Podcast Summary: The MSing Link

Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Episode 271: Toe Exercises for MS: Improve Balance, Foot Drop & Walking
Date: February 11, 2026

Episode Overview

This episode delves into the critical and often-overlooked role of toe mobility in people living with Multiple Sclerosis (MS). Dr. Gretchen Hawley explains why toe movement is foundational for balance, addresses common complications like foot drop and spasticity, and provides MS-specific exercises designed to strengthen neural and muscular control of the toes. Listeners are encouraged to challenge their perception of toe function, learn actionable techniques, and recognize that even micro-improvements can be meaningful on the MS journey.

Key Discussion Points & Insights

Why Toe Mobility Matters for MS

• Many people (with or without MS) struggle to move their toes independently, which has major implications for balance and mobility.

• MS often impacts the muscles and nerves controlling the toes and ankles, creating compounded challenges for movement.

  • Quote:
    "If neurotypical people... struggle with moving their toes, then imagine the challenge with MS, which tends to affect those muscles anyways, but also the opportunity for improvement." (03:00 – Dr. Gretchen Hawley)

• Toe movement supports:

  • Balance: The toes are a foundation in standing and walking.

  • Foot Drop Management: Strong, mobile toes can combat ankle/toe weakness causing dragging or scuffing of the foot.

  • Spasticity Reduction: Regular toe exercises can help relax curled or stiff toes.

  • Circulation & Proprioception: Better toe movement increases blood flow and improves the brain's awareness of foot position.

  • Quote:
    “Better toe control and toe mobility can actually improve foot drop. It can also help improve spasticity if you have toe curling... Toe mobility can help with that. It can also help with circulation and blood flow. It can help with proprioception...” (05:06 – Dr. Gretchen Hawley)

The Link Between Sensory Changes & Toe Exercise

• Sensory symptoms (numbness, tingling, burning, pins & needles) are common with MS, but are not targeted by these exercises.

• Toe mobility exercises focus on muscles, while sensation requires different (desensitization) techniques.

• Visual feedback is key for people with diminished foot sensation; Dr. Hawley encourages watching your feet during exercises for better results.

  • Quote:
    “It's really important that we look down at our toes so that we can see what's happening.” (08:55 – Dr. Gretchen Hawley)

Step-by-Step: Toe Exercises for MS

Note: Listeners are guided to be seated, with shoes and socks off for visibility and movement.

1. Toe Wiggling (10:43)

   • “Just wiggle your toes. We can use this as an assessment... but also an actual exercise.”
     Try to move all toes, then separately; see if only your ankle moves (that’s not the target).
   • Practice throughout the day; discreet, yet effective.

2. Big Toe Lifts (12:55)

   • “Practice lifting just your big toe up and then down... even if it’s really hard right now, within a few days or weeks, it will actually start moving.”
   • Focus: Isolate movement to the big toe, keeping the other toes relaxed.

3. All Toes Up & Spread (13:37)

   • "Can you lift and spread all of your toes? ...Try to get your toes as far apart.”
   • Lift all toes, spread wide, set down wide, relax—repeat.

4. Small Toes Up, Big Toe Down (14:18)

   • “Keeping your big toe down, but lifting your smaller toes… up and down. I know, I’m well aware that I sound like a crazy person right now, especially if you’ve never done these before.”
   • Focus: Separate big toe stability from the rest.

5. Stretching & Releasing (15:10)

   • Massage the arches, use toe spacers, or interlace fingers between the toes.
   • Stretching enhances mobility and addresses spasticity.

Progress, Frequency & Realistic Expectations

• Don’t worry if you see no immediate movement—zero visible change still means your brain is working to form new pathways.
• Individual improvement varies; it may take weeks to months.
• Recommended Routine:

  • 2 times/day

  • 6 days a week

  • Minimum 8 weeks

  • About 10 repetitions each exercise

  • Memorable Quote:
    “Even attempts of these movements without visible movement is meaningful and it's still building strong neural pathways over time so you don't need to see movement in order to actually be improving.” (17:17 – Dr. Gretchen Hawley)

Notable Quotes & Moments (With Timestamps)

• Toe Movement and MS Specifics:
  “MS seems to attack... the nerves weaker that go to your toes and go to your ankle, and that can be what's causing difficulty wiggling your toes.” (04:20)

• Why Toe Yoga?
  “Our toe movement is so, so, so important for a lot of our movements that we do throughout the day.” (03:45)

• If You See No Progress:
  “If you see no movement, that is not an excuse to not do these exercises. If anything, it's a reason to even more so to do these exercises.” (16:40)

• Celebrating Small Wins:
  “When you're looking down, you say to yourself, 'Oh my gosh, I think that's lifting a little bit higher.' …That is a win.” (16:19)

Additional Resources Mentioned

• Visual Demonstrations:

  • YouTube (companion video for visual learners)
  • In-depth Toe Yoga class in The Missing Link online program

• Desensitization & Special Socks/Inserts:

  • Naboso sensory products for better foot sensation
  • Desensitization exercise demo videos (Missing Link members)

Action Steps for Listeners

• Start toe exercises daily, regardless of current ability.
• Watch your toes for visual feedback, especially if sensation is altered.
• Embrace tiny improvements — progress is personal and meaningful.
• Share your experiences and questions with Dr. Hawley!

Tone & Engagement

Dr. Gretchen’s style is friendly, encouraging, and empowering. She breaks down clinical topics into approachable language and repeatedly reassures listeners that progress is possible for everyone, regardless of where they start. Listeners are invited to connect, celebrate small wins, and never underestimate the importance of “toe-tingling” effort!