From the Guidelines
The initial workup for a patient presenting with burning feet should begin with a comprehensive foot evaluation, including a thorough history and physical examination, to identify potential causes and risk factors for ulcers and amputations, as recommended by the most recent guidelines 1. The physical exam should evaluate for sensory deficits, motor weakness, and reflex changes, and include inspection of the skin, assessment of foot deformities, neurological assessment (10-g monofilament testing with at least one other assessment: pinprick, temperature, vibration), and vascular assessment, including pulses in the legs and feet. Key elements of the history include assessing for diabetes, alcohol use, vitamin deficiencies (particularly B12, folate, and thiamine), medication history, and exposure to toxins, as well as obtaining a prior history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease, and assessing current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication) 1. Laboratory testing should include complete blood count, comprehensive metabolic panel, hemoglobin A1c, vitamin B12, folate, and thyroid function tests, and additional tests may include erythrocyte sedimentation rate and C-reactive protein to assess for inflammatory conditions. Nerve conduction studies and electromyography may be necessary if peripheral neuropathy is suspected, and imaging studies such as MRI of the spine might be indicated if radiculopathy is considered. Treatment depends on the underlying cause, but may include gabapentin, pregabalin, duloxetine, or tricyclic antidepressants like amitriptyline for symptomatic relief, and a multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet 1. It is essential to identify and treat the underlying cause of burning feet, which can be idiopathic or secondary to systemic conditions, to prevent long-term complications and improve quality of life. Some patients may require referral to foot care specialists for ongoing preventive care and lifelong surveillance, particularly those who smoke or have a history of prior lower-extremity complications, loss of protective sensation, structural abnormalities, or peripheral arterial disease 1.
From the Research
Initial Workup for Burning Feet
The initial workup for a patient presenting with burning feet involves a comprehensive evaluation to determine the underlying cause of the symptoms.
- The patient's medical history, including any pre-existing conditions such as diabetes, should be thoroughly reviewed 2.
- A physical examination should be performed to assess for any signs of trauma, infection, or neuropathy 3, 4.
- Laboratory tests, such as blood glucose levels, may be ordered to rule out underlying conditions like diabetes 2.
- Quantitative sensory testing may be used to evaluate the patient's sensory function and detect any abnormalities 3.
Potential Causes of Burning Feet
Burning feet can be caused by a variety of factors, including:
- Diabetic peripheral neuropathy, which can cause burning pain, numbness, and tingling in the feet 5.
- Traumatic injuries, such as burns or sciatic mononeuropathies, which can lead to sympathetically maintained pain 3.
- Inherited sensory neuropathies, which can manifest with burning pain and other positive symptoms 4.
- Other conditions, such as alcohol-nutritional neuropathy, which can cause burning feet and other symptoms 3.
Treatment and Management
The treatment and management of burning feet depend on the underlying cause of the symptoms.
- For diabetic peripheral neuropathy, treatment may involve medications like amitriptyline, duloxetine, or pregabalin, which can help alleviate pain and other symptoms 5.
- For sympathetically maintained pain, treatment may involve sympathetic blockade, which can help reduce pain and improve autonomic function 3.
- For inherited sensory neuropathies, treatment may involve managing symptoms and preventing further nerve damage 4.