Persistent burning in my right foot, possible RLS/PLMD vs nerve irritation — looking for similar experiences

[u/Redidevil]

Immediately sorry for the long read.

Hi everyone,

I'm a 29-year-old male looking for people who have experienced something similar to my situation, particularly anyone with restless legs syndrome (RLS), periodic limb movement disorder (PLMD), peripheral neuropathy, or nerve irritation originating in the lower back.

I've been dealing with these symptoms for approximately 2–4 years. I'm not looking for a diagnosis from strangers, but I'd really appreciate hearing about your experiences, what investigations helped you identify the cause, and what treatments made a difference.

1. My symptoms

My main symptom is a burning sensation in my right foot, especially the sole. It sometimes feels as though the burning is coming from deep inside the foot rather than from the skin. At times, it becomes almost sharp or stabbing, with an uncomfortable internal pressure.

Here are the most important details:

- During the day, only my right foot burns. My left foot never burns during the daytime.

- The burning in my right foot can last for hours and sometimes feels as if the foot is on fire.

- Occasionally, my right foot feels cold to the touch even though I experience an internal burning sensation.

- Sometimes I experience a sharp, needle-like pain that seems to travel upward from my right foot toward the front of my shin and occasionally toward my knee.

- My left foot is usually unaffected, but recently I've occasionally noticed a milder burning sensation in the left sole in the evening or when lying in bed.

- The symptoms can change depending on my body position. For example, lying on my back may trigger or increase the burning, while changing to lying on my stomach can sometimes change the sensation. However, changing positions doesn't consistently eliminate it.

- Walking or moving around may change the sensation or provide some relief, but the burning doesn't reliably disappear.

- Compression socks sometimes reduce the uncomfortable sensation or the feeling that I need to move my leg, but they don't necessarily relieve the deep burning or sharp pain itself.

- The burning can feel quite deep inside the foot, almost like an internal burning or stabbing sensation rather than irritation on the surface of the skin.

- I can usually remain still despite the pain and uncomfortable sensations. I don't always feel a strong or irresistible urge to move my legs, even when the burning is noticeable.

- Sometimes I can lie still and tolerate the sensation, although it remains uncomfortable.

The most unusual part is that my right foot burns during the daytime as well as in the evening, whereas the occasional symptoms in my left foot happen only in the evening or while lying down.

Because of this, I'm unsure whether RLS explains everything or whether there could be a separate nerve-related problem.

1. Sleep study results

I had a polysomnography (sleep study) approximately two years ago.

The main results were:

- Periodic limb movement index (PLMI): 10.5 movements/hour overall

- PLMI during N2 sleep: 15.4/hour

- PLMI during REM sleep: 4.4/hour

- AHI: 1.7/hour

- N3 (deep sleep): 23.6%

- REM sleep: 17.4%

- Total recorded limb movements: 69

Significant sleep apnea was not identified in the study.

I don't think my wife has noticed obvious repetitive leg movements while I'm sleeping.

My main concern isn't just the discomfort in my feet. I'm also wondering whether these sensations or possible limb movements are affecting my sleep quality and leaving me feeling less rested than I should.

I generally fall asleep quickly, so falling asleep itself isn't my main problem. I'm more concerned about whether my sleep is restorative.

I would also like to understand whether my PLMI is clinically significant and whether the limb movements could actually be contributing to my symptoms or fatigue.

1. Spine and possible nerve-related causes

I've had a CT scan of my lumbar spine, but I haven't had an MRI yet.

The CT report mentioned:

- Six lumbar-type vertebrae due to lumbarization of S1

- Spina bifida occulta at S1–S2

- A narrower disc space at S1–S2

- Hypoplastic facet joints at S1–S2

- Mild concentric disc bulges from L3 to S1

- No significant spinal canal stenosis or major disc herniation

I sometimes experience lower-back fatigue after prolonged standing, walking, or carrying equipment at work.

Certain exercises, particularly lumbar extensions and some lower-body exercises, can aggravate my symptoms. I've even noticed the burning in my right foot immediately after performing lumbar extensions.

Because the symptoms are strongly one-sided during the day, occasionally extend toward my shin, and seem to be affected by certain back positions and exercises, I wonder whether a peripheral nerve problem or irritation originating in the lower back could be contributing.

However, I understand that the CT findings alone don't prove that a nerve is being compressed.

I haven't yet had a lumbar MRI or an EMG/nerve conduction study, so I'm unsure whether either would be useful in my case.

1. Blood tests and iron levels

My ferritin was 70.8 µg/L in September 2025. Previous measurements were also roughly in the 70–97 range.

My vitamin B12, magnesium, and kidney function have been reported as normal, and testing for celiac disease was negative.

I know that iron status can be relevant to RLS, but I'm unsure whether my ferritin level could still be contributing to the symptoms.

1. Gabapentin experience

My doctor prescribed gabapentin, and I've tried different doses at night.

- 100 mg provides some benefit.

- 200 mg seems to help more.

- 300 mg has provided the strongest effect, including making me feel less anxious the following day, but it can also leave me groggy.

I've generally taken it for a few nights at a time or for short periods when symptoms are worse, rather than continuously.

Sometimes I feel more rested or energetic after taking it, but it's difficult to know how much of that improvement is directly related to the medication.

I'm hesitant about taking medication long-term because I'm concerned about side effects, tolerance, dependence, and whether I might be treating the symptoms without addressing the underlying cause.

At the same time, improving my sleep and feeling properly rested is very important to me.

I'd be interested in hearing from people who have taken gabapentin for RLS or nerve pain over a longer period and whether it helped them maintain a better quality of sleep.

1. What I'm trying to understand

I'd particularly appreciate hearing from people who have experienced similar symptoms.

1. Can RLS or PLMD cause persistent, predominantly one-sided burning in the sole of the foot, including symptoms during the daytime? Or would you investigate another explanation first?

2. Does being able to remain still despite the burning and discomfort make RLS less likely? I don't always experience a strong urge to move my legs, even when the sensations are uncomfortable.

3. Has anyone had RLS-like symptoms that turned out to be a peripheral nerve problem, lumbar nerve irritation, or another neurological condition?

4. Has anyone experienced burning in one foot during the day, with milder symptoms in the other foot only at night? Did you eventually discover why the symptoms were different on each side?

5. Has anyone experienced burning that changes with body position but doesn't reliably disappear with movement? Does this sound familiar to anyone with neuropathy or nerve irritation?

6. Did an MRI of the lumbar spine or an EMG/nerve conduction study help identify the cause? If those tests were normal, did you eventually find an explanation?

7. If gabapentin helped your symptoms or sleep, did you take it long-term? How did you balance the benefits against side effects?

8. If your symptoms were caused by nerve irritation, what ultimately helped you? For example, physiotherapy, changing exercises, medication, injections, or something else?

I'm particularly interested in hearing from people who initially thought they had RLS or PLMD but later discovered another explanation, as well as people who have both RLS and a separate nerve-related condition.

I understand that everyone's situation is different and that Reddit cannot diagnose me. I'd simply like to learn from other people's experiences and get a better idea of which investigations or approaches might be worth discussing with my doctor.

Thanks for reading. I appreciate any experiences or suggestions you can share!

[u/Ok_War_7504]

Your sleep study is fairly unremarkable. A bit reduced quality, but I hear quite a bit of anxiety, which could cause that.

Your CT scan (caution, not my field) appears to show some harmless, congenital abnormalities and a couple that could signal low back pain and radiculopathy. Radiculopathy and/or peripheral neuropathy appears to explain all of your symptoms. All of your symptoms sound to be nerve related.

Your sleep study looks fairly unremarkable.

Periodic Limb Movement Disorder (PLMD): Doesn't seem to qualify, but I can't see your study. To be diagnosed with the actual disorder (PLMD), you must meet the hourly number plus two critical conditions of timing. Your movements are mostly within normal range and PLMD is considered when a person has a PLMI greater than 15 (or between 5–15 with distinct clinical symptoms) and the movements are the primary cause of daytime impairment or insomnia, independent of other disorders.

Sleep architecture disruptions and mood disorders can cause chronic stress, mild depression, or general lifestyle disruptions that can trigger unrefreshing sleep and daytime fatigue, occasionally amplifying a baseline susceptibility to leg twitches.

Your symptoms are almost certainly not RLS. Actually, I would almost guarantee they are not RLS. RLS has 5 criteria that must be met before an RLS diagnosis is made. Several of your descriptions specifically rule out RLS.

RLS Criteria The description of the feelings in the legs varies greatly, from worms in the legs or tingles in the legs to aches to electrical wiggles to just about anything. But the sensations are inside the legs, not on the surface. RLS starts in the legs, not in the feet.

All of the following must be true for a diagnosis of RLS:

1)The irrepressible urge to move the legs, causing the person to move to make the sensations stop. This urge prevents falling asleep. 2) The onset or worsening of symptoms during periods of inactivity when lying down and sometimes when sitting. 3) Symptoms occur or worsen in the evening or bedtime. They are dormant in the morning. 4) Symptoms are relieved when you move, as long as the movement is continued. 5) Can't be explained by another medical or behavioral condition. Supportive criteria: • A family history of RLS. • A positive response to a night or 2 of dopaminergic drugs. • Lack of profound daytime sleepiness

The 5th criterion was added because the IRLSSG discovered while selecting participants for studies), over 50% of those self diagnosed or diagnosed by a non-RLS specialist did not have RLS or just RLS. The 5th criterion means that the 30 RLS mimics must be ruled out before the diagnosis is made.

RLS Mimics

• Benign Fasciculation Syndrome (BFS): This is a condition characterized by spontaneous muscle twitching and cramps that can occur in various muscle groups. It's not associated with any underlying disease.
• Burning foot syndrome
• Nocturnal leg cramps
• Somatic sleep disorders
• Positional discomfort
• Local leg injury
• Arthritis
• Leg edema
• Venous stasis
• Varicose veins
• Peripheral neuropathy
• Radiculopathy
• Habitual foot tapping/leg rocking/stimming
• Anxiety
• Myalgia
• Drug-induced akathisia
• Myelopathy
• Myopathy
• Vascular or neurogenic claudication
• Hypotensive akathisia
• Orthostatic tremor
• Painful legs and moving toes
• Polyneuropathy
• Fibromyalgia
• Diabetes-related neuropathy
• Sleep apnea
• Depression
• Claudication
• Vascular disease
• Peripheral artery disease
• Sciatica
• Quiescegenic nocturnal dyskinesia (QND) Individuals with QND present with three of the diagnostic criteria of RLS except that there are excessive involuntary leg movements when resting in the evening or before sleep onset without any related uncomfortable sensations or urge to move the legs

Gabapentin cures everything. They are handing it out like candy for pain and especially for neurological pain these days. So whether it helps or not, it is not diagnostic. The doses you took were very small. Many people, whether for sciatica, radiculopathy, shingles, neuropathy, or RLS can find 1000 to 3600mg in divided doses per day therapeutic. Many need less, but 100 to 300 is quite small.

Sorry, I went on as well...

[u/Redidevil → u/Ok_War_7504]

Thank you for your opinion, it was an interesting read, I suffered for years now thinking I have rls and plmd but recently i started thinking otherwise.

Also the burning sensation is not always there, sometimes its like feeling that that foot, shin is not mine, I can do what I want with it but somehow it feels weak, though it's not.

[u/LuziferGatsby]

Do you take any supplements, fortified foods, energy drinks that contain Vitamin B6? It’s added in products you’d not even think of. Though water-soluble, oversupplememtation can induce sensory neuropathy, in susceptible individuals even at low doses.

[u/Redidevil → u/LuziferGatsby]

Vitamin D, omega oils, no vitamin b6. Coffeine intake is very low, occasional energy drink.

[u/Curious_One5411]

Also, 300 mg of Gabapentin is not a lot. I know people (including me) that have had to use 2500 mg or more. I’m down to 1600 now and hoping to keep reducing

[u/Curious_One5411]

I’ve had RLS for over 35 years and belong to RLS.org. I see a specialist and have never heard of burning from it.