tingling and burning in feet

I have burning and tingling in both my feet, but also have discomfort in my left ankle after I have been on my feet for a while. Have had a pain specialist look at my lower back, he ran some tests and determined that there are no pinched nerves in my legs or back.

RESPONSE

Hi,

Although I have no hard statistics to back this up, I would suggest to you that more often than not, tingling and burning in the feet is due to a local disorder rather than a nerve impingement in the lower back. Certainly in this type of pain, a radiculopathy (nerve impingement) should be ruled out.
Based on your narrative, the first thing that comes to mind is the possibility of a tarsal tunnel syndrome.
Although probably seen more often occurring in only one foot, it certainly can be present in both feet. In a tarsal tunnel, which by the way, is the foot version of carpal tunnel seen in the hand, the nerves, as they come down the leg and under the inside of the ankle, get "pinched" by a ligament that covers them. This will tend to occur more frequently in individuals who pronate, or whose feet flatten out too much when they walk. Pronation causes a jamming on the outside of the ankle, but more importantly, it causes a stretching of the structures on the inside of the ankle. The stretching of the ligament I just mentioned puts pressure on the nerves and course on the inside of the ankle and will give symptoms of burning, tingling, numbness and pain. Generally the more you walk, the greater the symptoms.
In severe cases the symptoms may also persist even when not ambulating, but again, will probably worsen as you do a lot of walking.
One little test you can do yourself, although not totally scientific is to see if your feet feel somewhat better when wearing a good sneaker with an arch support as opposed to walking barefoot or in flimsy shoes like flip flops. If this is the case, then you may have a tarsal tunnel because in a good pair of sneakers with a good arch support, your feet are not pronating as much as opposed to barefoot and so the symptoms would not be as bad.
The other reason I am thinking tarsal tunnel is because you mention one of your ankles begin to hurt when you walk. I wish I knew your age (and some other things about you), but many times when a person is excessively pronated, it will cause ankle pain as well because of the malalignment of the foot relative to the lower leg.
Another area where the nerves can become entrapped and cause your symptoms is the area just below the knee on the outside of the leg. In this area the nerves pass by what is known as the head of fibula bone and nerve entrapments can occur here although not as frequently as in a tarsal tunnel or radiculopathy.
Your next step? I would suggest you see a podiatrist in your area to rule out tarsal tunnel. Sometimes nothing more than a good orthotic to reduce your pronation, is all that is needed to reduce your symptoms. In more severe cases that do not respond to conservative care, surgical intervention may be necessary.

see related
article....tarsal tunnel

Marc Mitnick DPM
DISCLAIMER