Burning in Bottom of Feet

Burning in bottom of feet (also known as tingling feet or paresthesia) is the feeling of painful burning sensation in feet. It is a very common complaint from people as it can affect a wide age group. The severity could range from mild to severe. It can be an acute or chronic problem depending on the cause. Sometimes this burning sensation can be present along with ‘pins and needles’ sensation (or paresthesia) or numbness.

Symptoms

The symptoms can vary in a range from a mild discomfort felt at the bottom of feet up to an unbearable sensation of hot pain. According to the cause, the symptoms can be intermittent or persistent. Daily routine of some people may get affected due to this as severe and persistent pain could be disabling. Weakness, loss of balance and coordination, pins and needle sensation and numbness too can be present in addition to burning sensation.

What Causes Burning in Bottom of Feet?

There are many causes for burning sensation of feet:

An acute burning of feet can be felt due to a skin infection of the feet (e.g. fungal infection known as “Athlete’s foot”) or due to tiredness. After treating the infection or after resting the feet, normally the burning sensation settles.

But a chronic symptom can be due to many reasons. Amongst all of the causes the commonest is peripheral neuropathy.

Peripheral neuropathy

It is the condition in which the nerves in the peripheries get damaged. The damage could be anywhere along the course of the peripheral nerve up to the spinal cord. The nerves in the feet are one of the commonest sites to get damaged easily. The damaged nerves become hypersensitive than the normal nerves. As a result, these patients feel “pain” even to touch. Few commonest causes for peripheral neuropathy are:

• Diabetes mellitus
• Alcoholism
• Chronic kidney disease causing accumulation of excessive toxins and metabolic wastes
• Nutritional deficiencies including vitamin B12, vitamin B6, folic acid and calcium
• Other medical conditions including hypothyroidism (low thyroid hormone levels), lyme disease, HIV/AIDS, vasculitis, sarcoidosis, Guillain-Barre Syndrome (GBS), and chronic inflammatory demyelinating polyneuropathy (CIDP)
  as side effects of some drugs including chemotherapy drugs, HIV drugs, amiodarone, isoniazid, metformin, and vitamin B6 overdose
• Heavy metal poisoning including lead, mercury and arsenic
• Fractures of the bones in the foot

Peripheral neuropathy can damage both feet simultaneously. Symptoms can be persistent or intermittent depending on the cause for peripheral neuropathy.

• Peripheral artery disease (PAD) – which is also known as peripheral vascular disease (PVD) is the condition which results in poor blood circulation due to an obstruction of the artery in the periphery by an atherosclerosis, stenosis or a thrombus. This condition results in burning sensation which increases with activity, along with numbness, muscle cramps, ulcers and change in skin color due to necrosis. The symptoms reduce with resting and it can affect either one or both feet.
• Morton’s neuroma – is the fibrosis and degeneration of tissues surrounding the nerves of the foot, specially in between third and fourth metatarsals. The characteristic feature of this condition is the feeling of “standing on a ball”. This condition is also associated with numbness.
• Metatarsalgia – this is the condition of pain in metatarsal bones due to inflammation. It causes burning sensation and pain especially while standing or walking right under the big toe.
• Charcot – Marie Tooth disease – it is a genetic disorder resulting in a complex group of motor and sensory neuropathies. In addition to burning sensation it results in wasting and weakness of muscles with loss of sensation and reflexes, foot drop, and imbalance.
• Tarsal tunnel syndrome – it is the condition causing compression of the tibial nerve as it passes through the tarsal tunnel near the ankle. It causes burning foot pain, numbness and paresthesia. It usually affects one foot.
• Chronic regional pain syndrome – it is a condition that causes the peripheral nerves to send false signals to central nervous system due to overstimulation. It results in very severe, painful burning sensation of feet. Normally it is accompanied by swelling, stiffness, spasms, sleep and mood disturbances.
• Burning feet syndrome – this condition is also known as Grierson-Gopalan Syndrome which damages the peripheral nerves of the feet. In addition to the burning sensation of the feet, numbness, pins and needles are also present. The prominent feature is that the burning sensation is high at night time compared to daytime.

Diagnosis

The diagnosis process would start with a complete history including the onset, duration and progression of the symptoms; medical history, drug history, social history and family history (for hereditary conditions) and a complete physical examination of the nervous system and lower limbs.

Often with the history and physical examination of the patients the cause for the symptom can be diagnosed. Mostly it is due to peripheral neuropathy due to diabetes. But further investigations are required if the condition is of acute onset or increasing in severity or without an obvious cause or to analyze the progression of the condition.

The investigations are as below:

• Nerve conduction test – it is carried out to test the nerve’s ability to carry the impulse. It is one of the main tests that are done to diagnose peripheral neuropathy.
• Electromyography (EMG) – it is a test done using probes to measure the electrical activity of the muscles. It helps to detect any nerve damage within muscles.
• Nerve biopsy – a piece of nerve is cut to examine under the microscope, but this is done rarely.
• Laboratory tests – blood tests, urine tests, spinal fluid tests are checked according to the presence of other comorbidities such as diabetes or arthritis.
• Imaging tests (X ray, MRI, CT scan, ultrasound scan) – to rule out any injuries or fractures of the feet.
• Skin samples – in case of skin infections skin samples are taken to diagnose the infection.

Treatment

The main aim of treatment is to prevent any further damage to the nerves. In general the treatment can be mainly classified as pharmacological and nonpharmacological. The treatment procedure depends on the cause of the problem and other co-morbidities of the patient.

Treating the underlying cause of the burning in bottom of feet will help in improvement of the symptoms, such as in case of peripheral neuropathy caused by:

• Diabetes mellitus – proper dietary modifications with oral hypoglycemic drugs or insulin injections to maintain the blood glucose level within the desired range.
• Alcoholism – taking proper measures to stop further alcohol intake and medications to cure the alcohol withdrawal syndrome to prevent further nerve damage.
• Vitamins and other nutritional deficiencies – proper dietary supplements given orally or intramuscularly to maintain the required levels.
• Chronic kidney disease – hemodialysis or peritoneal dialysis to remove the excess toxins.
• Hypothyroidism – proper oral medications to bring back the thyroid hormone levels back to normal.
• HIV/AIDS – proper treatment according to the condition of the patient.
• Guillain-Barre Syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) – plasmapheresis and immunoglobulin therapy.

If the symptoms are due to peripheral artery disease treatment should involve lifestyle modification such as exercises, quitting smoking, and healthy diet in addition to lipid lowering drugs to maintain proper lipid levels. Sometimes surgeries will be needed too.

In case of Morton’s neuroma, metatarsalgia and tarsal tunnel syndrome, simple measures including the use of ice, resting, and proper footwear usage can be adopted along with the use of anti inflammatory medications. Surgeries, injections and orthotics may be used based on the severity and extent of disease. Although there is no definitive treatment for Charcot-Marie tooth disease, some exercises, orthotics and some surgeries may be used to improve the condition.

If the reason is chronic regional pain syndrome, treatment involves pain killers, anti depressants, physiotherapy and exercises. Burning feet syndrome can be managed easily by proper footwear, vitamin B supplements and cold water baths.

• If it is due to a skin infection such as athlete’s foot, antifungals can be given.
• Relieving the pain is another main aspect of treatment. Painkillers including NSAIDS, neuropathic pain killers or low dose narcotics can be given according to the severity of the symptoms.
• The non-pharmacological methods include;
• Wearing proper, comfortable footwear.
• Resting the feet as often as possible.
• Elevating the feet while resting.
• Wearing insoles and other supports as orthotics and change them regularly.

Home remedies

In addition to the treatment prescribed by the doctor, several measures can be taken at home to prevent and to control the burning in bottom of feet, which includes:

• Cold water – immersion of the legs in cold water for few minutes is the best remedy for burning sensation. This can be repeated several times a day.
• Massage – gentle massage of the feet helps in soothing the burning sensation and improves the blood circulation of the feet.
• Exercises – exercises help to maintain proper blood circulation in the whole body which helps in the relieving of symptoms.

In addition to these, apple cider vinegar, turmeric, Epsom salt, ginger, bitter gourd and thyme can be used as well due to their anti-inflammatory and cooling properties.

When should I be concerned?

Although burning sensation of feet is a common problem, proper diagnosis and treatment is important to prevent complications. A person should seek emergency medical care if the symptoms appear acutely or in case of an infected open wound in the foot of a diabetic patient. A person should visit the doctor during other circumstances such as persistent symptoms, increasing severity, radiation of the burning sensation up along the legs or when started to experience other associated symptoms such as numbness and ‘pins and needles’ sensation.