Defeating foot drop

A range of treatments can help you stay active.

by Lori De Milto

Jill Walsh had been feeling so well physically in July 2011 that she actually competed in a half triathlon. So it came as a surprise to her when, just months later, in December, she had a relapse of her multiple sclerosis. “When I came out of that, I had weakness in my left foot. I couldn’t lift it up or push it down,” says the 52-year-old retired New York state trooper and mother of three.

Walsh had foot drop, a common problem in people with MS, though no one knows the precise number of people who are affected, says Patty Bobryk, a physical therapist at Orlando Health MS Comprehensive Care Center. In foot drop, the toes drop down instead of pointing up when attempting to lift the foot. This makes it hard to walk, especially on curbs, stairs and uneven surfaces.

Walsh, who lives in Jamesville, New York, got a custom-fitted brace called an ankle-foot orthosis to help her walk, based on a recommendation from a friend who’s an orthotist (a specialist in using mechanical devices to support weakened or abnormal joints or muscles). The brace holds her foot in a normal position and prevents it from dropping.

Walsh went back to competing; however, as her MS worsened, she switched from triathlons to just cycling races, and then from a two-wheeled bicycle to a three-wheeled bicycle. In 2014—four years after being diagnosed with MS—Walsh qualified for the USA Paralympic Cycling Team, and the following year, was the gold medal winner, making her the road para-cycling world champion. She will seek to defend that title in the 2016 contest in Brazil.

Different people, different symptoms
Foot drop (also called drop foot) is caused by damage to the nerves that control the muscles used to flex the ankle. “The brain has decided it wants to lift up the foot. It sends the impulse to the muscles. Somewhere in the pathway, the message is blocked or short-circuited,” Bobryk says.

[foot-drop]

Along with spasticity in the muscles that make the toes go down, other factors can contribute to or accompany foot drop, including fatigue, weakness and loss of the sense of where the foot is in space (this sense is called proprioception).

People who have foot drop can stumble and fall when their toes don’t lift up. That’s what happened to Jonna Patton, 43, a former social worker for the state of Wyoming, and a former college basketball player who has been living with MS since 1997. “I went out for a run one day and was stumbling. Then I was really off balance when I was coaching basketball,” says the Cheyenne resident. Patton relied on a cane for balance until her MS—and her foot drop—were properly diagnosed and treated. Walsh experiences loss of proprioception, so she has to watch her foot as she walks since she can’t feel where it is as she takes a step.

Jonna Patton wears a functional electrical stimulation device to hike five miles in the 2014 Hike MS event in Colorado. The cuff below her right knee delivers electric stimulation to the nerve and muscles that lift her toes. A gait sensor is located under her heel. Photo courtesy of Jonna Patton

People with foot drop often find additional ways to compensate, sometimes by swinging the leg out to the side to take a step instead of bending the knee and lifting the foot, or by lifting the hip and knee really high to clear the foot. But this compensation “strains and stresses the body, and requires more energy for walking,” Bobryk says. Patton found out that she had been compensating for her foot drop when she saw a physical therapist. “That explained why I would fall from time to time,” she says.

The right treatment
Physical therapists who specialize in MS usually assess foot drop, and work with doctors to design the best treatment (see “Treatments for foot drop” below) for an individual’s lifestyle and condition. “There’s always something we can do,” says Bobryk, who recommends keeping an open mind, since treatments that people are reluctant to try often help them walk farther or feel more energetic. “Don’t just accept that you have this challenge. See what you can do to overcome it,” Patton says.

Working with her physical therapist, Patton chose a functional electrical stimulation device. With gentle wireless stimulation, the device temporarily restores the normal nerve-to-muscle messages, signaling the leg muscles to lift the foot when she walks. A sensor in the heel of her shoe tells the “brains” of the unit where her heel is, and sends the right signals at the right time. “It has given me my life back,” says Patton, who wears the device to hike five miles in the annual Hike MS event in Colorado and wears it for nearly every activity outside her home.

“If you want to keep doing what you love, there’s a way to do it,” says Walsh. “It’s probably not going to be the same way, like when I went from a two-wheeled bike to a three-wheeled bike. As new physical challenges develop, I challenge myself to adapt so that I can keep moving.”

Lori De Milto is a Sicklerville, New Jersey-based freelance writer.

To learn more about factors that may affect walking, visit Walking (Gait) Difficulties.