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Sunday, February 24, 2013

Nerve Pain: Double Crush, Diabetic, Low Back??


I have had severe sharp stabbing and burning left foot pain for some time now. I was tested twice for neuropathy and found I am showing signs of it. A slight increase shown in the last test from the first which was three years apart. I am a Diabetic, not on insulin but taking 1500 mg of Metformin/day. I also have sciatic problems but mostly in my right foot. I blew out my l5-s1 in 1991 and had surgery to fix it. 6 moths later I was at the GYM working out on a machine and felt my right foot go numb. I put up with it ever since. I have been to three different Doctors about my pain. One claims it’s my neuropathy, another says it’s my back injury, and the last doctor (and current one) says it is Tarsitis. He gave my a shot in my ankle which took the pain away. BUT, it came back after two weeks. He gave me another shot but it only lasted four days. The pain is getting worse, keeping me from sleeping. Ice dose not work anymore. The pain is on top of my foot and on it’s left side looking down at it. It is also into my small toes. Seems to travel from in front of my ankle to my toes and wraps around the left of the foot.

No body has done an x-ray or a MRI. I am taking Lyrica which at first I thought it was helping but now the pain is worse.

Any suggestions?

John in PA  (name changed)

Dr Blake's response:

    Thank you so very much for the email. I am sure that there are some versions of Diabetic neuropathy that present like this, but it is an unlikely presentation and therefore not my top pick. However, it is a perfect time to make sure that your diabetes is under control. What is your HbA1c? Make sure it is below 6. You need to get a handle on what your neurological exam tells us. Please review the videos next.

So, from your description, and the 2 videos you can be dealing with a localized nerve (superficial peroneal or sural) or the L5 and S1 nerve roots, or both called the double crush syndrome. See the link below.

The injection you got was very diagnostic in identifying what nerve was involved, but it still does not tell you if all or some of the pain is coming from your back. Please follow these steps.

  1. Develop quickly a pain free environment, since nerve pain can get out of control. I personally had to get both an epidural and a sympathetic block since I could not calm mine down in 2004. I am presently nursing another back injury, and trying to be much better. 
  2. Get to a back doctor to do back xrays, MRI, and NCS/EMG. You deserve all these things because of the severity of your problem.
  3. Typically with nerve pain you are on some topical medication and oral like Lyrica. So, for right now ask about a topical and build the Lyrica gradually to 150 mg twice daily. 
  4. Work on your diabetes by getting the HbA1c and fasting blood glucose. 
  5. Use crutches, removable boots, activity modification, etc to get out of pain ASAP. 
 I hope this helps your direction. Feel free to comment. Rich Blake

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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.