Hi all and thanks for a great forum!

I could use some ideas on further testing, treatment and management of what appears to be peripheral neuropathy in both feet and ankles.

Here's a quick history. I am now a male 43 and used to be a runner for 20 about years, until the age of 40. Not a marathon runner type, just 3 miles a few times per week. In August 2006 I did a few runs that left me in pain so I stopped for a week or so. My final run left me in pain and never subsided. My symptoms were burning, random stinging and general aching. Most symptoms got worse in the evening when the burning was the worst.

I have seen 2 Podiatrist, 1 Neurologist, and 1 Orthopedic Surgeon who specializes in feet/ankles. I have done/tried:
- 3 rounds of PT, including massage, that seems to just make things worse
- Orthotics that don't seem to help or hurt much
- Ankle Foot Orthotics (AFOs) maybe help a little
- Lyrica just made me sleepy, Amatriptaline the same and Gabapentine that helps (see below), B complex that doesn't seem to help, Capzasine Cream 3 weeks that doesn't seem to work.

For testing:
- Blood work such as B vitamin, Gout, etc. All blood work normal. I can post all if needed
- 2 sets of X-Rays of feet show nothing.
- Nerve conduction shows very mild neuropathy of left knee
- MRI of left knee shows nothing
- MRI of both feet show nothing

Over time my symptoms have lessened to a point with some weeks having worse episodes than other weeks. Now my feet tend to get cold at different times of the day. I can't seem to pin down what aggravates the neuropathy or how my episode start/stop.

I am now seeing a pain specialist who has tried me on Gabapentine 100 mg/day. At first it worked great after about 10 days but after 2 weeks wore off. They now have me increasing to 200 mg and then to 300 mg. Jury is still out on that but at least it has stopped the burning at night.

I am scheduled for a nerve block but keep rescheduling to see if the Gabapentine will take hold. That way I can pull the trigger quicker on the nerve block if need be. I have considered acupuncture but again am holding off.

I would greatly appreciate any ideas on treatment, testing and general management I would appreciate it. Forgive me if I have forgotten something, but it has been a long 3 ½ years.

Thanks again,
Dave