burning foot pain

I have been suffering from burning foot pain for over 4 years. I have seen 2 podiatrists and 2 neurologists. I have tried physical therapy, ultrasound, custom insoles, nerve testing 3 times, MRI of brain and spine, blood tests, chiropractor, accupuncture, skin punch biopsy, x-rays, arterial doppler study, and QSART testing. It really feels like a nerve problem, but the last neurologist has ruled that out. Should I see an orthopaidic doctor, a different neurologist or podiatrist, or what? I am taking 75mg. of Lyrica 3 times a day, but my feet still burn(when I am standing)along the arches and slightly when I am sitting. If I have sandals on, the strap on top causes burning. On some days, I have burning up the outside of my right leg. The last neurologist looked at the spinal MRI and doesn't think the slight bulge at T10-T11 would cause any of this pain. Thank you for your help.

RESPONSE

Hi,

Well.... you have been to a least four doctors who have actually examined you, performed numerous tests and now asking someone on the other side of the internet to try and help you.
Generally, when answering questions, most of the people who have written in may have only seen one doctor and in some cases no doctor.
My point is that it sounds like you have had a thorough work up and I am not sure I can add anything to the mix.
Having said that, let me make a few points that may be of some help to you.
First of all, sometimes there is no solution for a given medical problem, particularly with your type of problem. In many instances, medicine, such as Lyrica is all that can be done to try and make you more comfortable. It is certainly not a solution but if it reduces your symptoms, then there is benefit derived.
In reading your narrative a couple of bells rang in my head.
First of all your symptoms are in both feet. That tells me there is a common denominator here, as opposed to the problem being a local issue with one foot. For instance a condition like tarsal tunnel could be causing your symptoms but in the majority of the cases, the problem occurs in one foot.
A nerve entrapment at the head of the fibula bone (just below the knee) could also cause some of your symptoms, but again, it would usually be only one foot.
So, the fact that both feet are involved and the fact that your symptoms are worse when you stand (very important) leads me to believe that the issue may be coming from your lower back.
I know your neurologist does not think the slight herniation you have could be causing your symptoms, however, that does not mean that the herniation is not causing your symptoms. Sometimes pain is not proportional to the problem causing it. I would suggest you have another neurologist, or even a pain management physician re-visit that problem.
A moment ago I mentioned the fact that since your symptoms are worse when standing as opposed to sitting has significance. To me that means there are no metabolic issues here such as diabetes, vitamin deficiencies, reaction to other medications that you are on. In those cases your symptoms would be similar whether standing or sitting. I would hope, however, that all those possibilities have also been ruled out, nonetheless.
In answer to your question, I am not sure an orthopedist can offer more help. Neuropathy is not their strong suite unless there is a bone spur pressing on a nerve, or something to that effect.
I would think your best course at this time would be to consult with another neurologist or as I mentioned earlier, a pain management physician, as they may be more inclined to be more aggressive with a treatment plan.
Sorry, I could not be more specific.

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Marc Mitnick DPM
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