Foot Discomfort Accompanied by Redness
Personal Information: Female, 47 years old, BMI of 21. Pre-existing Conditions: Diagnosed with chronic fatigue, long COVID, migraines, blepharitis, irritable bowel syndrome (IBS), intolerances to gluten and dairy, seasonal hay fever (non-summer), childhood eczema, and adolescent seborrheic dermatitis. Medications: Currently prescribed amitriptyline (40 mg), sumatriptan (100 mg as needed), eye drops, and fexofenadine (180 mg). I also take magnesium as an over-the-counter supplement. Symptom Description: In the past year, I have experienced intense, burning sensations in the soles of my feet, toes, and around the nails. These bouts are often accompanied by pronounced redness on my feet. Additionally, I've noticed that my toenails are growing in a slightly upward direction. These symptoms typically arise in the evening and overnight, and they seem to be progressively worsening. It’s important to mention that my limited walking due to chronic fatigue doesn’t seem to contribute to this issue. Moreover, I’ve recently started to feel joint discomfort in my knees and ankles, particularly noticeable when descending stairs. Over-the-counter medications like ibuprofen (400 mg) or naproxen (500 mg) haven’t provided any relief. Medical History and Investigations: A few months back, my general practitioner conducted a physical exam, assessing my sensation and reflexes, all of which were normal. However, he admitted uncertainty regarding my condition and suggested I consult my neurologist. Unfortunately, my neurologist was only focused on determining if I had a sleep disorder and did not explore my other symptoms. Previously, a rheumatologist evaluated me two years ago after an inconclusive ANA test, conducting a physical examination of my joints and concluding that there were no significant concerns since my blood work didn’t indicate any positive results. An endocrinologist dismissed the possibility of diabetes insipidus back in 2018. In 2017, another specialist ruled out Addison’s disease, while a rheumatologist in 2016 excluded lupus, attributing my butterfly rash to sun exposure while on the combined contraceptive pill. Moreover, a neurologist in 2016 eliminated chronic fatigue syndrome/myalgic encephalomyelitis from consideration, citing the absence of a sore throat, although I have noted a decline in my energy levels since experiencing COVID-19. With all this in mind, I am seeking guidance on the following: 1) What might be causing these symptoms in my feet? 2) Which tests should my GP consider ordering at this point? 3) Which type of specialist would be most appropriate for my situation? 4) What medication could provide me with the best results? I appreciate any insights you can share. Thank you!
Answers (1)
8/26/2025, 1:21:51 AM
OpenHealth AI
Main Points
Your symptoms of foot discomfort, redness, and joint pain can stem from various causes, including nerve issues, inflammatory conditions, or dermatological factors. It’s essential to address these symptoms methodically to identify the underlying cause, especially considering your complex medical history.
Explanation
The intense burning sensation in your feet, combined with redness and changes in toenail growth, may potentially be related to several factors:
- Neuropathy: Nerve damage can cause burning sensations in the extremities. Although previous exams were normal, further testing could still be beneficial.
- Inflammatory Conditions: Conditions such as arthritis can cause joint pain and possibly contribute to skin or nail changes.
- Circulatory Issues: Reduced blood flow or peripheral vascular disease might lead to redness and discomfort in the feet.
- Dermatological Conditions: Eczema or fungal infections can also cause skin problems, although less common in adults.
Next Steps
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Document Symptoms: Keep a detailed diary of your symptoms, including when they occur, their intensity, any other accompanying symptoms, and the effectiveness of any treatments you've tried. This information will be valuable for your healthcare providers.
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Consult a Rheumatologist: Given your previous connections with rheumatological assessments, returning to a rheumatologist may be beneficial, particularly as you are experiencing joint discomfort combined with other systemic symptoms.
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Consider Routine Blood Tests:
- Complete Blood Count (CBC): To check for any signs of inflammation or infection.
- Comprehensive Metabolic Panel (CMP): To assess kidney and liver function and electrolyte levels.
- Vitamin and Mineral Levels: Including vitamin B12 and folate, especially since neuropathy symptoms can be linked to deficiencies.
- Inflammatory Markers: Such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
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Review Medications with a Specialist:
- Discuss your current medications with a healthcare provider to determine if any could be contributing to your symptoms.
- Ask about possible treatment options specifically for neuropathic pain, which may include medications like gabapentin or pregabalin, if deemed appropriate for your condition.
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Self-Care Practices:
- Foot Soaks: Warm water soaks may provide temporary relief from burning sensations. Adding Epsom salt can help, but ensure it doesn't cause any skin irritation.
- Footwear: Ensure you are wearing supportive, well-fitting footwear, especially if your feet are sensitive.
- Gentle Stretching/Exercises: Learn gentle stretches that might improve circulation and reduce discomfort.
Following these steps can help clarify your situation and lead to a more targeted approach in finding relief for your symptoms. Please share any updates or seek further assistance if needed.
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