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The response to the question below was authored by Marc Mitnick DPM
chronic feet pain of unknown etiology
by Jennifer Gonzalez
I've contacted you once before regarding my pain. I'm a nurse on a high acuity unit. I started experincing pain in my left foot and it steadily worsened enough that I went to see a podiatrist in April. Since april I have treated plantar fascitis with PT, walking boot, splint at night and steriods but it was eventually r/o with an MRI of the heel. We, then,stablized my foot by wearing the walking boot at all times for possible tear which was r/o by a second MRI of the forefront of foot. X-rays r/o fractures and arthritis. The doctor had no answers for the source of my pain from a podiatry point of view. He prescibed Tordol which helped some and sent me to a neurologist. I had nerve conduction studies done which were normal so the the MD did not proceed with further studies. He sent me to my primary MD. She sent me for arterial dopplers and lumbar xray. She also did bloodwork for various tests- all of these were normal( no diabetes, gout, B12 defiencies, etc). I am 35 years old and have been on short term disability because, although I am ambulatory, I can not tolerate the pain enough to be able to carry out my duties as a critical care nurse. I am at wits end with very little options left. I will be seeing a pain specialist next week and am seriously considering acupuncture. I've purchased supportive shoes- MBTs, ECCOs and new balance 900 series. I have corrected my custom orthotics. But the pain is still there- even with tramadol
50mg q 6-8 hrs on board. The pain usually is strongest in the forefront/ ball of the left foot and extends through the arch and it throbs with burning sensation. It does occasionally tingle and/ or feels like I'm stepping on shells or glass. The sharp pain intermittently radiates up the leg. The heel rarely hurts. Icing the foot to the point of numbness brings the pain to a zero but it usu, hangs at or around 5-7 out of 10 all the time. The right foot hurts in the same way except to a lesser degree and there is never the shooting pain up the leg experience. Prior to this problem, I was not experincing overwhelming stress or any other mental problems (this is now driving my crazy). I did not experience a fall or any other trauma except perhaps wearing unsupportive shoes. I don't and never have worn high heeled shoes. I think I have pretty much covered my situation to the best of my ability and recollection. Do you have any insight at all as to why I'm still having pain and can you recommend... anything? I'm so desperate and frustrated. Thanks you in advance.
This sounds like nerve pain to me. I know you have been to a neurologist but I find many neurologists do not think "outside the box", meaning if the nerve conduction studies are normal as far as they are concerned there is no neurological involvement.
Since you are going to a pain management specialist I would certainly mention those symptoms specifically.
Marc Mitnick DPM
Johns Hopkins Medicine
University of Rochester Medical Center
American Academy of Pediatrics
Penn State Medical Center
National Institutes of Health
Columbia University Department of Rehabilitation
Stanford Health Care
Illinois Bone and Joint Institute
Mount Sinai Hospital
Institute for Chronic Pain
University of Florida Health
American Family Physician
University of Maryland Medical Center