Erythromelalgia in the foot is one of those conditions that seems to fly under the radar until it happens to you – and then it can’t be ignored.
The sensation is like having your feet suddenly start to burn, throb, and turn bright red, with the skin feeling almost unbearably hot.
For sufferers, pain can become a part of the whole experience of just moving around on the bottom of their feet – every step, every step in shoes, and every shift of weight can bring pain.
This article will cover the specifics of what erythromelalgia does in the foot, explain some of the common causes, give tips on managing the symptoms, and talk about some of the things you can do if you experience this.
Understanding what the problems are is the first step in finding realistic ways to live with them.
Understanding Erythromelalgia in the Foot Causes
‘Erythromelalgia’ derives from Greek words—erythros meaning red, melos meaning limb, and algos meaning pain.
The simple translation is ‘pain in a red limb,’ which could hardly be more on-the-nose.
The basics of what kind of blood flow dysfunction this is
The core symptom of erythromelalgia in the foot, which involves burning pain, redness and warmth, occurs due to problems with blood flow regulation in small blood vessels close to the skin.
The body’s natural way to regulate temperature relies on blood vessels narrowing and dilating as needed in response to changing heat levels.
This process gets all mixed up in erythromelalgia.
Instead of keeping the blood vessels’ diameter in a steady range, they randomly dilate in response to certain triggers, like increased temperature or activity.
This causes excess blood to rush into the skin of the foot and makes the skin flush bright red, feel burning hot, and sometimes actually raise in temperature.
In addition to the redness and warmth, certain other symptoms arise: mild to severe burning pain, this can become quite intense, can be stinging or aching, and certain severity of the episodes can cause swelling of the foot and ankle.
The pain can seem as if you were standing on hot stones and can get worse with anything that increase blood flow to the foot—like walking on a hot day or hot drinks.
How the primary form differs from the secondary form of erythromelalgia
For the most part, whether or not an underlying cause is identified makes a huge difference in care for erythromelalgia.
If an underlying disorder causes the erythromelalgia (secondary case), treatment of the second condition can, in some cases, decrease or even eliminate the painful episodes.
The primary form will likely require different medications, since there isn’t a specific rheumatologic or oncological target.
While individual symptoms can vary, a good history and work up can usually tell you if an underlying cause is evident, which makes a big difference in how it is best managed.
Identifying Erythromelalgia in the Foot Symptoms
The symptoms, understandably, are unique in every case.
Sometimes symptoms will come and go very quickly, or in recurrent flares, but sometimes they hang around comfortably for hours.
The worst part is not knowing when they’ll occur or how long they will last.
Classic symptoms include a triad of burning pain, redness, and warmth spreading across an area of the foot, often the sole or the top.
The skin may look blotchy, be transformed into a bright shade of red, or have a “milkiness” to the hue, and the pain can be described as similar to standing on hot embers or having a cast iron frying pan resting on the foot.
In severe episodes, the swelling can be quite notable.
An additional symptom seen occasionally is allodynia, a heightened sensitivity to touch.
The symptoms can have numerous triggers.
Heat is a very consistent trigger, whether from hot weather, hot foods and drinks, socks made of non-breathable fabrics, or walking on hot sand.
Exercise is a frequent cause due to the heat produced by contracting muscles.
Prolonged elevation of the feet to above heart level can help symptoms decrease.
Increased circulation and increased body temperature contribute, conversely, to its triggers. Cold, on the other hand, gets rid of symptoms a little too well.
Using cold water to soak feet is often efficacious, though it’s important not to make this too much of a habit—excessive cold water exposure can have negative effects on skin even while bringing relief.
Treatment Options and Management Strategies
You can try a variety of medications, and lifestyle changes to actively manage symptoms.
The approach to treatment depends on whether the source of the erythromelalgia is primary or secondary.
If there is an identified underlying condition (despite the name, this may not just be due to a genetic mutation), then that condition can be managed or quelled and sometimes that gets rid of the erythromelalgia altogether.
In cases of primary erythromelalgia, finding the right combination of medications takes work and patience.
In some instances, Aspirin can make a tremendous difference, especially for patients whose erythromelalgia relates to increased platelet activity in the blood.
Some in select case studies have experienced relief with sodium channel blockers such as mexiletine.
Capsaicin cream, also used in neuropathy cases, can numb the local nerves and reduce pain during an episode.
Tricyclic antidepressants and anticonvulsants are also sometimes successfully implemented.
Most importantly, lifestyle modifications can significantly influence the severity, if not the frequency, of episodes.
Refining footwear to be lightweight, wear cotton or other breathable fabrics, avoid heat sources in the bathroom, find a comfortable sleeping room temperature, and allocate cooling fans during rest, all can take the edge off the episodes.
Job modifications may also be necessary: for instance, sitting with feet up as often as possible, not walking barefoot, avoiding long-distance travel, and wearing shoes with adequate room for the toes to breathe will become more critical.
Keeping notes on days and times where symptoms flare can help both patients and physicians treat it more effectively.
Social groups of erythromelalgia sufferers can prove very helpful for all involved.
This condition can be very frustrating to deal with on a day-to-day basis, but the more you understand about the triggers that aggravate it and the things you can do to avoid them, the better you are equipped to live with it.
If you think you have it, get checked out – because the quicker you get the right remedy, the sooner quality of life can change. You don’t have to suffer the burn.