BFS has been mainly reported in Asian and Far East countries during a hot summer (1)
most common in those over 50 years; although can occur in any age group
symptoms characterised by a burning sensation, heaviness, numbness, or a dull ache in the feet
burning is usually limited to the soles of the feet but may ascend to involve the dorsum, ankles or lower legs
arms and palms of the hands are spared
sometimes a patient may complain of 'pins and needles' or tingling in the lower extremities
symptoms show worsening at night and a day time improvement
on examination, there is a paucity of objective signs
overlying skin and blood vessels are normal in most - however in some patients there may be accompanying erythema of the feet with warm overlying skin as in erythromelalgia
no local tenderness over the affected parts
neurological examination is essentially normal in most patients; however some may exhibit a varying degree of hypo or hyperaesthesia
knee and ankle jerks show normal to brisk reaction
no signs of upper motor neuron involvement
motor power is maintained - no atrophy or wasting of the overlying muscles
if nutritional deficiency is the cause then most patients develop signs and symptoms of burning feet after approximately 4-5 months of deficient diet
skin manifestations of vitamin deficiency such as scrotal dermatitis or pellagra-like rash can precede the onset of burning sensation in the feet
physical examination may be entirely normal (as in familial BFS)
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