Burning pain

Burning foot pain is a common complaint, usually as a result of damage to the nerves of the foot or leg.  It may develop due to an injury or medical condition. Symptoms may be constant or come and go, vary in intensity and be accompanied by other sensations such as pins and needles or numbness.

Accurate diagnosis of burning foot pain is vital to ensure appropriate treatment is started as soon as possible to prevent further damage.

Here we will look at the most common causes of burning pain in feet, how they present, what causes them and how they are treated.

Common Causes of Burning Foot Pain

1)  Peripheral Neuropathy
What Is It: Peripheral neuropathy is caused by damage to the nerves in the leg or foot, anywhere along their path from the spine down to the feet.  It is the most common cause of burning pain in feet.

Causes: Various medical conditions e.g. diabetes, injury e.g. fractures, infections e.g. shingles or medication.  In approximately 30% of cases the cause is unknown.

Symptoms: Burning foot pain often accompanied by weakness, altered sensation e.g. pins and needles or numbness, altered balance and co-ordination.  It tends to affect both feet at the same time.  Symptoms may come and go or get progressively worse.

2)  Morton’s Neuroma
A Morton’s Neuroma causes burning pain in foot and feels like you are standing on a pebble

What Is It: Thickening of the soft tissues surrounding one of the nerves in your foot
Causes: Anything which places pressure on the foot such as abnormal foot position, repetitive high-impact activities e.g. running or poor fitting footwear e.g. narrow shoes or high heels.

Symptoms: The most classic symptom is that it feels like you are standing on a pebble.  This may also be associated with burning foot pain in the ball of your foot and toes and numbness

3) Peripheral Vascular Disease (PVD)
Peripheral Vascular Disease reduces blood flow to the extremities which can result in burning pain in feet

What Is It: Obstruction of the large arteries of the extremities (i.e. those not around the heart or brain) which limits blood flow.  Also known as peripheral artery disease (PAD)
Causes: Atherosclerosis (thickening of the artery wall), stenosis (narrowing of the artery) or a blood clot.  Prevalance increases with age.

Symptoms: Burning foot pain especially when walking, weakness, muscle cramp, sores or ulcers, changes in skin colour (usually blue/purple), decreased hair and nail growth.  May affect one or both feet.  Symptoms usually get worse with activity and improve with rest.

4)  Metatarsalgia
Metatarsalgia causes burning foot pain underneath the metatarsal bones (shown here in green)

What Is It: Irritation and inflammation of the foot bones and surrounding soft tissues
Causes: Overuse (e.g. lots of walking/running), repetitive stress, muscles weakness and tightness, poor-fitting footwear, abnormal foot position e.g. bunions, stress fractures, gout
Symptoms: Burning foot pain in the ball of the foot, most commonly under the big toe, worse with standing or walking.  Tends to come on gradually over time rather than suddenly.

5)  Charcot-Marie Tooth Disease
Charcot-Marie_tooth Disease causes weakness and burning pain in feet

What Is It: A group of disorders that affect the peripheral nerves.

Causes: It is an inherited disorder caused by genetic mutation

Symptoms: Foot drop (inability to lift the foot up straight), high foot arches, muscle weakness, burning pain in foot, numbness and poor balance.

6)  Tarsal Tunnel Syndrome
What Is It: 
Compression of the tibial nerve as it passes through the tarsal tunnel (a space between the foot bones) on the inner side of the foot near the ankle.

Causes: Bone spurs, tumour, foot swelling, cyst, ganglions.

Symptoms: Burning foot pain on the sole of the foot, pins and needles, numbness in the heel and toes.  Usually only affects one foot.

7)  Diabetic Neuropathy
Diabetic peripheral neuropathy can often lead to the formation of ulcers

What Is It: A serious complication of Diabetes which damages the nerves causing peripheral neuropathy.

Causes: Prolonged high blood sugar levels damage the blood vessels that supply the nerves with oxygen and nutrients and affect how the nerves transmit signals.

Symptoms: Symptoms usually start in the feet and legs and can spread to the hands.  Tingling, numbness, burning foot pain often worse at night, hypersensitivity, muscle weakness, ulcers

Anyone suffering from Diabetes should take extra care of their feet, examining them daily for any problems. The loss of sensation in the foot often results in foot problems going unnoticed.

8)  Erythromelalgia
Erythromelalgia is a rare condition where blood vessels are intermittently blocked causing burning foot pain

What Is It: A rare neurovascular disorder where blood vessels get intermittently blocked
Causes: A problem with the neuropathological and microvascular systems.

Symptoms: The most defining symptom is redness of the foot with associated swelling and burning foot pain.

9)  Chronic Regional Pain Syndrome
Chronic Regional Pain Syndrome (CRPS) causes extreme burning foot pain

What Is It: A chronic, progressive disorder caused by dysfunction and over-sensitisation of the nervous system where peripheral nerves send inappropriate pain signals to the central nervous system.  Previously known as Reflex Sympathetic Dystrophy (RSD), it is the most painful form of chronic (long-term) pain.

Causes: CRPS is poorly understood but it is thought to be caused by the body responding inappropriately to an injury and a resultant inflammatory response.  There are two types of CRPS defined by the initial cause, type 1 (the most common) develops after a soft tissue injury (often minor such as a sprain), disuse or crush injury, type 2 develops after a nerve injury.

Symptoms: Intense, constant, extreme burning foot pain that is much greater and lasts longer than would be expected after the initial injury.  Associated swelling, spasms, changes in skin temperature (e.g. excessive sweating), redness, allodynia (hypersensitivity to light touch), stiffness, sleep disturbance and affected mood.  Starts in one limb but often spreads.

10)  Burning Feet Syndrome
What Is It: A medical condition also known as Grierson-Gopalan Syndrome where there is damage to the small nerve fibres of the foot.

Causes: There is often no clear cause but it is thought to be linked with factors such as vitamin B deficiency, diabetes, hypothyroidism, rheumatoid arthritis, renal failure and abnormal foot biomechanics.  There is also thought to be a genetic link.

Symptoms: Burning foot pain, usually on the soles of the feet but occasionally spreading up the lower leg which is worse at night-time.  Sometimes accompanied by pins and needles and numbness.  In most cases there is no redness or tenderness in the affected region.  It can also cause affect vision.