The real problem with multires is not the infamous spikes. It only happens if you try to edit the topology of the mesh after sculpting, which is not a recommended process anyway, not in Blender, not in Zbrush, not in Mudbox or any other app that uses regular subdivision for this; as @cgCody mentioned:
…you really should try not to mess with the topology with multiple sub d levels anyway. That goes for ZB and Multires.
On the software side: Yes, in ZBrush, you can go to the base level and change the topology, but it will often cause unpredictable results all the same. You would generally rely on other tools entirely for this sort of thing, such as creating a new mesh with the topology changes, and then projecting the sculpted detail onto it.
On the workflow side: If you’re getting into detailed sculpting work before you have proper clean topology, you’re not really working as efficiently as you should be. Yes, the detail work is fun, which is why one of the biggest mistakes people make in sculpting is to rush into that part. In practice, however, you should be nearly done with a project before even thinking about adding additional sub d levels.
Let’s see the 2 most common scenarios:
1. Sculpting and detailing for animation/games: You will either do a highpoly sculpt and retopo after is done, or do the sculpt and detailing on a model with proper topology. Then the high poly detail is baked onto disp and normal textures. In this case, for Blender you can delete the multires modifier after the maps are baked (I’ve seen some complaints about Blender not being able to handle a character with a multires AND an armature modifier, which is nuts).
Doing this process properly wouldn’t need you to go back to the mesh and edit it while sculpting, so the spikes shouldn’t be a problem right? But, if there’s the need to change the topology, then the sculpt info should be projected into a new mesh, instead of modifying the original.
There’s real problem number 1: There’s no easy way in Blender to project Multires sculpt info from one object to another. :no:
2. Sculpting for concept art and/or stills: most of the times a clean topology won’t be needed for this since a lot of paintover and post-processing is done after render, so probably a combination of Dyntopo/Remesh/Multires can be used. Again, if the Multires comes at the end, and only for final detailing, the spike issue won’t be a problem.
Also, with a powerful enough PC, you could even do the whole thing in Dyntopo without ever touching Multires.
Now, if the concept/sketch gets approved and the model needs to be optimized for production, then retopo must be done to have a clean mesh ready for detailing.
There’s real problem number 2: Despite having several addons for retopology in Blender, there’s still a hole in that department. We need proper retopology tools for Blender, or a better Remesh modifier, on steroids.
Problem number 3: No sculpt layers.
Problem number 4: No way to bake or use vector displacement maps.
Problem number 5: Vertex paint is still wonky (I hope the GSOC project for this gets added to trunk soon).
Problem number 6: In general, the whole sculpt workflow is complicated and unintuitive, so in terms of UI something should be done too. Hopefully this will be taken into account for the templates of 2.8
Now, if the multires modifier gets to be rewritten, great! All of this could be fixed and properly implemented.
BUT! If there’s no plans for a rewritte or fix then it should be left alone. Incomplete as it is right now, there’s still a LOT of things you can do with Multires.