Dear All,

I was diagnosed with severe PN in my feet four years ago. I take 3,000mg Neurontin + 25mg Amitriptylene. During this time I have been on my feet 1 hour per day, and sitting with my feet elevated the rest of the time. My PN is not worse at night.

In April I did some stretching (overstretching?) exercises - for suspected plantar fasciitis - which perhaps annoyed the already fragile nerves. Since then I have been housebound - using crutches and only walking a few metres on the balls of my feet. Despite basically resting around the clock, there is NO improvement since April. MRI scans in May showed diffuse muscle and plantar swelling (no plantar fasciitis), but nothing that could explain my situation. The physiotherapist says he cannot help because this is mostly a neurogenic issue.

If I try to massage or walk a little bit, there is a flare-up so that my feet get painful and swollen. It can take a week before my feet 'calm down' again.

What caused this? 1. Can overstretching your feet damage the myelin sheath so that the PN gets worse? 2. Can diffuse muscle and plantar swelling somehow squeeze and irritate the already fragile nerves? 3. What else?

What can I do? I suppose it depends on whether it is 1. or 2. above that caused this.

A. Rest for yet another few months and hope time heals this? B. Put the worst foot in an aircast so that the foot is immobile and give the subtle tendonitis/muscle swelling a chance to heal? C. What else? Medication would only make the situation more tolerable.

I am so worried and am grateful for any help. Sorry for the long post.

Kindly,
Grete Cooper

--to have nerve compression caused by a shifting in other bodily tissues or by swelling, and yes, nerves can be overstretched by severe mechanical forces leading to myelin sheath and even axonal damage.

Usually for the latter, though, it takes major torsional forces on the body part involved--it's not likely something one could do to oneself easily, unless one was lifting heavy weights or doing major gymnastics, for example. It would be much more likely to happen after a bad fall, a motor vehicle accident, or an assault, or some such injury.

There are nerves in tendons and these
Are myelinated and they will respond to
Any extreme thing that happens to tendons.

That is why a sprain often hurts more
Than a break.

Hi,

Thanks for the feedback – just one more question if you don’t mind.

As I mentioned in my neuro-talk post, the ill advised stretching that I did back in April/May has resulted in my feet now being significantly more swollen and painful than they were even though almost 4 months have passed. I really don’t know the best thing to do. Do you think it is better to just sit still and hope for some improvement, or should I grit my teeth and try walking to get the circulation moving a bit? Over the last few months I have tried both – neither worked but perhaps I was too impatient. I have tried gentle massage, soaking my feet in hot water and also ice to try to reduce the swelling – no joy. My feet are so swollen and sore right now that it is hard to contemplate trying to walk. Do you have any suggestions for me?

Thank you.

Grete

Thank you so much for your reply.

The 'Impression' from the MRI (end of May), L and R foot, were as follows:

-No imaging evidence of plantar fasciitis.
-Mild flexor hallucis longus tenosynovitis at mid plantar level.
-Diffuse subtle plantar group muscles swelling with rather increased signal of medial, lateral plantar and medial calcaneal nerves. Possibly subacute neuropathy, please clinically correlate.

Everything seems rather subtle/diffuse/mild. It is hard to couple the findings with the fact that I cannot walk.

Kindly,

Grete

You can try soaking in lukewarm epsom salts.
This often impeoves circulation and can
Reduce some pain.

There is a nice new lotion form called
Morton Epsom lotion. At Walmart, some
Walgreens and online at Amazon.
You would only need a small amount daily on the feet
To see some improvements. A little goes a long
Way and if you apply at night, it will help
you sleep too.