught by your physiotherapist rather than assuming that the affected leg must always move in the same order.

Which Leg Should Lead Going Downstairs?

A commonly taught step-to technique is to place the walking aid and affected or weaker leg onto the lower step first, followed by the stronger leg.

This allows the stronger leg to help control lowering from the upper step. NHS physiotherapy stair guidance commonly describes this sequence for suitable patients.

Again, this should be individually confirmed.

Foot drop may coexist with:

• Knee instability
• Spasticity
• Bilateral weakness
• Altered sensation
• Restrictions following surgery

These can change the safest sequence.

A Simple Step-to Technique Going Upstairs

Only use this method where it matches the advice given for your condition.

1. Stand close to the first step.
2. Hold the handrail securely.
3. Keep your body upright.
4. Place the stronger leg fully onto the next step.
5. Push through the stronger leg and handrail.
6. Lift the affected foot high enough to clear the stair edge.
7. Place the affected foot beside the stronger foot.
8. Bring the walking aid up where applicable and as taught.
9. Pause before repeating.

Move slowly and make sure the affected toes have cleared the riser before bringing the foot forwards.

A Simple Step-to Technique Going Downstairs

Only use this method where it has been confirmed as appropriate.

1. Stand close to the stair edge without allowing the toes to hang over.
2. Hold the handrail.
3. Place the walking aid onto the lower step where applicable and as taught.
4. Move the affected leg down.
5. Place the whole foot securely on the lower step.
6. Control your body weight through the rail and stronger leg.
7. Bring the stronger leg onto the same step.
8. Pause before continuing.

Do not allow the affected foot to drop suddenly onto the stair.

Why Might Going Downstairs Be Harder?

Going downstairs requires controlled lowering of body weight.

Difficulty may result from:

• Weak quadriceps
• Poor knee control
• Reduced ankle movement
• Fear of the knee giving way
• Poor sensation
• The AFO restricting ankle movement
• The foot landing too far forwards
• Reduced balance
• Visual difficulty judging the stair edge

A rigid AFO may improve foot alignment but also limit ankle movement used during descent.

If the knee:

• Buckles
• Moves sharply backwards
• Becomes painful
• Feels unreliable

stop and arrange assessment.

Why Do My Toes Hit the Stair Going Up?

The toes may catch the front of the step because:

• The AFO is not fitted correctly
• The heel is lifted
• The textile strap is too loose
• The brace is moving
• The shoe is too long or heavy
• The ankle remains pointed downwards
• The knee is not bending enough
• Hip lifting is reduced
• The affected leg is tired
• The stair is unusually high
• The foot turns inwards

Do not respond only by lifting the hip dramatically higher.

Repeated exaggerated hip movement can increase effort and may affect balance.

A physiotherapist should assess whether the issue originates from the ankle, knee, hip or brace.

What if Only the Inside or Outside of the Shoe Catches?

Catching one edge may indicate that the foot is turning:

• Inwards
• Outwards
• Onto the outer border
• Towards the opposite leg

A simple dorsiflexion-assistance support may lift the foot without fully controlling side-to-side movement.

StepUp® can provide some mild medio-lateral support through its strapping system, but it may not be sufficient for substantial instability or spasticity.

Do not overtighten one side without assessment. Uneven tension may rotate the foot or create pressure.

How Does StepUp® Help With Foot Clearance?

The StepUp® uses a calf section, foot component and adjustable textile straps to provide dynamic upward assistance to the front of the foot.

Its features include:

• Soft textile construction
• Touch-close fastenings
• Adjustable lifting straps
• Anti-slip silicone beading
• Dorsiflexion assistance
• Toe-clearance support
• Mild medio-lateral control
• A low-profile design
• Latex-free materials

It is intended principally for flaccid foot drop and dorsiflexion weakness.

The StepUp® may assist suitable wearers during everyday mobility, but it does not provide the same structural control as every rigid, carbon or custom-made AFO.

Can a Textile AFO Catch on the Stair?

Yes.

Check whether:

• A strap end is loose
• The shoe attachment projects forwards
• The trouser hem is caught around the brace
• The foot component has moved
• The cuff is slipping
• A fastening is partly open
• The shoe is longer than necessary

The support should remain fully contained and secured before stairs are attempted.

Do not leave touch-close strap ends hanging loose.

Can a Rigid AFO Be Used on Stairs?

Many people use rigid AFOs on stairs, but the device may alter ankle and knee movement.

A rigid AFO may:

• Improve toe clearance
• Limit excessive plantarflexion
• Stabilise the ankle
• Provide side-to-side control
• Change how the knee moves
• Reduce ankle movement used to lower the body downstairs

The brace should be assessed during stair use rather than only during flat walking.

An AFO is designed to influence the position of the foot and ankle and can also affect joints higher in the leg.

Can a Carbon AFO Be Used on Stairs?

Potentially, but the response depends on:

• Carbon stiffness
• Strut position
• Footplate design
• Ankle range
• Knee control
• Footwear
• Stair technique

Carbon devices can store and return energy during walking, but stairs create different loading and movement demands.

Do not select a carbon AFO solely because it is lightweight or appears more advanced.

What if the AFO Restricts My Ankle on the Stairs?

Some ankle restriction may be intentional.

However, the brace needs review if it causes:

• The heel to lift
• The knee to buckle
• The knee to move backwards
• Pain at the front of the ankle
• Difficulty placing the foot flat
• Inability to control descent
• The foot to twist
• Loss of balance

Do not loosen or modify the brace on the staircase.

Sit somewhere safe and arrange professional advice.

Using a Walking Stick on Stairs

Do not assume that a stick should be used on stairs in exactly the same way as on level ground.

The usual approach may involve:

• One hand on the rail
• The stick held in the other hand
• A specific order for moving the stick and legs
• Both feet meeting on each step

The safe sequence depends on:

• Which side is affected
• The handrail side
• Upper-limb strength
• Balance
• Whether the stick is needed for weight support or confidence
• Whether both legs are weak

Ask a physiotherapist to demonstrate the sequence.

Do not carry a stick loosely or place it near the outer edge of the stair.

Using Crutches on Stairs

Crutch stair techniques need to be specifically taught.

NHS stair guidance commonly advises:

• Using the handrail where available
• Holding the crutch or crutches as instructed
• Placing the aid centrally on the step
• Moving one step at a time
• Following the prescribed leg sequence

Do not attempt stairs with crutches for the first time without instruction.

What if There Is No Handrail?

Stairs without a handrail are more hazardous for someone with foot drop, poor balance or leg weakness.

Do not attempt them alone when:

• You rely on the rail
• You use a walking aid
• Your knee is unstable
• You have recently fallen
• Your toes still catch
• You are unfamiliar with the staircase

A physiotherapist may teach a specific technique for stairs without a rail, but it should not be improvised. NHS services provide separate instructions for stair use without a bannister because the method and risks differ.

Consider installing a handrail where the stairs are used regularly.

Should You Use Two Handrails?

Two secure handrails can provide additional stability, particularly when:

• Both legs are weak
• Balance is limited
• No walking aid is used
• The person has sufficient arm strength
• The staircase is wide enough

However, two rails do not remove the need for safe foot placement and an appropriate sequence.

Avoid Carrying Items on the Stairs

Keep your hand available for the rail.

Avoid carrying:

• Shopping
• Laundry baskets
• Drinks
• Large bags
• Boxes
• Pets
• Items that obstruct your view of the steps

Possible alternatives include:

• Asking another person to carry items
• Using a shoulder bag where safe
• Keeping frequently used items on both floors
• Installing a stairlift where appropriate
• Using a secure method recommended by an occupational therapist

Do not sacrifice the handrail to carry an object.

Keep the Staircase Clear

Remove:

• Shoes
• Bags
• Electrical cables
• Loose rugs
• Clothing
• Children’s toys
• Pet items
• Cleaning equipment

Foot drop already reduces the available clearance between the foot and the step. Even a small object can increase the risk of catching or losing balance.

Check Stair Carpets and Edges

Stair carpeting should be:

• Secure
• Flat
• Free from lifted edges
• Free from tears
• Firmly attached at the nosing

Loose carpet can catch:

• The toe of the shoe
• The AFO footplate
• Textile straps
• A walking aid

A heavily patterned carpet may also make it harder to identify the stair edge.

Take Care on Outdoor Steps

Outdoor steps may be:

• Wet
• Icy
• Uneven
• Covered with leaves
• Poorly lit
• Different heights
• Without handrails

Before using them:

• Check the surface
• Use the rail
• Slow down
• Place the whole foot where possible
• Avoid carrying items
• Use appropriate footwear
• Consider another route

An AFO that works well on a standard indoor staircase may be more difficult to use on irregular outdoor steps.

What About Kerbs?

A kerb is a single step but still requires toe clearance and controlled lowering.

Approach the kerb directly rather than at an angle where possible.

Use:

• A walking aid as taught
• A stable surface
• A controlled step
• The technique recommended by your physiotherapist

Do not rush because the road is busy. Choose a crossing point with a dropped kerb where available.

Can You Use an Escalator?

Escalators add movement, changing step depth and a restricted time to get on and off.

Foot drop, an AFO or a walking aid may make this more difficult.

Risks include:

• The toe catching
• The brace or shoelace becoming trapped
• Losing balance when the step changes shape
• Difficulty stepping off quickly
• Clothing catching
• Limited access to a stable handrail

A lift is often the safer option when there is uncertainty.

Do not use an escalator simply to prove that the AFO can manage it.

Can You Use a Stairlift?

A stairlift may be considered when:

• Stairs remain unsafe despite rehabilitation
• Both legs are affected
• Falls have occurred
• Fatigue is severe
• The person cannot reliably use a rail or aid
• A progressive condition is reducing mobility

An occupational therapist may assess:

• Home layout
• Transfers on and off the stairlift
• Seat and footplate position
• Where the AFO or walking aid will be stored
• Safety at the top and bottom

A stairlift is not a failure of rehabilitation. It may allow safer access between floors.

What if the AFO Slips Halfway Up the Stairs?

Stop immediately.

Keep hold of the handrail and avoid bending down on the stairs to adjust the brace.

Where safe:

1. Place both feet securely on one step.
2. Keep your body close to the rail.
3. Ask for assistance.
4. Move to a landing or stable seated area if possible.
5. Refit the brace while seated.

Do not continue when:

• A fastening has opened
• The heel has lifted
• The brace has rotated
• The shoe is loose
• A strap is catching

What if the Toes Still Catch With the AFO?

Repeated catching may indicate:

• Incorrect fitting
• Insufficient dorsiflexion assistance
• Brace movement
• A worn textile strap
• An AFO that is too flexible
• Ankle stiffness
• Spasticity
• Knee weakness
• Hip weakness
• Fatigue
• Unsuitable footwear

Do not keep increasing the strap tension without identifying the cause.

Read our guide: Why Do My Toes Still Catch With a Foot Drop Brace?

What if My Knee Gives Way?

A knee that gives way on stairs is a significant safety concern.

It may result from:

• Muscle weakness
• Pain
• Neurological impairment
• Fatigue
• Poor foot position
• An AFO that affects knee movement
• Progression of the underlying condition

Stop using the stairs independently and arrange assessment.

An ankle brace cannot always provide sufficient knee control.

What if My Knee Pushes Backwards?

Knee hyperextension can occur when the ankle, AFO and ground reaction forces alter the position of the leg.

On stairs, this may make it harder to:

• Control weight
• Bend the knee
• Descend smoothly
• Maintain balance

Do not alter the AFO angle or add a heel lift yourself.

A professional should assess the brace, footwear and walking pattern together.

Why Are Stairs Harder When I Am Tired?

Fatigue can reduce:

• Toe clearance
• Hip lifting
• Knee bending
• Balance
• Concentration
• Strap stability
• Foot placement accuracy

Symptoms may be more noticeable:

• At the end of the day
• After a long walk
• During a multiple-sclerosis fatigue episode
• Following exercise
• After repeated stair use
• When carrying an item

Plan rest periods and avoid unnecessary repeated trips between floors.

Can Foot Drop Affect Both Sides on Stairs?

Yes.

Bilateral foot drop can make it difficult to identify one clearly stronger leg.

It may also affect:

• Balance
• Toe clearance on both sides
• Foot placement
• Stair speed
• The ability to use a conventional step-to sequence

Professional stair assessment is particularly important.

Do not assume that the standard “strong leg first” method applies when neither side provides reliable control.

Can You Go Upstairs Sideways?

Some people are taught a sideways technique while holding the rail with both hands.

This may occasionally provide greater control, but it is not suitable for everyone.

Potential concerns include:

• Limited tread space
• The foot being placed at an angle
• The AFO catching
• Reduced view of the steps
• Difficulty turning at the top
• Hip or knee limitations

Only use a sideways technique if a physiotherapist has assessed and taught it.

Should You Go Up or Down on Your Bottom?

Some rehabilitation services teach bottom-shuffling where upright stair use is temporarily unsafe.

This technique still requires:

• Safe lowering onto the steps
• Sufficient arm strength
• Skin protection
• A safe method of standing again
• A stable chair or stool where appropriate
• Clear stairs
• Professional instruction

It may not be suitable for people with:

• Shoulder or wrist problems
• Reduced trunk control
• Fragile skin
• Severe fatigue
• Difficulty rising from the floor
• Narrow or steep stairs

Do not improvise this method without assessment.

How To Practise Stairs Safely

When stairs have been approved:

1. Practise when you are not fatigued.
2. Wear the usual brace and footwear.
3. Use a familiar staircase.
4. Ensure the area is well lit.
5. Clear all objects.
6. Have a physiotherapist or capable helper present initially.
7. Use the handrail.
8. Move one step at a time.
9. Place the whole foot securely.
10. Pause if balance changes.
11. Stop before fatigue affects the technique.
12. Check the brace and skin afterwards.

Do not begin by repeatedly walking up and down for exercise.

First establish a safe, consistent technique.

Check the Skin After Stair Practice

Stairs can create different pressure from level walking.

After practice, inspect:

• The heel
• Ankle bones
• Front of the ankle
• Calf
• Top of the foot
• Sides of the foot
• Toe area
• Strap contact points

Stop using the brace and seek advice if there is:

• Persistent redness
• Blistering
• Broken skin
• Increasing pain
• Numbness
• Swelling
• A change in foot colour
• An unusually hot or cold area

Signs You Should Not Use Stairs Alone

Do not use stairs independently when:

• Your toes repeatedly catch
• The knee gives way
• You cannot hold the rail
• You cannot place the foot securely
• You become dizzy
• Your balance is unreliable
• The brace slips
• You cannot coordinate the walking aid
• You have recently fallen
• Both legs are rapidly becoming weaker
• Sensation is severely reduced
• Vision prevents you judging the step
• You have not been taught a safe technique

Ask for assistance or use another route.

Recommended Lightweight Textile Support

The StepUp® Drop Foot Support, SKU SU, may suit people with flaccid foot drop who require lightweight dorsiflexion assistance for everyday mobility.

Its features include:

• Dynamic upward foot assistance
• Soft textile materials
• An adjustable strap-tension system
• Mild medio-lateral support
• Touch-close fastenings
• Anti-slip silicone beading
• A supportive calf band
• Use with or without footwear
• Small, Medium, Large and Universal sizes
• Latex-free construction
• A low-profile design beneath clothing

It does not replace professional stair training and may not provide enough control for:

• Significant spasticity
• A fixed ankle position
• Severe side-to-side instability
• Major knee weakness
• Major hip weakness
• Complex neurological impairment

Simple Stair-Safety Checklist

Before using the stairs, confirm that:

• You have been medically assessed for new foot drop
• You know the stair sequence recommended for you
• The stairs are well lit
• The steps are clear
• The handrail is secure
• The AFO is correctly fitted
• No strap is twisted
• The heel is secure
• The shoe fits properly
• The sole has adequate grip
• The trouser hem is controlled
• The toes clear during level walking
• The knee feels stable
• Your walking aid is used as taught
• You are not unusually tired
• You are not carrying an object
• Assistance is available where needed
• You can place the whole foot on the step
• The brace does not cause pain or numbness

Can an AFO Guarantee Safe Stair Use?

No.

An AFO may improve foot clearance and alignment, but stair safety also depends on:

• Strength
• Balance
• Knee and hip control
• Sensation
• Vision
• Stair design
• Handrail access
• Footwear
• Fatigue
• Technique

A brace should form one part of a wider mobility and falls-prevention plan.

Can Stair Practice Cure Foot Drop?

No.

An AFO assists or controls the position of the foot while it is being worn. Stair practice may improve confidence, coordination and functional mobility, but it does not repair the nerve, muscle, brain or spinal condition causing the weakness.

Treatment may also involve:

• Physiotherapy
• Investigation or treatment of nerve compression
• Functional electrical stimulation
• Management of an underlying neurological condition
• Walking aids
• Falls prevention
• Surgery in selected cases

The NHS advises arranging a GP assessment when it becomes difficult to lift the front of the foot or toes.

When Should You Seek Medical Help?

Arrange further assessment if:

• Foot drop is new
• Weakness is worsening
• Both feet are affected
• You have more trips or falls
• The AFO has become less effective
• Numbness is increasing
• Weakness is spreading up the leg
• Your knee has started giving way
• Symptoms followed an injury or operation

Call 999 if sudden weakness occurs with:

• Facial drooping
• Arm weakness
• Slurred or confused speech

These may be symptoms of a stroke.

Seek urgent medical assessment if new leg weakness occurs with:

• Severe or worsening back pain
• Numbness around the buttocks, inner thighs or genitals
• Difficulty starting or controlling urination
• Loss of bladder or bowel control
• Rapidly worsening weakness

These symptoms may indicate serious compression of the nerves at the bottom of the spine.