FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Foot Sliding for Ankle and Leg Weakness

Most likely fit: The foot sticks, drags or will not lift cleanly during an ordinary forward step, while keeping the sole in light contact with the floor allows a smoother forward-and-back movement. [Clinical consensus]

Important limit: Foot drag can also result from peripheral nerve injury, radiculopathy, stroke, multiple sclerosis, pain, contracture, dystonia or an unsuitable orthosis. This technique follows assessment; it does not replace it.

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Why sliding may help

Trying hard to lift a dragging foot can lead to repeated testing, stiffening through the whole leg or exaggerated hip hiking. Sliding keeps some contact with the floor, reduces the immediate clearance demand and gives continuous sensory information about direction. The slide can become a bridge toward a step; it is not a goal to drag the foot permanently.

Anatomy in everyday language

During the swing part of walking, the tibialis anterior and other ankle dorsiflexors (muscles at the front and outer side of the lower leg that lift the forefoot) help clear the toes. Hip and knee flexion shorten the leg as it travels forward. In a slide, floor contact reduces the amount of toe clearance required while the hip and knee still practise moving the limb forward and backward.

What practice may look like

A seated version may start with the foot on a cloth or low-friction board, sliding toward a floor mark and back. A standing version requires an assessed support and enough safe loading through the other leg. The clinician may use a continuous “forward—back” or “skiing” rhythm, then gradually ask for the heel or whole foot to become lighter.

The surface should be predictable: too much friction can catch the foot; too little can create a slip. Do not improvise with socks on a polished floor. Stop for skin rubbing, a near fall, increasing joint pain, repeated knee collapse or a new neurological change.

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Set up only the surface and support approved by the clinician. Do not move the foot for the person unless you have been taught a specific assistance technique. Give the agreed destination cue and keep obstacles out of the slide path. If movement becomes rougher, shorter practice or returning to sitting may be more useful than urging greater effort.

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Selection and differential assessment

Characterize ankle dorsiflexion during isolated testing, automatic repositioning, sitting, sliding and gait. Assess passive ankle range, pain, edema, plantarflexor shortening, dystonic inversion, spasticity, proprioception, common fibular nerve and L5-pattern weakness, footwear and orthotic needs. Establish whether the primary functional limitation is swing initiation, toe clearance, limb advancement, stance stability or fear of catching the foot.

Anatomy and biomechanics

Swing-phase clearance combines hip flexion, knee flexion and ankle dorsiflexion; pelvic rotation and stance-limb mechanics also contribute. Dorsiflexion is produced mainly by tibialis anterior, extensor hallucis longus and extensor digitorum longus, with fibularis tertius variably contributing. Translate this as: “The hip and knee shorten the moving leg, while the shin muscles lift the front of the foot.” Sliding temporarily reduces the vertical-clearance requirement while retaining directional limb movement.

Explicit treatment sequence

  1. Select sitting or supported standing based on falls risk and stance-limb control.
  2. Optimize friction, footwear and foot alignment. Mark a short forward target.
  3. Cue movement of the whole foot toward the target rather than isolated maximal dorsiflexion.
  4. Establish repeated forward-and-back sliding with a comfortable rhythm. Minimize unnecessary hip hiking, trunk lean, breath-holding and global leg stiffening without demanding perfect form.
  5. When the sequence is reliable, introduce brief unloading: reduce sole pressure, release the heel or clear a very low marker.
  6. Integrate the movement into weight shift and a short step, then into forward gait if safe.

Regression, progression and measures

Regress by sitting, using a shorter lever, supporting the thigh, decreasing friction or reducing range. Progress from full-foot slide to lighter contact, heel release, toe clearance, stepping and varied surfaces. Consider an orthosis or mobility aid when needed for safety or participation; do not withhold it to force retraining.

Measure slide distance, continuity, number of repetitions, degree of unloading, toe clearance, compensatory hip or trunk movement, assistance, trips and transfer to ordinary walking. Include pain, fatigue and delayed response.

Safety and evidence boundary

Avoid unsafe slippery surfaces, unprotected standing and practice that repeatedly catches the toes. Inspect skin and footwear when sensation is impaired. This exact progression is a clinician-selected application of consensus examples; it has not been established as an independent treatment in a controlled trial. [1][2]

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Research and Sources

Citation Full citation
[1] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. 2015;86(10):1113–1119. FND-CIT-0028. https://doi.org/10.1136/jnnp-2014-309255
[2] Nielsen G, Stone J, Lee TC, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD). The Lancet Neurology. 2024;23(7):675–686. FND-CIT-0029. https://doi.org/10.1016/S1474-4422(24)00135-2

Detailed technique page created: September 10, 2026 · Clinical and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
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