burning feet syndrome (BFS)

Last reviewed 07/2021

• burning feet syndrome (BFS) is characterised by a sensation of burning and heaviness in the feet and lower extremities
  • Grierson was, in 1826, was the earliest to document the symptom of burning feet. However a detailed description was given by Gopalan in 1946, hence, BFS is also known as Grierson-Gopalan syndrome
    
    
• no specific aetiology for BFS - often is idiopathic
  
  
• may be associated with nutritional/endocrine causes e.g.
  • vitamin B deficiency
  • diabetes mellitus
  • renal failure (dialysis patients)
  • hypothyroidism
    
    
• most common in those over 50 years; although can occur in any age group
  • symptoms characterised by a burning sensation, heaviness, numbness, or a dull ache in the feet
    • burning is usually limited to the soles of the feet but may ascend to involve the dorsum, ankles or lower legs
      • arms and palms of the hands are spared
      • sometimes a patient may complain of 'pins and needles' or tingling in the lower extremities
      • symptoms show worsening at night and a day time improvement
  • on examination, there is a paucity of objective signs
    
    
• investigations
  • first line investigations include FBC, ESR, U+Es, B12, TFTs, fasting glucose
    
    
• treatment
  • specific measures
    • depend on the cause
  • general measures
    • wearing open and comfortable shoes, particularly those with arch supports, and wearing cotton socks is helpful (1)
    • symptomatic relief can be brought about by soaking the feet in cold water (not ice cold) for around 15 minutes
    • avoidance of feet exposure to heat
    • pharmacological therapies include tricyclic antidepressants and membrane stabilising agents (such as carbamazepine or gabapentin)

Reference:

1. Makkar RP et al. Burning feet syndrome. A clinical review. Aust Fam Physician. 2003 Dec;32(12):1006-9.