clinical features

Last reviewed 01/2018

• BFS has been mainly reported in Asian and Far East countries during a hot summer (1)
• 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
  • overlying skin and blood vessels are normal in most - however in some patients there may be accompanying erythema of the feet with warm overlying skin as in erythromelalgia
  • no local tenderness over the affected parts
  • neurological examination is essentially normal in most patients; however some may exhibit a varying degree of hypo or hyperaesthesia
  • knee and ankle jerks show normal to brisk reaction
  • no signs of upper motor neuron involvement
  • motor power is maintained - no atrophy or wasting of the overlying muscles
• if nutritional deficiency is the cause then most patients develop signs and symptoms of burning feet after approximately 4-5 months of deficient diet
  • skin manifestations of vitamin deficiency such as scrotal dermatitis or pellagra-like rash can precede the onset of burning sensation in the feet
• physical examination may be entirely normal (as in familial BFS)

Reference:

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