Clinical Overview

Burning feet syndrome is a common manifestation of peripheral neuropathy, particularly small fibre neuropathy affecting the cutaneous nerve fibres of the feet. The sensation is most commonly burning, tingling, or crawling and characteristically worsens at night. Peripheral neuropathy is a clinical syndrome — not a single disease — and identifying the underlying cause is essential for treatment.

Diabetes mellitus accounts for the largest proportion of peripheral neuropathy cases globally, affecting up to 50% of diabetic patients over their lifetime. Vitamin B12 deficiency is the most common treatable metabolic cause.

Callaghan BC, et al. Distal symmetric polyneuropathy: a review. JAMA. 2015;314(20):2172–2181. doi:10.1001/jama.2015.13611 — Comprehensive review of peripheral neuropathy aetiology and management.

Common Causes

• Diabetic peripheral neuropathy (most common)
• Vitamin B12 deficiency (reversible cause)
• Alcohol-related neuropathy
• Chronic kidney disease
• Hypothyroidism
• Chemotherapy-induced neuropathy (cisplatin, vincristine, taxanes)
• Vasculitic neuropathy
• Hereditary neuropathy (Charcot-Marie-Tooth disease)

Investigations

• Fasting blood glucose and HbA1c (diabetes screening)
• Vitamin B12 and folate levels
• Thyroid function tests
• Renal function and LFTs
• Nerve Conduction Studies (NCS) and Electromyography (EMG)
• Skin punch biopsy (for small fibre neuropathy diagnosis)
• MRI Spine (if myelopathy is a differential consideration)