Hello all.
I am a health care practitioner tired of getting the short answers and no information. So I thought this looked like a place I could post for some more potential answers. Mainly I would just like a list of items on the metabolic or phyiologic side of things as I am fairly familiar with the musculoskeletal system including many common neurological disorders. However I don't want to get in my own way and over analyze it either. Well here you go.

I am a 36 y.o. male Caucasian with a hx of working out 3 x per week. No prior medical conditions. No medications. Primarily c/o burning in B. feet in a stocking glove pattern x 3 months. Occasionally in B. palmar aspect of my hands in the AM or after a lot of typing ( but I suspect this is median nerve carpal tunnel type symptoms) appears to be peripheral nerve in distribution. No myotomal hand weakness noted. It will feel a bit pins and needles in the feet, but mostly burning on the plantar aspect. I am aware of it into B. dorsal feet slightly proximal to the B. Malleoli. Father with hx of type II diabetes, but otherwise no significant family hx for this condition. I live in the Northwest so I don't get tons of Vit D but trialed a OTC supplement. MD Tested for Vit. B12 deficiency one young doctor recommended shots, the other said " it is not that." so I did not get the shots. Does not appear to be a dermatome type pattern. No myotomal weakness noted with function or testing. Negative for L/S pain except for occasional mild L/S twinge after a long day at work (mixed standing and sitting). Condition appears ( though not definite) to increase with sitting at the end of the day, and reduce with standing and walking. I cannot reproduce the pain with neural tension testing, slump test, SLR test etc.. Pedal pulses feel present but to me a little weak. I have self tested to light touch, have not tested deep pressure or pain, but to me that seems pointless because . No other neurological sensations to note ( from my observation or sensation). Diabetes tests have had multiple fasting blood glucose that were all negative, though haven't had a recent one. Asked physician to run a metabolic panel that came back negative as I asked her to rule out kidney and liver. I asked to rule out liver because there was one day one of my eyes looked a little yellow to my girlfriend and I get very fatigued after drinking only a beer or two. So I thought it might be a early sign of Jaundice of some sort, but appears not according to testing per MD.

What I would really hope for is a list of items to request next time I am at the physician to rule out all the common causes of burning feet. Or a list of specialists to work my way through ( with tests to request) to get a definitive answer.

Sorry if it is a long obnoxious post. I just have yet to find a GP that has any interest. Maybe I am obnoxious--I don't mean to be, I just expect a rational for the suggestions and I am not getting one.

Thanks,
Pedaburn

Welcome

Can't give you a definite answer, but sounds like you'll find out.

How about good old neuropathy for starters?

Keep asking. someone will come along with more answers for you.

Look forward to following your quest.

--a small-fiber neuropathy, possibly ischemic in nature (associated with fluctuations in blood pressure/blood flow to the extremities), and/or influenced by biomechanical compressive forces (the "double crush" hypothesis, which implies that multiple negative forces on peripheral nerve can produce symptoms that are more than the sum of their parts, and which would not otherwise be anywhere near as noticable).

It seems like you need a good work-up from a neuropathy specialist, which would include a lot more blood work (and probably a multi-hour glucose tolerance test, which mught be far more accurate at determining glucose dysregulation/insulin resistance than a fasting blood test of hemoglobin H1Ac--it is now well established that small-fiber neuropathy can happen with impaired glucose tolerance well in advance of a diagnosis of frank diabetes) and probably some nerve conduction tests. A caveat, though--small-fiber (the fibers that subsume the sensations of pain and temperature) problems cannot be ascertained through standard nerve conduction studies, which can only measure the transmission of fairly large, myelinated nerves.

Some good places to check out protocols:

The Liza Jane spreadhseets:

www.lizajane.org

This Quest application paper:

http://www.questdiagnostics.com/hcp/...eralNeurop.htm

The Poncelet protocols:

http://www.aafp.org/afp/980215ap/poncelet.html

Welcome to our board.

First off I'd get the numbers you had when the B12 test was run.
What was the result? Interpretation of "normal" of this test is very spotty in US. If you are below 500... you need a supplement. You don't need shots as an only intervention.
Proper use of oral B12 can work as well. Do you take acid lowering drugs? If so you may be low in other things like folic acid, calcium, zinc, magnesium, iron.

Do you do cycle workouts? Ride a bicycle for exercise?
This may compress nerves.

Did you have thyroid testing?

I would investigate gluten intolerance. This can cause alot of neuro symptoms that do not show up on standard metabolic panels.
Here is an excellent resource:
http://jccglutenfree.googlepages.com/
This is our gluten board:
http://neurotalk.psychcentral.com/thread98657.html

Have you had fluoroquinolone antibiotics recently?
Do you take statins for cholesterol?
Have you been exposed to solvents/strippers?
Were you tested for heavy metal levels?
Did you receive a vaccine before this started?

The above questions reflect the possibility of mitochondrial damage. This would point to using acetyl carnitine and CoQ-10 to help in this area.

Check out the Quest diagnostic link that Glenn provided.
It has a more complete list of tests that are suggested for PN.

If you are alcohol intolerant, then that points to Thiamine as a support nutrient. The improved version of this is called benfotiamine and is used often for PN.

i am betting on a low B12....if the newer doc (with newer education) wanted to supplement i would bet it is below 500......i would also bet that your condition is going to be multifactorial....an MRI of L/S spine an evaluation of your work station.....do you need glasses? or new ones, ie are you altering your posture antagonizine your L/S area? are your feet planted firmly on the floor, avoinding pressure on the back of your thighs (part of Glenn"s double crush idea). fasting glucose really isnt worth the powder to blow it to you know where.....especially with family hx, and you are getting into the right age group. and my favorite, gluten intolerance/celiac disease. See, you were correct in posting here! Isnt it lovely when we are blown off by our own,not!

But, I gotta ask two questions key to which direction you mite go....
1- Have you 'fallen' either this past winter, or sprained your back in your work in the last few months? That could send you more on the 'spinal damage' track. OR
2- Did you have a pesky long-lasting flue or pneumonia or bug of some sort in the past few months? How long since such did you start getting numb-ish?
Does it just feel like BURNING [as in scalded]? OR...Does it feel as if you've had your feet dipped in hot-french-fry oil? Believe me, the difference is HUGE in terms of pain! [And, I was admitted to ER and hospital due to it all.] The latter, combined w/a past 'bug' could indicate auto-immune [which is what I have?]. and the faster the diagnoses the better.
What would be best to do now? Get an appt w/a neurologist and make it clear that you'd be open to squeezing in for a cancellation! As the first appts w/neuros are usually 8-12 weeks from a first call. GET and bring copies of all your test results done by other docs to date and bring COPIES, you keep the originals, as you mite need those in the future. I've seen 7 neuros since I first came down w/this...I even 'interviewed' my current GP to be sure that they KNEW what immune issues they were dealing with? Of the 7 I've seen, I'd reccommend 2 one I see and a super-neuro-dept Hospital head who'd diagnosed me. It is, after all, YOUR LIFE? and some baad things can happen w/immune neuropathies. But, KNOWING what all is going on with the chemistry of ANY neuropathy keeps the mind alert to all that the body is telling you!
Go to the PN Forum here in Blue? Just click it on... http://neurotalk.psychcentral.com/forum20.html And read all the 'Stickies' at the top...this is INFO to keep STUCK at the top and It's got key goodies to read.
Since I 'started' 6 years ago with my own PN? I can only recall 2 instances when I've NOT felt that old 'stocking-glove' issue.
Good luck and learn and never be afraid to ask questions! People here are kind and do share freely! I just hope all of this doesn't hurt your career. Caring folks in the medical profession are rare. Since I've just come outta a hospital and rehab stint.. I TREASURE those folks especially for keeping my sanity!

Hello pedaburn, and welcome to NeuroTalk! You've been given some good advice. You wouldn't believe the number of caring, helpful people here!

I wish you all the best in getting an answer as to what's causing your pain, and in resolving it as best as it can be resolved.

We are so glad you found us!

I would continue to monitor what seems to aggravate it the most,,its veryironic that you mention liver problems,,i have liver prblems and my feet burn and sting,,i have rsd too , which you could factor infor me,,but when im on alot of meds and because it doeant take alot [such as your drinking, not taking much] is a sign of liver problems,,,,,one thing that you didnt mention,,,Are the bottoms of you feet and palms warm or hot[exspecially the feet,,thats another liver dyfunctional indicator,,,thats whta happens to me,,ussally in the evening or in the nite time ,the bottom of my feet burn and are physically hot when im laying down ],,,,lay off the drinking and do a liver detox,,,milkthistle and caned sliced beets are good along with b1 and folic acid, ,,im not saying this is your problem,,but detoxing the liver should be done antway,,and will help eliminate one of the obvious,,and you can also runanother liver function test,,and see if the ALDOLASE level is elevated too,,,,,,,,,,,,,,,,,,,,,,,,,bobber,,,keep us posted and good luck