An Overview of Hot Feet in Multiple Sclerosis

If you sometimes feel like your feet are hot, even when they feel normal to the touch, you are experiencing something known as dysesthesia. Dysesthesia is a common symptom in multiple sclerosis (MS) and refers to abnormal sensations that are potentially painful. They can occur anywhere on the body, although they are most commonly experienced in the legs and feet.

There may some variations in how you experience the sensation of hot feet, including:

• An itching, burning sensation that may resemble a crawling under or on the skin
• Feelings of "pins and needles"
• The sensation of being on fire
• The sensation of electric shocks

Like other MS-related symptoms, the cause of the burning sensation in your feet is related to myelin damage in the central nervous system, most likely in your spinal cord.

The myelin sheath is the protective coating surrounding nerve fibers. Since it allows nerve signals to be transmitted rapidly and efficiently, damage to it disrupts nerve communication and signals are not sent properly. This can lead to faulty messaging that causes the brain to release pain signals when there is no reason for the pain.

MS-related pain does not correlate with the number of MS lesions indicated on a magnetic resonance imaging (MRI) scan or even where those lesions are located. In other words, having pain is likely not a sign that your MS is worsening.

Dysesthesias can occur spontaneously or be provoked by a stimulus (for example, when you put on a shoe or when the bed covers touch your feet).

Finally, burning feet or other dysesthesias may be worsened at night and after exposure to exercise or other activity or an environment that increases your body temperature; this is called the Uhthoff's phenomenon.

Coming to the conclusion that the sensation of hot feet is MS-related involves ruling out other potential causes, the most common of which is peripheral neuropathy—nerve damage in the feet that is especially common in diabetes. Peripheral artery disease and gout can also lead to neuropathy.

Your doctor will ask you about your specific symptoms and likely start with a neurological exam, which is a standard part of MS care. He or she will perform sensory tests to record how accurately you feel touch, vibration, cooling, and heat. Other tests include checking your reflexes, your muscle strength and tone, and your posture and coordination.

Your doctor may also want to do nerve function tests, such as electromyography (EMG). With this, a probe sends electrical signals to a nerve, and an electrode placed along the nerve's pathway records the nerve's response to those signals. Other nerve conduction studies record electrical activity in your muscles to detect nerve damage.

Of course, if you are experiencing hot feet and have not yet been diagnosed with MS, your doctor will run tests used to diagnose the disease.

There is no perfect way to treat hot feet or other painful sensations related to your MS. In fact, most of the time a person needs to try different strategies until they find one that works. Some options include:

These are easy to try and may be enough to provide you with relief:

• Wear a pressure stocking or tight sock—this changes the way your brain perceives the discomfort (heat now feels like pressure).
• Place a cool compress on your feet or stick your feet in a pan of cool water; again, this changes the way your brain perceives the burning sensation.
• Go swimming or take a lukewarm bath or shower.
• Stand barefoot on cold tile.
• Place a fan near your feet.
• Distract yourself by going for a walk, watching a movie, or taking a nap.

Sensory problems like hot feet usually come and go, but in some people, they can evolve into a chronic condition. This can be problematic as a person's nervous system may become sensitized to the pain, meaning even stepping on a small stone or having someone lightly touch your foot can be interpreted by your brain as severe painful.

Medications that neurologists sometimes use to treat painful sensations like burning or hot feet include:

• An antiseizure medication like Neurontin (gabapentin) or Lyrica (pregabalin)
• An antidepressant like Elavil (amitriptyline) or Cymbalta (duloxetine)
• A benzodiazepine line Klonopin (clonazepam) or Valium (diazepam)

The downside of these medications is that they do have side effects. For instance, many of these medications cause fatigue. Sometimes, an easy solution can minimize a side effect (for example, taking the medicine at night); but other times, the side effect ends up being more burdensome than the problem.

Oftentimes, taking a medication along with participating in a complementary therapy can be useful in coping with your MS-related pain. Examples of complementary therapies that may help soothe your pain include:

• Biofeedback
• Hypnosis
• Yoga
• Mindfulness meditation

It's important to remember that pain like burning, hot feet can take a toll on your emotional health. You may experience symptoms of depression and/or feel particularly fearful or anxious about when you will experience relief from the pain or what it means for your future with MS.

In addition to seeking out ways to relieve your physical discomfort, seek out ways to alleviate your worry. This may mean finding a support group or seeing a therapist who specializes in treating pain-related health conditions.