Millions of people experience sudden muscle cramping at night or know the pain that accompanies aging bones and joints.
But fewer people may be familiar with something called rest pain – and while it may sound benign, it could be a symptom of a serious health condition.
Rest pain – pain in the foot or toes that occurs even when a person is not walking or putting weight on the foot – is a distinct form of pain and many patients I’ve treated have come to me reporting symptoms of intense burning pain in the feet.
Approximately 1 in 100 individuals in the US will develop rest pain in their lifetime.
While rest pain can occur on its own or as a result of various foot conditions, it can also be a sign of chronic limb-threatening ischemia (CLTI), formerly known as critical limb ischemia.
CLTI is an advanced stage of peripheral artery disease (PAD), which occurs when plaque accumulates in the arteries and narrows the blood vessels, limiting blood flow to the legs and feet.
With CLTI, the extreme buildup of plaque severely reduces blood flow to the legs, feet or toes.
People experiencing rest pain due to CLTI who do not receive prompt treatment may go on to develop non-healing wounds or ulcers, tissue death and, in severe cases, amputation.
Rest pain – pain in the foot or toes that occurs even when a person is not walking or putting weight on the foot – is a distinct form of pain (stock image)
And because CLTI is caused by PAD, urgent treatment is required to avoid PAD-related complications, including life-threatening cardiovascular events such as heart attack and stroke.
Jonathan Brocklehurst (pictured) is a podiatrist who has seen hundreds of diabetic patients at risk of foot amputations
According to the Journal of Vascular Surgery, 80 percent of patients presenting with rest pain may die within 10 years of diagnosis.
This is because severe arterial plaque buildup in the legs is strongly linked with widespread cardiovascular blockages and CTLI complications.
Recognizing the symptoms of rest pain early is the difference between faster surgical life-saving intervention and a higher risk of mortality.
The top five symptoms to be aware of are severe burning pain in the feet, hair loss on the feet, shiny pale appearance on the feet, intense cramping of the legs when walking and a purple or blue color on the toes.
Some people may be more prone to rest pain based on their lifestyle.
Smoking, alcoholism, sedentary behaviors and poor diet are just some of factors that play a part in contributing to serious blood loss to the lower limb.
Staying active is important even in older age.
The top five symptoms to be aware of are severe burning pain in the feet, hair loss on the feet, shiny pale appearance on the feet, intense cramping of the legs when walking and a purple or blue color on the toes (stock image)
This can encourage a healthier flow of blood to the feet and reducing the likelihood of serious vascular complications at a younger age.
I remember a particular patient – a man in his 70s – who had recently been on vacation and had become confused about the intense burning pain in his feet.
He had never had a podiatry appointment before and had admitted to resorting to self-care for much of his life.
When I performed an ultrasound scan to test the blood flow to the arteries in his feet and noticed swelling on the top of his feet, which made it challenging to feel the pulses with my fingers, there was a clear indication that blood flow was impaired.
Crucially, there was also no hair on his feet and his skin had a slightly shiny, pale appearance.
By looking at the big picture, I was able to ascertain that his background of smoking regularly for 30 years, excessive weekly intake of alcohol and relatively sedentary lifestyle, had contributed significantly to bodily inflammation, including in his arteries.
However, because of that appointment, I was able to refer him to a hospital vascular team for further assessment, provide smoking cessation advice, recommend an alcoholics awareness group and encourage him to take up regular physical activities.
Too often there are cases where symptoms have been occurring for an extended period of time and seeking assessment has been delayed, resulting in more serious cases and health outcomes.
To treat rest pain, you must treat the underlying cause of it, such as CTLI or PAD.
Treatment may include medications to reduce the risk of blood clots, lower cholesterol and manage conditions such as high blood pressure or diabetes, as well as lifestyle changes such as smoking cessation, increased exercise and an improved diet.
For people with CLTI or PAD, more aggressive treatment is sometimes needed to restore circulation, including minimally invasive procedures such as angioplasty or stenting, or surgical bypass procedures that reroute blood flow around blocked arteries.
Rest pain may be a condition that creeps up on people at a moment’s notice; however, the underlying causes may have been occurring for years.
Seeking advice from a podiatrist is crucial even if there is uncertainty over the type of pain experienced, particularly at night. Don’t ignore it. The earlier you seek help, the more likely a better outcome for your legs and feet.
Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist based in the UK.
