The most important drug classes to review in any burning feet workup: Chemotherapy agents: Taxanes (paclitaxel, docetaxel), platinum compounds (cisplatin, oxaliplatin), and vincristine produce chemotherapy-induced peripheral neuropathy (CIPN) in 3040% of treated patients Fluoroquinolone antibiotics: Ciprofloxacin, levofloxacin FDA black box warning for peripheral neuropathy that may be permanent Metronidazole: Prolonged use associated with peripheral neuropathy Statins: Rare but documented association with peripheral neuropathy in some patients Metformin: Indirectly via B12 depletion (see above) Amiodarone, isoniazid, thalidomide: Additional agents with established neuropathy risk Burning feet symptoms requiring urgent evaluation New or worsening burning feet in a diabetic patient neuropathy progression, needs A1c optimization and ulcer risk assessment Burning feet with systemic symptoms: weight loss, fatigue, night sweats possible malignancy or systemic disease Rapidly progressive bilateral burning with leg weakness Guillain-Barr syndrome or other acute neuropathy, emergency evaluation Burning feet with episodes of red, hot, swollen feet relieved by cold erythromelalgia, needs hematologic workup Burning feet plus balance problems or falls large fiber neuropathy or CNS cause, neurology referral warranted Diagnosis: The Workup We Run Our standard evaluation for burning feet syndrome in the podiatric setting: detailed history (diabetes status, medications, alcohol use, diet, B12 risk factors, symptom distribution and timing)
Updated December 22, 2015
For most people, daily oral methylcobalamin is more practical than chasing B12 energy shots, which are really designed for confirmed deficiency or malabsorption
Frequently asked questions Frequently asked questions about the BPC+TB Blend Vial
When the same provider performs both an evaluation and management service and administers an injection on the same date, the E/M must be appended with Modifier 25 to signal it was a significant, separately identifiable service
