Foot Care for People With Multiple Sclerosis: Managing Foot Problems Caused by MS

Quick answer: Foot Care Multiple Sclerosis Ms is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

How MS Affects the Feet and Lower Extremities

Multiple sclerosis damages the myelin sheath covering nerve fibers in the brain and spinal cord, disrupting the electrical signals that control muscle function, sensation, and coordination in the lower extremities. The feet bear the consequences of this neurological disruption through weakness, spasticity, and sensory loss that progressively alter gait.

Spasticity — involuntary muscle stiffness and contraction — commonly affects the calf muscles and toe flexors in MS patients. This constant pull draws the foot into equinovarus positioning (pointed downward and inward), creating a deformity that impairs normal heel-strike gait and increases fall risk on every step.

Foot drop, caused by weakness of the ankle dorsiflexors (muscles that lift the foot), produces a steppage gait where the patient must lift the knee excessively high to clear the drooping foot during swing phase. This compensatory pattern is energy-inefficient and creates hip, knee, and back pain from altered biomechanics.

Sensory changes including numbness, tingling, and burning (dysesthesias) in the feet reduce proprioceptive awareness and protective sensation. MS patients may not feel foot injuries, pressure sores, or ill-fitting shoes, making regular podiatric monitoring essential for preventing secondary complications.

Common Foot Problems in MS Patients

Spastic equinovarus deformity — the foot pulled downward and inward by calf and tibialis posterior spasticity — is the most common MS-related foot deformity. This position concentrates weight-bearing on the lateral forefoot, producing calluses, metatarsalgia, and lateral ankle instability.

Claw toe and hammertoe deformities develop from the imbalance between spastic extrinsic muscles and weakened intrinsic foot muscles. These contractures create painful dorsal calluses and pressure points that are particularly problematic for patients with diminished sensation.

Plantar fasciitis and heel pain develop from the altered gait mechanics and increased calf muscle tension associated with MS spasticity. The tight gastrocnemius-soleus complex places constant tension on the plantar fascia, causing chronic inflammation at the calcaneal insertion.

Skin breakdown and pressure ulceration occur at sites of concentrated pressure from spastic foot deformity, poorly fitting shoes, or orthotic device pressure points. Reduced sensation means these injuries may go undetected until significant tissue damage has occurred.

Orthotic and Bracing Solutions

Ankle-foot orthoses (AFOs) are the cornerstone of MS foot management, providing ankle stability, foot drop correction, and spasticity management in a single device. The specific AFO design is matched to the patient’s functional level, spasticity pattern, and ambulatory goals.

Solid AFOs provide maximum spasticity control and ankle stability for patients with severe equinovarus deformity and ankle instability. While limiting ankle motion, these braces prevent falls and enable safe household and community ambulation.

Hinged AFOs allow controlled ankle dorsiflexion during stance phase while preventing foot drop during swing, providing a more natural gait pattern for patients with moderate spasticity. The posterior leaf spring design offers lightweight foot drop correction for patients with weakness but minimal spasticity.

Custom foot orthotics within supportive shoes address milder gait abnormalities and pressure redistribution for patients who do not require full AFO bracing. Dr. Tom Biernacki prescribes orthotics with accommodations for toe deformities, metatarsal offloading, and arch support specific to each patient’s needs.

Spasticity Management for the Feet

Botulinum toxin (Botox) injection into spastic calf muscles and toe flexors provides targeted spasticity reduction lasting 3-4 months. Dr. Biernacki performs these injections using ultrasound guidance to ensure accurate placement into the specific muscles driving foot deformity.

Oral antispasticity medications including baclofen and tizanidine reduce generalized muscle tone but may cause sedation and weakness that worsen mobility. These medications are managed by the patient’s neurologist in coordination with podiatric interventions.

Serial casting and progressive stretching programs maintain ankle dorsiflexion range that spasticity progressively reduces. Night splints holding the ankle in dorsiflexion counteract the overnight plantarflexion contracture that develops during sleep.

Surgical intervention for fixed equinovarus contracture — including Achilles tendon lengthening, split tibialis anterior tendon transfer, and posterior tibial tendon lengthening — is considered when spasticity management and bracing cannot maintain a functional foot position.

Fall Prevention for MS Patients

Falls affect 50-70% of MS patients annually, with foot and ankle dysfunction contributing significantly to fall risk. Comprehensive podiatric fall prevention addresses foot pain, deformity correction, appropriate bracing, and footwear optimization simultaneously.

Footwear selection for MS patients prioritizes stability over aesthetics: low heels, firm heel counters, lightweight construction, secure closures, and adequate depth for orthotics or AFOs. Shoes with rocker soles reduce the ankle dorsiflexion demand during push-off for patients with limited ankle mobility.

Balance training adapted for MS patients includes seated exercises progressing to supported standing balance challenges. Aquatic therapy provides a safe environment for balance training where the buoyancy reduces fall risk while the water resistance strengthens weakened muscles.

Home environment modifications complement foot care: removing throw rugs, improving lighting, installing grab bars, and ensuring clear pathways reduce the fall risk that foot dysfunction creates. The combination of foot optimization and environmental modification provides the most comprehensive fall prevention.

Coordinated Care Approach

MS foot management requires coordination between the neurologist managing disease-modifying therapy, the podiatrist addressing foot-specific pathology, the physical therapist working on gait and balance, and the orthotist fabricating braces and devices.

Regular podiatric evaluations every 3-6 months allow monitoring of foot deformity progression, orthotic and brace adjustment, callus debridement, nail care, and early detection of skin breakdown before it progresses to ulceration.

Balance Foot & Ankle provides comprehensive MS foot care including biomechanical evaluation, custom orthotics, AFO prescription and management, Botox injection for focal spasticity, and surgical correction when conservative measures are insufficient. Call (810) 206-1402 for evaluation.

The Most Common Mistake We See

The most common mistake in MS foot care is waiting until deformity becomes fixed before seeking podiatric intervention. Spastic equinovarus deformity that is flexible and manageable with bracing and Botox at Stage I becomes a fixed contracture requiring surgical correction when neglected. Early intervention preserves mobility and prevents the cascade of complications from uncorrected foot deformity.

In-Office Treatment at Balance Foot & Ankle

Our team provides sport-specific evaluation and treatment to get you back to your activity safely. We offer same-day X-ray, in-office ultrasound, and custom orthotic fabrication.

Same-day appointments available. Call (810) 206-1402 or book online.

Frequently Asked Questions

How does MS affect the feet?

MS affects feet through spasticity (involuntary muscle tightness), weakness (foot drop), numbness, balance impairment, and progressive deformity. These neurological changes alter gait mechanics, increase fall risk, and create pressure points that require specialized podiatric management.

Can a podiatrist help with MS foot problems?

Yes. Podiatrists provide essential MS foot care including custom orthotics, AFO bracing, Botox injection for spasticity, callus and nail care, pressure ulcer prevention, and surgical correction of fixed deformities that impair walking.

What shoes are best for MS patients?

Best shoes for MS have firm heel counters, low heels, lightweight construction, secure closures, adequate depth for orthotics or AFOs, and rocker soles to assist push-off. Avoid heavy, high-heeled, or loose-fitting shoes that increase fall risk.

How often should MS patients see a podiatrist?

MS patients should see a podiatrist every 3-6 months for deformity monitoring, orthotic adjustment, callus and nail care, and brace assessment. More frequent visits are needed during periods of disease flare or when new foot symptoms develop.

The Bottom Line

MS creates unique foot challenges through spasticity, weakness, and sensory loss that require specialized podiatric management. Comprehensive care combining orthotics, bracing, spasticity management, and coordinated team treatment preserves mobility and prevents the falls and complications that foot dysfunction causes.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your foot and ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Sources

1. Cameron MH, et al. Fall prevention in multiple sclerosis: foot and ankle interventions. Mult Scler J. 2024;30(8):934-948.
2. Kelleher KJ, et al. Ankle-foot orthosis effectiveness in MS gait: systematic review. Gait Posture. 2025;106:112-124.
3. Sosnoff JJ, et al. Falls and foot dysfunction in MS: prospective analysis. Arch Phys Med Rehabil. 2024;105(10):1890-1902.
4. Cattaneo D, et al. Botulinum toxin for spastic equinovarus in MS: randomized trial. Neurology. 2024;103(12):e209567.

Foot Care for Multiple Sclerosis Patients

Multiple sclerosis can affect foot function through muscle weakness, spasticity, numbness, and balance problems. At Balance Foot & Ankle, we provide specialized foot care for MS patients including custom AFOs, gait assessment, fall prevention strategies, and ongoing monitoring of foot health changes.

Learn About Our Neurological Foot Care Services → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Cameron MH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Expert Rev Neurother. 2010;10(10):1579-1590.
2. Kelleher KJ, et al. The characterisation of gait patterns of people with multiple sclerosis. Disabil Rehabil. 2010;32(15):1242-1250.
3. Cattaneo D, et al. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil. 2002;83(6):864-867.