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An active, healthy, late-30's woman with no visible signs of pedal deformity or dysfunction presented recently complaining of a burning sensation in the soles of her feet - only when wearing walking boots. The pain starts sub-MTHs and slowly spreads to her heels.

Her walking boots appeared too short, and the wear pattern on her existing insoles indicated that they provided support only at the heel and trans-MTHs, where there is clearly heavy focal pressure, particulalry sub-2nd MTH.

I customised insoles in an effort to increase the plantar contact surface area and so offload the forefoot and rearfoot, incorporating met domes to restore and support her transverse arches to offer some relief from the metatarsalgia. I measured her feet unweighted and weighted and fitted new boots.

She went for a short walk (about 6 miles) and reported that the boots felt better but that the burning sensation started to return.

Any ideas of what might be the cause of the burning?

Other observations: a history of lower back and unilateral hip pain (R side); pedograph indicated neutral arch R side, high arch L side; bilateral plantar callus sub-2nd met head; bilaterally her 2nd toe was a little longer than her 1st (Morton's toe?) - I suspect this is the source...

I suggested she request an assessment of any LLD at her next osteopath appointment or referral to a podiatrist.

Any advice gratefully received, cheers,
Dhonuill, C. Ped

 

Buring pain = (painful) peripheral neuropathy or similar (eg erythromelalgia)

Perpiheral neuropathy mnemonic "DANG THERAPIST"

D - diabetes
A - alcohol
N - Nutritional (eg B1, B6, B12)
G - Guillain-Barre

T - Toxic (lead, arsenic)
H - Hereditary (eg CMT)
E - Endocrine (eg hypothyroidism)
R - Recurrent (eg tarsal tunnel)
A - Amyloid
P - Porphyria
I - Infectious (eg HIV, leprosy)
S - Sarcoidosis
T - Tumour (eg spinal cord)


Those in bold are the more common causes.

Hope this helps.

LL

 

If the burning occurs with wearing a particular pair of boots and not in other reasonable shoes, then I would suspect it is not neuropathy.

Apparently her boots and feet are not getting along. The solution is obvious.....

 

Thanks. Glad to report the lady's new boots/custom insoles are serving her well, however I'm also recommending that she experiment with different sock materials and temporary 1/8" platforms I've sent her to support her 1st ray.
Dhonuill.

 

That makes a lot of sense.If only in the boots,then she should get rid of the boots.