Foot Health for People with Multiple Sclerosis

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

Multiple Sclerosis and the Foot: Neurological Effects on Lower Extremity Function

Multiple sclerosis (MS) — the autoimmune demyelinating disease of the central nervous system — produces foot and lower extremity manifestations through several mechanisms: motor pathway demyelination causing weakness and spasticity, sensory pathway involvement causing numbness and pain, and cerebellar pathway damage affecting coordination and gait. Understanding these MS-related foot and ankle problems — and their management — is important for both people living with MS and the podiatrists who care for them. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we provide neurologically-informed foot care for patients with MS.

Foot Drop: The Most Common MS Foot Problem

Foot drop — weakness of ankle dorsiflexion that causes the foot to drag during the swing phase of gait — is the most common MS-related gait disturbance and a major cause of falls and functional limitation. It results from demyelination of the corticospinal tract (motor pathways) controlling tibialis anterior and the other ankle dorsiflexors. Management options: ankle foot orthosis (AFO) — the standard treatment that holds the foot in neutral and allows more normal gait pattern. Functional electrical stimulation (FES) — devices like the Bioness L300 deliver electrical stimulation to the peroneal nerve during gait, activating the foot dorsiflexors at the appropriate phase of the gait cycle. This provides more dynamic foot clearance than a rigid AFO and may have neurological training benefits. Custom AFO fitting and FES device coordination are part of our MS foot care services.

Spasticity and Its Foot Consequences

Spasticity — velocity-dependent increased muscle tone — from MS motor pathway involvement causes multiple foot problems. Equinus: spastic calf musculature holds the foot in plantarflexion, creating problems with shoe fitting, AFO tolerance, and gait. Serial casting or Botox injection to the gastrocnemius can reduce equinus spasticity to allow AFO fitting and improved gait. Claw toe deformity: intrinsic foot muscle imbalance from upper motor neuron spasticity causes claw toe progression similar to Charcot-Marie-Tooth. Appropriate footwear with deep toe boxes and toe spacers manages mild claw toe; surgical correction for fixed, shoe-resistant deformity.

Sensory Complications and Fall Prevention

MS sensory manifestations in the foot include numbness (reducing proprioceptive feedback needed for balance), dysesthesias (painful abnormal sensations including burning and electric pain), and the Uhthoff phenomenon (temporary symptom worsening with heat). Sensory numbness in the feet significantly increases fall risk — proprioceptive loss from numbness impairs the body’s ability to detect and respond to unstable surfaces. Fall prevention strategies: textured insoles or vibration platforms provide enhanced somatosensory feedback. High ankle footwear improves mechanical stability when proprioception is impaired. Regular professional foot checks prevent unrecognized wounds in insensate feet. Contact Balance Foot & Ankle at (810) 206-1402 for MS-specific foot evaluation and management.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Multiple Sclerosis Foot Problems

Multiple sclerosis can cause foot drop, spasticity, numbness, and balance problems that significantly affect mobility. At Balance Foot & Ankle, Dr. Tom Biernacki provides custom AFO bracing, spasticity management, orthotic support, and footwear modifications for MS-related foot conditions.

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Clinical References

1. Cameron MH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Curr Neurol Neurosci Rep. 2010;10(5):407-412.
2. Cattaneo D, De Nuzzo C, Fascia T, et al. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil. 2002;83(6):864-867.
3. Benedetti MG, Piperno R, Simoncini L, et al. Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler. 1999;5(5):363-368.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.