Q: I am a 64 years old man with burning sensation in my feet for a long time. I came to know that burning feet syndrome could be treated with calcium pantothenate and vitamin B12 and B6. So, I took multivitamin tablets for some time and found no change. Then I consulted a doctor along with my back pain problem. After an MRI of the spine and blood tests done for calcium and phosphorous, he prescribed Tegretol but in vain. After taking this for 4 months, he asked me to use soft-soled slippers and to stop medication. Then I started self-medication and took calcium pentothenate along with B-complex containing higher percent of B-12 and B-6 for 5 months but again in vain. I consulted another doctor who prescribed Mecobalamine for 4 months and but I did not find any significant improvement. My feet become extremely cold in winters and warm in summers. So, I consulted a neurologist to know whether demyelination of peripheral fibres was taking place but he rules it out. Please suggest what I should do next. Incidentally my muscle tone appears to be poor and even little pressure is intolerable.

A:Unexplained burning feet syndrome is a difficult condition for doctors to diagnose and treat and an intolerable state for patients to bear. In fact, I don't know any physician whose heart doesn't sink when a patient presents with this complaint. You seem to be a knowledgeable person and have already sought appropriate advice. Presumably, the first doctor you saw has excluded diabetes mellitus by checking your fasting blood sugar or, better still, by carrying out a glucose tolerance test. This should be done if it hasn't been done already. You have also seen a neurologist and he would have considered and excluded peripheral neuritis. On the positive side is the fact that you have had this condition for about ten years and it has not deteriorated and no serious underlying condition has emerged. It is unlikely to be a serious, life-threatening disease and it comes down to living with it and controlling the symptoms with some treatment. Incidentally, tegratol is not a bad treatment and has been tried in this condition. Some physicians try one of the tricyclic antidepressants, such as amitriptyline 25 mg two or three times a day, with good effect. You could discuss it with your doctor and see if he would be agreeable trying this line of treatment. Using soft slippers or and warm, fleecy socks is not bad advice either.