Unexplained Foot Symptoms: A Guide to Possible Causes

What is wrong with my foot?

Hello Dr.
Zhou,
I have been experiencing strange symptoms in my legs for the past two years.
Whenever I am very tired or have stayed up late without sleep, red spots start to appear on both of my legs, and they become swollen.
The spots grow larger, but the redness is only present below my waist.
I also feel pain around my ankles, while the rest of my body is unaffected.
However, after a good night's sleep, the redness and swelling disappear, but the skin on my legs appears dark.
I have consulted other doctors, and they all said this is a type of rheumatic disease.
As far as I know, rheumatism is triggered by changes in the weather, but my symptoms only occur when I am fatigued.
What could be the cause of this? I hope you can help me understand.
Thank you very much for your valuable time.

Sincerely,
Ah Hua

Ah Hua, 20~29 year old female. Ask Date: 2004/04/12

Dr. Zhou Lizhi reply Orthopedics

Dear A-Hua,
Your symptoms are indeed quite unique.
Simply attributing them to rheumatic diseases is insufficient.
In short, this should be classified as an immune hypersensitivity disorder.
When your body is fatigued, your immune function decreases, or the allergic mechanisms are activated (leading to an increase in histamine and other components in the blood, causing vasodilation and resulting in erythema in the lower body).
Once these allergic mechanisms subside, your condition returns to normal (or improves with medication).
Therefore, this is a type of rheumatic immune hypersensitivity disorder.
Our hospital has a specialized department for this (AIR department), and you should first consider getting a blood test done there.
Some individuals believe in traditional Chinese medicine, which suggests that this may be related to poor liver function, so you might also consider that option.
Thank you for your message.

Reply Date: 2004/04/12

More Info

Hello Ah-Hua,
Thank you for sharing your concerns regarding the unusual symptoms you've been experiencing in your feet over the past two years. Based on your description, it seems that you are dealing with a complex issue that may involve several factors, including fatigue, potential inflammatory responses, and possibly underlying rheumatological conditions.

The symptoms you describe—red spots, swelling, and pain in the ankles, particularly after periods of fatigue or lack of sleep—could indeed be indicative of an inflammatory process. While you mentioned that other doctors have suggested it might be a rheumatic condition, it's important to clarify that rheumatic diseases can manifest in various ways and are not solely triggered by changes in weather. Conditions such as rheumatoid arthritis, lupus, or even vasculitis can lead to localized symptoms in the extremities, especially when the body is under stress or fatigue.

The fact that your symptoms improve significantly after a good night's sleep suggests that there may be a connection between your overall health, stress levels, and the inflammatory response in your body. Sleep is crucial for recovery and immune function, and inadequate rest can exacerbate inflammatory conditions. The appearance of red spots and swelling could be a result of increased blood flow to the area as part of the inflammatory response, which is often heightened during periods of stress or fatigue.

Moreover, the darkening of the skin you mentioned could be related to several factors, including chronic inflammation, changes in blood circulation, or even post-inflammatory hyperpigmentation. This occurs when the skin darkens after an inflammatory process has resolved, leaving behind a darker pigmentation.

Given the complexity of your symptoms, it would be advisable to pursue a comprehensive evaluation by a rheumatologist or a specialist in internal medicine. They can conduct a thorough examination, possibly including blood tests to check for markers of inflammation, autoimmune diseases, and other relevant conditions. Imaging studies may also be warranted to assess the joints and soft tissues in your feet and ankles.

In the meantime, managing your symptoms through lifestyle modifications may be beneficial. Ensuring adequate rest, managing stress through relaxation techniques, and possibly incorporating gentle exercises or stretching could help alleviate some discomfort. Additionally, keeping a symptom diary to track when your symptoms worsen or improve can provide valuable information for your healthcare provider.

In conclusion, while your symptoms may be frustrating and concerning, they are not uncommon in individuals with underlying inflammatory or rheumatic conditions. A thorough evaluation and a tailored treatment plan can help you manage your symptoms effectively and improve your quality of life. Please do not hesitate to seek further medical advice to get to the root of your symptoms.

Take care and best wishes for your health,
Doctor Q&A Teams

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