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Pain radiating up into the leg, [1] behind the shin, and down into the arch, heel, and toes; Hot and cold sensations in the feet; A feeling as though the feet do not have enough padding; Pain while operating automobiles; Pain along the posterior tibial nerve path; Burning sensation on the bottom of foot that radiates upward reaching the knee
When toes are squeezed together too often and for too long, the nerve that runs between the toes can swell and get thicker. This swelling can make it painful when walking on that foot. High-heeled, tight, or narrow shoes can make pain worse. This is common in runners, particularly of long distance.
The first reported case was in 1878 by Silas Weir Mitchell who suggested the term erythromelalgia to describe a syndrome of red congestion and burning pain in the hands and feet. [49] [50] Silas Weir Mitchell. He distinguished it from the painful red limbs seen in some patients with gout or rheumatoid arthritis. [49]
The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toe boxes and high heels (which have been linked to the condition). [3] [4] The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher. [5] [6]
Typically the fingers, and, less commonly, the toes, are involved. [1] Rarely, the nose, ears, nipples, or lips are affected. [1] The episodes classically result in the affected part turning white and then blue. [2] Often, numbness or pain occurs. [2] As blood flow returns, the area turns red and burns. [2]
The second and third metatarsals are fixed while walking, thus these metatarsals are common sites of injury. The fifth metatarsal may be fractured if the foot is oversupinated during locomotion. [9] Protection from injuries can be given by the use of safety footwear which can use built-in or removable metatarsal guards.
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Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis. The problem can also arise in patients after bone marrow transplants , as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first three weeks) graft-versus-host disease .
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