Long term foot and ankle pain

[Rblewis7]

Hello all,
  I have had the pain for about 10 years and docs have not been able to id the issue. So, thought I might see if anyone has any other thoughts. I have pain when I stand, walk, sit or lay down (this is in the order of level of pain as well - standing is the worse). When I stand the bottom of my feet will throb. Sometimes most of the bottom and sometimes I will get certain points like the heel or by the big toe that almost feels like a cigarette burn. Other time when I sit the ankle to my whole foot will burn/tingle. It's almost like the pressure on the back of my leg causes this. Also, sometimes if you run your hand from the top of my leg to the ankle you can feel,it goes from warm to very cold at the ankle. I now have started to have issue with my hands where it will start to hurt in my wrist and radiate into my pinky and next 2 fingers.

This has been gradually getting worse over the past 10 years and I have seen a ton of doctors. General doc, neurologist, chiro, podiatrist, homeopathy, acupuncture, pulmutalagist,. I have had MRI leg, ankle, back, X-ray, blood pressure test, nerve conduction test, lots of blood work with nothing has been found. I have also tried lots of drugs neurotics, cymbalta, niacin, vitamins like the Bs and other.

At is point not sure who else to talk to or what else to try, so any thoughts would be much appreciated:)

Other issues:
Migraines

Link to other post I have made:
http://www.medhelp.org/posts/Undiagnosed-Symptoms/-Long-term-foot-and-ankle-pain/show/2039220

http://www.medhelp.org/posts/Undiagnosed-Symptoms/Long-term-foot-and-ankle-pain/show/1958475

[Rblewis7]

thanks - I see the doctor next week (setting up a 2nd MRI of spine) and will get these run as well. Appreciate the thoughts!

[Dr. Kokil Mathur]

Hi!
I am sorry I took some time answering that. I was really baffled about your condition just like your doctors probably are. Most common causes like pinched nerves, diabetes and peripheral neuropathy, ligament tears and fractures etc have been ruled out in your case. Hence I have been giving it a lot of thought and though have not come up with something really brilliant would like you to read this post and re-think in this line! Hopefully you will find your answers here!

I’ll start with your symptoms of temperature difference on your feet, burning sensation, and feet turning purple on hanging them down. Typically this sounds like Raynaud’s disease and you have probably been tested for it except may be a couple of tests and clinical evaluation. The blood vessels go in spasm in respond to stress, temperature difference or without a cause (primary Raynaud’s). Hence dopplar studies of limb vessels do not show any plaques, atherosclerosis etc. Also, MRI and nerve conduction studies, EMG etc are normal. The problem can affect your upper limbs as has started in your case.

Raynaud disease commonly occurs secondary to lupus, scleroderma, rheumatoid arthritis, mixed connective tissue disease, Sjogren’s syndrome, smoking, exposure to certain chemical, and repeated injury to foot (as in playing sports, excessive exercising etc). Some times no cause is identified (primary Raynaud’s). Use of over the counter cold medications, and beta blockers aggravate the condition.

To diagnose or rule out this disease your doctor needs to request for a complete antibody panel and carry out nail fold capillaroscopy to examine the condition of the tiny blood vessels. Sometimes there is no disease and just a Raynaud’s phenomenon. The general treatment is the same except that in secondary Raynaud’s, the underlying cause needs to be treated. Drugs like calcium channel blockers, alpha blockers and vasodilators are used to treat the condition.

Looking over your list of tests, I see that you had rheumatoid arthritis and autoimmune panel done. However, please ask your doctor if it was a detailed panel covering all the above points. Also, you should undergo a test for insulin resistance and glucose tolerance test (GTT) as often the regular blood tests for diabetes are unable to spot the disease.

I also suggest you try physiotherapy, swimming, deep breathing exercise and yoga to reduce the stress of your pain and symptoms and to improve the blood circulation and nerve conduction.

I sincerely hope you will find this information useful in your journey towards better health.

Hope you get well soon! Good Luck and take care!

[Rblewis7]

Coupe extra things:
1. I also started having migraines around the same time as my lower extremity pain
2. Lately I have started to get a pain burning in my wrist - seems it happens at night
3. I can make my feet turn a purple if i seat on anything that I hang my legs off of like a chair or doctors table
4. I eat a fairly clean diet no dairy, no soy and I have tried:
  - Palio diet
  - Eat for your blood type
  - Atkins
  - Chinese Med diet
5. I have also tried several foot insert from the store and 3 different type made by a doctor (from a mold, using pins, metal mold). None helped

Drugs I have tried:
AMLODIPINE BESYLATE 2.5 MG TAB
HYDROCODON-ACETAMINOPHEN 5-325
GABAPENTIN 300 MG CAPSULE
VOLTAREN 1% GEL
TRAMADOL HCL 50 MG TABLET
TIZANIDINE HCL 4 MG TABLET
CIPRODEX OTIC SUSPENSION
POTASSIUM CITRATE ER 10 MEQ TB
CEPHALEXIN 500 MG CAPSULE
ALTACE 2.5 MG CAPSULE
NORTRIPTYLINE HCL 25 MG CAP
CYMBALTA 60 MG CAPSULE
TRILYTE WITH FLAVOR PACKETS
MAXALT 10 MG TABLET
ERY-TAB EC 333 MG TABLET
LYRICA 75 MG CAPSULE
NAPROXEN 500 MG TABLET
CIPRO HC OTIC SUSPENSION

Also, here is the long list of test that have been run with nothing showing bad:

Tests & Procedures
Leg artery doppler ultrasound study
N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI


Intra-lesion injection
Triamcinolone injection
Autoantibody test
Complement blood test
COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT
CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE
Fat blood tests
Immunofixation electrophoresis test
Rheumatoid factor assay
Knee MRI
Lower limb MRI
CIRCUMFERENCE.AT UMBILICUS
INTRAVASCULAR DIASTOLIC
INTRAVASCULAR SYSTOLIC
Chiropractic treatment
Electrical stimulation application
Chest spine X-ray
Lower spine X-ray
Brain MRI
ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE
ESR test
Ferritin blood test
General health panel
Limb vein doppler ultrasound study
Lyme disease antibody test
Noninfectious agent antibody test
Protein typing test
Total CPK blood test
Total protein blood test
Bone scan
Radioactive isotope supply
Foot X-ray
Sex hormone binding globulin blood test
Thyroid hormones uptake test
Total testosterone blood test
Total thyroxine blood test
Vitamin D-3 blood test
Nerve conduction study
Limb artery study
Immunization administration
Tdap vaccine
Urinalysis
Vitamin B12 blood test
Neck spine X-ray
@LABCATEGORY_HEMATOCRIT@
@LABCATEGORY_HEMOGLOBIN@
ALANINE AMINOTRANSFERASE
ALBUMIN
ALKALINE PHOSPHATASE
ASPARTATE AMINOTRANSFERASE
BASOPHILS
BASOPHILS/100 LEUKOCYTES
BILIRUBIN
BILIRUBIN.GLUCURONIDATED
Complete blood count
EOSINOPHILS
EOSINOPHILS/100 LEUKOCYTES
ERYTHROCYTE DISTRIBUTION WIDT
ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN
ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION
Date of Test/Procedure: 09/30/2010
ERYTHROCYTES
Granulocytes.immature
GRANULOCYTES.IMMATURE/100 LEUKOCYTES
LEUKOCYTES
Liver function tests
LYMPHOCYTES
LYMPHOCYTES/100 LEUKOCYTES
MEAN CORPUSCULAR VOLUME
MONOCYTES
MONOCYTES/100 LEUKOCYTES
NEUTROPHILS
NEUTROPHILS/100 LEUKOCYTES
PLATELETS
PROTEIN
CHOLINESTERASE
ASSAY OF ALUMINUM
ASSAY OF NICKEL
CADMIUM
HEAVY METAL SCREEN
Lead blood test
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
Pulse oximetry
MOLEC SIGNAL AMP NUCLEIC ACID EA SEQUENCE
Molecular study
DNA ANTIBODY SINGLE STRANDED
Muscle electric testing with needle
Kidney function tests
Creatinine urine test
Urinalysis
Glomerular filtration rate/1.73 sq M.predicted.black
Total protein urine test
ASSAY OF THIAMINE-VITAMIN B-1
Glomerular filtration rate/1.73 sq M.predicted.black
Glomerular filtration rate/1.73 sq M.predicted.black
ASSAY OF COPPER
Glycosylated hemoglobin test
Organic acid test
Antinuclear antibody (ANA) test
Syphillis test
Vein puncture
Lower spine MRI
Complete blood count
CRP blood test
Flow cytometry
Rheumatoid factor assay
Date of Test/Procedure: 09/25/2007
Uric acid blood test
Folic acid blood test
HLA typing
LIFT ELEVATION HEEL TAPERED METATARSALS PER INCH

Other lab reports:
here are some of my lab results

Name Result Normal Range
DAT, BS Coombs NEG

Angiotensin Converting Enzyme 13

WBC 4.3 K/uL 3.6 - 10.4
RBC 4.65 M/uL 4.16 - 5.83
HGB 14.0 gm/dL 13.0 - 17.4
HCT 41 % 39 - 52
MCV 88 fL 82 - 99
MCH 30 pg 27 - 34
MCHC 34 gm/dL 32 - 35
RDW 12.5 % 12.2 - 16.3
Platelet 306 K/uL 142 - 328
MPV 7.2 fL 6.0 - 9.5

Absolute Neut 2.81 K/uL 1.60 - 7.71
Absolute Lymph 1.11 K/uL 1.05 - 3.20
Absolute Mono 0.22 K/uL 0.20 - 0.90
Absolute EOS 0.09 K/uL 0.00 - 0.50
Absolute Basos 0.02 K/uL 0.00 - 0.11
Neutrophils 66 % 41 - 74
Lymph 26 % 15 - 48
Monocytes 5 % 5 - 13
Eosinophils 2 % 0.0 - 7.0
Basophils 0 % 0.0 - 2.0

Sedimentation Rate 1 mm/hr 0 - 15

LDH-Total 176 IU/L 135.0 - 225.0

Complement C3 115 mg/dL 79 - 152

Complement C4 30 mg/dL 14 - 38

Cholesterol 208 mg/dL 59
Estimated GFR African American >59 mL/min/1.73 m2 >59
Calcium Level 9.7 mg/dL 8.4 - 10.4
Albumin Level 5.4 gm/dL 3.50 - 5.20
Total Protein 7.4 gm/dL 6.6 - 8.7
Total Bilirubin 0.9 mg/dL 0.0 - 1.2
Alkaline Phosphatase 67 IU/L 40.0 - 129.0
ALT 18 IU/L 0.0 - 41.0
AST 22 IU/L 0.0 - 40.0

CPK-Total 196 IU/L 39.0 - 308.0

Albumin Level 4.9 gm/dL 3.4 - 5.2

Total Protein, Serum Electrophoresis 7.2 gm/dL 6.1 - 7.9
Alpha 1 Electro. Serum 0.3 gm/dL 0.2 - 0.4
Alpha 2 Electro-Serum 0.5 gm/dL 0.4 - 0.9
Beta Globulin, Serum 0.7 gm/dL 0.5 - 1.1
Gamma Globulin, Serum 0.8 gm/dL 0.7 - 1.5
M Spike, Serum NEGATIVE gm/dL 0.00
Quantitative M Spike NEGATIVE gm/dL 0.0
PE Interpretation, Serum NORMAL ELECTROPHORETIC PATTERN