Hi All,
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I have been racking my brain as to this patient with quite an unusual presentation. Please help if you have any insight :)
42yo male, healthy, active
L foot burning + tingling since 1.5yrs.
R foot burning + tingling since 1 year.
First noticed after skiing Jan 2015 - tight boots
May have been mainly toes when it first began
Plantar surface of feet seem HOT to patient
Used to be intermittent, now more constant and both feet
Occurs mainly at night during sleeping. Wakes patient up.
No awareness of family history of burning feet
Has not noticed swelling, excessive sweating on feet, no changes in skin temperature
Occasionally tingling sensation - back of the arches bilateral
Usually a disconnect between feet - one is not always as sore/burning as the other
No joint pains
Improved by exercise eg. cycling & walking
Aggravated by sleeping
Alcohol consumption- 1 glass of wine or beer/day
Had BSLs taken - WNL - non-fasting though
Using Scholl gel insoles - do not improve or aggravate symptoms
Sport/Activities: walking 2km/day, mountain biking 1x/week 10-20km
Traumas/Injuries:
Occasionally gets pain in lower back, manages by being active
Medical history:
Atrial fibrillation (1998)
Meds: Pradaxa, diovan, Linoxin
Tenderness palpated at peroneus longus near peroneal head and tibial nerve at tarsal tunnel.
Patient notes burning at proximal medial longitudinal arch/distal to medial calcaneal tubercle
Patient notes tingling lateral legs
Toes warm initial visit, cool to cold second visit
Pedal pulses palpated - strong
No abnormal temperature gradient
Monofilament WNL
Footwear:
- Daily: RMW boots or lace-up oxfords, slip on loafers
- Sporting: "Specialist" bike shoes
Foot Posture: R planus, L neutral
Rearfoot: R everted slightly, L neutral
Gear: R low, L high
Single Leg Lunge: VMOs WNL
Glutes: WNL
Calves/ ankle ROM: 12cm + bilateral
Functional Hallux Limitus: R 35 deg, L 15 deg
Supination Resistance: moderate
Body Posture: posteriorly displaced COG - shoulders behind hips
Gait: posteriorly displaced COG - shoulders behind hips, abducted feet, L>R abductory twist
Orthotics: gel insoles
Diagnosis: ????
Treatments performed:
First visit:
Rigid Low Dye taping applied to R, flexible longitudinal arch taping taping applied to L
Results: Night of taping - L foot felt better
When woke up in morning R foot felt better than L
Thinks feet felt better with tape on first day (but not significantly better)
Did not notice a difference in sensations when took tape off
Night after removed tape burning returned to normal
Second Visit:
Dry needles applied to L peroneus longus + L tarsal tunnel
Issued neural stretch to be performed for 1 minute daily both legs
Results: Noted no difference in burning sensations after dry needling. Patient thinks that no intervention has really helped so far.
Patient went bike riding last weekend 18km, 25km steep incline
Feet were sweating profusely, seemed to be "swimming" in socks
I keep thinking is this vascular?? Is this neurological?? I don't think it is biomechanical but maybe a combination?
I have been meaning to give COG exercises to patient but I do not think this is related to his night pain anyway.
Please help :)
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Alternate Hot And Cold Application In The Management Of Heel Pain
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The Relationship Between Arch Height And Foot Length: Implications For Size Grading
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Alternate Hot And Cold Application In The Management Of Heel Pain
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The Relationship Between Arch Height And Foot Length: Implications For Size Grading
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