The Medicine Cabinet
By Howard LeWine, M.D.
Q: Every morning when I get up my right foot hurts so much that I can hardly walk. In addition, I feel a burning and tingling sensation in my right foot and leg during the day. What could be causing this?
A: You definitely need to seek medical evaluation. Your symptoms could be related to several different types of problems. More detail about the symptoms and a physical examination will be critical to defining the cause and determining the best treatment.
Common problems that could contribute to your symptoms include nerve disease (neuropathy), tendon inflammation (tendinitis), ligament injury, arthritis and bone injury, including stress fracture. Other, rarer causes would include an infection or a vascular problem.
Plantar fasciitis classically causes foot pain that is worse in the morning when you take your first steps. It’s due to tightening and inflammation of the special ligaments, called the plantar fascia, along the sole of the foot. Tendon inflammation in the ankle or foot could also result in severe pain first thing in the morning because the tendons tighten during sleep and are painful when stressed during walking. However, most people with plantar fasciitis or tendinitis don’t describe a burning sensation.
Burning, tingling or numbness sensations are the usual way that nerve problems make themselves known. Nerve disorders that cause foot pain such as those related to diabetes or tarsal tunnel syndrome could cause a burning sensation in the foot. Tarsal tunnel syndrome is similar to carpal tunnel syndrome in that a nerve is pinched as it travels through a narrow space. Pain in the back of the leg that travels down to the foot could be due to a disc pressing on a nerve in the back, commonly called sciatica.
The medical evaluation should emphasize a neurologic exam to be sure the nerves are functioning properly, a joint examination for arthritis and the application of pressure around the foot and ankle which, if painful, could indicate a bone, tendon or ligament problem. Additional testing such as X-rays, nerve tests or referral to a specialist may be necessary to confirm or exclude a specific diagnosis.
Given the constellation of your symptoms, there may be more than one problem. It may take a while to discover the best therapeutic options. Meanwhile, you may find some relief by wearing a supportive running shoe with a cushioned insole.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)