- Neural Flossing three times daily (find out if sitting or laying techniques more productive)
- Nerve Pain supplements like B12, Vit C, (gradually you add one per month to check effectiveness, so you would wait on this right now) etc
- Some topical nerve cream applied 4 times daily (NeuroEze or Rx)
- Heat over ice
- No sciatic nerve/calf stretching (find out everything postural wise that is tasking your sciatic nerve from beds, sitting chairs, standing habits, workout techniques).
- Oral meds (start with evening doses only of Lyrica, Neurotin, or Cymbalta).
- Epidural injections into L5 nerve root
- Soft based orthotic devices like Hannafords
- See if there is a Calmare Pain Therapy center near you
- Sometimes TENS and Capsacin is helpful (but you have to go through 14-20 days of more pain first)
Thursday, November 5, 2015
Chronic Forefoot Nerve Pain: Email Advice
After baffling yet another Doc with my condition, I returned to the internet in search of a sport medicine podiatrist and came across your blog.
If you could offer any advice I would certainly be grateful. My situation is as follows (if you are able to help I can provide more detail J):
· 57 year old male – was active and in good health.
· While recovering from bilateral quad tendon issues I injured both forefeet in 2012 while hiking for 2 days in a caved area with stairs and slopes. To protect the quads I went up many, many stairs using my feet and calves (think of it as doing 4,000 calf raises).
· Result was bilateral stinging pain on the balls of the feet, the metatarsal marble sensation and sharper pain with dorsiflexion of 2 and to a lesser extent 3 and 4. No issue with great toes. And no foot issues whatsoever prior to hiking.
· Upper body issues have been ruled out – very confident on that.
· Failed treatments over 3 years have included: cortisone shots, orthotics, regrettably a right foot bunionectomy and shortening osteotomy on 2 along with pinning 3. Did PT and then was sent to a pain clinic. Next Doc focused on the left foot and performed a 2/3 neurectomy. No relief and told cannot treat if cannot diagnose. Indicated I had no serious issues such as cancer, etc.
· Current status is broad ball of foot stinging sensation that escalates with use (now constant), marble sensation on metatarsal heads (left 2 and 4; right 4), and toss in some stiffness and numbness from the surgeries! No swelling. No toe drifting on the left foot; slight pulling down of 3 on the right foot. Aggressive stretching = stinging, sometimes on a delayed basis – i.e. the next day.
· I have had 3 MRI’s (generally unremarkable according to Docs, but may provide some insight) and 1 diagnostic ultrasound (identified micro tears on the plantar plate).
· I have been wrestling this for 3 years and feel my condition is deteriorating while my activity level is very low.
· I buy into your concept of getting to a 0-2 pain level and then progress from there – but could use assistance developing a course of action.
If you are willing to help, I can get my hands on the MRIs and ultrasound reports or answer any questions you may have.
Thank you for considering my situation.
Dr Blake's response:
Thank you so very much for your email. It sounds nerve related more than plantar plate, at least this would be the area to explore. Nerve Pain is helped by some combination of the following (many of these topics are in the blog already):
Hope this points you in the right direction. Rich