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I saw a man in his 60's complaining of burning on the tops of his feet over the mid foot area (bilateral). It does not extend to the digits or plantar surface of the foot.
The burning is less noticable - " feels better" when he exercises and more noticable at night.
He has had this for some years. Diabetes has been excluded. He was a moderate drinker, slightly over weight, no back injuries.
This sounds pretty specific and localized, so I'm thinking dorsal medial cutaneous nerve impingement from lacing his shoes too tight. One would think symptoms would decrease out of shoes at night, but it takes less discomfort to bother you when you are trying to get to sleep, especially in your 60's.
Look for a positive Tinel, and have him skip a lace on his shoes. Slip-on shoes, with elasticised tongues can actually be the worst. A cortisone injection might be in order.
This is dead simple, and may be wrong. If you decide to chase all the differentials for burning feet, good luck to you.
Frederick has made a good point. If it is just a simple mechanical problem, then my suggestion is not relevant. However, if all else fails, it may assist to consider if there is any psychological component. Is there a history of recent bereavement, financial worry or other such psychological trauma? Although psychological conversion reactions are reported to be on the decline due to an increase in psychological sophistication, psychosomatic disorders appear to be on the increase. See:-
Personality, Individual Differences and Intelligence Maltby, Day and Macaskill. pub. Pearson Prentice Hall 2007
ok assuming that there is a psychological component, how do we convince a patient (of whom the majority dont really know what a Podiatrist does at the best of times) that they may need to see a psychologist/counsellor/therapist. most of my patients would suggest the same back at me for even suggesting it! I like the idea, but isnt it out of our league a bit??
Thank you for your reply. I think that you have raised a very important concern. Firstly, after qualifying as a podiatrist I embarked on further studies. Over 20 years ago, I majored in psychology as part of a science degree. My wife who assists me in the practice has read 6 years of clinical psychology at university in France. For these reasons we do not automatically feel out of our league. We have been referred a lot of psychologically vulnerable patients with various foot and lower limb problems. If you have any time for further study, psychology is to be recommended, it is a fascinating field to get involved in.
ok well that sure makes more sense then. i agree with you too, i have completed some psychology subjects in my exercise science degree amd definitely found it interesting, almost to the point where it seems to explain a lot of day to day experiences/situations. very interesting to hear a few podiatrists on here combining fields, eg yourself with pod and psych. i think it only improves the level of treatment available to your patients.