Cold Feet as a Symptom of Multiple Sclerosis

Updated on January 15, 2023

Medically reviewed by Nicholas R. Metrus, MD

Cold feet symptoms that occur with multiple sclerosis (MS), even when your feet feel warm to the touch, are known as a dysesthesia. Dysesthesias are abnormal sensations that are unpleasant, potentially painful, and occur anywhere on the body, although they're most commonly experienced in the legs and feet.

While other conditions can lead to cold feet, there are specific reasons for why cold feet may be linked to MS and specific strategies for dealing with the discomfort.

This article explains how the effects of MS on the nervous system lead to dysesthesia symptoms. It presents some treatments and therapies that can help with the MS-related sensation of cold feet.

Ways to Manage Cold Feet in Multiple Sclerosis — Verywell / Cindy Chung

Dysesthesia and the Nervous System

With MS, the myelin sheath—the protective coating around the nerve fibers in your brain and spinal cord (your central nervous system)—is damaged.

This damage leads to faulty nerve communications that can cause erroneous pain messages to be sent to your brain. In other words, your feet are actually warm, but you think they're cold because your nervous system is telling you they are.

With sensitization of the nervous system, two phenomena may develop:

Allodynia means that a benign stimulus like a light touch or cool breeze triggers pain.
Hyperalgesia refers to an increased sensitivity to pain. For instance, a pinprick on your foot, which is normally a little painful, may feel like a sharp knife.

It's important to note that cold feet and other sensory symptoms are not necessarily signs that your MS is getting worse, especially if the symptoms come and go.

Up to half of all people with MS experience pain at some point. Many develop chronic pain, or experience the facial pain of trigeminal neuralgia or the eye pain of optic neuritis.

Dysesthesia and Cold Feet

When it comes to cold feet, MS experts call this pain a dysesthesia. It occurs on its own or worsens with weather changes. It tends to be worse at night and intensified with exercise.Let your healthcare provider know if you experience cold feet for the first time.

Tips to Manage Your Cold Feet

Cold feet with MS can be managed in different ways. Warming your feet with blankets may seem obvious, but there are other techniques—both medical and behavioral—that can help you to manage your discomfort.

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Distraction

Distraction is a great psychological intervention for managing pain, as it forces your brain to shift focus from your pain onto the activity at hand, especially if that activity is cognitively demanding.

If your feet are bothering you, consider trying one of these distraction techniques. Remember, though, depending on the intensity or nature of your discomfort, you may have to try a few different techniques before finding the one that works for you:

Reading a book
Calling a friend on the phone
Playing a video game
Listening to music or a podcast
Coloring or painting
Completing a puzzle
Journaling

Complementary Therapies

Complementary therapies can be especially useful in managing your pain, as well as other symptoms of your MS like fatigue or cognitive problems.

These therapies may include:

Hypnosis
Cognitive-behavioral therapy
Mindfulness meditation

Medications

If your cold feet are significantly affecting your quality of life or impairing your functioning (for example, if you're falling or not going to work or seeing your friends and family), be sure to speak to your healthcare provider.

Some medications may help, though there are side effects in some cases. Among them are:

The tricyclic antidepressant Elavil (amitriptyline)
Serotonin-norepinephrine reuptake inhibitor (SSRI) drugs such as Cymbalta (duloxetine)
Anti-seizure medications used to treat neuropathic pain like Neurontin (gabapentin) or Lyrica (pregabalin)

Topical capsaicin cream is another potential option for your feet.

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Other Therapies

If your cold feet are impairing your walking and balance, you may need physical or occupational therapy.

Regular visits to a podiatrist to ensure your feet appear healthy without ulcers, as well as special shoes called orthotics, may also be warranted.

Seeing a therapist or psychiatrist may also be helpful as pain in multiple sclerosis can trigger or worsen depression or anxiety.

Remember to discuss any medications or therapies with your healthcare provider first.

Other Reasons for Cold Feet

Examples of other health conditions that may cause cold or painful feet include:

An underactive thyroid (hypothyroidism)
Blood vessel problems (for example, peripheral arterial disease)
Diabetes (cold feet can result from both circulation and nerve problems)
Raynaud's phenomenon

While these can be the cause of cold feet, they can also compound cold feet that are due to other issues like MS.

Summary

People living with multiple sclerosis may experience the sensation of cold feet even when their feet are warm. This is due to nerve damage, caused by the MS, that leads to dysesthesias like cold feet.

While cold feet may cause pain or discomfort, there are steps you can take to remedy the symptoms. If focusing on a distraction doesn't work, physical therapy or medications may help.

Be sure to tell your healthcare provider about any cold feet episodes that are new. They'll need to evaluate the symptoms and rule out other possible causes before you decide on treatment options.

A Word From Verywell

Whatever form it takes, pain in MS can be debilitating, both physically and mentally. Our Healthcare Provider Discussion Guide can help you to start a conversation about your symptoms with a health professional.

Multiple Sclerosis Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Download PDF

5 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Freiha J, Riachi N, Chalah MA, Zoghaib R, Ayache SS, Ahdab R. Paroxysmal Symptoms in Multiple Sclerosis-A Review of the Literature. J Clin Med. 2020 Sep 25;9(10):3100. doi:10.3390/jcm9103100.
National Multiple Sclerosis Society. Pain: the basic facts. 2016.
Sajeev MF, Kelada L, Yahya Nur AB, Wakefield CE, Wewege MA, Karpelowsky J, et al. Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth. 2021 Oct;127(4):608-619. doi:10.1016/j.bja.2021.06.039.
Azmi S, Elhadd KT, Nelson A, et al. Pregabalin in the management of painful diabetic neuropathy: a narrative review. Diabetes Ther. 2019;10(1):35-56. doi:10.1007/s13300-018-0550-x
Bae KH, Go HY, Park KH, Ahn I, Yoon Y, Lee S. The association between cold hypersensitivity in the hands and feet and chronic disease: results of a multicentre study. BMC Complement Altern Med. 2018;18(1):40. doi:10.1186/s12906-018-2082-3

By Colleen Doherty, MD
Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.

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