Differential Diagnosis for Burning Feet at Night in a Non-Diabetic 43-Year-Old Female

Single Most Likely Diagnosis

• Vitamin B12 Deficiency: This condition is a common cause of burning feet, especially at night, due to the role of vitamin B12 in the synthesis of myelin, the fatty substance that surrounds and protects nerve fibers. A deficiency can lead to neuropathy, which often presents with symptoms such as burning sensations in the feet.

Other Likely Diagnoses

• Iron Deficiency: Similar to vitamin B12 deficiency, iron deficiency can cause neuropathic symptoms, including burning feet, due to its role in maintaining healthy nerve cells.
• Hypothyroidism: This condition can lead to neuropathic symptoms, including burning sensations in the feet, although it is less common compared to other symptoms like fatigue and weight gain.
• Tarsal Tunnel Syndrome: Compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle can cause burning sensations in the feet, especially at night.
• Peripheral Artery Disease (PAD): Although less common in a 43-year-old without risk factors, PAD can cause burning sensations in the feet, especially during rest or at night, due to reduced blood flow.

Do Not Miss Diagnoses

• Multiple Myeloma: A type of blood cancer that can cause neuropathy leading to burning feet. Although rare, missing this diagnosis could have severe consequences.
• Amyloidosis: A condition characterized by the deposition of abnormal proteins (amyloid) in various tissues, which can lead to neuropathy and burning sensations in the feet.
• Heavy Metal Poisoning (e.g., Lead, Arsenic): Exposure to heavy metals can cause neuropathy, and missing this diagnosis could lead to continued exposure and worsening symptoms.

Rare Diagnoses

• Fabry Disease: A genetic disorder that leads to the accumulation of a particular type of fat in the body's cells, affecting many parts of the body including the nerves, which can cause burning sensations in the feet.
• Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, leading to neuropathy and potentially burning sensations in the feet.
• Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can be primary (genetic) or secondary to other conditions.