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Red blotchy warm feet

Jemima37

Senior Member
Messages
407
Location
UK
Does anyone else get this with CFS? POTS?

For 2 years now I’ve had this. It started during a very bad time in my life. I was having 12 hour panic attacks daily for 9 months. One evening my feet flared hot as I walked about, they went all red and blotchy over the toes and top of the door. I thought nothing of it as I’d been lying down for hours in a panic attack so assumed due to that. I thought it would be a one off but this continues every night and has since. I spoke to my GP about it and showed her photos and she was baffled. I was worried it was neuropathy but I get no numbness and 2 years on they aren’t numb. Between these flare ups my feet are fine.

It starts like a warm rushing of blood feeling in my toes so I know before I stand it’ll flare once I’m walking about. Then once I lie down again, within a minute or 2 they’ve cooled down and the blotchy red rash has vanished too. It was just an evening thing but now I get it during the day at times. I can’t really paint point a trigger as it happens if I’ve rest a lot, happens if I’ve been too active. Some days it’s mild and flares just once just before bed as I brush my teeth, other times it happens in the daytime while I am cleaning or just walking around.

It always worries me it’s related to my heart or something. My gp says it won’t be that as I’ve no symptoms of heart issues. I still worry as I’ve not had a physical exam or recent blood tests due to my issues with appointments that I’ve discussed here.


My GP thinks I have pots after we spoke recently. I’m doubting this is a pots symptom though as it’s every night, never a day without it, sometimes it flares once in the evening, sometimes twice and once in the day. It only flares when I walk about or I may feel the flushing and rushing of blood in my feet before i stand up. Surely red feet aren’t a pots symptom? She thinks I have it as I get strong symptoms on activity. When I’m upright I can only manage 5-10 minutes before I feel really funny in my head like all swimmy and woozy headed. My feet will feel warm, inside my body feels warm and I just get this strong feeling that I need to lie down. If I ignore it then I then have a data heart rate and feel faint. Then when I lie down I often have a panic attack out of fear because those symptoms are scary. I’ve had this for over a year and it does limit me but it was just put down to CFS but now my GP says it’s sounds like POTs as it’s like I’ve an intolerance to standing for long. I got through weeks it’s much better and I can be more active then other weeks it’s really hard to be active. My steps recently have been under 800 a day on my phone. I was doing about 1800 around the house before lockdown and I was in a better place with my symptoms.

I’d say it’s milder than it was in the beginning, my whole foot used to go red and I’d have stabbing pains. It’s a lot milder these days but it’s still a daily thing.
Anyone else experience this? I’ve just had a flare up now while cleaning the bathroom. I was stood up 5 minutes and then I felt my feet warm so I took my slippers off and my feet/toes were blotchy and warm. I lay down and now they’re fine within 2 minutes

I’m sorry for the foot photo lol.
 

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pattismith

Senior Member
Messages
3,946
did you investigate Erythromelalgia?
It's nature is at less partly neuropathic and it can be secondary to Small Fiber Neuropathy.
 

Jemima37

Senior Member
Messages
407
Location
UK
did you investigate Erythromelalgia?
It's nature is at less partly neuropathic and it can be secondary to Small Fiber Neuropathy.
I actually suggested this to my GP as reading up I matched it. A lady I spoke to said her dad has it and my symptoms sounded similar.

I was worried sick incase it’s neuropathy but my GP said as I’ve no tingling or numbness in my feet, especially after 2 years then it’s unlikely that. I’m hoping she’s right.

Can you get erithroymalgea without having neuropathy? Maybe it is that minus neuropathy itself.
Thank you for replying. I am a bit of a mystery to my doctor at times haha.
 

pattismith

Senior Member
Messages
3,946
I actually suggested this to my GP as reading up I matched it. A lady I spoke to said her dad has it and my symptoms sounded similar.

I was worried sick incase it’s neuropathy but my GP said as I’ve no tingling or numbness in my feet, especially after 2 years then it’s unlikely that. I’m hoping she’s right.
.

Yes some erythromelalgia may be the result of microthrombi only, and they usually stop with salicylic acid treatment. This kind of EM may be a kind of vasculitis only.

But many EM cases doesn't resolve with salicylic acid and may be neuropathic in nature, even if the tingling is not present.

You can see in this 2019 article, that tingling and numbness (typical symptoms in Peripheral Neuropathy) are not listed in EM clinical presentation :


"Table 2. Clinical diagnostic criteria proposed by Thompson et al .21 "

Burning extremity pain
Pain aggravated by warming
Pain relieved by cooling
Erythema of affected skin
Increased temperature of affected skin


Nevertheless, Erythromyalgia is not totally understood yet, and some doc think small sympathetic nerve fibers are involved.
We can also see that genetic SFN and EM share mutations in the same genes, coding for nerve sodium channels:

About EM genes:
"Recently, rare variants of genes other than SCN9a were described in patients with clinically verified erythromelalgia: those genes included SCN10A (Nav1.8), SCN11A (Nav1.9), SCN5A (Nav1.5), SCN7A (Nav2.1), SCN8A (Nav1.6), SCN1B (Nav β1 subunit), SCN3B (Nav β3 subunit), TRPA1, TRPV1, WNK1 and NGFR [8]."

in SFN, rare variants in SCN9a, SCN10A and SCN11A are found, and this article notes:

" Among 1139 patients with SFN, 132 (11.6%) patients harboured 73 different (potentially) pathogenic VGSC variants, of which 50 were novel and 22 were found in ≥ 1 patient. The frequency of (potentially) pathogenic variants was 5.1% (n=58/1139) for SCN9A, 3.7% (n=42/1139) for SCN10A and 2.9% (n=33/1139) for SCN11A.
Only erythromelalgia-like symptoms and warmth-induced pain were significantly more common in patients harbouring VGSC variants. "

@wigglethemouse
@Hip
 

Jemima37

Senior Member
Messages
407
Location
UK
Yes some erythromelalgia may be the result of microthrombi only, and they usually stop with salicylic acid treatment. This kind of EM may be a kind of vasculitis only.

But many EM cases doesn't resolve with salicylic acid and may be neuropathic in nature, even if the tingling is not present.

You can see in this 2019 article, that tingling and numbness (typical symptoms in Peripheral Neuropathy) are not listed in EM clinical presentation :


"Table 2. Clinical diagnostic criteria proposed by Thompson et al .21 "

Burning extremity pain
Pain aggravated by warming
Pain relieved by cooling
Erythema of affected skin
Increased temperature of affected skin


Nevertheless, Erythromyalgia is not totally understood yet, and some doc think small sympathetic nerve fibers are involved.
We can also see that genetic SFN and EM share mutations in the same genes, coding for nerve sodium channels:

About EM genes:
"Recently, rare variants of genes other than SCN9a were described in patients with clinically verified erythromelalgia: those genes included SCN10A (Nav1.8), SCN11A (Nav1.9), SCN5A (Nav1.5), SCN7A (Nav2.1), SCN8A (Nav1.6), SCN1B (Nav β1 subunit), SCN3B (Nav β3 subunit), TRPA1, TRPV1, WNK1 and NGFR [8]."

in SFN, rare variants in SCN9a, SCN10A and SCN11A are found, and this articlenotes:

" Among 1139 patients with SFN, 132 (11.6%) patients harboured 73 different (potentially) pathogenic VGSC variants, of which 50 were novel and 22 were found in ≥ 1 patient. The frequency of (potentially) pathogenic variants was 5.1% (n=58/1139) for SCN9A, 3.7% (n=42/1139) for SCN10A and 2.9% (n=33/1139) for SCN11A.
Only erythromelalgia-like symptoms and warmth-induced pain were significantly more common in patients harbouring VGSC variants. "

@wigglethemouse
@Hip
Thank you.
I don't get any pain, sometimes some mild stabbing but that’s rare. It’s just heat and red blotchy rash across the toes and just below the toes on the top of the foot. It’s worse on walking then goes away when I elevate the feet again on my bed. It’s walking about that makes it worse. My GP said it’s not vascular as it would be every time I was active and it was only at night to start with For 2 years, now it can start late afternoon if I have a flare up, other times just at night. It’s not every time I walk about either. Yesterday I wanted to take photos so I walked about a lot and it didn’t flare up haha. .

It’s flaring now at 6pm I can feel my toes warm and aggravated and under the feet feel warm . I have found this heat in the UK has made my feet much worse, as does wearing socks or slippers. I’m a mystery haha.