What Is Burning Feet Syndrome?

Foot burn syndrome (Erythromelalgia) is a peripheral systolic dysfunction disorder of unknown origin. It is mainly characterized by paroxysmal vasodilation of the distal limb, elevated skin temperature, flushing of the complexion and severe burning-like pain. On both feet.

Foot burn syndrome

This entry lacks an information bar and an overview map . Supplementing related content makes the entry more complete and can be upgraded quickly. Come on!

Foot burn syndrome (Erythromelalgia) is an unexplained tip

In 1878, Mitchell first reported a disease characterized by redness, swelling, heat, and pain on the fingertips, and named it foot burning syndrome. In 1964, Babb et al. Divided this disease into two categories, primary and secondary.

In 1995, Professor Wang Jiaju defined idiopathic erythematous limb pain as a kind of epidemic foot burn syndrome that mainly occurred in southern China.

Foot burn syndrome is a rare vascular dilatation disease of the extremities. The disease most easily invades the distal ends of the limbs, especially the lower extremities, and is characterized by paroxysmal pain, congestion of skin blood vessels, and increased skin temperature.

Its pathogenesis may be due to

Disease name

Foot burn syndrome

English name

erythromelalgia

Alias

Erythematous limb pain; erythema; foot pain syndrome; erythematous limb pain

ICD number: G90.8

Neurology> Diseases of the autonomic nervous system

ICD number: I73.8

Dermatology> Dermatological vascular disease and lymphangiopathy

Cardiovascular Medicine> Peripheral vascular disease

In the past 30 years, in China, Nanjing, Tibet, Guizhou, and Guangdong, Guangdong and other regions, foot burn syndrome has been epidemic in a large number of healthy people. The youngest was 8 years old and the oldest was 52 years old. More common in young adults is a rare disease.

The etiology and pathogenesis of foot burn syndrome have not been clarified. Generally speaking, there are three types:

The etiology of the primary foot burn syndrome is unknown, and may be related to autonomic or vascular nerve central dysfunction, skin allergy to warmth, and an increase in certain heating substances in the blood. Few patients have family factors.

Secondary foot burning syndrome is secondary to certain diseases such as diabetes, polycythemia vera, malignant anemia, gout, mild cellulitis, rheumatoid arthritis, systemic lupus erythematosus, thromboocclusive vasculitis, Carbon monoxide neutralizes carbon poisoning, heart failure, hypertension, etc.

The causative factors of idiopathic foot burning syndrome may not be single, but the result of a combination of many factors. The first is related to sudden changes in temperature and cold stimuli.

Adolescent students frequently develop this disease, which indicates that the autonomic nervous system and endocrine system are unstable during adolescent development, and their ability to adapt to external environmental changes is poor. In addition, whether it is related to certain biological pathogenic factors or nutritional deficiencies has not been determined.

The pathogenesis of primary erythematous limb pain is unclear. Currently thought to be related to autonomic or vasomotor central nervous system dysfunction. However, there is no evidence of pathological basis in the vasomotor system, the central hypothalamus, or ganglia. Some patients have improved their clinical performance after sympathectomy, so Buerger proposed the theory of sympathetic dysfunction.

It is also believed that the burning pain of foot burning syndrome is caused by vasomotor contraction and dysfunction between the dilated arteries and the capillaries or arteries that have contracted. When capillaries encounter obstacles, the anastomotic arteriovenous and venous anastomotic branches, which are rich in receptors, are strongly impacted, resulting in intense burning pain. Vasodilation is not the only cause of this pain. May be related to the skin's hypersensitivity to warmth or the small blood vessels' overreaction to warmth. In recent years, it may be related to the accumulation of serotonin (serotonin and bradykinin) in the blood for some reason.

The pathogenesis of secondary erythema limb pain may be due to the above reasons leading to vascular and nerve dysfunction, causing excessive opening of the anterior capillary short circuit, increasing local skin and arterial blood flow, and causing clinical manifestations of local redness, swelling, pain, and heat .

Foot burn syndrome mainly affects the extremities, with the two feet and two lower legs most common. The main manifestations during the attack are paroxysmal redness of the palms, soles of the feet, or fingers (toes), accompanied by burning pain and elevated skin temperature, which can be temporarily relieved by immersion in cold water.

Often excited by elevated ambient temperature or exercise. When you fall asleep at night, your feet often experience severe pain due to warmth, and when the limbs are cold or elevated, the pain is reduced or relieved. Seizures are paroxysmal and can last for minutes or hours, or even days.

Foot burn syndrome can last for many years. Primary cases are common in young people, and they occur symmetrically on both sides. The lesions mainly involve the hands and feet, especially the two feet. Secondary cases are common in middle-aged people, with unilateral onset, even involving only one finger or toe, will not be relieved by cooling, and often develop into ischemic gangrene, with their primary disease manifestations.

Complications of foot burn syndrome

There are no serious complications of foot burn syndrome.

According to the clinical manifestations of foot burning syndrome, it can be classified into the categories of "biosis", "foot pain" and "hand and foot pain" in traditional Chinese medicine, especially similar to "Bleeding Acupuncture. As early as in" The Yellow Emperor's Canon ", there is" blood "Bi". "Su Wen · Zang Zeng Sheng Pian" cloud: "When lying down and the wind blows, blood clots on the skin is bi. It points out that the etiology and pathogenesis of this disease are related to Zhengxue evil attack and cold coagulation meridians. "Shengji Records" recorded in the Song Dynasty "Saijie pain or day and night onset, pain through the bone marrow, said that the festival also has the solar term. "It is also quite similar to this disease. The" Pujifang "of the Ming Dynasty has a deeper discussion of the disease name and cause of the disease. By the Qing Dynasty, there were more detailed records of the symptoms of the disease. "The Secret Record" reads: "A woman's feet have ten fingers, such as those who are hot, this is caused by Yingwei's qi deficiency, and a stream of damp poisoning injected into the meridians, ... the feet hurt when they attack the foot, and their feet are burnt. "" Encyclopedia of Medical Treatment of the Stomach "said:" Human feet are as red as fire. "And proposed treatment with Quhuo Decoction. The above discussion shows that ancient doctors have a certain understanding of this disease.

Articles on the treatment of foot burn syndrome by modern Chinese medicine first appeared in 1955. During the 1950s and 1960s, there were few clinical reports, and acupuncture was the main treatment, and more meridian points of the Foot Shaoyin Kidney Meridian and Foot Jue Yin Liver Meridian were taken. In the 1970s, treatments such as pricking and auricular electroacupuncture appeared successively, with good results. After the 1980s, on the basis of affirmative effects of acupuncture treatment for this disease, there have been more reports of syndrome differentiation and special treatments, and the understanding of the etiology and pathogenesis has gradually deepened. Most of the medicines taken are selected according to the evidence and Liangxue Sanyu. , Qingre Lishi, detoxification and Tongluo analgesic products, to achieve a certain clinical effect. From the analysis of existing data, whether it is treated with Chinese medicine or acupuncture, its effective rate is above 90%.

Regarding the study of the mechanism of TCM treatment of this disease, in recent years, through observation of microcirculation, it has been found that the blood flow pattern, number of tubes, clarity, and blood flow velocity of patients after treatment are significantly different from those before treatment, thus correcting the microcirculation. Obstacles are key to improving efficacy. Some doctors believe that the ear electricity is effective for this disease because the auricles are rich in sensation and sensitive to pain. When local electrical stimulation is introduced into the center, it can play a role in calming, sleeping, and protecting the brain, thereby adjusting the autonomic nerve. Central to improve autonomic nerve function. At present, there are still problems such as the small number of clinical observation samples and the lack of the establishment of a control group. The mechanism research needs to be further strengthened to further improve the clinical efficacy of traditional Chinese medicine in treating this disease.

Etiology and pathogenesis of foot burn syndrome

The cause of this disease is unknown. May be related to dysfunction of capillaries due to cold. Due to the dilation of the acral arteries, the blood flow is significantly increased, the local congestion is increased, the intravascular tension is increased, and the arteries and adjacent nerve endings are compressed or stimulated before severe pain occurs. Often caused by cold or long-distance marches due to sudden temperature drops.

Traditional Chinese medicine's understanding of the etiology and pathogenesis of foot burn syndrome is mostly scattered in various clinical treatises. The ancient and modern doctors' understanding has basically become the same, which can be summarized as follows:

The element body is full of yang (or yin deficiency), and the cold caused by cold and evil is in the body veins, the heat is cold, the cold from the heat, the evil heat enters the blood, the heat gathers, the veins are blocked, and the blood and blood are not running smoothly Causes burning pain.

The body has spleen deficiency and dampness, and re-feeling evil heat, so that the contents of dampness and heat flow into the meridians, block qi and blood, and cause pain if it fails.

For a long time, the body is weak, the reason is empty, or the external evils attack the skin, or the emotions are unsuccessful, the Qi is not smooth, and the cold feeling is regained.

Syndrome classification of foot burn syndrome

Based on the ancient and modern doctors' experience in syndrome differentiation, they can be divided into the following three types:

Limb pain recurs repeatedly, at night, the skin is flushed, the hands are burned, the pain is not close, the pain is reduced when it is cold, the disease is more acute, and the stool is dry, the urine is short, and the mouth is dry. Red tongue, yellow fur, and number of pulse strings.

Paroxysmal burning pain at the extremities of the extremities, pain, redness, soreness in the cold, exacerbation of heat, and numbness in the limbs, fatigue, heavyness, irritability, dry mouth, dizziness, chest tightness, fatigue , Then . The tongue is reddish, the fur is yellow or greasy, the number of pulse strings or slippery.

Extremity pain is unbearable, sometimes painful and ceases, fever decreases, drama in cold, emotional depression, irritability. The tongue is purple or dark with petechiae, or see the blue tongue under the tongue, the pulse string is astringent.

Clinical manifestations of foot burn syndrome

Foot burn syndrome is more common in young adults between the ages of 20 and 40, with more men than women. The onset can be acute or slow, involving both limbs at the same time, more common with both feet. It manifests as redness on the toes, soles, fingers and palms, increased arterial pulsation, increased skin temperature, and unbearable burning pain. Attacks or exacerbations occur at night, usually for several hours. Heat, elevated ambient temperature, exercise, standing, foot drop, or touching the affected limb can all lead to clinical attacks or exacerbation of symptoms; rest in rest, raise the affected limb, expose the affected limb to cold air or soak in cold water Can reduce or relieve pain. The patient was reluctant to wear shoes, socks and put his limbs in the quilt, fearing a doctor's examination. There may be objective sensation loss in the extremities, thickened fingernails and muscular atrophy, but few extremity ulcers and gangrene. Symptoms of a long course and / or severe illness are not limited to the extremities, but can extend to the entire lower limb and involve the upper limb.

Differential diagnosis of foot burn syndrome

Under certain incentives, paroxysmal redness, swelling, heat, and pain can be diagnosed frequently. However, it must be distinguished from frostbite, occlusive vasculitis, polycythemia vera, Raynaud's phenomenon, diabetic neuropathy, spinal ridge, and toxic peripheral neuritis.

Prognosis of foot burn syndrome

Foot burn syndrome often has remission, recurrence, and can have a chronic course. Most have a good prognosis and can recover naturally.

Foot Burn Syndrome Treatment

In cold seasons, keep warm at the extremities and keep your shoes and socks dry; when you are driving, standing, sentry, or walking for a long time, you should change your posture in time and get off the vehicle regularly to prevent or reduce outbreaks or reduce symptoms. Symptomatic treatment is the main treatment. Local cold compresses or cold water immersion can be given during the attack to reduce symptoms. Elevating the affected limbs, avoiding overheating or touching, and other bad stimuli. Oral reserpine, chlorpromazine, and rifampicin may improve symptoms. . Intra-sacral nerve block and lumbar sympathetic nerve block have better effects.

Treatment: Qingrejiedu, cooling blood and removing blood stasis.

Prescription: 15 grams of honeysuckle, 9 grams of scutellaria baicalensis, 12 grams of forsythia, 12 grams of gui wei, 12 grams of black ginseng, 12 grams of powdered tan bark, 12 grams of red peony, 15 grams of habitat.

Usage: 1 dose daily, decoction, take 2 times.

Common recipes: Rhizoma Dihuang Decoction, Simiao Yongan Decoction.

Treatment: clearing away dampness and heat, removing blood stasis and clearing collaterals.

Prescription: 12 grams of scutellaria baicalensis, 9 grams of scutellaria baicalensis, 15 grams of scallion, 12 grams of forsythia, 12 grams of coix seed, 12 grams of red scallion, 15 grams of guiwei, 12 grams of Lulutong, 9 grams of weilingxian, Dilong 9 grams, Qin Wei 12 grams.

Usage: 1 dose daily, decoction, take 2 times.

Common formulas: Simiao Wan, Samiao Wan, Eriao Wan.

Treatment: Xinghuoxue, Huayu Tongluo.

Prescription: 15 grams of angelica tail, 12 grams of habitat, 12 grams of chuanxiong, 15 grams of red scallion, 12 grams of incense sticks, 12 grams of woody incense, 15 grams of turmeric, 9 grams of safflower, 6 grams of peach kernel, 9 grams of groundworm Leave 9 grams, 12 grams on the road.

Usage: 1 dose daily, decoction, take 2 times.

Common recipe: Taohong Siwu Soup.

Addition and subtraction: Any of the above types, those who have blood deficiency, plus Shouwu, cooked land, chicken blood rattan; those who have Qi deficiency, add Atractylodes, Codonopsis, Astragalus, and Huangjing; those who have dry mouth and lack of Jin, Gaza ginseng, Dendrobium ; Those who have constipation or dry stools, increase yellow and senna leaves; Those who have poor appetite, add turmeric, Divine Comedy, Hawthorn; People who have insomnia, palpitations, dreams, irritability, Jiabaiziren, Jujube Ren, Polygala; those with severe upper limb pain, add turmeric, sea wind rattan, mulberry; those with severe lower limb pain, add Achyranthes bidentata, papaya, eucommia; severe pain in the extremities can be added with painkillers, consisting of 12 grams of angelica, 9 grams of salvia miltiorrhiza , 6 grams of raw frankincense, 6 grams of raw myrrh, 9 grams of golden bell, 6 grams of xuanhu. Participate in the research, divided into four equal parts. Take 1 serving every 6 hours.

Efficacy: According to the above classification and prescription, a total of 47 cases of this disease were treated, 41 cases were cured, 3 cases were improved, and 3 cases were ineffective. The total effective rate was 93.6%.

Composition: Frankincense, myrrh, peach kernel, safflower, angelica, astragalus, silver flower, red peony, cork, black ginseng, salvia miltiorrhiza.

Usage: add 1000 ml of water to the medicine, fry 400 ml, filter; add 500 ml of water, fry to 200 ml, filter; third fry add 500 ml of water, fry to 200 ml, filter. Mix the three decoction together, mix well, and take three times. Children under 10 are halved.

Efficacy: A total of 33 patients were treated with the above method, 27 cases were cured, 6 cases improved, and the total effective rate was 100%.

Composition: buffalo horns (fried first), 30 grams each of habitat, 20 grams of ground elm, 12 grams of red scallion, white grass root, and fusca, 6 grams of licorice.

Addition and subtraction: wet weight plus coix seed; heat weight plus honeysuckle; tongue ecchymosis plus salvia miltiorrhiza.

Usage: 2 doses daily, each decoction 2 times, mix well, take 4 times orally, once every 6 hours.

Efficacy: A total of 17 cases were treated with the upper part, 14 cases were cured, 2 cases were improved, and 1 case was ineffective. The total effective rate was 94.1%.

Composition: 10 grams of Cangzhu, 6 grams of Cork, 6 grams of Achyranthes bidentata, 12 grams of Fangji, 10 grams of Amaranth.

Usage: 1 dose daily, decoction, take 2 times.

Efficacy: A total of 176 patients were treated with the above method, 163 cases were cured, 13 cases were ineffective, and the total effective rate was 92.6%.

Composition: 20 grams of cork, 30 grams of coix seed, 20 grams of Atractylodes macrocephala, 12 grams of diarrhea, 15 grams of Sichuan achyranthes bidentata, 12 grams of Zhimu, 30 grams of white peony, 10 grams of licorice. Usage: 1 dose daily, decoction 3 times, take 3 times decoction and mix well, take 3 times.

Efficacy: A total of 10 patients were treated with the upper part, and the results were all cured, and the total effective rate was 100%.

Composition: 30 grams each of silver flower, red scallion, and black ginseng, 15 grams each of angelica, achyranthes, cork, big green leaf, and purple sage, 10 grams each of licorice and mangosteen. Usage: After the decoction is left to cool, wash and soak the affected limbs for 30 minutes, 2 to 4 times a day. During the treatment, you should rest adequately, raise the affected limbs slightly, and eat lightly.

Efficacy: 9 cases were treated with the above method, 7 cases were cured, and 2 cases were improved. The total effective rate was 100%.

Composition: 10 g of raw land, 9 g of salvia, 10 g of dioscorea, 3 g of asarum, 15 g of angelica, 10 g of Achyranthes bidentata, 9 g of scutellaria baicalensis, 9 g of Yanhusuo, 15 g of white peony, 9 g of licorice, 9 g of jujube .

Usage: 1 dose daily, decoction, take 2 times.

Efficacy: A total of 10 cases were treated with the upper part, all of them were cured, and the total effective rate was 100%.

Xu Luhe Medical Case

Chen ××, male, 11 years old. First diagnosis: For 6 years, symmetry pain in both hands and feet occurs every summer. The pain is like burning, large erythema and blisters on the skin. He has been seen in a local and Nanjing hospital and diagnosed with foot burn syndrome. After treatment with various methods, it can not be controlled. Common cold water immersion is used to reduce the pain. After half a day, the redness and swelling subside. After another 5 days of this onset, his hands and feet burned like scorching pains. He came to our hospital for medical treatment. His hands and feet were immersed in a cold water basin for examination. The skin of both hands and feet was faintly red. The pulse strings are slippery, the tongue root is pale yellow and slightly greasy, and the dorsal foot artery beats well. First take 3 doses of heat-clearing and cooling-blood medicine, the burning pain in both hands is reduced, but the two feet still have severe pain, soak in cold water. The pulse is slippery and the tip of the tongue is red. It is planned to rule internally and externally.

Prescription: 15 grams of black ginseng, 30 grams of honeysuckle vine, 10 grams of angelica, 30 grams of safflower diced, 4.5 grams of raw licorice, 12 grams of white peony, 9 grams of powdered tannin, 12 grams of raw land 2 agents.

Washing formula: 12 grams each of hot milk, 9 grams of safflower, 15 grams of comfrey. 2 agents. After the medicine, hand and foot burning pain was greatly reduced. Cold water immersion was no longer needed. The large area of purple erythema on the forearm of both hands had obviously faded. Oral administration of the original prescription plus 10 grams of forsythia, topical prescription as above, for a total of 10 days of treatment, extremity red pain relief.

Note: The patient's extremities are red and painful, and he is cold and hot, and must be soaked with cold water. The pain is reduced. This is evidence of hot pain. Thirst in the mouth, red tongue and yellow fur are hot images, so the method of clearing up, adding and subtracting the four wonderful Yongan decoction, the medicine and the medicine are combined, and the cure works.

Summarize the medication situation of the 8 literatures with a curative effect of more than 90% and more than 10 cases, with nearly 60 flavors shared.

Frequency of application (example) Literature reported (article) Drug 200 5 200 70 3 4 <70 40 2 <40

According to the table above, there are nearly 20 flavors of commonly used and more commonly used drugs. With cooling blood and activating blood, the most frequent use of heat-clearing and detoxifying agents is red peony, angelica, Sichuan achyranthes bidentata, peach kernel, atractylodes, cork and so on. Yangyintongluo analgesic drugs are also more commonly used, such as raw land, black ginseng, frankincense, myrrh, white peony and so on. In addition, warm menstruation and analgesia, bitter cold and purging fire medicine also account for a certain proportion, and the use of tonic drugs is very little. Tips: Foot burn syndrome is often clinically based on clearing dampness and heat, expelling heat and poisoning, and promoting blood circulation and collaterals. The medication has certain rules to follow.

Acupoints: Main points: Sanyinjiao, Taixi, Taichong, Kunlun. Acupoints: Fuluo, Inner Court, Interline, Jiexi, Qiuxu, Zhongfeng, Xiaxi. The lesions were on the feet, such as Kunlun, Jiexi, Jianxing, Fuliu, Zusanli, Yinlingquan, Taichong, etc .; the lesions were on the upper limbs, such as Quchi, Waiguan, Hegu, Neiguan, and applied alternately.

Operation: Select the main acupoints 2 to 3 at a time, and add acupoints when the effect is not obvious. Laxative method is generally used. Those with a strong constitution should insert and twist after inserting the needle until the needle feels stronger and then exit the needle. The weaker can use the method of flattening and reducing diarrhea, leaving the needle for 15 minutes. At the same time, burning the moxa roll on the needle handle is as big as the thumb, and the warm needle method is usually used once every other day. Those with severe symptoms can be treated once a day, 7 days as a course of treatment, and 3 days of rest, followed by a second course of treatment.

Efficacy: A total of 24 cases of this disease were treated by the above method, all of them were cured, and the total effective rate was 100%.

Acupoint selection: a. Sympathetic (double), Shenmen (double). b. Heart (double), subcortical (double). c. Heart (double), Shenmen (double).

Operation: Select one group at a time, which can be used alternately. After acupuncture the auricular point of acupuncture, a pulse current stimulation is applied at a frequency of 500 to 600 times / minute, and then adjusted to a level that the patient can tolerate. Each treatment is 30 to 40 minutes, 1 or 2 times a day, and can be increased once before going to bed as appropriate.

Efficacy: 16 cases of this disease were treated by the above method, and all of them were cured. Except for 2 cases with more treatments, the remaining 14 cases were cured on average 16 times. Ten patients were followed up, and no recurrence occurred in 2-10 years.

Acupoints: a. Upper limbs: C6 T3 Jiaji points, Quchi, Waiguan; lower limbs: L1 L5 Jiaji points, Zhibian, Yanglingquan; b. Upper limbs: Eight evils or upper eight evils; Lower limbs: eight Wind or eight winds.

Upper Eight Evil Position: The depression between the back edge of the palm joint 1 to 5 of the hand.

Eight wind position: the back of the foot 1-5 toe metatarsal joint, between the two metatarsals.

Operation: The first group of acupuncture, select acupuncture points according to the lesion site, take 1 to 2 points each time, and use alternately. Use 28 # 1.5 to 2 inch milliseconds needles, twist and diarrhea, and then move the needles for 3 to 5 minutes, then move the needles every 5 minutes, and leave the needles for 15 to 20 minutes. When acupuncture C6 T3 Jiaji points, the straight puncture is slightly inward, and the needle is inserted 0.7 1 inch, and L1 L5 Jiaji points are inserted 1 1.2 inch. The acupuncture points of the limbs are radiated toward the affected toe (finger). The above points are used alternately, taking 1-2 points each time, once a day, 10 times as a course of treatment. The second group is dialing: it is advisable to take 1 point at a time. After routine disinfection, use a three-pointed needle to puncture, and then pull out the cupping cup to absorb 5 to 10 milliliters of blood as the degree. Postoperative treatment is performed as usual, once every other day (or every other day), and 5 times is a course of treatment. The stabbings were performed at the same time.

Efficacy: A total of 8 cases were treated with the above method, 5 cases were cured, 2 cases were improved, and 1 case was ineffective. The total effective rate was 87.5%.

Point selection: Main point: Jiexi, Zusanli. Acupoints: Hegu, Kunlun.

Operation: Take a 5 ml syringe with a 20-gauge needle, and take 0.5 2 ml of compound vitamin B injection into the selected acupoints, 1 to 4 points each time, the total dose should not exceed 2 ml, once a day, 4 times as a course of treatment.

Efficacy: The above method was used to treat 18 cases of this disease, 8 cases were cured, 8 cases were significantly improved, and 2 cases were ineffective. The total effective rate was 88.9%.

Avoid heat, cold compresses during the attack, and eliminate all factors that cause vasodilation.

When the pain is severe, analgesic drugs can be used to temporarily relieve the pain.

Sympathetic ganglion closure is performed for patients with insignificant curative effects and can also be used for sympathetic ganglion resection.