If you experience difficulty lifting the front part of your foot — known as foot drop or, sometimes, drop foot — due to multiple sclerosis (MS), chances are your doctor will discuss various adaptive options with you, including wearing a brace.
But another option that may prove beneficial is a functional electrical stimulation (FES) device, which is worn around your leg just under the knee and sends an electrical signal to the peroneal nerve, which in turn causes the muscles that enable you to lift your foot to contract.
FES devices — including common brands WalkAide and Bioness — may be used not just by people with multiple sclerosis, but also by stroke survivors and those withcerebral palsy, a spinal cord injury, or a traumatic brain injury.
Treating Foot Drop in MS
Inpeople with MS, foot drop is caused by a brain or spinal lesion that disrupts the signal sent from the cortex of your brain to your foot, saysMatthew A. Tremblay, MD, a neurologist and multiple sclerosis specialist at UConn Health in Farmington, Connecticut.
“I would say the issue of foot drop is one that is usually seen in patients with progressive forms of MS,” says Dr. Tremblay. “It’s not the majority of patients.”
When you wear an FES device, says Tremblay, “What it does is provide low-amplitude electrical stimulation to the peroneal nerve and the muscle that you need in order to lift the foot.”
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This, he says, can lead to a more natural gait and may improve walking safety by helping to prevent tripping.
But like many neurologists, Tremblay doesn’t routinely recommend FES devices to his patients. “I usually recommend, as a more common practice, using something like an ankle-foot orthosis,” or AFO, he says — a brace that wraps around your ankle or lower leg and around or under your foot.
Are FES Devices Worth the Price?
Among the reasons Tremblay doesn’t routinely recommend FES devices is their high cost, he says, which tends to run in the ballpark of $5,000. For most of his patients, insurance doesn’t pay for the devices.
Mona Sen, a 51-year-old resident of Schenevus, New York, who hassecondary-progressive MSand was first diagnosed 31 years ago, knows firsthand how difficult it can be to get an FES device.
Five years ago, she was wearing an AFO, which she had used for the previous six-and-a-half years. “It was fine in the beginning,” she says of the brace. “It was actually miraculous, because I could walk. But then slowly, over the years, my leg started to atrophy, and my circulation got really poor.”
She found out aboutFES devicesby doing research online — and also found out that most people’s insurance doesn’t cover them for MS, including hers.
“I had to find $5,000 for this thing,” she says, a challenge because she’s on disability with a fixed income. In the end, she pulled together the money from the NationalMultiple Sclerosis Society, a variety of charities, and a friend from college who heard about her situation.
Sen considers her FES device to be a definite improvement over a brace, because when she got it, “My foot finally had activity. It was moving.” Also, unlike a brace, “You can wear sandals” and a variety of other shoes with it, she says. It has also reduced her fatigue related to walking.
Getting Started With an FES Device
To start using an FES device, Sen had to visit aphysical therapist. She was fitted for the device and had it programmed specifically for her, with the signal adjusted between several passes of walking up and down a hallway.
She initially wore the device for a two-week trial, during which time she learned that “You don’t just take off running” with it. Instead, “You have to wait for the stimulus. I stand up, and I have to wait until I feel this stimulus and I feel my foot move,” she says.
During her two-week trial, Sen had a few incidents in which she fell down. But after getting the device reprogrammed again, it was easier to use without falling.
‘Not a Miracle’
Tremblay says that according to the scientific literature, FES devices “work relatively well for most people.” But, he notes, “They don’t necessarily provide the amount of support that everyone is looking for.”
Studies of FES devices for MS include one published in September 2010 in theMultiple Sclerosis Journal,which found that participants who wore an FES device reported greater satisfaction in dealing with problematic daily activities than those who received physical therapy exercises.
While Sen is mostly satisfied with her FES device, walking still takes thought and effort. “It is not a miracle, not for me,” she says.
Tremblay echoes this sentiment, noting that an FES device “doesn’t really work seamlessly in the way that your brain and spinal cord are able to coordinate” walking absent a disability.
For people considering an FES device, Tremblay advises looking into all your options, including wearing a brace instead, and investigating how much a device would cost you. If you then decide that an FES device might still be worth it, “It’s worthwhile to find a clinic that does the fitting for the devices” and to try one out, he says.
In the end, says Tremblay, many people report being happy “using their own muscles, their own anatomy, to produce a fairly natural gait.”
