BACKGROUND Among patients with multiple sclerosis (MS), increased disease severity of disease is associated with increased burden of caregiving and  decreased employment status. Specific effects of walking/mobility problems (WMPs) on caregiving requirements and employment status are unknown. OBJECTIVES: Examine the relationship between presence/severity of WMPs in MS patients on: formal (paid professional) and informal (friends/family) caregiving; and indirect costs related to employment status. METHODS: Data were obtained from a cross-sectional study of 340 neurologists in France, Germany, Italy, Spain and UK. Neurologists completed records on the next 10-12 consulting MS patients. Among 3572 patients, 2111 completed a questionnaire indicating their level of WMPs: none(n=1342), mild(n=271), moderate(n=314),  severe(n=184). Chi-square with Bonferroni-adjusted Fisher’s-Exact tests assessed the relationship between WMPs and level of caregiving required and employment status. ANOVA with Bonferroni-corrected t-tests assessed the relationship between WMPs and annual days off-work. RESULTS: Analysis showed a positive association between severity of WMPs and caregiver requirement (P<0.0001). Patients reporting severe WMPs required more formal care (50%) compared with no WMPs(10%), mild(11%) and moderate(23%)  (P<0.0001). A similar pattern was observed for informal care; no WMPS(11%), mild(14%), moderate(28%), severe(31%) (P<0.0001). Mean annual days off-work was 21(s.d.43) for no WMPs compared with 74(s.d.121) for severe WMPs (P<0.0001). 12% of patients with no WMPs had reduced weekly work-hours compared with 22%-26% among those with WMPs (P<0.0001). Only 7% of patients with no WMPs had given up work altogether compared with 29% of moderate and 38% of patients with severe WMPs (P<0.0001). CONCLUSIONS: These analyses highlight an increased need for formal care among MS patients with WMPs, especially those in whom they are severe. A negative impact in employment status is associated with severity of WMPs. Given that walking problems impose a strain on MS patients, friends/family and health/social care authorities, therapeutic options that improve WMPs should be a public health priority.