A simple test for drop foot is to sit or stand with your feet flat on the floor. Keeping the heel planted, bend your ankle up to lift your toes off the floor, repeat on the other side. If one side is more difficult to lift, or doesn't move at all, you may be developing or may already have drop foot.
You may be able to lift it once with no issue, but try repeating with alternating feet 10-20 times, if one foot begins to struggle, you may have fatigable drop foot. This means that while your ankle may work okay to start with, but as the muscle fatigues it becomes more challenging. This can be more noticeable on longer distance walking.
Managing drop foot
A common symptom in Multiple Sclerosis as the condition progresses is called drop foot. This may initially present with catching one of your feet as you are walking, or difficulty lifting your toes on a certain side, and it can progress to having little to no ability to lift the toes and ankle. Recognising and managing this symptom early can give you the best chance of running into issues as it progresses.
How to know if you have drop foot?
What is causing the drop foot
The MS condition will likely be causing your foot drop, this happens for two potential reasons:
Weakness - Your front ankle muscles are weakening. These are the muscles on the front of your shin that controls the ability to lift your ankle.
Spasticity/stiffness - A common symptom of MS is spasticity, where the muscles become more stiff and struggle to fully relax or "switch off". This affects the foot by gradually shortening your calf muscle on the back of your lower leg over time, as this muscle tightens and shortens, the weakened muscles on the front of your shin lengthen, causing the range of movement at the ankle to become reduced.
This means that any exercise for the ankle should look to strengthen those muscles on the front of the lower leg, and lengthen the muscles at the calf.
Weakness - Your front ankle muscles are weakening. These are the muscles on the front of your shin that controls the ability to lift your ankle.
Spasticity/stiffness - A common symptom of MS is spasticity, where the muscles become more stiff and struggle to fully relax or "switch off". This affects the foot by gradually shortening your calf muscle on the back of your lower leg over time, as this muscle tightens and shortens, the weakened muscles on the front of your shin lengthen, causing the range of movement at the ankle to become reduced.
This means that any exercise for the ankle should look to strengthen those muscles on the front of the lower leg, and lengthen the muscles at the calf.
What exercises can help?
Starting targeted exercises for these affected muscle groups can give you the best chance of improving these symptoms. The earlier you can spot and treat drop foot, the better chance you have of seeing improvement. The best exercises to do should target the strength of the front muscles, while stretching the rear muscles of the lower leg. Some exercises to try include:
1) Strengthening exercise - Dorsiflexion
- This exercise can be performed in any position (sitting, lying or standing). If your ankle is very weak, lying is normally the easiest version. For this exercise, simply pull your toes/ankle up towards you while keeping the rest of your leg still. Repetition is key for the exercise so try to perform 20-30 repetitions for 2-3 sets if possible.
- To make this easier if unable to perform the movement, try placing a belt, rolled up towel or dressing gown cord around the fad pads of your foot, below the toes, while holding each end of with your hands. Now, as you bend the ankle up use the object to assist you to bend it further while allowing the muscles of the ankle to do as much of the movement as possible.
2) Strengthening exercise - Resisted Dorsiflexion
- Place your opposite foot on top of your affected foot. Try to lift the toes and ankle of the affected foot while applying some resistance with your other foot. Try to allow the affected foot to do the movement against the resistance and avoid overpowering it. Repeat 10-20 times for 3 sets.
- Another version of this would be to use an exercise band attached to a sold surface. Get tension in the band and then try to pull your ankle up towards you against the resistance.
3) Calf stretch - Gastrocnemius
- To perform this stretch, stand with a wall or supportive surface in front of you. Take a large step back with the affected leg, with your toes pointing forward. Keep the rear leg straight and heel planted as you bend your front knee. You should feel a stretch in the back of your calf. Stretch within comfortable range and do not force into pain. Hold for 30 seconds and repeat 3 times.
- If this position is too challenging for your balance, another version is to lie or sit with a belt, rolled up towel or dressing gown cord around your foot. Keep the foot and ankle relaxed as you pull the belt with your hands to bend your ankle up.
- A different version of this stretch involves standing on your bottom step, if safe to do so, with the toes on the step and heels hanging off, Slowly allow your heels to drop until you feel a stretch in the back of the calves.
4) Calf Stretch - Soleus
- This time, take a smaller step back with the affected leg, allowing around 6 inches of space between your front heel and toes of the rear foot. With toes pointing forwards and heels planted. Bend both knees to stretch the rear ankle. As with the previous stretch, this should be a gentle stretch and avoid pushing into pain. Hold for 30 seconds and repeat 3 times.
1) Strengthening exercise - Dorsiflexion
- This exercise can be performed in any position (sitting, lying or standing). If your ankle is very weak, lying is normally the easiest version. For this exercise, simply pull your toes/ankle up towards you while keeping the rest of your leg still. Repetition is key for the exercise so try to perform 20-30 repetitions for 2-3 sets if possible.
- To make this easier if unable to perform the movement, try placing a belt, rolled up towel or dressing gown cord around the fad pads of your foot, below the toes, while holding each end of with your hands. Now, as you bend the ankle up use the object to assist you to bend it further while allowing the muscles of the ankle to do as much of the movement as possible.
2) Strengthening exercise - Resisted Dorsiflexion
- Place your opposite foot on top of your affected foot. Try to lift the toes and ankle of the affected foot while applying some resistance with your other foot. Try to allow the affected foot to do the movement against the resistance and avoid overpowering it. Repeat 10-20 times for 3 sets.
- Another version of this would be to use an exercise band attached to a sold surface. Get tension in the band and then try to pull your ankle up towards you against the resistance.
3) Calf stretch - Gastrocnemius
- To perform this stretch, stand with a wall or supportive surface in front of you. Take a large step back with the affected leg, with your toes pointing forward. Keep the rear leg straight and heel planted as you bend your front knee. You should feel a stretch in the back of your calf. Stretch within comfortable range and do not force into pain. Hold for 30 seconds and repeat 3 times.
- If this position is too challenging for your balance, another version is to lie or sit with a belt, rolled up towel or dressing gown cord around your foot. Keep the foot and ankle relaxed as you pull the belt with your hands to bend your ankle up.
- A different version of this stretch involves standing on your bottom step, if safe to do so, with the toes on the step and heels hanging off, Slowly allow your heels to drop until you feel a stretch in the back of the calves.
4) Calf Stretch - Soleus
- This time, take a smaller step back with the affected leg, allowing around 6 inches of space between your front heel and toes of the rear foot. With toes pointing forwards and heels planted. Bend both knees to stretch the rear ankle. As with the previous stretch, this should be a gentle stretch and avoid pushing into pain. Hold for 30 seconds and repeat 3 times.
Follow along video
Please watch this follow along video for exercises to reduce the risk and improve drop foot. (Video coming soon).
Other things to try
If you see no improvement with these exercises, there are another couple of options. You could try a Functional Electrical Stimulation device (FES) which provides electrical pules into the muscle to increase muscle contraction. Another option would be to consider a brace or support to assist the ankle to keep your toes up.
Please speak with your Neurology Physiotherapist if you feel like these may be of use for you.
Please speak with your Neurology Physiotherapist if you feel like these may be of use for you.