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What Causes Burning Sensation Under The Feet?
Question: yes i have orthostatic intolerance with dysautonomia also difficulty walking and weakness in my left leg and sometimes my right with numbness in both feet. my left lower leg has atrophied some and I experience burning under my foot aat times Im afraid its als im 64 year old woman i also hav limited range in my left ankle. Is it more als or ms XXXXXXX
Brief Answer:
I vote for neither....how about you.
Detailed Answer:
Good evening young lady....and I do mean that to be the case....I am a neurologist from the XXXXXXX OH area. I see a lot of both ALS and MS in my hospital and outpatient practice.
My vote is that you probably have NEITHER of those entities. It's almost certain you don't have ALS from your description for a number of reasons and it would be almost as unusual to not have been diagnosed with MS with the symptoms you have prior to age 64. I did diagnose a woman at 72 with MS for the first time who was essentially healthy until she took a plane ride....at least that what she said...and when she came off the plane she simply couldn't stand without assistance and we discovered her to have MS....so I won't be as adamant against that diagnosis as I am against the ALS...but at any rate.
First of all, classic ALS is not allowed to have SENSORY types of symptoms..no burning, no numbness, no prickly feelings, and you seem to have all of these. ALS is defined as a MOTOR NEURON disease. It is infinitely more common in men compared to women...unless, you are a woman with a family history of ALS then, you stand a more likely chance to get it compared to women who get it randomly...again, that's RARE....Also, ALS does not cause ISOLATED (or focal) ATROPHY in a leg or arm, or half the body...it's SYMMETRIC (both sides the same) so both legs would tend to be equally involved.
MS doesn't cause isolated limb atrophy which occurs well ahead of its diagnosis. MS almost is never associated with autonomic dysfunction unless it is being caused by medications taken for the condition. 64 years old at diagnosis for MS with the symptoms going on which are clearly chronic relatively speaking would be a record setter as well.
I would like to know much more diagnostic information as well as laboratory tests that have been done...etc.
I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 59 minutes of physician specific time to read, research, and compile a return envoy to the patient.
I vote for neither....how about you.
Detailed Answer:
Good evening young lady....and I do mean that to be the case....I am a neurologist from the XXXXXXX OH area. I see a lot of both ALS and MS in my hospital and outpatient practice.
My vote is that you probably have NEITHER of those entities. It's almost certain you don't have ALS from your description for a number of reasons and it would be almost as unusual to not have been diagnosed with MS with the symptoms you have prior to age 64. I did diagnose a woman at 72 with MS for the first time who was essentially healthy until she took a plane ride....at least that what she said...and when she came off the plane she simply couldn't stand without assistance and we discovered her to have MS....so I won't be as adamant against that diagnosis as I am against the ALS...but at any rate.
First of all, classic ALS is not allowed to have SENSORY types of symptoms..no burning, no numbness, no prickly feelings, and you seem to have all of these. ALS is defined as a MOTOR NEURON disease. It is infinitely more common in men compared to women...unless, you are a woman with a family history of ALS then, you stand a more likely chance to get it compared to women who get it randomly...again, that's RARE....Also, ALS does not cause ISOLATED (or focal) ATROPHY in a leg or arm, or half the body...it's SYMMETRIC (both sides the same) so both legs would tend to be equally involved.
MS doesn't cause isolated limb atrophy which occurs well ahead of its diagnosis. MS almost is never associated with autonomic dysfunction unless it is being caused by medications taken for the condition. 64 years old at diagnosis for MS with the symptoms going on which are clearly chronic relatively speaking would be a record setter as well.
I would like to know much more diagnostic information as well as laboratory tests that have been done...etc.
I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 59 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much for your attention. lthink it is important to note that i suffer from severe anxiety and ptsd and mitral valve prolapse in the past. the motor issues all started about 3 months ago. started to lose my balance or felt unsteady. thought it was due to a viral infection that i had. then the heat intolerance whereby at the time i felt weakness on my left side and felt like passing out. soon i became housebound with less walking mobility and very disturbing symptoms from the dysautonomia. my life life iun 3 months is extremely limited with all these symptoms. i came to notice this weakness mostly in the left limb and sometimes wrist as well. because of all the stress i ended up in the ER and had CT scan of hed - nothing. upon the advice of my doctor i was transferred to a psych hospital for the acute anxiety and depression. there i was treated by a neuro psychiatrist who like you felt it wasn't either ms or als. he conferred with other neurologist. he wanted to do a spinal tap but i was too anxious. at the time i did not have the stamina or comfort to walk in the hospital. the doctor wanted to gine me a vasocontrictor but my personal doctor was aganst it because of my sinus tachy. at home the numbness has been present
it was not clinically present while i was in the hospital. also the burning or heat felt under the left foot is a new development. what concerns me is the when i feel the gnawing weakness in my left limb, it will many times develop into a generalized weakness and a trembling sensation in my chest. no chest pain but a
sick feeling its hard to say how much is neuro or anxiety or the dysautonomia. so all these symptoms plus the atrophy in my left leg and ankle ROM change.and loss of 8 pounds leads me to als. the emg test has been recommended and i fear this is what they will tell me. if i attempt to walk the perimeter of the house outside i can barely make it. it has been a nightmare i know the numbness is more ms but can be with als. also my gait on the left has limited heel to toe. ive had pain some months ago on in my right eye and then it went away. i did not mention sometimes the right side feels weak but not as significantly yet. feel terrible with all these horrifying sympytoms. afraid its more als or if ms it would be progressive. also want to mention a history of chronic fatigue syndrome. it must be something to explain the clinical manifestations please explain more with your expertise i will be glad to keep you updated i am so hosebound that just keeping an appt. is monumental. very despairing need guidance on how to cope. frigthened also the boneunder the kneecap looks like a bump on both legs. im looking at both calfs and both seem atrophied but the left more significantly both feet get numb. better mobility with right ankle. 21 years ago aftr ihad my daughter i went a few years with tingling sensations in my left lower extremity. it was treated with b12 but it could have been a residual of the cfs. Doctor after your reply and my review of my history and current symptoms i think it is als please explain where you think i stand currently. since ms is never associated with auto dys. then again ALS please explain. XXXXXXX
it was not clinically present while i was in the hospital. also the burning or heat felt under the left foot is a new development. what concerns me is the when i feel the gnawing weakness in my left limb, it will many times develop into a generalized weakness and a trembling sensation in my chest. no chest pain but a
sick feeling its hard to say how much is neuro or anxiety or the dysautonomia. so all these symptoms plus the atrophy in my left leg and ankle ROM change.and loss of 8 pounds leads me to als. the emg test has been recommended and i fear this is what they will tell me. if i attempt to walk the perimeter of the house outside i can barely make it. it has been a nightmare i know the numbness is more ms but can be with als. also my gait on the left has limited heel to toe. ive had pain some months ago on in my right eye and then it went away. i did not mention sometimes the right side feels weak but not as significantly yet. feel terrible with all these horrifying sympytoms. afraid its more als or if ms it would be progressive. also want to mention a history of chronic fatigue syndrome. it must be something to explain the clinical manifestations please explain more with your expertise i will be glad to keep you updated i am so hosebound that just keeping an appt. is monumental. very despairing need guidance on how to cope. frigthened also the boneunder the kneecap looks like a bump on both legs. im looking at both calfs and both seem atrophied but the left more significantly both feet get numb. better mobility with right ankle. 21 years ago aftr ihad my daughter i went a few years with tingling sensations in my left lower extremity. it was treated with b12 but it could have been a residual of the cfs. Doctor after your reply and my review of my history and current symptoms i think it is als please explain where you think i stand currently. since ms is never associated with auto dys. then again ALS please explain. XXXXXXX
Brief Answer:
Very sorry that things have gone this way
Detailed Answer:
Thank you for the added information. I've read all of your detailed descriptions of things and would like to know how the diagnosis of "dysautonomia" came to be made and what if any causative factor has been found to be causing the problem. I am assuming that due to your symptoms of anxiety and so forth that you are currently not on any specific anxiety for the symptoms you refer to as dysautonomia.
I believe it will be very difficult to make a diagnosis without some additional diagnostic testing. I would be hesitant to say any particular type of test without having had the opportunity to examine you physically but I will say that unless you had an MRI of the brain first I would hesitate performing a spinal tap. Not that a spinal tap in and of itself could not yield some information but for my taste I think we will get more mileage out of ruling something IN or OUT more with an MRI of the brain and cervical and lumbar cords (with gadolinium contrast) more so than with a spinal tap.
As I said before, if in fact there is atrophy of the leg with is focal on the left side then, I would be very suspicious of a process having to do with nerve root compression at the lumbar spine level. This would have to show up on an MRI for the leg to actually be lacking muscle mass on the left compared to the right which is what "atrophy" means. You say you've lost 8 lbs. but in ALS, numbers are generally much higher than that....one can lose 8 lbs. easily from anxiety and PTSD issues....I'm not overly impressed with 8 lbs. when it comes to wanting to make a diagnosis of ALS. And for all the reason I mentioned in my previous thread above ALS as a diagnosis would violate all the classic rules of it being a motor neuron type of disease...and in a 64 year old yet as a first presentation. I don't think I've ever read about a case similar to yours with a confirmed diagnosis either by electrical study or nerve/muscle biopsy.
I am not a psychiatrist by any means but many of the ancillary symptoms you mention of chest sensations, fluttering, shaking, etc. are more likely from psychological sources having to do with your anxiety disorder and PTSD rather than from organic disease either having to do with radiculopathy, neuropathy, or demyelinating disease processes. So those don't fit the XXXXXXX so to speak when it comes to explaining everything else.
Do you have pictures of your legs in order to demonstrate to me the degree of atrophy of the leg....you can upload such images as .jpg in order for me to get a visual. If you had measurements of the various muscle groups as documented in a medical note by anyone who cared to measure them I'd be interested in seeing those as well.
If you have previous pictures of when you felt completely well then, you can include those as well so that I might compare THEN to NOW.
I am not an expert on issues having to do with chronic fatigue syndrome but I do not believe that your symptoms really fit those criteria either which are very precise as set out by the rheumatological experts who deal with that entity.
In conclusion, my thought process still remains unchanged in terms of a differential diagnosis which would NOT INCLUDE either ALS or MS for all the reasons mentioned in the previous answer I gave to you. I believe that if the neurologist has determined that a spinal tap should be necessary that a preliminary MRI of the brain, cervical, and lumbar spinal cord be obtained. I believe that an EMG/NCV study is of utility though it is an invasive test if you truly wish to have diagnostic testing evidence for ALS for consideration
Personally, I wouldn't want it done to me if I could avoid it because I simply don't like needles but in your case perhaps the results of the test would convince you if they were negative?
Please note that in the future if you wish to write to me specifically for medical opinions or responses to questions that you can reach me directly by landing on the following website:
bit.ly/drdariushsaghafi
I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
I'd be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 84 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Very sorry that things have gone this way
Detailed Answer:
Thank you for the added information. I've read all of your detailed descriptions of things and would like to know how the diagnosis of "dysautonomia" came to be made and what if any causative factor has been found to be causing the problem. I am assuming that due to your symptoms of anxiety and so forth that you are currently not on any specific anxiety for the symptoms you refer to as dysautonomia.
I believe it will be very difficult to make a diagnosis without some additional diagnostic testing. I would be hesitant to say any particular type of test without having had the opportunity to examine you physically but I will say that unless you had an MRI of the brain first I would hesitate performing a spinal tap. Not that a spinal tap in and of itself could not yield some information but for my taste I think we will get more mileage out of ruling something IN or OUT more with an MRI of the brain and cervical and lumbar cords (with gadolinium contrast) more so than with a spinal tap.
As I said before, if in fact there is atrophy of the leg with is focal on the left side then, I would be very suspicious of a process having to do with nerve root compression at the lumbar spine level. This would have to show up on an MRI for the leg to actually be lacking muscle mass on the left compared to the right which is what "atrophy" means. You say you've lost 8 lbs. but in ALS, numbers are generally much higher than that....one can lose 8 lbs. easily from anxiety and PTSD issues....I'm not overly impressed with 8 lbs. when it comes to wanting to make a diagnosis of ALS. And for all the reason I mentioned in my previous thread above ALS as a diagnosis would violate all the classic rules of it being a motor neuron type of disease...and in a 64 year old yet as a first presentation. I don't think I've ever read about a case similar to yours with a confirmed diagnosis either by electrical study or nerve/muscle biopsy.
I am not a psychiatrist by any means but many of the ancillary symptoms you mention of chest sensations, fluttering, shaking, etc. are more likely from psychological sources having to do with your anxiety disorder and PTSD rather than from organic disease either having to do with radiculopathy, neuropathy, or demyelinating disease processes. So those don't fit the XXXXXXX so to speak when it comes to explaining everything else.
Do you have pictures of your legs in order to demonstrate to me the degree of atrophy of the leg....you can upload such images as .jpg in order for me to get a visual. If you had measurements of the various muscle groups as documented in a medical note by anyone who cared to measure them I'd be interested in seeing those as well.
If you have previous pictures of when you felt completely well then, you can include those as well so that I might compare THEN to NOW.
I am not an expert on issues having to do with chronic fatigue syndrome but I do not believe that your symptoms really fit those criteria either which are very precise as set out by the rheumatological experts who deal with that entity.
In conclusion, my thought process still remains unchanged in terms of a differential diagnosis which would NOT INCLUDE either ALS or MS for all the reasons mentioned in the previous answer I gave to you. I believe that if the neurologist has determined that a spinal tap should be necessary that a preliminary MRI of the brain, cervical, and lumbar spinal cord be obtained. I believe that an EMG/NCV study is of utility though it is an invasive test if you truly wish to have diagnostic testing evidence for ALS for consideration
Personally, I wouldn't want it done to me if I could avoid it because I simply don't like needles but in your case perhaps the results of the test would convince you if they were negative?
Please note that in the future if you wish to write to me specifically for medical opinions or responses to questions that you can reach me directly by landing on the following website:
bit.ly/drdariushsaghafi
I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
I'd be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 84 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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