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Patient with Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)

Discussion in 'General Issues and Discussion Forum' started by Lovefeet, Dec 8, 2012.

  1. Lovefeet

    Lovefeet Banned

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    Hi there,

    Please can you advise how best I can remove corns from a patient's feet who suffers from the above-mentioned condition.

    I am due to see her in a fortnight's time and thought I would research it now.

    The patient says that if I used a scalpel on her feet to enucleate corns, and haemed her, her feet would turn black . She also said that the GP told her to use salycillic acid, but patient to scared to use it because it would damage her healthy skin. Also she is worried the acid will also cause her feet to go black.

    Patient said she has suffered from the condition for 10 years and is on amitriptyline for pain management. She is very hypersensitive to hot/cold/ pain, etc. Her body reacts to stimulus in the same way a patient would who has Raynauds..

    She said months ago she stood on small pieces of glass, and that is how her corns developed. She has managed to date with using an emory board and moisturing her feet, but she can still feel the corns.

    If there are any Pods out there who have treated patients with this medical disorder, if it is not too much trouble, please give me some advice. Thanx.
  2. Admin2

    Admin2 Administrator Staff Member

  3. Lovefeet

    Lovefeet Banned

    Thank you Admin 2, that was very helpful. However, am still trying to find out info how best to treat painful corns on a pt who has this disorder. Would the best thing be for pt to to be referred to surgeon (via the GP)????? All helpful input would be greatly appreciated....
  4. davidh

    davidh Podiatry Arena Veteran

    See your patient - make up your own mind on how best to treat.
    As far as I know her feet will not turn black if you haem:D.

    I've seen several patients with this condition over the years - all different presentations.
    I would see her and not treat initially. Discuss between you treatment/risks/possible problems/benefits, then rebook her in for treatment if appropriate.

    Document everything:cool:.
  5. Dananberg

    Dananberg Active Member

    About 20 years ago, I saw a woman who was referred by her primary care physician. She was 42, non-smoker but already 2 years s/p cardiac bypass. She was perspiring, with rapid pulse generally poor physical appearance. She was mildly hysterical. Legs exhibited pronounced livido reticularis B/L. After history taking, I began a physical exam. She was tender just gently touch. When I gently tried to dorsiflex her ankles with her knees extended, she almost jumped off the table.
    Having had prior success with severe pain patients, I decided that trying to manipulate her ankle may relieve some of the tightness and perhaps ease some of her pain. What I observed after this adjustment was truly miraculous. As I approached the 2nd ankle, I looked back at the side I had just treated, and the livido began resolving from distal to proximal. By the time I finished with the 2nd limb, the classic livido discoloration was gone on the 1st and just starting to decrease on the 2nd. I sat her up on the chair and realized she stopped perspiring and her pulse rate returned to normal. My jaw didn’t drop….it damn near fell off. I followed her two weeks later….and she was fine. It was like a systemic RSDS which resolved from an ankle manipulation.
    I have come to understand this outcome as related to neuropeptide secretion modification. Nociceptors (pain sensing C-fiber nerves) are known to secrete neuropeptides from their distal endings. Neuropeptides (substance P, calcitonin gene related peptide, etc.) are potent neuro-irritants and when secreted can cause nerve inflammation and promote pain. These same chemicals are also vasoactive, promoting either vascular constriction or dilatation (think Raynaud’s, migraine headache, temp change with CRPS). Manipulation has the potential via its neuromechanical effect, to “reset” nociceptor hypersensivity and spontaneously resolve seemingly complex neuro-vascular symptoms.
    Over my career, I have seen some very odd conditions respond to manipulation, but the one described above was the most astonishing. In many other cases, I have had excellent success with ankle manipulation for the symptoms of CRPS and RSDS. It’s worth a referral to someone who performs this regularly. Perhaps she will then let you remove the glass from her toe.
  6. dsfeet

    dsfeet Active Member

    I dedride callous's and a small corn from a one of my patients with stage4 crps on a 6 weekly basis, it just requires softening, try KOH, potassium hydroxide or soaking , gentle slow debriding and padding afterwards. He copes as long as I'm slow and don't take off to much .
    May need to make appts weekly taking a small amt at a time, as david suggested discuss first and see what she will feel comfortable with.
    Trust helps, this patient of mine is a sad story. small incidents of 3 minor injuries , no one listened to him , we were helping with padding , u/sounds getting tests done , then as pain changed and s& S of CRPS started referred and spoke to GP , who also treated him and referred , again no one listened or treated ended up with stage 4 before getting pain management to late.
    Was so frustrating when I could recognise what was happening and specialist all dismissed him till to late. therefore developed trust with him from early stages, as he recognised I was trying to get him help as was the gp.
  7. Lovefeet

    Lovefeet Banned

    Hi DavidH, Danaberg, and DsFeet,

    Thank you so much for your knowledge and advice. It has been very helpful indeed - thanks!!!.


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