'My feet burn with pain if I go walking': DR MARTIN SCURR answers your health questions

I’m an avid walker aged 74, but now find after a few miles I get a tingling feeling in my little toe which spreads to the pad of my foot and burns, so it’s painful to walk. A consultant said it’s not to do with nerve endings, but could it be peripheral neuropathy?

Christine Champeny, via email.

This pain sounds challenging, especially as it affects an activity you enjoy. But there is a simple solution.

I agree with your consultant that your symptom is not a nerve condition, nor do i think it a sign of peripheral neuropathy (as you say in your longer email that the pain is relieved with rest). 

I think, instead, this may be a trapped nerve, causing metatarsalgia — irritation and pain of a nerve in the ball of your foot.

The nerve supply to each toe has a journey fraught with potential pinch points in the joints where the foot bones (metatarsals) meet in the pad of the foot.

As we age, there is a degree of wear-and-tear in these joints — and if the foot is compressed in some way, as in a walking boot, this can lead to those nerves becoming pinched or irritated.

If my assessment is correct, the sensation will disappear when you remove your boot and rest with your foot elevated to alleviate the pressure on the nerve.

Talk to your pharmacist about a metatarsal pad. Usually made of gel or silicone foam, this is worn under the ball of the foot in spacious shoes and allows the end of the foot bones to spread apart and so prevents nerve impingement and pain.

My son has raised white blood cells but multiple tests have not found out why. He also has peripheral arterial disease but has been told he cannot have a stent to fix it until the former is sorted.

Joan Keenan, Ballymena, Northern Ireland.

Your son’s blood test results have clearly caused you much anxiety and the important point is that a raised white blood cell count is not, in itself, sinister.

It’s a common problem, though nearly always the reason is clear from the start. What matters is the type of white blood cells that is increased. There are six types, but generally it’s the neutrophils that are raised. 

White blood cells, which are produced in the bone marrow, help the body fight infection or inflammation. A white blood cell count is normally given as an overall figure for all the types. 

A normal range for the white cell count is around 4,400 to 11,000 cells per microlitre of blood and 70 per cent of these are neutrophils.

Raised levels can be caused by both short-term or acute inflammatory disease (for instance, tonsillitis) and longer-term or chronic inflammatory disease, such as rheumatoid arthritis.

It is worth repeating that a raised level does not necessarily mean anything sinister: a small study of more than 30 healthy people showed their levels of white cells went up to 40,000 at any one time, yet over ten years of follow-up no illness occurred.

Two factors may be relevant. First, you mention in your longer letter that your son smokes, which is known to raise the white cell count; and second, is the peripheral arterial disease (PAD), a common condition caused by the build-up of fatty deposits in the arteries affecting blood supply in the legs — this will also cause inflammation in the form of a raised count of white blood cells.

I imagine the reason your GP recommends a delay is because the stent procedure is a major operation. This would be unwise when it’s not clear what lies behind the elevated white blood cell count.

If it’s not the neutrophils, but other types of white blood cells, the haematologist, will carry out a bone marrow study, involving bone marrow extracted under local anaesthetic from the sternum or the pelvis for examination. Hopefully, this will provide the answer.  

Write to Dr Scurr

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email: [email protected] — include contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.

In my view… Give medics the Covid jab first

The arrival of the first batches of the Covid vaccine is very welcome. But the initial supplies are scarce, and in their distribution, I think the Joint Committee on Vaccination and Immunisation missed a trick.

For although older people, who are being prioritised, are most at risk, shouldn’t healthcare workers, especially those giving the injections, be at the front of the queue?

For however careful medics are, there’s still a risk they carry the virus and could breathe it onto the vaccine recipient, who will be ill before their immunity kicks in.

It’s not just the vaccinators; frontline health workers ‘who provide care to vulnerable people’ are meant to be a high priority. 

Yet in North-West London, as I write, there are no supplies for hospital medical staff, while many doctors and nurses are laid off, isolating, because their children have tested positive.

Only one GP colleague I know of has received the injection — and that’s because she works in a Covid assessment centre; her practice staff must wait until mid-January.

I’m hoping we will shortly see a re-think of priorities.