Burning Feet Syndrome

Mark Russell · Dec 2, 2004

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Male 66 y/o with history of COPD and angina presents with burning feet syndrome of 18 months duration. Occasional remission but for only short periods < 2hours. Worse at night. Non smoker. Significant history - when he was 35 y/o working with Glaxo manufacturing penicillin, he received compensation for lung damage from over-exposure to sulphuric acid fumes.

Current medication regime:

Terbutaline Sulphate Nebuliser; Ipratropium Bromide Nebuliser; Risedronate Sodium Tabs; Atorvastatin; Prednisolone; Candesartan Cilexetil; Nitrazepam; Nortriptyline; Salmeterol Xinafoate Dry Powder Inhaler; Furosemide; Co-codamol; Uniphyllin Continus; Salbutamol Inhaler; Amlodipine Besilate;Isosorbide Mononitrate.

The only way this gentleman is able to sleep is by building a dose of nortriptyline and nitrazepam up during the evening. Even then, because of his feet, he is only able to sleep for 2-3 hours. Any suggestions?

Mark Russell

Craig Payne · Dec 2, 2004

Peripheral neuropathy in chronic respiratory insufficiency.
J Peripher Nerv Syst. 1998;3(1):69-74.
Jann S, Gatti A, Crespi S, Rolo J, Beretta S.

Peripheral neuropathy commonly occurs in patients with chronic obstructive lung disease (COPD). We report the presence of peripheral neuropathy in 19 of our 30 COPD patients (63.3%): 7 patients had clinical signs of a symmetric motor and sensory polyneuropathy, 12 patients had only subclinical evidence of peripheral nervous system involvement. Neurophysiological studies showed low amplitude compound muscle action potentials (CMAP) and sensory action potentials (SAP) with only slight reduction of nerve conduction velocity in affected patients: these data confirm an axonal polyneuropathy. The severity of the peripheral nervous system involvement in COPD patients was correlated with hypercapnia, the degree of disability and thus with the severity of COPD. Hypoxia, age and duration of the disease were not related with the presence of polyneuropathy. Improvement of respiratory function produced slight but progressive improvement of neurological symptoms. Within one year, also neurophysiological studies revealed a progressive and statistically significant improvement in CMAP and SAP amplitude and motor and sensory conduction velocity and, in some cases, normal electromyography.
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admin · Dec 5, 2004

The original message in this thread was also posted on he JISC Podiatry list. Here are some of the responses:

Try acupuncture as for painful diabetic neuropathy - see "Acupuncture for the treatment of chronic painful peripheral diabetic neruopathy: a long term study" Diabetes Research and Clinical Practice 39 (1998) 115 - 121. - I have used this approach on 2 patients (who were not suffering from diabetes and with burning feet at night in bed. One experienced lasting relief after 6 treatments, the other did not.

Clive Chapman
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Thanks Clive. Have you come across capsaicin for the treatment of diabetic
neuropathy and if so, how did you rate it?

Mark Russell
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In the trust in which I worked we advised patients with painful diabetic
neuropathy to use it. More than 50% found that it helped to bring some
relief. It may make things feel more burning for the first few days, but
after that there is an improvement

Clive Chapman
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Andrea Castello · Dec 6, 2004

Hi Mark

I have had some success with the use of Opsite wrapping of the feet in this type of situation. The treatment is effectively wrapping the feet in Opsite (with the skin under some tension). I had improvement in enough cases to feel that it is at least worth a try. I read about it in a journal (can't for the life of me remember which one). Hope this helps!! :)

Sammy · Dec 27, 2004

Hi Mark, you wouldn't by any chance be the same Mark Russell thats causing all the trouble in the UK SOCAP site? Anyway, re sore feet. It is quite probable that the aforementioned replies are spot on. There are 2 other avenues you could try.
1) Check out the bio-mech etc. Long term ab-twist etc will cause pl metatarsalgia etc ( I know this re-ply is crap but I'm presuming all sorts of stuff and anyway I haven't seen the patient, tho for a small fee...)
2) Put the pt on pantothenic acid tablets ( Vit.B5.I think/hope - jeez, why are you asking these technical questions at Christmas?? hic!) I know this works in some cases and is worth a shot. The underlying problems will need sorting tho' but with a bit of luck it might be one of your colleagues whoes on next time the pts due.. Sam

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