Burning pain in the feet that strikes even while resting, known as rest pain, can be an early warning sign of a serious and potentially fatal circulatory condition, according to a UK podiatrist who has treated hundreds of patients at risk of foot amputation.
Jonathan Brocklehurst, a podiatrist based in the UK, said rest pain is a distinct form of pain from the muscle cramps or joint aches many people experience with age. He said many of his patients have come to him reporting intense burning pain in their feet. Approximately 1 in 100 people in the United States will develop rest pain in their lifetime, he said.
While rest pain can occur on its own or as a result of various foot conditions, Brocklehurst said it can also signal chronic limb-threatening ischemia, or CLTI, formerly known as critical limb ischemia. CLTI is an advanced stage of peripheral artery disease, which develops when plaque builds up in the arteries and narrows blood vessels, restricting blood flow to the legs and feet.
Risk of amputation and heart attack
People experiencing rest pain caused by CLTI who do not get prompt treatment may go on to develop non-healing wounds or ulcers, tissue death and, in severe cases, amputation, Brocklehurst said. Because CLTI stems from peripheral artery disease, he said urgent treatment is needed to avoid related complications, including life-threatening cardiovascular events such as heart attack and stroke.
Citing the Journal of Vascular Surgery, Brocklehurst said 80 percent of patients who present with rest pain may die within 10 years of diagnosis, because severe arterial plaque buildup in the legs is strongly linked to widespread cardiovascular blockages and CLTI complications. He said recognising the symptoms early can be the difference between faster, life-saving surgical intervention and a higher risk of death.
Five symptoms to watch for
Brocklehurst listed the top five symptoms to be aware of: severe burning pain in the feet, hair loss on the feet, a shiny pale appearance on the feet, intense cramping of the legs when walking, and a purple or blue colour on the toes.
He said smoking, alcoholism, sedentary behaviour and a poor diet are among the factors that contribute to serious blood loss in the lower limb, and that staying active, even in older age, can encourage healthier blood flow to the feet and reduce the likelihood of serious vascular complications at a younger age.
A patient in his 70s
Brocklehurst recalled a patient in his 70s who had recently been on holiday and had become confused about intense burning pain in his feet. The man had never had a podiatry appointment before and admitted he had relied on self-care for much of his life.
When Brocklehurst performed an ultrasound scan to test blood flow in the arteries of the man's feet, he noticed swelling on the top of the feet that made it hard to feel the pulses with his fingers, a clear sign that blood flow was impaired. He said there was also no hair on the man's feet and his skin had a slightly shiny, pale appearance.
Brocklehurst said the man's history of smoking for 30 years, excessive weekly alcohol intake and a relatively sedentary lifestyle had contributed significantly to inflammation in his body, including his arteries. Because of the appointment, Brocklehurst referred him to a hospital vascular team for further assessment, gave him smoking cessation advice, recommended an alcohol awareness group and encouraged him to take up regular physical activity.
Treatment options
Brocklehurst said cases too often arise where symptoms have gone on for an extended period before assessment is sought, leading to more serious outcomes. To treat rest pain, he said, the underlying cause, such as CLTI or peripheral artery disease, must be treated.
Treatment may include medications to reduce the risk of blood clots, lower cholesterol and manage conditions such as high blood pressure or diabetes, along with lifestyle changes such as quitting smoking, increased exercise and an improved diet, he said. For people with CLTI or peripheral artery disease, more aggressive treatment is sometimes needed to restore circulation, including minimally invasive procedures such as angioplasty or stenting, or surgical bypass procedures that reroute blood flow around blocked arteries.
Brocklehurst said rest pain can appear to creep up on people suddenly, even though its underlying causes may have been developing for years. He urged anyone uncertain about the type of foot pain they are experiencing, particularly at night, to seek advice from a podiatrist rather than ignore it, saying the earlier help is sought, the more likely a better outcome for the legs and feet.
