My husband experiences a burning sensation in his feet whenever he walks. The general practitioner diagnosed it as burning feet syndrome and recommended a visit to a neurologist, but there’s a lengthy wait. He was given gabapentin, but it hasn’t alleviated the symptoms.
Hazel Hanley, Bexhill
Dr. Martin Scurr responds: Burning feet syndrome is characterized by an intense heat sensation in the soles, often occurring during activity and subsiding with rest. This usually points to a nerve issue. The most prevalent cause is peripheral neuropathy, which involves damage to the nerves in the limbs. Symptoms may include tingling, numbness, or pain, generally starting in the hands or feet.
Peripheral neuropathy may arise from diabetes, excessive alcohol consumption, or a deficiency in vitamin B12. This deficiency becomes more prevalent with age, as the stomach’s ability to produce acid, crucial for vitamin absorption, diminishes, affecting nerve health.
In some instances, the cause of the condition remains unknown. Diagnosis is conducted by a neurologist through a nerve conduction study, which uses small electric currents on the skin to evaluate nerve signal efficiency. Further investigations would then aim to determine the underlying cause of the nerve damage.
Gabapentin, an anticonvulsant medication prescribed to your husband, functions by calming abnormal nerve signals. Although it hasn’t been effective yet, it may take several weeks to show results, and the dosage might need gradual adjustments. If it continues to be ineffective, other medications such as low-dose antidepressants might be considered.
Burning feet syndrome is typically a sign of some kind of nerve malfunction. The most common cause is peripheral neuropathy
Anticonvulsant drugs such as gabapentin work by calming abnormal signals in the nerves, but it can take weeks to work
Another potential but much more rare cause of burning feet is erythromelalgia, a condition linked to blood cell disorders.
A classic sign of this is the symptoms easing when you rest with the feet elevated or cool them in water. Whilst waiting for his neurology appointment, I’d suggest your husband ask his GP for a blood test to check his blood count and blood film picture (where a thin film of blood is put on a glass slide and examined under a microscope).
I’m an 81-year-old woman in good health but, as far as I can remember, I’ve had a high heart rate (70 beats per minute). Recently, I have been feeling constantly tired, sleeping more than I’ve been awake. Also my heart rate has been consistently over 100 and up to 125. I always seem to feel light-headed and unwell. An ECG and blood tests were normal. I am just fed up with feeling unwell all the time.
Dot Pardy, Poole, Dorset
Dr Martin Scurr replies: Even though your tests were normal, in my view your ongoing symptoms suggest you need more investigation. While you wait to see your GP again, I’d suggest weighing yourself at the same time of day once a week and taking your temperature twice daily – and recording your results.
These are useful details that will give your doctor some information upon which to base further investigations. Your symptoms could indicate a thyroid issue or an infection – and it is possible that the blood tests you had didn’t check key markers of these.
Fatigue is potentially a sign of a ‘silent’ urinary infection, so, as well as blood tests, I would advise a urine test. Plus, of course, a physical examination, which must include your heart and abdomen. GPs have had many years of training in how to do this – it is not something that can be delegated to a nurse or medical assistant.
You mention in your longer letter having chronic obstructive pulmonary disease, an umbrella term for chronic lung disease. Given this, I would also suggest you have a chest X-ray. Please do let me know how you get on.
In my view… The antibiotics that can harm gut health
Not so long ago, we would have regarded microbes in the gut as deeply worrying, but we now know the community of bacteria, fungi and viruses there – the gut microbiome – plays a key role in our wellbeing.
Alarmingly, even a single course of antibiotics can damage the gut microbiome.
A study, published in Nature Medicine involving 15,000 adults, has found that clindamycin, ciprofloxacin and flucloxacillin may be the most disruptive – penicillin V (a specific type), amoxicillin and nitrofurantoin the least.
To my mind, this confirms we GPs should avoid handing out broad-spectrum antibiotics – only after samples have been analysed in the lab, and the culprit organism identified, should we prescribe an antibiotic for that particular bacteria.
Of course, for acute emergency care in hospitals, antibiotics may have to be administered before there’s time for a microbiology report. Meanwhile, if you need antibiotics, once you’ve finished the whole course, add probiotics to your diet. Try live yoghurt, kombucha or kefir every day for a week or two.
