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Burning/swelling/nerve pain in feet 15 years

Discussion in 'General Issues and Discussion Forum' started by Footprint101, Nov 28, 2011.

  1. Footprint101

    Footprint101 Member

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    Hi all,

    If anyone could help me out with this pt it would be greatly appreciated - even just with the appropriate referrals.
    Below are pt notes & further info from pt emails.

    PCO – Hot & painful joints in feet.
    69 y/o Female, white female, artist.

    Seen GP, pain clinic, orthotics lab, 1 podiatrist & orthopaedic surgeon - we are last resort.

    On feet 1-2 hours continuous during the day. Has to be able to sit down. Uses machine to send electro impulses through her feet. Heels also very sore at the back

    History: Swelling in feet present about 15 years, been hot most of her life, splaying (between 2-3 digits bilat "V") stared to happen about 15 years ago. Ball of foot is seminumb all the time.
    Worse in L foot, feet ankles and legs swell up, this is when nerve pain is the worst.
    Ankles balls of feet feel stiff, not tight,
    Started to take 2 glucosamine, seems to have helped.

    Medical conditions / Medications: GP diagnosed erythromalalgia, tried natural remedies, Dr referred to the pain clinic gave gabapentin - VERY disatisfied with this med, has not told them shes off it.

    Betaloc, aspirin. Parsley for fluid, eats alot of fruit and veges, salads everyday all organic,some protein, some carbs eats them separatley, glucosamine and chondroitin, flaxseed caps, OPC (antiox) vitamin B, magnesium & coral calcuim from health shop.


    Derm- Good, dorsum of BF swollen. Nil fat pat atrophy.
    Vas- CRT 2 sec, DP pulses palpable, non pitting oedema present.
    Neu- No sensation loss - some points missed, but due to callus. Feet feel like a wooden block.
    Msk- Retracted digits BF, large "V" between 1-2 BF.
    Footwear- Open sandals as feet get too hot in closed shoes. Wearing Josepf Seibel sandals at the moment. Also wears TEVA, hush Puppies and brooks for the gym.

    Treatment Plan: Apply PMP or met pad today to spread FF. Talk to collegues about symptoms. Possibly need diuretic to reduce swelling, gout tests, medication control.
    May need orthotics - fitted pad, affected balance - have not done BMX assessment.
    RA ruled out.


    Where exactly is the pain:
    * *Pain and stiffness in toe joints, L big toe ball joint, insteps, ankles. * Sense of numbness in L foot ball and toes - feels like wood.

    Is one foot worse:
    Left foot is worse, probably because that is where the problem began and it was several years before the R foot decided to follow suit.*
    Any history of Injury:
    As a child I frequently turned my ankles and was forced to wear boys shoes until about 10 yrs of age*

    Describe the pain:
    My ankles are stiff and have intermittent nerve pains shooting through them.
    My toes also have terrible nerve pain shooting through them at times.
    The numbness is present all the time and includes my L instep.
    My L instep frequently has cramping pain and shooting pain.
    Pain increases when my feet are swollen and hot.
    My feet swell whenever they get hot which is why I wear sandals and sleep with a 'coldie' filled with water from the fridge.

    When I am on the bike at the gym my feet get pretty sore from the pressure of pushing the pedals - I work at a very moderate resistance.

    I can only do 12 mins on the treadmill because of the repetitive nature of the movement.
    My best place for walking is in the sea as my feet stay cool - I do this even in the middle of winter.

    When does the pain start after you get up:
    Sometimes I need to make my instep 'click' before it will sit properly on the ground - that can be quite painful, but necessary for me to be able to walk properly. * The pain never really goes away - it subsides at times. * If I flex my feet they are painful. * When I sit I tend to move my feet in circles to keep them from stffening even more - it also relieves the pain and stiffness a little.

    Does it get worse as the day goes on:
    Yes it does, I am constantly considering my feet and how to keep them cool. * If I have a lot of walking to do then I just have to put up with it. * I take my sandals off whenever I can - cafes, movies etc. * I find it very hard to stand for long as in at an opening etc (I am an artist)

    In my studio I stand a lot to work, although I try to sit where possible, but in painting I need to be over my work to see what is happening.

    Is it sore when you have no weight on them:
    They can be, but not all the time. * I sit with them up whenever I am able that relieves pain as well as swelling.*

    When is it at its worst:
    When my feet are hot and swollen. * When I wear shoes - I don't except at the gym.*
    What do you do to relieve it:
    I put my feet up, on my massage machine, or put them in a cold bath or on an icepack. * At night I use a cold waterbottle with water from the fridge. * I also sleep with no bedding over my feet for most of the year and with a ceiling fan going in my bedroom even in winter. * I stand on the tiles in the kitchen or hose them if I am outside.

    I don't take anything to relieve the pain because I don't like taking drugs, I would rather endure. * Usually the pain is not continuous but intermittent. * Use my machine as below.

    What is the name of the electro machine you use:
    *High Tech Health - The Circulation Booster.* * It has reduced the swelling in my legs and ankles amazingly. * I have been using it for about 4-5 yrs
    Would you mind if I gave your Doctor a ring to see what has been done so far?
    The only treatment she has organised is to attend the Pain Clinic where I was prescribed Gabapentin, a drug of mind bending power that I found totally terrible and was only on for about 3 months. * She agrees with my ceasing to take it.

    Prior to that my Doctor sent me to see Orthotics Dept, and a podiatrist. * I also saw orthopaedics with whom I discussed options. * They are unable to help because of the swelling.
    Noone has been able to come up with a suggestion that works and accomodates the fact that my feet get unbearably hot and swollen as well as painful.*

    Any help would be greatly appreciated, this lady has been referred to many different people, I am relatively inexperienced with nerve/circ issues, so any advice about the best course of action would be great.
  2. podiman

    podiman Welcome New Poster

    Hi Footprint

    Very interesting case. forgive me if I run through thought processes you have already covered or if I state the obvious.

    1)to me it sounds like a sensory neuropathy of some cause?? and I believe her GP is close with Erythromelalgia. This is often secondary to a primary trigger such as a vasospastic disorder

    2)Although she has been to Orthopods: have autoimmune pathologies and arthritides been ruled out?

    3)have any spinal pathologies been ruled out given the bilateral nature.? Have you checked reflexes? I see she is taking VIT B but if she has chronic pernicious anemia (which we assume the gp has already checked) she may need an injection

    4)Has diabetes def been ruled out? (obvious I Know but not mentioned)

    5)The V in the toes also suggest a neuropathy. A definative diagnosis would be great but going on your post I would concentrate on neuropathic symptom alleviation
    Possible TENS machine, capsacin cream,
    Gabapentin was originally used for siezures and such like and there have been a few patient complaints of "zombie" feeling ...maybe she should return to pain clinic and get Amitriptyline

    6)There is evidence that local anaesthetic injections relieve symptoms and help reduce pain for small periods. (poss post tib block) However Im not too sure of contra indications if she does have a vasospastic disorder.

    I hope this helps you in some way..if at the least it jogs your thinking

    Good Luk
  3. Footprint101

    Footprint101 Member

    Great Thanks for the reply Podiman,

    Gives me a few things to think about - she isn't Diabetic (well not reported) and only RA has been ruled out so far, I will investigate further and get in touch with her Dr - need to do some research 1st though, this is just one case, it's so hard to find the time!

    Really appreciate your time.
  4. Sally Smillie

    Sally Smillie Active Member

    I'd echo the capsaicin cream for the neuralgic pain.

    I'd be sending to a neurodynamic guru physio. I do quite a bit of nuerodynamic stuff, but due to the complexity and long-term nature of this case I'd be sending her off. From your POV though, it would be worthwhile doing some nuerodynamic tests, SLR or slump.

    Really interesting though, keep us informed with what's happening. Great histroy presentation, btw, saves us all asking the obvious questions
  5. Footprint101

    Footprint101 Member

    Thanks Sally,
    I will get her back in soon and keep you posted :)
  6. kirstyboyd89

    kirstyboyd89 Member

    Hi There,

    I too am inexperienced, if not more so, with regards to nerve pathology, especially the many signs and symptoms surrounding your case. However I will add a patient of mine suffering from neuralgic pain was prescribed amitriptyline and gained significant relief. Hope all goes well

    Kirsty :)

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