Association Between Foot Alterations and Disability in People With Multiple Sclerosis: A Cross-Sectional Study
Sara Zúnica-García, Blanca Pastor-Vidal, Alba Gracia-Sánchez, María Isabel Jiménez-Trujillo, Esther Chicharro-Luna, Ángel Pérez-SempereBackground
Multiple sclerosis (MS) is a leading cause of disability in young adults. While gait and lower limb dysfunction are well studied, foot- and ankle-specific impairments remain underexplored despite their potential impact on mobility, independence, and quality of life.
Objective
To examine the relationship between foot alterations and functional disability in MS using the Expanded Disability Status Scale (EDSS).
Methods
A cross-sectional study was conducted in an endocrinology outpatient clinic and MS associations. Disability was classified as mild (EDSS < 2.5) or moderate (EDSS 2.5-5.5). Foot assessments included digital deformities, foot posture, hyperkeratosis, dorsiflexion range of motion, and plantar tactile sensitivity using the Semmes-Weinstein monofilament at 8 anatomical foot sites. Multiple linear regression was applied to identify predictors of disability.
Results
One hundred individuals with MS participated; 78% were women. Mean EDSS was 2.5 (range: 1.5-4), with mild disability in 51% and moderate in 49%. Claw toes (P = .042), fewer metatarsal head hyperkeratoses (r = −.024; P = .025), altered tactile sensitivity (P = .010), and a higher number of insensitive sites (r = .333; P < .001) were linked to higher EDSS scores. In multivariate analysis, absent tactile sensitivity (β = 0.142, P = .004), anxiety (β = 0.838, P = .013), and occupational inactivity (β = 0.359, P = .057) emerged as significant predictors.
Conclusion
Plantar tactile sensory loss was the only podiatric factor independently associated with disability in MS, with anxiety and occupational inactivity also contributing. Findings underscore the need for podiatric assessment within multidisciplinary care to help preserve mobility and quality of life.