My husband’s feet feel as if they’re burning when he walks. The GP said it’s burning feet syndrome and referred him to a neurologist but there’s a several months’ wait. He was prescribed gabapentin, but it didn’t help.
Hazel Hanley, Bexhill
Dr Martin Scurr replies: Burning feet syndrome – an intensely hot sensation in the soles caused by activity and improving when you rest – is typically a sign of some kind of nerve malfunction. The most common cause is peripheral neuropathy – damage to nerves in the limbs; other symptoms often include tingling, numbness or pain. These symptoms usually start in the hands or feet.
Peripheral neuropathy can be the result of diabetes, excessive alcohol intake or vitamin B12 deficiency (which becomes more common with age, as the stomach produces less acid, needed to help the body absorb the vitamin, important for nerve health, from food).
However, in some cases the cause is not clear. The condition is diagnosed by a neurologist using a nerve conduction study, where small electric currents are administered to the skin to judge how well the signals are being passed along the nerves. This would be followed by investigations to find the cause of the nerve damage.
Anticonvulsant drugs such as gabapentin – which your husband was prescribed – work by calming abnormal signals in the nerves. This hasn’t worked in his case, but it can take weeks to do so, and doses may need to be raised slowly – if this fails, different drugs, such as antidepressants at a low dose, could help.
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.
