Dear doctor;

Three middle toes on my right foot keep experiencing sensational and sometimes sharp pains that last a few seconds to one minute before subsiding. Could this be a cause to worry? 

Belindah, 32, Kanombe.

Dear Belindah,

Since when have you been experiencing this sensational and sharp pains? Are they present on rest or after walking, do they occur on some fixed time like at night?

Abnormal sensations and sharp pain in toes can occur when the nerves supplying the peripheral neuropathy is affected. This can occur due to multiple causes. Diabetes particularly uncontrolled, smoking, alcohol, some drugs like anti TB Isoniazid, trauma involving nerves, all these can cause this problem. Deficiency of vitamin B1 and or B6 and B12 also manifests as abnormal sensations in fingers and or toes. In this case sharp burning pain occurs mostly in night.

Affected blood vessels supplying the toes can lead to reduced blood supply and sharp pains. Alcohol, tobacco use, certain drugs, uncontrolled high blood pressure, high blood cholesterol, among others, cause enhanced atherosclerosis, that is, deposition of fat inside blood vessels. due to this blood vessels of the body including that of fingers and toes become narrowed, which results in reduced blood supply and tingling, numbness, sharp pain and other abnormal sensations. Raynaud’s disease is a rare disease which causes intermittent bouts of abnormal pain in fingers and toes due to intermittent narrowing of blood vessels. Exposure to extreme cold may cause pain in toes. At times, there may have  been a minor trauma which may pass unnoticed at that moment. Later on, it can cause sharp shooting pain when affected toes are moved.

Taking a balanced nutritious diet, including whole grains and nuts, green vegetables and fruits, regular physical exercise and adequate relaxation helps to keep body healthy and prevents such kind of pains. If one takes alcohol and or tobacco it is good to quit now.

It is advised to get tested for diabetes. If pain is severe taking a pain killer like paracetamol along with supplements of vitamin B. complex and gabba pentin tablets for some days will help relieve the pain.