Burning feet syndrome

Overview

Burning feet syndrome, also known as Grierson-Gopalan syndrome, is a neurological condition characterized by a sensation of burning, tingling, or heat in the feet, often accompanied by pain, numbness, or sensitivity to touch. Symptoms are usually worse at night and may interfere with sleep. While it can affect individuals of any age, it is most commonly seen in middle-aged and older adults. Burning feet syndrome can be a primary condition or a symptom of an underlying disorder, most notably peripheral neuropathy.

Causes

Burning feet syndrome can arise from a variety of causes, which may be classified as primary (idiopathic) or secondary (due to another condition). Common causes include:

• Peripheral neuropathy – often due to:

  • Diabetes mellitus (most common)

  • Chronic alcohol abuse

  • Vitamin B12 or B6 deficiency

  • Hypothyroidism

  • Kidney failure (uremic neuropathy)

• Infections – such as HIV or Lyme disease

• Heavy metal poisoning – including lead or mercury

• Autoimmune diseases – like lupus or rheumatoid arthritis

• Hereditary neuropathies – such as Charcot-Marie-Tooth disease

• Medication side effects – including chemotherapy agents and certain antibiotics

• Idiopathic burning feet syndrome – where no identifiable cause is found

Symptoms

The hallmark symptom is a burning sensation in the feet, often worsening at night and improving during the day. Other associated symptoms may include:

• Tingling or prickling sensation

• Redness or warmth of the feet

• Sharp, stabbing, or shooting pain

• Numbness or loss of sensation

• Heightened sensitivity to touch (hyperesthesia)

• Occasionally, involvement of the hands in more severe cases (glove and stocking distribution)

Diagnosis

Diagnosis of burning feet syndrome involves clinical evaluation and identification of any underlying condition. The process may include:

• Detailed medical history and symptom assessment

• Physical and neurological examination – to assess reflexes, sensation, and strength

• Blood tests – to check for diabetes, vitamin deficiencies, thyroid function, kidney function, and autoimmune markers

• Nerve conduction studies and electromyography (EMG) – to evaluate nerve function and detect neuropathy

• Skin biopsy – in cases of suspected small fiber neuropathy

• Urinalysis and heavy metal screening – if toxic exposure is suspected

Treatment

Treatment of burning feet syndrome depends on the underlying cause and symptom severity. Approaches include:

• Treating underlying conditions:

  • Blood sugar control in diabetes

  • Vitamin B12 or B6 supplementation

  • Thyroid hormone replacement in hypothyroidism

  • Discontinuation of causative medications or toxins

• Medications for symptom relief:

  • Anticonvulsants (e.g., gabapentin, pregabalin)

  • Antidepressants (e.g., amitriptyline, duloxetine)

  • Topical treatments – capsaicin cream or lidocaine patches

  • Pain relievers – acetaminophen or NSAIDs

• Lifestyle and supportive care:

  • Wearing comfortable, breathable footwear

  • Cooling foot baths or ice packs (avoiding frostbite)

  • Foot elevation to reduce swelling and improve circulation

  • Physical therapy or gentle exercises

Prognosis

The outlook for burning feet syndrome depends on the underlying cause. In cases where the root cause is treatable (e.g., vitamin deficiency or medication side effect), symptoms may significantly improve or resolve entirely. However, if the syndrome results from chronic conditions like diabetic neuropathy or hereditary neuropathies, symptoms may persist and require long-term management. Early diagnosis and appropriate intervention can help reduce symptom severity and improve quality of life.