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Monday, July 7, 2014

Complex Regional Pain Syndrome: Email Advice

good morning Dr. blake 

hope you are doing fine, i really admire your blog and hope you can help me .
after 7 month of suffering from sesamoiditis in the big toe, i was finally diagnosed with algodystrophy in all the first metatarsal and some on the heel.
Dr Blake's comment: Algodystrophy is another term for a subject I write about called "Complex Regional Pain Syndrome".

ALGODYSTROPHY: AN UNDER-RECOGNIZED COMPLICATION OF MINOR TRAUMA

http://medical-dictionary.thefreedictionary.com/_/dict.aspx?rd=1&word=algodystrophy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004542/?page=1

 i am really worried about my case , i can no longer wear orthotics because of the pain and i am now on crutches.
Dr Blake's comment: The inability to wear sturdy orthotics due to the pressure produced on the nerves at the bottom of your foot is almost diagnostic of this problem. However, low dye taping (without any wrap that goes all around the foot) and dancer's pads to off load the sesamoids can be very helpful when the sesamoid is still a trigger. 
i have passed the hot phase of algodystrophy and now is in the cold period where minor swelling and pain is focused mainly on the seasmoids.
Dr Blake's comment: The hot phase is the acute phase, the cold phase when the condition becomes more chronic, more stubborn, more centralized in your nervous system. 

i know this is very very rare case , but have you faced sesamoiditis algodystrophy and do you think i can heal without operation.
Dr Blake's comment: Your treatment should be 4 fold: local treatments of the sesamoid, oral and topical medications for the nerve pain, evaluation for one of the big guns (sympathetic nerve blocks, IV Ketamine Infusion, and Calmare Pain Therapy), and holistic approaches (biofeedback, psychological counseling, meditation, laterality cards, dietary supplements, etc). All of these are discussed within my blog, but you can email me what you are doing at present so I can point you in the right direction. 

do you advise to use a bone stimulator on my sesamoiditis since they lost their calcium or i risk braking them?
Dr Blake's comment: I will contact our rep on Exogen bone stim and see if it can be used, I am not sure why not? You should check yourself, but is the sesamoid inflamed (sesamoiditis) or broken? 

Regards,

Dr Blake's comment: I hope this is helpful. Please feel free to send me more information. Definitely check if there is a Calmare Pain Therapy center near you. Worth one treatment to see if helps, while you start working on other areas of this very demanding problem. Also, see if you can get low dose naltrexone prescribed for you. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.