My friend was recently diagnosed with diabetes. He complains that his feet feel very hot from time to time. Is this related to diabetes?

Nompumelelo Cele
Port Elizabeth, Eastern Cape, South Africa

Lee Sanders, DPM, responds: A painfully hot or burning sensation in the feet, especially in middle-aged and older people, could be caused by small fiber neuropathy. Diabetes is the most common cause of this condition; symptoms typically start with burning feet and numb toes. Even though your friend was only recently diagnosed with diabetes, if it is the cause of the burning in his feet, then he has probably had impaired glucose tolerance for years now. Peripheral neuropathy and peripheral vascular disease, which can be caused by diabetes, are potential culprits, and your friend should see his podiatrist or medical doctor for a foot screening.

Though this sensation is not uncommon in people with diabetes, hot or burning feet can have many other causes. Since your friend says his feet feel very hot from time to time, but not all the time, he and his doctor should rule out other causes. A person's occupation and footwear are frequently responsible for hot feet. A postal worker, police officer, or construction worker might experience hot or burning feet because of prolonged periods of standing as well as exposure to hot temperatures on the ground. Playing golf or tennis on a hot day could also cause this sensation. Shoes, especially those that are enclosed or made from synthetic materials, can cause hot and sweaty feet, which in turn can lead to a burning sensation. Socks may also contribute to this condition.

Another common cause of burning feet is athlete's foot fungus. Some less common causes include alcoholism, chronic kidney failure, peripheral arterial disease, tarsal tunnel syndrome, Morton's neuroma, vitamin deficiency, HIV or AIDS, complex regional pain syndrome, and gastric bypass surgery.

Your friend should discuss this concern with his podiatrist, family doctor, or endocrinologist. A change in footwear or treatment of athlete's foot may be all that is required to remedy this ailment. In the meantime, the following recommendations may be helpful:

• Alternate shoes every other day to air them out.
• If weather permits, wear an enclosed protective sandal to allow your feet to breathe. 
• Change your socks often, especially after exercise. Socks made from CoolMax or a blend of polyester fibers are recommended because they more effectively wick sweat away from the feet and cool them down. 
• Wear rubber sandals when using public showers or pools. 
• Use a medicated foot powder to absorb excess moisture and to treat athlete's foot fungus.