podiatric/foot problems

[Spiral]

Sorry this is a bit long... I saw my podiatrist this evening as I have had some foot symptoms over the last couple of months.

Last time I saw her was last November - I see her because I have a (minor) soft tissue foot injury following a car accident a couple of years ago which has caused havoc in my life and may require surgery. This injury has some symptoms in common with a Morton's Neuroma, if that means anything to anyone. However, I was assessed by an orthopaedic surgeon last year and he assures me that I don't have that condition. I have also had extensive physiotherapy on this foot, including manipulation/massage and ultrasound and electrotherapy.

Anyway, over the last couple of months I have had some mild but worrying symptoms in both feet. These tend to be worse if I've been on my feet all day and they were actually much worse about 2 weeks ago. The picture is complicated by the foot injury.

I have an almost triangular area of numbness/loss of senssation on the ball of my left foot and this extends to my toes, especially the 2nd, 3rd and 4th toes, but predominantly the 2nd toe. The loss of sensation doesn't affect the top of my feet, only the sole and sides of toes. I have also had cold feet sometimes.

I have been aware of a similar pattern of lack of sensation on the ball of my (injured) right foot since the accident in March 07. However, the treatment I had last year improved the symptoms and sensation a lot, but didn't solve all the problems, which includes a claw/hammer toe as a result of the injury - my car was stationary when I was rear-ended at speed with my foot hard on the brake pedal. However, over the last few weeks there has been a loss of sensation in the same area of the right foot and the lack of sensation has extended to my toes.

She did various tests and I had problems with the sensory tests, specifically with the monofilament, light touch and pain, as my sharp sensation is reduced. She said that there was no evidence of motor nerve problems and my skin, pulse and circualtion appeared fine.

The distribution of numbness/loss of sensation in the affected area was very specific. After she had examined me she thought that my "good" left foot was slightly worse than my injured right foot.

She was unclear about what all this meant. She thought that the kind of symptoms I have leant more towards neuropathy than entrapment, but the distribution of the symptoms leant more towards entrapement/compression of the media plantar nerve. We also discussed vitamin B12 deficiency and I will ask if this can be tested.

We discussed this in the context of me thinking I have probably been diabetic for about 18 months - based on being insulin resistant 3 years ago and having had a dry mouth for about 18 months (this has now improved in the last couple of weeks as my blood sugar has fallen). The people she sees with diabetic neuropathy have usually had diabetes for many years, but we did acknowledge that things start off less severe.

She was unclear if these symptoms would resolve once I stabilse my blood sugar and loose the weight. We also discussed possible treatments and she left me with some exercises to do. I have an appointment in my GP's diabetic clinic on Monday. I will be asking him for advice there, but when I told her about the kind of info I'd got here she suggested that I post a message and ask if anyone has had similar problems.

Does this sound familiar to anyone? Any insights for me and my podiatrist or suggestions of things I can do to help?

 

[Trinkwasser]

IF it is neuropathy then #1 treatment is tight BG control. My neuropathy has now gone away *unless* my BG goes over 8.

A protocol of 300 - 600mg Alpha Lipoic Acid + 500 - 1000 mg Evening Primrose Oil may also be helpful, this is a long term treatment. Also benfotiamine (a fat-soluble derivative of Thiamine) but I can't recall the dose for that, the website where this was listed went down after the owner died and I didn't yet find the information reposted.

Blood pressure control and a diet rich in antioxidants and bioflavinoids as per the Eat The Rainbow thread may help with inflammatory issues. All this may also help with inflammatory problems caused by mechanical damage, but I might be tempted to get a second opinion from a trustworthy Osteopath or similar who may have a different point of view, it's possible there may be a problem further up the nerve, maybe from the accident. My old man had sciatica which presented as leg pain but the actual problem was in the spine.

 

[Spiral]

Thanks, trinkwasser.

It is a bit puzzling as the symptoms seem to be neither one thing nor the other, according to my podaitrist. But my "gut instinct" tells me it may be neuropathy from the symptoms because it is affecting both feet, which is surprising as I don't think I have been diabetic that long - 2 years max (insulin resistant 3 years ago).

My picture is complicated. I wasn't just involved in 1 accident, I was involved in 3 :shock: :evil: For a while I thought my car had a target painted on the back, I was rear-ended 3 times in a 15 month period, all fairly minor (no time off work) and it is almost possible to think i had some sort of insurance scam going on :roll: I was injured in all of the accidents (minor whiplash, but it took a while to heal) and had a bad back last year, when I was examined there was evidence of some sciatic nerve involvement. My podiatrist queried if this bad back may have been due to the accident as it was right sided :?

However, the loss of sensation is a new symptom and is affecting both feet. it is fairly minor, but I get very concerned about my feet and tend to act quite quickly when there are problems there.

I'm already doing the rainbow diet thing and my BG is on the way down, but with my last HbA1c at 7, I think that is still way too high :? which is why I'm currently considering metformin, but with absorbtion problems with the metformin, if B12 is a problem, I need to think about it. How long after your BG goes below 8 does it take for your symptoms to disappear?

I will talk to my GP tomorrow, it is a fairly long appointment in the diabetic clinic and I have lots of questions. I think he will refer me on.

 

[Trinkwasser]

It is a bit puzzling as the symptoms seem to be neither one thing nor the other, according to my podaitrist. But my "gut instinct" tells me it may be neuropathy from the symptoms because it is affecting both feet, which is surprising as I don't think I have been diabetic that long - 2 years max (insulin resistant 3 years ago).

Bear in mind the diagnostic point for "diabetes" is deliberately set high, at around the point it is (theoretically) irreversible, so you may have diabetic damage for many years while still technically being nondiabetic.

As to how long to reverse the symptoms this will depend on many factors. Nerves can do a pretty good job of rewiring themselves unless the damage has reached the point there are no spare wires in the bundle, but we're talking weeks to months - and one of my symptoms, heart locked to 60 - 80 bpm and beating harder but not speeding up properly on exertion - took a good couple of years before I suddenly realised it was working properly again. Another symptom, which may or may not be autonomic neuropathy, has shown no sign of improving after 4 - 5 years of BG control.

 

[Spiral]

That would make sense... the years I have been running high BG pre-diagnosis :?

My GP has referred me to the diabetic clinic for investigation and suggested they may refer me on to neurology, which is something I'd be ok with.

Interestingly, I banged the sole of my foot quite hard on the handle when I was climbing in to the bath for my shower. It hurt like anything for a bit, but I can feel the sensation has changed (imporved) a little, especially around the sides of my toes, which kind of goes with the compression/entrapment theory.

My GP, with whom I normally have a very good relationship, just looked at me when I said that I knew diabetics who's neuropathy had improved... He then told me about the research he has read and the training he has attended and he gave me the gradually progressive line, the not worth testing as I'm type 2 and the inevitability of insulin eventually blah blah blah... And I did the broken record with why I need to test and wanting to achieve HbA1c between 5-6, closer to 5, to prevent these complications.

Ironically, he gave me a questionaire on depression to complete as I left, I didn't feel depressed until I saw him in the clinic It is very difficult to resist this line, he's abeen my doctor for 20 years and I trust him :| I need to develop the hide of a rinoserous and be really bloody minded to stick with this. Although since reading here the last couple of days, with all the support and encouragement, I feel much better and seeing my BG staying much lower over the last couple of days feels very positive.

 

[Trinkwasser]

The trouble is that no-one studies successful diabetics (there's no money in it) so the huge quantity of anecdotal evidence stays anecdotal.

Agree that a second opinion would be a good plan. There's often a tendency for doctors to assume if you have one illness you aren't allowed any others: it sounds quite likely that you have more than one thing occurring simultaneously, maybe some physical damage and some neuropathy.