A Clinical Pathway for the Evaluation and Treatment of Foot Drop in MS

Friday, May 29, 2015
Griffin Hall
Robert J Schreyer, PT, DPT, NCS, MSCS, CSCS , Physical Therapy, Aspire Center for Health & Wellness, New York, NY
Emil Euaparadorn, PT, DSc, OCS, COMT, CMPT, CSCS, FAAOMPT , Physical Therapy, Aspire Center for Health & Wellness, New York, NY
Herbert I Karpatkin, PT, DSc, NCS, MSCS , Physical Therapy, Hunter College, New York, NY


Although Multiple Sclerosis (MS) is a disease of the central nervous system, musculoskeletal impairments are a common cause of immobility.Foot drop is a common example of this, in which the evaluation and treatment can be highly variable due to it’s multifactorial nature. No clinical guidelines exist to address this limitation leading to inconsistent approaches by clinicians. Formulaic, “one size fits all” approaches to foot drop often result in poor outcomes due to a lack of appreciation of the multiple factors that can lead to this condition.


The purpose of this project is to provide a clinical pathway for clinicians to ensure that a comprehensive and reliable method is performed on all patients with MS. We hypothesize that the use of such a pathway will result in better management of MS mobility deficits due to foot drop. If our hypothesis is correct, this pathway will result in therapists who treat MS having a more comprehensive and reliable set of tools to effectively manage individuals presenting with foot drop.


This clinical pathway is a multifactorial assessment that directs a clinician through a comprehensive evaluation with treatments based on the results.  The evaluation is examines the various contributions of range of motion (ROM), strength, spasticity, sensation, and fatigue/endurance taking into account primary vs. secondary causes, as well as the presence of compensatory techniques. Treatment is a clinical decision making process for respective limitations in ROM, strength, spasticity and endurance addressed through correction, accommodation and/or compensation. A correction of the problem is the first choice, but if this cannot be achieved the problem can be accommodated for through external devices, or compensated for through the utilization of neighboring muscle groups or altered functional techniques. Given the chronic and progressive nature of MS, it is important to note that an individual may be classified in more than one category and subsequently require multiple forms of treatment. 


After performing the clinical pathway, the clinician should have a clear understanding of the factor(s) causing foot drop allowing individualized classification and intervention.  Treatment based classifications clinicl pathways are utilized throughout rehabilitation to help guide the clinician towards an effective treatment approach, and should be utilized in the case of foot drop in MS. 


Foot drop is a common problem in MS, which is frequently treated ineffectively, resulting in progression of disability that cannot be treated medically. It is hoped that by utilizing this clinical pathway clinicians can consistently develop individualized treatment plans