Patient with symptomatic 'hot feet'

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I have a client a 69 yo lady, whose feet feel cold during the day (they are cool to touch) but when she lies down at night start to burn and only relief is gained by standing on cold tiles. It profoundly disrupts her sleep She taked Panedeine forte to control this discomfort .

She ia a long term smoker since the age of 14. (Approx 10 per day now).
she has epilepsy and takes Epilem and tegretol. Pulses are easily palable and quite strong . No foot pain or discomfort when walking only when lying down. Symmetrical discomfort.It started 7-8 years ago and has worsened.

the monofilament was patchy. She is to have BGL checked.

Any suggestions for relief or reduction of this pain. I don't think she's likely to give up the smokes, though I have raised that. Would it have any effect at this stage?

Jill

 

What about slump test? Could be referred pain maybe?

 

Try to give her trental as this sounds like PVD.A few questions:
1.Does she have any other pain elsewhere?Any back pain?
2.How is the color of her feet?Is there severe color changes in the winter?
3.Any history of angina or cardiac symptoms?
I would obtain a vascular consult.Also,it could be her meds are causing the problem.

 

Consider B-12 deficiency

Hi Jillian,
New to the forum, and just had this thread delivered to my in-box. Sorry if it's redundant or no longer germane. B-12 deficiency should also be on the differential, has she had serum B-12 test, or was CBC on high end for possible macrocytic anemia? Gate-control (Melzack and Wall) may explain the presentation of no pain when standing, but pain when off of the feet. If non-weightbearing provocative testing for radiculopathy and spinal stenosis is not fruitful, and no suspicion of vascular etiology, peripheral neuropathy is certainly up there on the DDX. Sounds like you've already investigated the possible diabetic route.

 

Burning feet

Are hot-burning sensations produced by the axonal damage of afferent unmyelinated fibres?
Minerva Anestesiol. 2006 May;72(5):321-7