Foot disorders in multiple sclerosis

NewsBot · Dec 5, 2012

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Biomechanical disorders of foot in multiple sclerosis.
Neamţu MC, Rusu L, Rusu PF, Marin M, Neamţu OM.
Rom J Morphol Embryol. 2012;53(3 Suppl):841-5.

Multiple sclerosis (MS) has a multifactorial etiology located at the interaction point of environmental factors - nutritional, geographic, infectious, etc. - with genetic factors, which confers susceptibility to disease or alters its development. This research presents a case study focused on complex assessment of a patient using clinical and functional assessment, biomechanical gait evaluation using RSScan force plate. Biomechanical parameters (contact area, load, impulse, force, pressure, foot balance) are the parameters that we obtain after force plate measurements. Analyzing the results of the functional assessment, it is found an anatomical functional abnormality with a tendency to increase. Biomechanical tests show an asymmetric gait due to the impact of neurological disorders generated in the proprioceptive system. Global analysis of values (surface contact, pressure, force, load, impulse, active contact area) indicates the fact that there is a tendency to develop a higher pressure in the anterior-medial region of the plant in an attempt to maintain balance. It is a tendency to increase the active contact area in the forefoot region; this increase is explained by the body tendency to develop compensatory mechanisms to maintain balance.
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Admin2 · Dec 5, 2012

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NewsBot · Nov 26, 2014

Test-retest reliability of four sensory measures in people with multiple sclerosis.
Uszynski M, Purtill H, Coote S.
Int J Rehabil Res. 2014 Nov 21

This study investigated the test-retest reliability of the Neurothesiometer (NT), Verbal Analogue Scale for sensation (VAS), Erasmus modifications to the Nottingham Sensory assessment (EmNSA) and Semmes-Weinstein monofilaments (SWM) in people with multiple sclerosis (MS). A random sample of 34 people with MS who walked with or without an assistive device participated in this study. Participants were tested twice with the NT, VAS, EmNSA and SWM, 1 week apart. For categorical data, Cohen's kappa (Κ), percentage agreement (P0) and prevalence-adjusted bias-adjusted kappa (PABAK) were used. For continuous data, intraclass correlation coefficients [ICC (3,1)] with 95% confidence intervals (95% CI), Bland-Altman plots and standard error of measurement (SEM) were calculated. The ICC values for NT were good, being the highest for the plantar aspect of the heel (ICC=0.92, 95% CI 0.85-0.96, SEM=4.24). Good ICC values were obtained for VAS questions on numbness, pins and needles and temperature and were supported by low SEM. Κ values for SWM were poor, ranging from 0.11 to 0.46 for the upper limb and 0.12 to 0.29 for the lower limb. Findings for EmNSA need further verification because of a possible ceiling effect in this test. The NT and VAS assessments for sensation had good test-retest reliability and should be considered for measuring changes in sensation in ambulatory people with MS. In contrast, findings from EmNSA and SWM revealed either questionable or poor test-retest reliability, suggesting that these two measures need further investigation.
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NewsBot · Dec 30, 2014

Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation.
Rusu L, Neamtu M, Rosulescu E, Cosma G, Dragomir M, Marin M.
Eur J Med Res. 2014 Dec 24;19(1):2.

BackgroundMultiple sclerosis (MS) is a disease of the central nervous system probably based on the autoimmune mechanism against myelin and the action of lymphocyte T. In the last 50 years, more than 150 descriptive studies regarding MS have focused on the etiopathogeny, treatment, diagnosis and prevention of the progressive evolution of MS. Most recently, studies in the field of rehabilitation and diagnosis have tried to present the postural aspects of control/foot and ankle control and gait pattern in MS. The aim of this study is focused on biomechanical foot analyses of MS patients.
MethodsOur clinical research and functional assessment was based on a scale like the EDSS/Kurtzke score: biomechanical foot assessment used the RSscan force plate to assess the foot loading, impulse and foot-ankle angle (subtalar angle), and pressure distribution methods for statistical analyses. The study included MS patients at the Neurologic Rehabilitation Unit, Craiova, we studied 48 patients (46.04¿±¿10.99 years) diagnosed with MS.
ResultsThis study shows that the major lesion is to the pyramidal system and the average value for functionality index (EDSS score) is 3.03¿±¿0.13, where 3 means easy paraparesis or hemiparesis. In considering postural strategies, we observed an instability left to right to be more evident in the swing phase and it influences the under the foot impulse for the next step and postural control. From the analysis of the data and pressure centre position, we can see that the high pressure is on metatarsian II to III and more or less at the heel. This means the development of an ankle strategy necessary to restore balance, stability and motor control cannot be assessed other than by clinical evaluation.Even if many physicians and physical therapists do use the functional scale in their daily assessment, it does not help us achieve a complex assessment of gait and lower limb behaviour during gait, nor does it provide information about the impact of gait on daily activities and on quality of life.
ConclusionsBiomechanical assessment can help the clinician predict the functional evolution of MS patients without visible clinical gait disorders and allows the development of a strategy for rehabilitation to prevent an incorrect ankle/ankle and foot position, resulting in a lack of motor control.
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NewsBot · Dec 18, 2015

Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis.
Marinelli L et al
Mult Scler. 2015 Apr;21(5):622-9. doi: 10.1177/1352458514549566.

BACKGROUND:
Radial shock wave therapy (RSWT) has been extensively used in rehabilitative medicine to treat pain, and more recently muscle hypertonia, in patients with cerebral palsy and stroke.
OBJECTIVES:
To assess the long-term effects of RSWT in a cohort of subjects affected by multiple sclerosis (MS) who were suffering from painful hypertonia of ankle extensor muscles.
METHODS:
In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (once weekly) and treated 34 patients with placebo. Participants were assessed at baseline, 1 week after the first session, and 1 week and 4 weeks after the last session. We measured pain using the visual analogue scale for pain, while we assessed muscle tone using the modified Ashworth scale and evaluated spinal excitability using the H-reflex.
RESULTS:
After RSWT, muscle tone decreased 1 week after the last session and pain decreased at all the follow-up evaluations, while spinal excitability was unaffected. No significant changes were found after the placebo treatment.
CONCLUSIONS:
RSWT can reduce pain and muscle tone in MS patients without adverse effects. The lack of RSWT effects on spinal excitability supports the idea that RSWT is likely to act on non-reflex hypertonia, for example reducing muscle fibrosis.
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NewsBot · Feb 7, 2016

Multiple Sclerosis Influences the Precision of the Ankle Plantarflexon Muscular Force Production
David J. Arpin, Brenda L. Davies, Max J. Kurz
Gait and Posture; Article in Press

Highlights
?Individuals with MS had greater variability in the ankle plantarflexion torque.
?Individuals with MS had weaker ankle plantarflexors.
?Individuals with MS walked slower and had altered spatiotemporal gait kinematics.
?Ankle torque variability was related to altered spatiotemporal kinematics.
?Weaker plantarflexors was related to altered spatiotemporal kinematics.
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The primary aim of this investigation was to quantify the precision of the steady-state isometric control of the ankle plantarflexors musculature of individuals with multiple sclerosis (MS), and to evaluate if the precision is related to the mobility impairments. Individuals with MS and healthy adults performed a submaximal steady-state isometric contraction with the ankle plantarflexors. The coefficient of variation was used to assess the amount of variability or error in the precision of the torques generated by the ankle plantarflexor musculature. The participants also walked across a digital mat at their preferred and fast-as-possible walking speeds, which recorded their spatiotemporal gait kinematics. The results of this investigation were that the individuals with MS: 1) had reduced maximal voluntary torques at the ankle, 2) a greater amount of variability in the precision of the isometric ankle torques, 3) altered and more variable spatiotemporal gait kinematics, and 4) a greater amount of variability in the isometric ankle torques were related to a slower walking speed and cadence, shorter step length and a greater amount of gait variability. These results further fuels the impression that a reduction in control of the ankle joint musculature may be a key factor in the mobility and balance impairments seen in individuals with MS.
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NewsBot · Mar 26, 2016

Back Pain and Musculoskeletal Disorders in Multiple Sclerosis
Caroline Massot et al
Massot et al., J Spine 2016, 5:1

Introduction: Musculoskeletal disorders and back pain can occur as a result of irregular, asymmetric movement
patterns and postures due to muscular weakness, spasticity or imbalance in Multiple Sclerosis (MS).
The aim was to investigate musculoskeletal disorders and risk factors of low back pain in MS patients.
Methods: In this study, patients followed in our large MS centre with confirmed MS with an EDSS score between 4
to 7 were selected. Data of MS history, pain, musculoskeletal disorders, muscle strength and spasticity in lower limbs
were collected.
Results: 190 patients were included. The mean age of the patients was 54.9 ? 9.2 years and 32.1% participants
were man. The mean disease duration was 19.3 ? 9.9 years, and the median EDSS score was 6. 48.9% of patients had
a secondary progressive form and 27.4% had a relapse remitting form. The most common musculoskeletal disorders
were: knee osteoarthritis (7.9%), claw toe (6.8%) and genu recurvatum (6.3%). The prevalence of low back pain was
41.6% and was higher in patients with a progressive form (secondary: OR=2.96 (p=0,0079) and primitive OR=2.63;
p=0.0398)) or a visual dysfunction at EDSS score (OR=1.41 (p=0.0124)) and decreased in male patients (OR= 0.31
(p=0.0014)).
Conclusions: A progressive form of MS and visual dysfunction increased the risk of low back pain in these patients.
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NewsBot · Jun 2, 2016

An investigation of commonly prescribed stretches of the ankle plantarflexors in people with Multiple Sclerosis
J. Ofori et al
Clinical Biomechanics; Article in Press

Highlights
?People with Multiple Sclerosis achieved less lengthening of the gastrocnemius when stretching.
?The plantarflexor torque during a stretch is higher with stretches in standing.
?People with Multiple Sclerosis had higher levels of background muscle activity when stretching.
?The severity of Multiple Sclerosis determines preferred stretch type and duration.
?The applied torque, stretch duration and muscle activity may influence stretch effectiveness.
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Background
Stretches are often prescribed to manage increased limb stiffness in people with Multiple Sclerosis. This study determined the ankle plantarflexor torque magnitude that people with Multiple Sclerosis can apply during four commonly prescribed stretches and determined the relationship between the applied torque and functional ability.
Methods
People with Multiple Sclerosis (N = 27) were compared to healthy control participants (n = 15). Four stretches were investigated; stretching in step standing; using a step; pulling the ankle into dorsiflexion and standing in a frame. Joint position and forces were measured using 3D motion analysis and torque transducers. Baseline ankle strength and stiffness was measured using motor driven ankle perturbations.
Findings
People with Multiple Sclerosis (N = 27) had higher stretch reflex amplitudes and lower strength compared to the control group (n = 15). People with Multiple Sclerosis achieved less lengthening of the plantarflexor muscle-tendon complex when stretching but similar ankle torques compared to controls. While stretching people with Multiple Sclerosis showed greater muscle activation in the ankle plantarflexors. Stretches in weight bearing positions produced higher plantarflexor torques. People with Multiple Sclerosis with lower functional ability preferred the more supported stretches (ankle pull and standing frame).
Interpretation
Stretches in weight bearing positions achieve higher ankle torques but this is in part due to increased postural activity in people with Multiple Sclerosis. Functional ability may limit stretch effectiveness
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NewsBot · Jan 16, 2017

Functional Electrical Stimulation for foot drop in Multiple Sclerosis: A Systematic Review and Meta-Analysis of the impact on gait speed.
Miller L et al
Arch Phys Med Rehabil. 2017 Jan 11. pii: S0003-9993(17)30003-5. doi: 10.1016/j.apmr.2016.12.007

OBJECTIVE:
To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests.
DATA SOURCES:
Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, Pubmed) and reference lists were searched.
STUDY SELECTION:
Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included.
DATA EXTRACTION:
Data were independently extracted and recorded. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) tool.
DATA SYNTHESIS:
Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed with regards to the impact of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t = 2.14, p = 0.016) with a mean increase in gait speed of 0.05 meters per second (m/s) and ongoing orthotic effect (t = 2.81, p = 0.003) with a mean increase of 0.08m/s. There were no initial or ongoing effect on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests.
CONCLUSIONS:
FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully-powered randomized controlled trials comparing FES with alternative treatments are required.
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NewsBot · Feb 28, 2017

Erythromelalgia as a manifestation of autonomic nervous system involvement in multiple sclerosis.
Adamec I et al
Mult Scler Relat Disord. 2016 Jul;8:1-3. doi: 10.1016/j.msard.2016.04.003

Erythromelalgia is a rare condition characterized by burning pain, erythema and increased temperature of the hands or the feet. Its etiology is not completely understood but it is believed that the underlying cause is a peripheral vascular dysfunction that leads to simultaneous tissue hypoxia and hyperemia. We present a rare co-occurrence of erythromelalgia and multiple sclerosis in a patient with autonomic nervous system dysfunction and propose a causative interconnection.
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NewsBot · Feb 8, 2018

Investigating the dynamic plantar pressure distribution and loading pattern in subjects with multiple sclerosis.
Keklicek H et al
Mult Scler Relat Disord. 2018 Jan 31;20:186-191. doi: 10.1016/j.msard.2018.01.023.

BACKGROUND:
Multiple sclerosis (MS) is a complex disorder affecting subjects by multiple system impairments. Gait problems are common in subjects with MS and various factors such as; ataxia, hypertonic muscles or/and seconder musculoskeletal system deformities affect the normal plantigrade contact by disturbing accommodation of foot to the ground while walking. The aim of this study was investigating the dynamic plantar pressure distribution and time of maximum pressure in subjects with MS and determining the differences from healthy subjects (HS).

METHODS:
Fifty-five subjects with MS (110 foot) and 20 HS (40 foot) were the participants of the study. The dynamic pedobarograph was utilized for evaluation of dynamic loading parameters; maximum pressure (N/cm2) and time of maximum pressure (ms) collected from heel medial, heel lateral, midfoot, heads of first, second, third, fourth and fifth metatarsal bones.

RESULTS:
There were differences between the groups in maximum pressure of heel medial (p < .001) and heel lateral (p < .001) was higher in HS. Also, there were differences between the groups the time of maximum pressure of all metatarsal head areas, midfoot, heel medial and heel lateral (p < .001). Subjects with MS spent lesser time to reach maximum pressure for forefoot loading and longer time for hindfoot loading.

CONCLUSION:
The study provided basic data about foot pressure distribution and time of maximum pressure in subjects with MS. Results of the study showed that the hindfoot loading was disrupted and inappropriate timing during load transfer from hindfoot to forefoot is exist in subjects with MS.
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NewsBot · Feb 3, 2019

THE EFFECTS OF FOOTWEAR CUSHIONING ON WALKING PERFORMANCE IN
FEMALES WITH MULTIPLE SCLEROSIS
Andrew S. Monaghan
Degree of Master of Science; Colorado State University

Multiple sclerosis is a chronic and progressive neurodegenerative disease which incurs a
multitude of walking impairments. Protective strategies targeted at maintaining postural stability
during walking include increasing stance and double support time with reciprocal decreases in
swing and single support time, however these adaptions inadvertently increase fall risk. The
midsole construct of footwear has demonstrated the ability to mediate these deficits in running
but has not been explored in a neurologic population with known fall risk. The purpose of this
study was to investigate the effects of two different midsole conditions on the spatiotemporal
parameters of gait in females with multiple sclerosis (MS). Gait testing was conducted while 18
females with MS performed two-minute walk tests in 1) a high-cushion and 2) a standardcushion midsole shoe. Spatiotemporal gait parameters were assessed using wireless inertial
sensors. Participants spent less time in double support and stance phase with concomitantly more
time in single support and swing phase in the high-cushion midsole shoe as compared to the
standard-cushion. The high-cushion shoe may decrease fall risk by improving gait parameters
associated with increased risk of falls.
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NewsBot · Aug 28, 2020

Research on lower extremity health in patients with multiple sclerosis: a systematic scoping review
Minna Stolt, Anne-Marie Laitinen, Juhani Ruutiainen & Helena Leino-Kilpi
Journal of Foot and Ankle Research volume 13, Article number: 54 (2020)

Background
Multiple sclerosis (MS) often affects ambulation and the function of the lower limbs. However, little is known about how much research has been conducted on lower extremity health in patients with MS.

Objective
To analyse empirical studies and their evidence on lower extremity health in patients with MS, in order to identify the need for future studies in key areas.

Methods
A systematic scoping review was conducted. A literature search of Medline (PubMed), CINAHL (EBSCO) and the Cochrane Library databases was performed. The search covered the period up to 15 January 2020 from the earliest records available. This led to the inclusion of 42 empirical articles. The data were analysed using content analysis and quantification techniques.

Results
The research on lower extremity health focused primarily on two main areas: gait and lower extremity muscle strength. Lower extremity health was assessed using a variety of methods, most of which consisted of objective physical tests and gait analysis. Patients with MS had many problems with the health of their lower extremities, which manifested in walking difficulties, balance problems, muscle weaknesses and spasticity. In the feet, pes cavus, claw toes, oedema and altered foot sensation were common.

Conclusions
MS affects lower limb and foot health, and these problems can affect patients’ daily lives. However, the extent of these problems is poorly understood, partly due to the dearth of research on lower limb and foot health. Therefore, further research is warranted in order to better understand the impact of MS on foot and lower limb health in everyday life.
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NewsBot · Nov 6, 2020

Test-retest reliability of the two-point discrimination test on the sole of the foot in people with multiple sclerosis
Sarah Taylor et al
Physiol Meas. 2020 Oct 26

Background: Two-point discrimination (TPD) is an assessment of tactile acuity. People with Multiple Sclerosis (MS) can have reduced foot sole tactile acuity, which has been linked to impaired balance.

Objective: To quantify the test-retest reliability of TPD on the sole of the foot in people with MS.

Method: 41 participants (32 females), with mean (SD) age of 60 (9) years, and Expanded Disability Status Scale of <7.5, had their TPD measured at the Head of the first Metatarsal and the Heel on two occasions, 2-14 days apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation and the Intraclass correlation coefficient (ICC) were quantified as point estimates (95% CI).

Results: Systematic learning effects were evident. The within-subjects SD at the metatarsal and the heel was 6.7 mm (5.5-8.6) and 8.3 mm (6.7-10.8), and the LOA were 18.6 mm (15.2-24.) and 23.7 mm (18.7-30.1), respectively. ICC for metatarsal and heel was 0.87 (0.76-0.93) and 0.90 (0.80-0.95), respectively, but these were likely inflated by sample heterogeneity.

Conclusion: In people with MS, TPD on the sole of the foot has an adequate test-retest reliability for research purposes, but there is substantial measurement variability for individual patients.
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NewsBot · Feb 10, 2023

Impact of Multiple Sclerosis on Foot Health and Quality of Life: a prospective case-control investigation
Francisco Javier Ruiz-Sánchez et al
Int J Public Health

Objectives: To assess quality of life or factors related to the foot and general health and to determine the impact taking into account foot health status in people with multiple sclerosis (MS). Methods: 50 subjects with MS and 50 healthy subjects were studied using the Foot Health Status Questionnaire, that is a validated and is reliable tool was used to assess foot health and quality of life.
Results: In both groups of the sample, 50% (n=15) were men and 50% (n=35) women, and the mean age in the case group was 48.04 ± 10.49 and the control group was 48.04 ± 10.45 were recruited. A statistically significant difference (p < 0.05) was shown for foot function, general foot health, general health, physical activity and vigor domains, stating that people with MS have a lower related to foot health (lower FHSQ scores) compared to healthy subjects who have higher FHSQ scores.
Conclusions: Patients with MS suffer a negative impact on the quality of life related to foot health, which appears to be associated with the chronic disease.
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NewsBot · Sep 26, 2023

A Case Report of Cryoneurolysis for Dorsal Foot Pain and Toe Clawing in a Patient With Multiple Sclerosis
Fraser MacRae et al
Arch Rehabil Res Clin Transl. 2023 Jul 28;5(3):100286

Toe clawing in patients with upper motor neuron disorders is often attributed to the flexor digitorum longus (FDL) and is a common presentation among patients with multiple sclerosis (MS). This movement may be painful because of the altered pressure distribution and may increase the risk of falls, heighten energy expenditure during gait, and lower gait speed. Cryoneurolysis is a minimally invasive treatment that may be beneficial for pain and focal muscle hypertonicity. An ambulatory patient with MS was treated bilaterally with cryoneurolysis to the superficial fibular nerves for pain on the dorsum of the foot, and to the intramuscular tibial nerve motor branch to FDL for toe clawing. The patient felt that toe clawing was immediately reduced during gait and noted the ability to voluntarily spread their toes. The patient stated that the neuropathic pain on the dorsum of the foot was fully eliminated immediately post procedure. The patient reported improved confidence in their gait, maintained independence, and reduced toe clawing during a structured interview 12 weeks after treatment. The effects lasted for 5.5 months before symptoms returned. Retreatment at 6 months reproduced the benefits. The patient reported a positive experience with cryoneurolysis for toe clawing and dorsal foot pain.
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NewsBot · Dec 26, 2023

Foot posture after Multiple Sclerosis and functional consequences
Alireza Taheri
Neurons and Neurological Disorders

Background and Aim Multiple sclerosis (MS) is a common cause of functional disorder in persons of able-bodied age. The female-to-male ratio is about 2:1. The disease is commonly divided into a relapsing-remitting form and a progressive form (primary or secondary) (1). Regaining mobility is a priority for MS survivors and rehabilitation. (2) There is extensive literature on gait abnormalities after stroke but Clinical Rehabilitation can’t information on the impact of MS on the foot. The foot is a highly complex and adaptable functional unit (3-5) and its problems are related to mobility limitations in other chronic conditions. (6-8) The shape of the foot or static foot posture is generally believed to be a significant predictor of foot function (9). The significant relationship between foot posture and dynamic foot function, lower limb function, and walking ability has been demonstrated in normal subjects and patients with musculoskeletal and neurological disorders (10 -13). Age-related changes in static foot posture have been reported through several cross-sectional studies; the older subjects have been shown to have more pronated feet compared to the younger adult population (14-15). As the first report of a programmed of work to develop evidence-based interventions for foot problems after MS, we undertook a nature of foot abnormalities and the relationships between foot abnormalities, MSrelated impairments, and mobility limitations in people with MS. Given the lack of previous work in this field, we addressed this aim by investigating five prevailing beliefs that underpin clinical reasoning and decision- making. (16-17) The impairments we investigated were walking disability; foot posture is related to walking ability – MS survivors with more severe abnormalities will have more limited walking ability. This study explores static foot posture in people with MS and their relationship to walking disability and limitations. Methods and Materials The study used a cross-sectional survey design. MS survivors who could stand (but without assistance from another person) for 30 s and walk 10 m and were able to give informed consent were recruited from the MS services of Kashani Hospital in Isfahan on 44 Abstract Clinical convention suggests that foot posture and movements are adversely affected by Multiple Sclerosis (MS) and cause walking difficulties but there is little objective data to support or refute these beliefs. This study explores static foot posture in people with MS and their relationship to walking disability and limitations. This is a cross-sectional study that was conducted in the multiple scoliosis specialist department of Kashani Hospital in Isfahan on 44 patients with MS with mobility limitations. The indices for determining foot posture index (FPI), demographic characteristics, expanded disability status scale (EDSS), and walking scale(msws12) were investigated. About one-third of participants had abnormal foot posture, which wasn’t associated with walking limitations. Most (80%) had a symmetrical foot posture with similar frequencies of supination (9%) and pronation (11/5 /%) abnormalities. There was no relationship between foot posture and walking limitation and expanding disability. A minority of people with MS had abnormal or asymmetrical foot posture and equal numbers suffered pronation and supination abnormalities; these findings challenge the beliefs that underpin the clinical management of MS-related foot problems.
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