Walking Problems in MS | Causes | Treatment | Support

Plantar fasciitis refers to pain in the bottom of the foot around the heel and arch. This pain results from inflammation of the ligament (called the plantar fascia) that connects the heel to the front of the foot. Although it is not a symptom of multiple sclerosis (MS), some people with MS also experience plantar fasciitis. There are several causes of plantar fasciitis in people with MS — and luckily, several treatments exist to alleviate the inflammatory pain.

Walking Problems in Multiple Sclerosis

Walking is one of the most commonly affected aspects of life for people living with MS. According to one study by the International Journal of MS Care, approximately 75 percent of people with MS experience significant walking problems.

Difficulties with walking can have a significant impact on your life. For instance, a second study found that only 34 percent of individuals with walking problems were employed. This figure suggests that difficulty with walking can affect your ability to complete everyday tasks, such as those required by a job.

It can be challenging to perform many activities when your walking is limited. Not only is it difficult to walk long distances, but it can also be hard to ride a bike or drive a car.

Problems with balance can also lead to falls. Individuals often fall while performing routine activities, such as walking, bathing, or preparing meals. According to various studies, 50 percent to 70 percent of people with multiple sclerosis report falls. Approximately 30 percent of those people report sustaining falls multiple times.

Injuries are often reported as a result of these falls. In some cases, these injuries can be severe enough to cause long-lasting problems, such as strained muscles and broken bones. These issues can further limit a person’s mobility.

Walking problems can affect other areas of life as well. As a person’s ability to move around decreases, they may lose the desire to leave the house. This can mean missing out on social activities, hobbies, and quality time with loved ones. Withdrawal from social activities can lead to mental health problems, notably depression.

Other significant impacts of walking problems on people with MS include spasticity, which can cause discomfort and make it difficult to fall asleep. Fatigue is also common and can cause loss of energy and motivation.

The Cause of Plantar Fasciitis in Multiple Sclerosis

Plantar fasciitis is one of the most frequent causes of heel pain. It is characterized by stabbing foot pain that often starts in the morning and improves with movement throughout the day.

The plantar fascia supports the arch of the foot when you are walking and acts as a shock absorber. Injury to this ligament can cause inflammation, leading to plantar fasciitis. In many cases, the exact cause of plantar fasciitis is not known. However, repetitive stretching and tearing of the plantar fascia is a known source of its inflammation.

MS-related plantar fasciitis does not develop as a symptom of the disease itself, but rather a result of walking-related issues, which are common in people with MS.

Walking problems are caused by one or more of these factors associated with MS:

• Loss of balance
• Changes in sensation
• Muscle tightness
• Leg weakness
• Fatigue

Loss of Balance

Maintaining proper balance depends on many different body parts and processes. These include the eyes, ears, sensory nerves, cerebellum (part of the brain that coordinates voluntary movements), and a wide range of muscles. MS can affect all these parts of the body.

Other symptoms of MS, such as fatigue and spasticity, can also contribute to loss of balance.

Loss of balance typically appears as an unsteady side-to-side gait, sometimes called a “drunk” walk. Damage to the cerebellum specifically can result in a neurological condition known as ataxia, which can cause this altered gait. The side-to-side swaying of this gait exerts pressure on the feet, causing strain to the plantar fascia.

Changes in Sensation

Medically known as paresthesia, sensory problems are among the earliest MS symptoms, occurring in 20 percent to 50 percent of individuals. These sensory disturbances include increased sensitivity, burning, numbness, and tingling.

Numbness, in particular, can cause sensory deficits in the feet. This results in problems feeling objects, such as shoes, as well as the ground. Numbness can also cause a person with MS to walk in hard, stomping, heavy steps, which can exert strain on the plantar fascia.

Muscle Tightness

Muscle tightness, also known as spasticity, results from a signal imbalance in the central nervous system (CNS). Spasticity causes the muscles to become stiff and heavy, leading to difficulty with movement.

If your legs are weak, muscle tightness can usually help you move from one point to another more easily. However, for most people with MS, spasticity hinders mobility.

Spasticity can cause poor posture. In turn, poor posture can result in improper alignment of the foot and ankle, causing strain to the plantar fascia.

Leg Weakness

The relationship between muscle weakness and plantar fasciitis is also related to inactivity and poor posture.

Due to imbalance, chronic pain, fatigue, and other symptoms of multiple sclerosis, people with MS often find themselves unable to get as much physical activity as they used to. Lack of physical activity causes the muscles to become weak and unable to support the body.

Muscle weakness can also result from lesions causing myelin damage to the nerve fibers responsible for muscle stimulation and movement. Sometimes, this can lead to difficulty with properly lifting the forefoot and toes when attempting to walk, a condition known as foot drop.

Weakness in the leg muscles can force a change in your normal walking stride. This change can result in strain and pain, making it even more difficult to walk.

Fatigue

Fatigue is among the most common and debilitating symptoms of MS, as well as one of the hardest to explain.

Fatigue is characterized by extreme loss of physical and mental energy. This can reduce a person’s walking activity or endurance. Dragging one leg and walking unsteadily as a result of fatigue can cause strain to the plantar fascia, potentially leading to irritation and inflammation.

Treating Plantar Fasciitis in MS

After receiving a diagnosis of plantar fasciitis, treatment may involve several approaches, including medications, therapies, surgery, and home remedies.

Medications

Pain and inflammation caused by plantar fasciitis may be eased by medications, such as over-the-counter pain relievers. Some examples include Advil or Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen). It is important to speak with your doctor before starting a new medication regimen.

Therapies

There are several types of therapies to relieve plantar fasciitis.

Physical Therapy

A physical therapist will help guide you through a series of exercises to stretch the plantar fascia, and will show you how to strengthen your leg muscles.

Night Splints

Wearing a splint while you sleep can help stretch the arch of your foot and calf.

Orthotics

Arch supports (orthotics) are inserted into your shoes and help diffuse pressure evenly across your feet. Orthotics can be custom-made for your feet or purchased at a local drugstore.

Procedures or Surgery

Typically, plantar fasciitis can be relieved with conservative treatment, such as with therapies and support devices. If conservative treatment does not work over several months, your doctor might suggest a procedure or surgery, which may involve:

• Steroid injections to temporarily relieve pain
• Therapy using sound waves to promote tissue healing
• Tissue repair using ultrasound to remove damaged tissue
• Plantar fascia removal surgery

Home Remedies

There are many self-care remedies you can use to manage the pain associated with plantar fasciitis.

Maintain a Healthy Weight

The more weight your plantar fascia has to bear, the more strain and pain you will experience. Talk to your doctor about healthy ways to reduce your weight if you are experiencing excessive strain.

Stretch

Simple stretches can help loosen your plantar fascia, as well as your calf muscles and Achilles tendon.

Proper Footwear

Wear shoes that provide good support to your feet. They should have a low to moderate heel, good arch and heel support, and extra cushioning. It is best to avoid walking barefoot.

Cold Therapy

If you experience pain or stiffness, holding an ice pack wrapped in a towel or cloth over the affected area for 15 minutes three or four times per day can help decrease pain and inflammation.

Light Physical Activity

Engaging in light physical activity, such as stretching, can help relieve stiffness and tension. Switching from high-impact exercise, such as running, to low-impact exercise, such as swimming or biking, can also help reduce pain.

Talk With Others Who Understand

MyMSTeam is the social network for people living with multiple sclerosis and their loved ones. On MyMSTeam, more than 166,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS and plantar fasciitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.