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

How Multiple Sclerosis Affects the Feet and Gait

Multiple sclerosis (MS) is a chronic autoimmune disease in which the immune system attacks the myelin sheath protecting nerve fibers in the brain, spinal cord, and optic nerves. The resulting nerve conduction abnormalities cause a wide range of neurological symptoms — and the feet and lower extremities are commonly affected, creating mobility challenges that significantly impact independence and quality of life.

Approximately 1 million Americans live with MS, with the majority experiencing some degree of lower extremity motor or sensory dysfunction during their disease course. The specific foot and gait problems that develop depend on which spinal cord and brain regions are demyelinated — MS is highly variable in its manifestations, and no two patients have exactly the same pattern of difficulty. However, several common foot-related problems occur frequently enough to deserve specific discussion.

Foot Drop: The Most Common Gait Problem in MS

Foot drop (drop foot) is the inability to dorsiflex (raise) the foot and toes normally during the swing phase of gait. In healthy gait, the foot is lifted during swing to clear the ground. When the neural pathways controlling dorsiflexion are disrupted by MS lesions, the foot hangs or drags during swing, causing toe scuffing, tripping, and falls.

Foot drop is present in approximately 50-75% of MS patients with walking difficulty. It creates a characteristic gait pattern — hip hiking (raising the hip to lift the dragging foot), circumduction (swinging the leg in a semicircle), or a steppage gait (exaggerated knee lift to help clear the foot) — each representing a compensation strategy for the lost dorsiflexion function. These compensations are fatiguing and over time create secondary problems in the hips and back.

The most effective intervention for MS-related foot drop is an ankle-foot orthosis (AFO) — a rigid or semi-rigid brace that holds the foot in neutral dorsiflexion during swing, restoring normal foot clearance. AFOs come in many designs: solid ankle, hinged, carbon fiber energy return designs, and custom-molded varieties. The appropriate AFO depends on the severity of foot drop, presence of spasticity, foot/ankle stability, and the patient’s activity level and goals.

Functional electrical stimulation (FES) devices such as the Bioness L300 and WalkAide stimulate the peroneal nerve electronically to activate dorsiflexion during the swing phase. These represent an alternative to AFOs for appropriate patients, with the advantage of stimulating the underlying muscles rather than passively compensating for weakness — potentially providing some degree of retained neural plasticity benefit. Research shows FES devices improve gait speed and walking endurance in MS foot drop patients.

Spasticity: When Muscles Are Too Tight

Spasticity — involuntary muscle tightness resulting from loss of upper motor neuron inhibition — is one of the most common MS symptoms, affecting approximately 80% of patients with progressive disease. In the lower extremity, spasticity commonly affects the calf muscles (causing equinus — the foot being drawn into a pointed position), hip adductors (causing scissoring gait), and knee flexors (causing crouched gait).

Calf spasticity in MS causes the foot to be pulled into plantarflexion and inversion, resisting dorsiflexion and creating a toe-walking pattern that stresses the forefoot. The chronically shortened calf eventually develops contracture — permanent loss of range of motion that persists even when the spasticity is treated medically. Daily stretching of the calf and Achilles complex, combined with AFO use to maintain the ankle in a neutral position, prevents or slows the development of contracture.

Botulinum toxin (Botox) injections into spastic calf muscles reduce the involuntary tightness for 3-4 months, improving foot clearance and allowing more normal foot and ankle mechanics during the treatment period. These injections are typically administered by a physiatrist or neurologist but are most effective when combined with rehabilitation and orthotic management by a podiatrist or physical therapist.

Sensory Changes: Numb Feet and Proprioception Loss

MS commonly causes sensory disturbances in the feet including numbness, tingling, burning, and tightness — sensations that patients often describe as “walking on sand,” “wearing tight socks,” or “feet in warm water.” More functionally significant is the loss of proprioception — the ability to sense foot position and movement — which is a major contributor to balance problems in MS.

Proprioceptive loss makes balance on uneven surfaces, in the dark, or with eyes closed very challenging. Falls are a major concern for MS patients — approximately 50-65% fall at least once per year, and falls are a leading cause of injury and reduced activity in this population. Foot and ankle proprioception exercises (balance training on foam surfaces, unstable boards, and with eyes closed) can partially compensate for proprioceptive deficits by retraining available sensory systems. Textured insoles that increase plantar sensory input may improve balance in some patients.

Fatigue and Foot Health: The Hidden Connection

MS-related fatigue — one of the most disabling and common MS symptoms — interacts with foot health in important ways. When MS patients fatigue, gait deteriorates, foot drop worsens, and fall risk increases. Many MS patients experience dramatic worsening of all neurological symptoms with heat (Uhthoff’s phenomenon). Cooling strategies — cooling vests, cold water for foot soaking — reduce symptom severity during heat-exacerbated periods.

Foot problems that increase the energy cost of walking — poorly fitting shoes, foot pain, inadequate orthotics — become proportionally more significant in the context of MS fatigue. Optimizing foot mechanics and comfort through appropriate footwear and orthotics reduces the energy expenditure of walking, leaving more reserve for daily activities and reducing fatigue burden.

At Balance Foot & Ankle, we have experience managing the foot and ankle complications of multiple sclerosis, providing AFO prescription and fitting, footwear consultation, orthotic management, and coordination with the patient’s neurology team. Our goal is to help MS patients maintain maximum safe mobility and foot health throughout their disease course. If you or a family member with MS has foot or gait concerns, we welcome a consultation.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Multiple Sclerosis Foot Care in Michigan

MS-related foot drop, spasticity, and balance issues require specialized podiatric management. At Balance Foot & Ankle, Dr. Tom Biernacki provides adaptive foot care and bracing for MS patients — serving Howell and Bloomfield Hills, MI.

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Clinical References

1. Cattaneo D, De Nuzzo C, Fascia T, Macalli M, Pisoni I, Cardini R. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil. 2002;83(6):864-867.
2. Boes MK, Sosnoff JJ, Socie MJ, Sandroff BM, Pula JH, Motl RW. Postural control in multiple sclerosis: effects of disability status and dual task. J Neurol Sci. 2012;315(1-2):44-48.
3. Cameron MH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Curr Neurol Neurosci Rep. 2010;10(5):407-412.

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.