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Wondering if anyone could provide me with some alternative suggesions for burning feet and/or numb other than the well known such as diabetes or nerve compressions. I have a lady who is 42 with burning, yet cold feet. No hx of chilblains, doppler looks good, SFVPFT of 5 sec, no medication. Are there any psycological reasons?
I wrote this a while ago for a lay person's websites on burning feet:
Quote:
The more common causes of burning feet are:
* many feet just ache and burn at the end of a long day, especially in those who are on their feet all day or are overweight (mechanical overload)
* hot and sweaty feet can cause a burning foot sensation (and may be related to the mechanical overload problem)
* the neuropathy that occurs in diabetes can cause a burning feet
* other types of neuropathy (nerve damage) that can cause a burning foot include those that occur in chronic alcoholism, vitamin deficiencies (usually B) and heavy metal poisoning
* blood disorders (eg thrombocytopenia, pernicious anemia) can cause burning feet
* Erythromelalgia is a rare circulatory disorder can can cause burning feet
* Reflex sympathetic dystrophy or complex regional pain syndrome can follow trauma (including surgery) and cause a burning foot sensation
* nerve entrapments, such as tarsal tunnel syndrome, which is the compression of a nerve at the inside of the ankle joint can cause a burning sensation
* a localized burning sensation may be due to other specific problems. If its in the forefoot only, it could be metatarsalgia, Morton's neuroma or some other cause. Athletes foot or a fungal infection can also cause a burning sensation in the area of the infection.
* it could also be due to a sensitivity to chemical substances in socks and shoes (contact dermatitis)
__________________ Craig Payne
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Local causes : contact dermatitis, ischemia,venous insufficiency,vasospastic disorders,sciatica,spinal chord lesions,porokeratosis plantaris discretum
Generalized causes: drugs,uremia, sarcoidosis,malignancies,infection, beriberi,leprosy,phycosis,amyloidosis, and heavy metals and chemical intoxicants
Obviously these are in additional to heriditary neuropathy,tarsal tunnel syndrome,alcoholism, diabetes mellitus, pernicius anemia,hypothyroidism, polycythemia
vera, causalgia
IMHO the description of "burning feet" is just screaming out for someone to just call it "peripheral neuropathy" in almost all cases.
To put the other posts into a more easily remembered format, try the acronym " DANG THERAPIST" whenever you are stumped over the cause of a peripheral neuralgia/buring feet:
D - Diabetes
A - Amyloid
N - Nutritional (eg B12 deficiency)
G - Guillain-Barre
T - Toxic (eg amiodarone)
H - Heriditary
E - Endocrine
R - Recurring (10% of G-B) Alcohol
P - Porphyria
I - Idiopathic
S - Sarcoid
T - Thyroid (-hypo)
I find the top causes are usually diabetes, hypothyroidism and B12 deficiency.
Hypothyroidism is a major aetiology for peripheral (entrapment-style) neuropathy.
From eMedicine:
Thyroid neuropathy
Entrapment neuropathy of the median nerve is the most common neuropathy associated with hypothyroidism. Compromise of the eighth nerve causing deafness is not uncommon. Multiple cranial nerve involvement is rare.
Polyneuropathy is usually subacute, sensory, and occurs in 31-65% of patients. Subclinical hypothyroidism also may present with peripheral nerve involvement.
Sensory complaints include painful dysesthesias in the hands and feet and radiating lancinating pains, occasionally suggesting nerve root compression. Examination findings may reveal distal glove-and-stocking sensory loss and ataxia.
Weakness is a common complaint, but it usually is related to myopathic involvement.
Hyporeflexia and delayed relaxation phase of the ankle jerk are common. Transient swelling on percussion of the skin (mounding phenomenon) may be observed.
Occasionally, hyperthyroidism may be associated with polyneuropath
sorry lucky, i must be as thick as a brick, but where does that say "burning feet"?
Mark, you are not thick as a brick - you're just looking for this particular symptom, when peripheral neuropathy will cause a range of symptoms, so they are all grouped together.
As mentioned in my earlier post on this topic, PN is often the best label to put on "burning feet", except where something like erythromelalgia exists. "Burning" is just another of the classic paraesthesia's that PN causes - along with "shooting", "pins and needles", "numbess" - the list goes on.
In diabetes for instance, "burning" pain will exist in about 10% of individuals with diabetic PN. This subgroup is often labelled as having "painful diabetic PN", and need to be managed for pain, as opposed to their aymptomatic counterparts. The same exists for tarsal tunnel, hypothyroidism and the many other aetiologies of PN. There can be a range of paraesthesia symptoms.
I can only reassure you from experience, and what is written in countless medical texts, that hypothyroidism will cause PN, and that "burning pain" is one of the classic hallmarks of this vague term - not present in everyone, but certainly a fair whack of them. My last case of hypothyroidism-related PN was about 3 months ago, and she was in a lot of discomfort.
LL
The Following User Says Thank You to LuckyLisfranc For This Useful Post:
so hypothyroidism sufferers can experience 'burning' (imagined) from the pn angle and cold feet (real) from the peripheral vascular insufficiency angle....another lesson i missed...
Just reading a book entitled Numb toes and aching soles: coping with peripheral neuropathyby John Senneff 1999 MedPress :San Antonio ISBN 0-9671107-1-8
Writtenby someone with peripheralneuropathy this isan interesting read as taken from the patient's perspective. It is not a medical text but the author is well informed, none the less. Written for the US but good sections on Pain and Pain Medications with afinalchapteron coping with PN
I can only reassure you from experience, and what is written in countless medical texts, that hypothyroidism will cause PN, and that "burning pain" is one of the classic hallmarks of this vague term - not present in everyone, but certainly a fair whack of them. My last case of hypothyroidism-related PN was about 3 months ago, and she was in a lot of discomfort.
LL
Hi Lucky,
Just browsing through the arena and came accross your discussion.
i came accross this recently in a clinic and the woman was referred back to her G.P.
this woman was in severe pain, she has hypothyroidism, nocturnal pain, hyperparasthesia(couldn't touch her with the scalpel to reduce callous and H/ Ds) used the podo spray.
from a Podiatric point of view, how do you or did you treat the woman with the burning pain, i know each case is different but this sounds very similar.
Just thought this case was interesting ( can you tell I've just qualified )
cheers Brian
Last edited by Admin : 25th July 2007 at 01:58 PM.
Reason: fixed quote
Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy.
Penza P, Lombardi R, Camozzi F, Ciano C, Lauria G. Neurol Sci. 2009 Apr;30(2):149-51.
Quote:
We describe a 60-year-old woman complaining of severe burning feet for 3 months. A neurological examination showed absent Achilles tendon reflexes; nerve conduction study demonstrated mild sensory neuropathy, and skin biopsy revealed a length-dependent loss of intraepidermal nerve fibres. Haematological exams demonstrated a subclinical hypothyroidism and hormone replacement therapy was started. Conversely, symptomatic treatments for neuropathic pain were withdrawn after few days because of side effects. During the following months, thyroid function recovered, and the patient experienced a progressive decrease of neuropathic pain intensity. At 6- and 12-month follow-ups, nerve conduction study and clinical examination were normal, whereas skin biopsy demonstrated a complete reinnervation of the epidermis. Subclinical hypothyroidism is a possible cause of sensory neuropathy and hormone replacement therapy can prompt nerve regeneration.
Reasons for burning feet
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