The Experts

Multiple Sclerosis Orthotics in London

Multiple sclerosis affects people in very different ways, and it rarely affects the same person in exactly the same way from one month to the next. Orthotic care has to account for that. A device that helps on a good day is of limited use if it becomes unmanageable on a difficult one.

Our consultant orthotists assess adults with MS across four London clinics, with particular attention to the weight, comfort and practicality of anything we prescribe.

How MS Affects Walking and Posture

The symptoms that most often bring people to an orthotist are:

Weakness in one or both legs, frequently below the knee first
Spasticity and stiffness, which can make the leg harder to swing through and harder to place accurately
Foot drop, sometimes intermittent rather than constant
Problems with balance and coordination, producing an unsteady walking pattern and a raised risk of falls
Fatigue, which for many people is the single most limiting symptom of allFatigue, which for many people is the single most limiting symptom of all
Reduced sensation in the feet, so surface changes are harder to detect
Reduced dexterity in the hands, which affects whether a device can be put on independently

Why fatigue changes the conversation

Walking with weakness or an altered gait pattern costs more energy than walking without. When fatigue is already a dominant symptom, that additional cost matters enormously, and it shapes what we prescribe.

In practice it means weight is a priority rather than an afterthought. It means the device needs to be quick and straightforward to put on, particularly if hand function is affected. And it means we would rather fit something you will actually wear all day than something technically ideal that stays in a cupboard.

Designing Around a Condition That Fluctuates

Many people with MS describe good days and bad days, or a marked difference between morning and evening. Heat sensitivity is a further factor, with some people finding symptoms noticeably worse in warm conditions or after exertion.

We take all of this into account at assessment, and will ask about the range rather than only about how things are on the day you attend. In some cases the answer is a device tuned to the more difficult end of that range. In others it is a rethink of when and where the device is worn.

What Happens at Your Assessment

Assessment covers your walking pattern, joint range, tone, sensation, skin and current footwear, alongside a discussion of what you want to be able to do. That might be managing a commute, staying on your feet at work, walking with children or grandchildren, or simply reducing the number of stumbles in a week.

Where the picture is complex, gait analysis can be used to examine the mechanics more closely. We will also want to know what else is in place, including physiotherapy, medication for spasticity and any input from your MS team.

Orthoses Used in Multiple Sclerosis

Lightweight ankle foot orthoses, including carbon fibre, 3D printed and posterior leaf spring designs, chosen where minimising weight and energy cost is a priority
Hinged ankle foot orthoses, where some controlled ankle movement is useful but stability is still needed
Rigid ankle foot orthoses, where weakness or instability is more pronounced
Knee bracing, where the knee is hyperextending or giving way
Custom insoles, to improve contact, comfort and stability inside the shoe
Wrist and hand orthoses, where upper limb function or positioning is affected

Balance, Falls and Confidence

Falls are a significant concern in MS, and the fear of falling can restrict activity as much as the falls themselves. Where balance is affected by coordination rather than weakness alone, an orthosis will not resolve the problem on its own, but improving foot clearance and giving a more predictable base of support can remove some of the situations in which trips occur.

It is worth being clear about this distinction at assessment. If unsteadiness is being driven mainly by ataxia, we will say so, and the conversation may turn towards what else needs to be in place alongside any device.

Review Over Time

MS is a long-term condition and orthotic needs change with it. We would expect to see you again rather than fit once and discharge. Reviews allow the prescription to keep pace with the condition, and allow problems such as rubbing, discomfort or a device that no longer suits your walking pattern to be dealt with before they put you off wearing it.

Common Questions

My walking varies a lot. Is an orthosis still worth considering?

Variability is common in MS and it does not rule out orthotic treatment. It does influence the design, and it is one of the main things we will ask about at assessment.

Will wearing an ankle foot orthosis make me rely on it?

An orthosis is prescribed to support a specific mechanical problem and could be viewed as a tool, and it is normally used alongside physiotherapy and any medical management already in place. If this is a concern for you, raise it at assessment so it can be talked through properly in the context of your own situation.

I struggle with my hands. Can I still manage a device on my own?

Independence in putting a device on and taking it off is part of the assessment, not an afterthought. Fastening type, closure design and overall handling are all things that can be adjusted.

Do I need a referral from my neurologist?

No. We accept self-referrals, and also see people referred by neurologists, physiotherapists, MS nurses and case managers.