What Causes Hot Feet in Multiple Sclerosis?

Erythromelalgia, also known as “hot feet,” is a symptom of multiple sclerosis (MS) that causes your feet to feel hot and swollen even though they feel and look normal. Erythromelalgia falls under a larger category of sensory symptoms called dysesthesia.

With MS, the immune system causes nerve damage that manifests in strange sensations, mainly affecting the legs, arms, feet, hands, and torso. Erythromelalgia is one type of dysesthesia, alongside “MS hug,” which causes bouts of pressure and pain around the chest and back.

This article describes the symptoms, causes, and diagnosis of “hot feet” in people with MS. It also looks at how this unique form of dysesthesia can be managed or treated.

What Hot Feet in MS May Feel Like

The severity and frequency of “hot feet” can vary from one person to the next. Erythromelalgia can happen at any stage of the disease and doesn’t necessarily coincide with the severity of other MS symptoms.

People with “hot feet” often experience:

• An intense itching, prickly, or burning sensation in both feet
• A crawling sensation under or on the skin
• A feeling that their feet are swollen even if they are not
• A feeling of tightness and compression while wearing shoes
• Electric shock-like jolts in the feet

With MS, erythromelalgia tends to be bilateral, meaning that both feet are affected. The hands can also sometimes be affected.

“Hot feet” can happen spontaneously for no apparent reason or in response to a stimulus, like walking or putting on a shoe. The symptoms tend to get worse at night or after exercise or standing too long. An increased body temperature can also trigger symptoms (referred to as Uhthoff’s phenomenon).

Dysesthesias like “hot feet” are generally paroxysmal, meaning that they appear suddenly, last for a few seconds or minutes, and quickly disappear. If the sensations are constant, they are more often referred to as neuropathy.

What Causes Hot Feet in MS?

As with other MS symptoms, erythromelalgia is caused by damage to myelin, a sheath that covers and protects nerve cells (neurons).

As an autoimmune disease, MS targets and attacks myelin with inflammation, stripping the protein from the surface of neurons. This causes nerve signals to be transmitted erratically.

When peripheral nerves that provide sensations to skin and muscles are affected, “hot feet” and other sensory abnormalities can develop.

This kind of pain is not a sign that your MS is getting worse. It has nothing to do with the number of MS lesions you have or where the MS lesions are located.

Diagnosing of Hot Feet in MS

The diagnosis of erythromelalgia starts with a review of your medical history and a physical exam. This includes a neurological exam to see how you respond to touch, vibration, and cool or warm temperature.

The healthcare provider will also want to check your reflexes, posture, coordination, and muscle strength and tone.

A test called electromyography (EMG) can sometimes aid in the diagnosis. During the test, a probe delivers electrical signals along a nerve route to see if there are any breaks in transmission. This can provide strong evidence of an MS-related sensory disorder.

Because no single test can diagnose MS dysesthesia, your healthcare provider will need to rule out other possible causes as part of the differential diagnosis, including:

• Diabetes
• Gout
• Myelin oligodendrocyte glycoprotein (MOG) demyelination
• Lupus
• Behçet’s disease
• Chronic venous insufficiency
• Rheumatoid arthritis

How Hot Feet in MS Is Treated

There is no ideal way to treat “hot feet” or other painful sensations of MS. You may need to try different strategies until you find one that works.

Home Treatments

Try these at-home remedies to help ease the pain and discomfort of “hot feet”:

• Wear compression stockings or socks.
• Place a cold compress on your feet.
• Go swimming or take a lukewarm bath.
• Stand barefoot on cold tiles.
• Place a fan near your feet.
• Try distracting yourself by taking a walk, watching a movie, or taking a nap.

Medications

Symptoms of “hot feet” usually come and go, but in some, the condition can become chronic (persistent) and cause extreme pain when walking on uneven surfaces or simply touching your foot.

For cases like these, neurologists will sometimes prescribe medications to help block or minimize pain signals, such as:

• Antiseizure medications like Neurontin (gabapentin) or Lyrica (pregabalin)
• Antidepressants like Elavil (amitriptyline) or Cymbalta (duloxetine)
• Benzodiazepines like Klonopin (clonazepam) or Valium (diazepam)

These medications can cause side effects, including fatigue which can aggravate the MS fatigue you’re already experiencing. Always speak with your provider to weigh the benefits and risks of any treatment you are prescribed to make an informed judgment.

Alternative Therapies

Medication combined with complementary therapies may help better ease MS-related pain. Examples include:

• Biofeedback
• Hypnosis
• Yoga
• Mindfulness meditation

Summary

Erythromelalgia (“hot feet”) is a symptom of MS caused by myelin damage. The symptoms of “hot feet” often get worse at night, while exercising, or when your body temperature rises.

A neurological exam and other tests can help confirm the diagnosis. The treatment may involve compression socks, cold compresses, and possibly prescription drugs if your symptoms are severe.