ASK THE DOCTOR: Why does my foot feel like it’s burning?

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I have a burning pain in the sole of my foot near my toes — it’s as if a lighted match is being applied. I am a 75-year-old male. I walk six miles per week, swim once a week and keep in reasonably good health. My GP has no idea what is causing this problem. Can you help?

William Thorburn, Wishaw, North Lanarkshire.

Pain around the ball of your foot is known as metatarsalgia, and it most commonly occurs between the top of the second and third metatarsals

This problem is not unusual, although it is often also associated with lightning or stabbing pains in one toe, usually the second or third (counting the big toe as the first).

The area where you feel the burning sensation is in the ball of the foot — medically referred to as the forefoot — under the top or heads of the metatarsal bones, the five long bones in the feet that connect to the toe bones.

This pain is known as metatarsalgia, and it most commonly occurs between the top of the second and third metatarsals.

Typically, it feels like you’re stepping on a stone and walking barefoot often makes the pain worse. It is relieved by taking the weight off your feet by sitting or lying down. When the pain feels like burning, or there is numbness in one or two toes, this suggests the problem is a neuroma that’s formed on one of the nerves supplying the toes.

Morton’s neuroma, to give it its technical name, is where the nerve becomes squeezed in the gap between the bones, causing a swelling or thickening of the nerve. It’s probably the result of a lifetime of repeated pressure (wearing tight shoes, for instance).

Diagnosis can be confirmed using ultrasound scanning, although some specialists prefer to use magnetic resonance imaging (MRI).

Treatment involves reducing the pressure on the metatarsal heads by using a padded insert in the shoes, such as a metatarsal pad or bar — these can be bought from a chemist.

These are placed under the ball of the foot and work by spreading the metatarsal heads apart and relieving the pressure so that the bruised and inflamed tissues get a chance to heal.

Usually the pain is relieved within days, and the inserts can then be used for a few months in the hope that the problem will resolve completely.

If it does not go away, an injection of steroids and local anaesthetic can be given into the area from above (through the sole of the foot would be far more painful). This is performed under the guidance of a simultaneous ultrasound to ensure the medication is in the correct place. If this doesn’t help, sometimes patients need to undergo surgical removal of the neuroma.

I hope this assessment is correct and that your GP, or perhaps a podiatrist or chiropodist, can steer you in the right direction to obtain a metatarsal pad or bar. Wear them in both shoes, so you don’t feel lopsided.

I have been on statins for a year — I take one 5mg Rosuvastatin pill daily. I’ve never had any heart problems as such, and my cholesterol is 5.8.

My GP prescribed statins because my father and his brother died young of undiagnosed conditions — my father was 33. I understand my doctor’s precautionary prescription, but would like to stop taking statins eventually, especially given the scare stories about their side-effects.

If I lost weight and brought down my cholesterol with diet and exercise, would you advise stopping the statins? I am 41, 5ft 6in tall and weigh 11st 11lb (75kg).

The main risk factors for narrowed arteries are family history, high cholesterol, smoking, high blood pressure, obesity and a sedentary lifestyle

Joseph Briffa, Malta, by email.

The early deaths of your father and uncle are alarming, and I understand the caution of your GP in doing the one thing he judges may protect your heart — the assumption being that your father probably died of coronary heart disease due to a build-up of plaque in his coronary arteries.

But in my view this does not necessarily follow. Primary prevention, which is what your doctor has implemented, means taking a healthy individual’s risk factors into account and attempting to modify those in order to prevent future disease.

The main risk factors for narrowed arteries, which can lead to coronary artery disease or brain damage from a stroke, are family history, high cholesterol, smoking, high blood pressure, obesity and a sedentary lifestyle. In your case, everything pivots on your worrying history, and your minimally raised cholesterol level (for healthy adults it should not exceed 5).

The theory is that for every percentage point that ‘bad’ cholesterol (known as low density lipoprotein or LDL) is lowered, there would be a 1 per cent reduction in risk of heart attacks.

Rosuvastatin is the most potent statin available. In a vast study where half the people enrolled took a placebo and half took the statin, the researchers found that there was a 4 per cent chance of heart attack or stroke in the placebo group and a 2 per cent incidence in the group taking the actual drug — so a significant advantage.

But is taking a drug for life to help two out of every 100 worthwhile, especially bearing in mind the fact that there is the unexpected danger of triggering diabetes in one in 200 users, not to mention the various side-effects, such as muscle and joint pain (although the evidence for these is debatable)?

Primary prevention is a little like obsessing about the tread depth on your car tyres as a way of preventing car accidents when there is a multiplicity of other factors — such as speeding, fog, ice, drink-drivers — involved in death on the roads.

Having said that, for secondary prevention — where someone has already had a heart attack or stroke — there is no debate that giving statins will save lives. In such patients we aim to lower their LDL cholesterol reading to 2 or lower, as there is proof that this can cause the plaques to shrivel.

My advice is to do nothing without careful discussion with your doctor. Take aerobic exercise on most days, lose a little weight, and try to steer towards a diet that’s more vegetarian than carnivore, also making sure your blood pressure is in the normal range.

And ask your doctor to screen your heart in detail. For unless your father was a heavy smoker, overweight, and perhaps diabetic, he is unlikely to have had coronary heart disease at the age of 33, despite the suggestion otherwise.

A sudden death such as his could well have been due to a problem with the heart itself. There are conditions that can cause abnormalities of the heart rhythm, such as cardiomyopathy or Long QT syndrome, which are hereditary.

Such conditions have no connection with plaque. You should have some heart screening, certainly an electrocardiogram (ECG), which checks the heart’s electrical activity, maybe an exercise treadmill ECG, and possibly an echocardiogram, an ultrasound scan of the heart, as minimum investigations in order to see if you are at risk.

By the way ... The REAL reason for the GP shortage 

Too few newly-trained doctors want to be GPs and that’s causing something of a panic.

The Government has pledged there will be 5,000 more GPs by the end of this Parliament and yet currently we’re not even providing enough to replace those who are about to retire, so great are the numbers leaving the service early on account of disillusionment.

Goodwill has been the oil on the wheels of general practice from time immemorial, but it appears that this invisible yet precious asset is now running out.

The fact is the joy and reward of GP work is being destroyed by frustration over endless changes, ever-increasing red tape — thanks to the cumbersome and incompetent Care Quality Commission — and other endless pressures.

All this detracts from what the job is about: taking care of sick patients. When I entered medical school, we were told that 50 per cent of us would eventually choose to become GPs, rather than consultants, as we imagined. Few of us really believed such propaganda, but as we approached graduation five years on, wiser and more experienced, more and more of us decided to train for family medicine.

Back then there were 50 or 60 competitors for every job, so great was the popularity of posts — despite the prospect of house calls, nights and weekends on duty, and that sense of being bottom of the pile again as the third or fourth partner in a group of senior GPs.

Why is it that now that fewer and fewer graduates are training for general practice?

It’s been suggested the problem is too few hours are given to GP training during university years.

In fact, in my day we had only a two to four-week attachment to a general practice and yet when the time came, we still fought tooth and nail for a job. We also had only one two-hour session of training in medical ethics.

My point is that it’s the culture in doctor training that influences medical students’ attitudes to becoming a GP, or to what constitutes professional and ethical behaviour.

More GP training for undergraduates is likely to put off young doctors from choosing it as their career. It’s not lack of exposure during undergraduate training, it’s the widely known destruction of the satisfaction of being a family doctor that’s the problem.

If those at the top don’t get the message, the way ahead is threatened by further erosion of a treasure of the NHS — primary care.

And the solution will only be more care via call centres with half-trained staff reading from lists of questions with the occasional supplementation of doctors, of some sort, drafted in from other cultures. Is that what we want?