Health

Burning Sensation in Feet: Causes, Diagnosis, Treatment

A burning sensation in your feet may be caused by nerve damagein the legs, also called neuropathy. Although many medical conditions can cause burning feet, diabetes is the most common. Most burning feet treatments focus on preventing further nerve damage and reducing pain.

Causes of Burning Feet

Most often, neuropathy is the cause of burning feet. Damaged nerve fibers are more likely to become overactive and misfire. The damaged nerves send pain signals to the brain even though there is no wound.

In most people with neuropathy, the leg nerves become damaged first. These people often have tingling and numbness in the feet as well. Many people complain that their feet are overly sensitive to touch (hyperesthesia) and can have varying degrees of burning pain. It can range from mild to disabling.

Diabetes and alcohol abuse are by far the most common causes of neuropathy in the legs. Many other conditions can cause neuropathy or a burning sensation in the feet:

Chronic kidney disease (uremia)
Small fiber neuropathy
Vitamin deficiency (vitamin B12, folate, and occasionally vitamin B6)
Alcohol abuse
Low thyroid hormone levels (hypothyroidism)
Lyme disease
HIV/AIDS
Amyloid polyneuropathy
Drug side effects, including chemotherapy drugs, vitamin B6 overdose, HIV medicines, amiodarone, isoniazid, metformin, and others
Erythromelalgia
Heavy metal poisoning (lead, mercury, arsenic)
Vasculitis (inflammation of blood vessels)
Sarcoidosis
Guillain-Barre syndrome (GBS)
Chronic inflammatory demyelinating polyneuropathy (CIDP)

Besides neuropathy, infections and inflammation of the feet can also cause a burning sensation. The most common of these is athlete’s foot, an infection of the skin caused by fungus.Peripheral artery disease (PAD) also commonly causes burning feet. The poor circulation of blood to the feet may frequently cause pain, tingling, and burning feet, especially while walking.Weeks or months after gastric bypass surgery, some people experience a burning feet sensation. Poor absorption of B vitamins after gastric bypasscan cause neuropathy in the legs and a sensation of burning feet.
Diagnosing Burning Feet

Most people who have burning feet have a likely cause (such as diabetes) that can be identified. For these people, the diagnosis of burning feet due to neuropathy is straightforward, and additional testing is not needed.

In a few people whose burning sensation is sudden, rapidly worsening, or has no explainable cause, further testing may be needed to make a correct diagnosis. These tests may include:
- Electromyography (EMG). A test of muscle function using recordings of electrical activity inside the muscles. A probe may be placed on the skin, or a needle may be inserted into the muscle, for an EMG test.
- Nerve conduction study. A nerve conduction study tests the ability of nerves to transmit impulses. A nerve is stimulated, and the response in the muscle controlled by that nerve is measured.
- Laboratory tests. Sometimes, tests of blood, urine, or spinal fluid may be suggested to help diagnose the cause of burning feet. Vitamin levels can be checked with a simple blood test.
- Nerve biopsy. Very rarely, a doctor may suggest cutting out a piece of nerve tissue and examining it under a microscope.
  
  Treatments for Burning Feet
  
  The most important treatment for burning feet due to neuropathy is to stop any ongoing nerve damage. In some cases treatment of the underlying disease will improve the neuropathy and symptoms. In other situations, like a small fiber neuropathy, where no cause can be identified, the physician will focus on treating the person’s symptoms.
  
  For people with diabetic neuropathy, treatment means keeping blood sugar levels in the normal range. This usually requires dietary changes, oral medications, and often insulin injections.
  
  For people with other forms of neuropathy that cause burning feet, preventing further nerve damage is equally important. Specific conditions and their treatments include:
  - Vitamin deficiency. Taking additional vitamin B12 orally or by injection can replace low levels of this nutrient.
  - Alcoholism. Stopping excessive drinking prevents ongoing nerve damage and allows nerves to heal.
  - Chronic kidney disease. Dialysis may be necessary to eliminate toxins causing neuropathy and burning feet symptoms.
  - Hypothyroidism. Taking oral thyroid hormone raises low thyroidlevels, often reversing neuropathy as well as burning feet symptoms.
  - GBS and CIDP. Treatments are very specialized and include plasma exchange (plasmapheresis) or immune globulin therapy (IVIG).
  Burning feet treatments include treating the pain and abnormal sensations created by neuropathy. Some commonly prescribed medications for burning feet include:
  - amitriptyline (Elavil)
  - carbamazepine (Tegretol)
  - desipramine (Norpramin)
  - duloxetine (Cymbalta)
  - gabapentin (Neurontin)
  - pregabalin (Lyrica)
  - topiramate (Topamax)
  - venlafaxine (Effexor XR)
  Other pain medications may be necessary to reduce the severe discomfort some people experience from burning feet. Over-the-counter medicines like Advil, Aleve, Motrin IB, and Tylenol control pain in many people with burning feet. Prescription pain relievers like tramadol (Ultram) or low-dose opiates (narcotics) may be necessary for severe pain.
  
  For burning feet caused by athlete’s foot, antifungal drugs can cure the fungal infection and relieve burning feet symptoms. Over-the-counter medicines like miconazole (Micatin) or terbinafine (Lamisil AT) should be used first. Prescription antifungals like fluconazole (Diflucan), itraconazole(Sporanox), and naftifine (Naftin) are also available.

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