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Boyner Clinic Blogs

Burning Feet

Burning feet - the sensation that your feet are painfully hot - can be mild or severe. In some cases, your burning feet may be so painful that the pain interferes with your sleep. With certain conditions, burning feet may also be accompanied by a pins and needles sensation (paresthesia) or numbness, or both.
Burning feet may also be referred to as tingling feet or paresthesia.

Burning feet that occurs infrequently or for a short time may simply occur because your feet are tired or you have an irritation such as athlete's foot. Persistent or progressive burning feet, however, can be a symptom of nerve damage (peripheral neuropathy), perhaps due to diabetes, chronic alcohol use, exposure to certain toxins, certain B vitamin deficiencies or HIV.
Seek emergency medical care if:

  • The burning sensation in your feet came on suddenly, particularly if you may have been exposed to some type of toxin
  • An open wound on your foot appears to be infected, especially if you have diabetes
Schedule an office visit if you:
  • Continue to experience burning feet, despite several weeks of self-care
  • Notice that the symptom is becoming more intense and painful
  • Feel the burning sensation has started to spread up into your legs
  • Start losing the feeling in your toes or feet

If your burning feet persist or if there is no apparent cause, then your doctor will need to do tests to determine if any of the various conditions that cause peripheral neuropathy are to blame.

  • Rest and elevate your feet.
  • Switch to more comfortable shoes.
  • Bathe your feet in cool water.

Morton's neuroma

Morton's neuroma, initially described by Morton in 1876, is a reactive fibrosis of a communicating branch of the third nerve and, histopathologically, is not a true neuroma.1 The neuroma is believed to be mechanically induced and most commonly affects the third common digital nerve located in the region of the third webspace of the foot (figure 2). Anatomic factors along with injury, irritation, or pressure from wearing pointed and/or high-heeled shoes result in compression and irritation of the third common digital nerve and lead to nerve fiber degeneration, intraneural and juxtaneural fibrosis, and hypertrophy of the nerve. Anatomical factors that may contribute to this condition include excessive motion of the third and fourth metatarsals, juxtaposition of the third and fourth metatarsal heads and the branches of medial and lateral plantar nerves between the third nerve, and the third transverse intermetatarsal ligament overlying the third common digital nerve and its communicating branches.
Interdigital plantar (Morton's) neuroma. Reproduced with permission. Copyright 2005 American College of Foot and Ankle Surgeons. All rights reserved.

Pathologic findings alone are insufficient to explain the symptoms of Morton's neuroma, since these same findings may occur in asymptomatic individuals. The diagnosis of Morton's neuroma is suspected clinically when patients complain of pain located in the webspace of their toes. Early in the course, patients may describe burning or tingling in this region. These symptoms may progress to the more typical paroxysmal, severe, sharp, lancinating pain that occurs with weightbearing and walking and is relieved by sitting, removing the shoes, and massaging and manipulating the affected region of the forefoot. The pain, as previously noted, typically involves the third and occasionally the fourth webspace and may radiate to the third and fourth toe.

The webspace compression test is used clinically for the diagnosis of Morton's neuroma and takes advantage of the pathophysiologic process responsible for this condition. With the patient in a sitting or prone position, the examiner squeezes the third and fourth metatarsal heads together with one hand and, using the other hand, compresses the soft tissue in the involved webspace. A positive test results in pain. Ultrasonography may be used in cases of diagnostic uncertainty, however, Morton's neuroma remains a clinical diagnosis.

Treatment options for Morton's neuroma include avoiding pointed and/or high-heeled shoes, using metatarsal pads, and administering local corticosteroid injections, the latter of which must be approached with caution. Inadvertent extravasations into the toe adjacent to the MTP joint may result in significant MTP joint instability. In refractory cases, neurolysis, transposition, or surgical excision of the nerve is performed. Recurrence of symptoms must provoke a search for a "stump neuroma" or pathology of adjacent structures, such as the MTP joints. Recurrence after surgical excision is most commonly associated with incomplete nerve release or excision.

Do Customized or Advanced Insoles Really Work?

Anyone who has recently bought a new pair of running trainers may well have found themselves being recommended some 'superior' insoles to replace those that come with the trainers.
In one major running store chain, the footwear recommendation service includes not only a gait analysis but also the creation of a "customised" insole to "enhance the fit and comfort of your shoe" by heating an 'off the shelf' insole and molding it to the shape of your foot.
Though some have accused this as being nothing more than a clever upsell, many runners do report that upgraded insoles have brought them a solution to running pain and even improvements in performance. This is has not been the case for everybody of course - some runners experience no change at all, and others find themselves in even more pain.
So what's it all about? Why the inconsistency? Do insoles work?
Insoles vs Orthoses

Before we start, it may be useful to differentiate between insoles and orthoses. The distinction is sometimes tricky, but generally a foot orthosis (pluralorthoses) is made specifically for your needs by a trained specialist (Podiatrist, Orthotist, Pedorthist). Orthoses can be divided into two categories: functional and accommodative.Functional orthoses are engineered with the aim of modifying the structural and functional characteristics of your skeletal system in an attempt to reduce a specific pain. Accommodative orthoses are made to provide cushion or comfortable support underneath your foot but not really meant to correct any dysfunction.
Insoles are not designed with just one foot in mind. They are prefabricated and mass produced. Though once upon a time they existed to simply enhance comfort, expansion of the industry has meant that today a huge variety of off-the- shelf insoles are now available offering different forms of support and cushioning to meet the needs of different types of runner.

The Foot Type Model
In an attempt to best serve a runner's specific needs, most brands of insoles offer three distinct types: High Arch, Neutral Arch, Low Arch.
Their sale typically involves an assessment in which you stand on some form of pressure plate from which an imprint of your feet shows whether you have low, neutral or high arches. The "Wet Foot Test" is also commonly practiced.
This method of categorisation is based on the Foot Type model (see diagram below) and has been used by the running shoe industry since the 1980's, theorising that an efficient, healthy, injury free running gait depends on achieving a "neutral" arch height at midstance (when the weight of the body passes over the weight bearing ankle).
If runners are seen to display a drop of the medial arch that exceeds this neutral position (collapsing), the ankle (subtalar joint) is said to be "overpronating" in which case some form of motion control shoe is advised, with built up support under the arch; for runners whose arches do not drop "enough", the ankle is said to be an "underpronator" or "supinator" and a flexible, cushioned shoe is advised in order to absorb some of the shock that "underpronating" is said to cause. For those whose ankles appear in "neutral" alignment, a "stability" or "neutral" shoe is advised.


Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes.

Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.

Hallux Valgus

Patients can present initially in several ways; therefore, evaluation of the history is extremely important. A patient may present with a nonacute onset of deep or sharp pain in the first metatarsophalangeal joint during ambulation, with exacerbation during particular activities. This presentation indicates degeneration of the intra-articular cartilage.

The patient may also describe aching pain in the metatarsal head secondary to shoe irritation that is relieved when the shoes are removed. This presentation is indicative of superficial bump pain. Often, both forms of pain are progressive and have been present for many years. The frequency or duration of pain may recently have begun to increase, and activity may exacerbate the pain. Patients may even describe a recent notable increase in the size of the deformity or medial bump.

Questions on limitation of physical or daily living activities are valuable for understanding the severity of the patient's pain. It is also important to ascertain what, if anything, relieves the pain and which treatments (eg, surgery) have been attempted previously. Occasionally, trauma or inflammatory arthritis is an associated finding.

Another possible presentation is burning pain or tingling in the dorsal aspect of the bunion, which indicates entrapment neuritis of the medial dorsal cutaneous nerve. The patient may also describe symptoms caused by the deformity, such as a painful overlapping second digit, interdigital keratosis, or ulceration to the medial metatarsal head, without complaint of the bunion deformity itself

What is Cavus Foot?

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

CausesCavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality.

An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

Facts About Corns and Callus?

These are common areas where corns and calluses develop on the feet. Corns and calluses are something that most people will develop at sometime or another. They are the result of thickening of the top layer of skin, or stratum corneum, usually in response to repeated physical trauma. For many people, corns and calluses cause some degree of pain and discomfort. For some they are a cosmetic concern, especially larger calluses that develop on the heel.
Facts about Corns:

  • They often develop on the areas near the joints of toes in response to shoe friction, especially if you have hammertoes.
  • Another common place for a corn is the side of the little toe.
  • Soft corns can develop in between toes in response to two toes rubbing against each other.
  • Tiny "seed corns" occur most often on the ball of the foot and can be quite painful.
  • They can sometimes be mistaken for warts.
Facts about Calluses
  • Calluses are often larger than corns and occur in response to friction from shoes or walking barefoot.
  • They often develop on the soles and ball of the foot because these areas experience the most ground pressure.
  • Heel calluses may develop into painful cracked areas of skin that become wounds.