Footdrop is a common symptom of multiple sclerosis, making it difficult to lift the front part of the foot. This condition increases the risk of falls and can significantly impact mobility and independence.
If you or your loved one is living with multiple sclerosis, the simple act of walking or standing can become extremely challenging. Multiple sclerosis footdrop is a common symptom of MS, but it is also one that is manageable.
Multiple sclerosis is a chronic neurological condition that affects the brain and spinal cord. In most cases, the immune system attacks the myelin, the protective layer surrounding nerve fibers. These layers of fat act as a protective barrier around the cells of the nervous system and brain. Once damaged, it can disrupt communication between the brain and the rest of the body, including the feet.
Karla Santis, a physical therapist at Encompass Health Rehabilitation Hospital of Sunrise, said the nerve damage that MS causes disrupts signals from the brain to the muscles and joints.
“Since the foot is the farthest from the brain, it can lead to symptoms of numbness, poor communication to and from the muscles, impaired timing and coordination, fatigue and even paralysis,” Santis said.
Common symptoms of MS
There are several types of MS, and symptoms may vary from person to person depending on the severity and location of nerve damage. Common symptoms that may develop over time include:
- Muscle spasms
- Numbness
- Loss of balance and coordination
- Fatigue
- Dizziness
- Cognitive difficulties
What is MS footdrop?
MS footdrop is a condition that makes it difficult to lift part of the foot. This can increase the risk of falls, injuries and fractures. Individuals may experience balance and coordination issues and muscle weakness in the legs. They may have to lift their knees higher than usual to avoid dragging their foot.
“Patients with MS will experience muscle weakness, spasticity, sensation impairments or pain,” Santis said. “It is possible that symptoms can become more noticeable if the patient’s core temperature increases. It is common for patients with footdrop to have a higher fall risk and difficulty with mobility.”
MS footdrop is caused by a disruption in nerve pathways. The nerves responsible for muscle control in the foot and ankle are affected, leading to weakness and limited mobility.
There are several factors other than MS that may lead to footdrop. The most common include:
- Neurological disorders. In addition to MS, conditions such as stroke, Parkinson’s and diabetes can cause nerve damage and footdrop.
- Peripheral nerve damage. Injury or illnesses that damage the peroneal nerve, often due to trauma or surgery, can cause footdrop.
Early signs of footdrop
Early detection is key to managing MS footdrop. Signs may include:
- Difficulty lifting the front part of the foot
- A high stepping walk (stepping gait)
- Frequently falling
- Numbness in foot
- Muscle weakness
Is footdrop a lifelong condition?
It can be, depending on the underlying cause of footdrop. Footdrop is reversible, but it may become a lifelong condition if associated with severe nerve damage. Whether it is caused by MS, stroke or other chronic illnesses, it is best to consult a physician for further evaluation.
Managing MS symptoms and footdrop
Inpatient rehabilitation plays a vital role in helping individuals manage MS symptoms, including footdrop. Therapy programs and treatment plans are tailored to meet each patient’s unique needs.
Together, care teams — including doctors, nurses, therapists, dietitians and case managers — collaborate to design treatment plans that help individuals regain their independence. These plans address physical, cognitive and emotional needs to support recovery.
“Inpatient rehabilitation addresses areas of concern that the patient has by helping patients restore and retain the nervous system and body function for safer and more efficient movement,” Santis said. “We assess how MS is causing footdrop. During therapy, we focus on strengthening and neuromuscular reeducation of the muscles causing footdrop, promoting improvement in motor control based on neuroplasticity.”
Exercises and adaptive tools and devices
Your care team may recommend strengthening programs that can benefit your unique needs when you return home. Santis advises patients to walk at least 30 minutes a day or complete household chores to stay active.
“Home exercise programs and continued therapy through home health or outpatient services are beneficial,” she said. “MS is a progressive disease and requires the patients to stay active. Tools may vary depending on the patient’s impairments. The use of a walker or cane may help increase stability and reduce the risk of falls.”
Orthotics might also be recommended to reduce the symptoms of footdrop. Orthotics are supportive devices that can help reduce pain, improve limb function and correct musculoskeletal alignment. During recovery, your care team will determine if orthotics are needed to support your recovery.
“Therapists determine the need of an assistive device such as an ankle-foot orthosis or functional electrical stimulation,” Santis said. “These tools reinforce normal walking and reduce fatigue, allowing the patient to gain stamina and independence.”
Support for individuals with MS and their families
Recovery can be intensive and challenging for patients and their families. Inpatient rehabilitation offers educational support, disease management and learning opportunities to support your loved one once they return home.
- Advocate for comprehensive assessments: Encourage thorough evaluations to determine the best treatment
- Stay informed: Learn about MS, footdrop and rehabilitation options
- Be present: Attend therapy sessions and family education programs
- Monitor progress: Track improvements or setbacks and communicate with health care providers
While MS is a lifelong condition, many individuals live fulfilling lives with the right support and treatment. Focusing on goals, maintaining a positive outlook and building a supportive network can ensure a higher quality of life.
To learn more about MS and support for caregivers, visit the National Multiple Sclerosis Society for more information.
What is dysphagia?
Like aphasia, it can be caused by neurological conditions such as brain injuries and stroke, but it also can stem from muscle disorders, certain cancers and blockages/strictures in the throat.
Depending on the cause, dysphagia can be temporary or long-term.
Conditions commonly associated with dysphagia include:
- Parkinson’s disease and multiple sclerosis
- Neck and throat cancers
- Late-stage Alzheimer’s disease and other dementias
- Cervical neck surgeries
Stages of dysphagia
There are three phases of swallowing that are impacted with dysphagia:
- Oral: This is the process of chewing food and mixing it with saliva to form a bolus in order for it to be moved from the front of the mouth to the back of the mouth. A person with dysphagia in this phase could have trouble breaking down the food enough to properly move it to the back of the mouth to trigger the swallowing reflex. This stage is also where tongue weakness or decreased sensation may impact the ability to clear food from the sides of the mouth causing it to pocket in the cheeks.
- Pharyngeal: This is where the swallowing reflex begins, and pharyngeal muscles push food down the throat to the esophagus. The epiglottis (a cartilage) inverts to protect the airway and sends the bolus towards the esophagus. This is when the upper esophageal sphincter opens to allow food to travel into the esophagus. A person with dysphagia in this phase might feel like the food is “entering the wrong pipe,” Delashaw said, because the muscles in the pharynx and/or larynx are not operating properly to prevent food or liquids from entering the airway.
- Esophageal: This is when the bolus is taken from the upper esophageal sphincter that has opened, allowing it to enter the esophagus. Peristalsis (muscle contractions) carries the bolus from the upper esophagus towards the stomach. In this phase, a person with dysphagia may feel like food is stuck in their throat or chest.
Symptoms of dysphagia
Dysphagia symptoms could include:
- Coughing or choking during or shortly after eating or drinking
- Heartburn or indigestion
- Feeling that food is stuck in the throat or chest
- Painful swallowing
- Regurgitation
- Food sitting in the mouth or being pocketed in the cheeks
- Unexplained weight loss
- Reduced desire to eat
Diagnosing dysphagia
Dysphagia is diagnosed by a healthcare provider. Speech-language pathologists diagnose dysphagia with a comprehensive oral exam and swallowing examination, which should include swallowing tests such as a FEES or MBS exam.
- FEES: FEES stands for fiberoptic endoscopic evaluation of swallowing. This is an exam where a speech-language pathologist inserts a small thin scope with a camera through the nose and allows visualization of the throat, larynx and vocal cords to assess swallow function as you eat and drink certain foods.
- MBS: During a modified barium swallow study, a speech-language pathologist will give you food and liquids covered in a small amount of barium. As you swallow, X-rays are performed to view your swallow in real-time.
Treatment of dysphagia
After a dysphagia diagnosis, a speech-language pathologist can help determine what consistency of food and liquids is safest to eliminate risk of choking or aspiration. They can also provide therapy and exercises to help strengthen the muscles used during the different stages of swallowing.
Treatment should always involve a discussion with the individual to determine their wishes regarding oral intake and development of dysphagia treatment.
“If difficulty is noted in the oral phase, we can design an exercise program to target movement for the muscles used when breaking down the food,” Delashaw said. “Say you had a stroke that impacted lip muscles, and you can’t hold food in your mouth. We’re going to work on increasing the control and strength of the lip muscles, so you do not lose liquids or foods out of the mouth.”
In addition to exercises, Delashaw said neuromuscular electrical stimulation could also be used to increase muscle awareness in the different stages of dysphagia.
In the esophageal stage, your speech-language pathologist could suggest obtaining a referral from your primary care doctor to a gastroenterologist for further evaluation.
Recovery from dysphagia
Depending on the diagnosis and related conditions, dysphagia could improve over time. If swallowing difficulty is related to a neurological condition, inpatient rehabilitation could help develop adaptive techniques and diet plans to meet your needs and quality of life standards.
The multidisciplinary approach in this setting also allows for other symptoms related to your condition to be addressed through intensive therapy. In addition to working with a speech-language pathologist, your therapy team would also include a physical therapist and occupational therapist to address mobility and strength as well as activities of daily living and quality of life.
