PN or Not? - That is the question
 

Symptoms:

* Ball of Foot Pain when stepping off barefooted (sharp nerve pain)
* Muscle Fasciculations in both calf's, Achilles and feet
* Tight calf muscles
* Tingling in legs and sometimes upper left side of back
* Occasional random nerve stings in different parts of body, usually in legs (5 or so per day, sometimes no stings in a 24 hour period)

Testing:
* Had blood work done, B12 is 1,000+ and all else checked out 100% normal, no mercury, arsenic, etc poisoning
* Had MRI's of brain done and it showed all normal

One doctor says it's idiopathic and stress/anxiety related and not in-line with PN, while another doctor says it might be PN and wants to conduct deeper testing and do EMG tests (which I told were painful).:(

I don't like being prodded and poked. Truth is some docs are only interested in making more $$$ and billing me for more tests, which might not be needed.

Questions:
Are my symptoms in-line with PN or not?
Should I do more testing (EMG) or just wait it out to see if things get better or worse?

Have you had x-rays of the ball of your foot? There are little bones in there called sesamoid bones. They can move, get damaged and cause a tendonitis in the ball of the foot.

If you don't move, do you still have that pain? Is there redness or swelling in that area of the foot?

* Yes, I had x-rays of the feet and they showed all to be OK.
* There is NO swelling or redness in the foot areas.
* If I don't move I don't have pain, 98% of the pain is during step off on hard surfaces while barefooted. Sometimes I get a shooting nerve pain in the ball of foot while sitting but that is maybe 1%-2% of the time. House slippers and padded shoes have helped a lot.

My podiatrist examined me and said it was "Metatarsalgia and neuritis" and said it was due to the foot mechanics (flat feet and hyper-pronation) and said my tight calf/Achilles muscles are contributing to the issue as the foot doesn't step off correctly when those muscles are tight.

He ordered me custom orthotics and stretching exercises.

MrsD - Do you think it is PN?

Hi Koi
 

I am sorry you are having the nerve pain. My doctor didn't require me to do the nerve conduction tests. They do hurt, and basically just confirm what she already knows. I it depends on the doctor, and wether or not they listen to you and believe what you say. I have PN after torn ligaments, and two surgeries of the left foot. What you described, is much like what I am feeling. I am not a doctor by any means, but you are describing alot of what happens with PN. I use lidocane patches, a compound, and some narcotics when it gets bad. I hope you find a compassionate doctor who will treat your symptoms. The patches help the most. They are hard to peel off however, and do cause some discomfort when removing them Worth it to get the relief. I do wish you all the best and I hope you can find the best possible treatment to ease your pain. ginnie

Thanks. Are your PN issues related to surgery?

It is very possible you just have mechanical issues in your feet.

This is very common, and you were wise to get that evaluated.

I would try Salonpas patches on that tendon, and across your arch. They work well for me for my sesamoiditis. It sounds like you have tendonitis and the anti-inflammatory actions of the patches may give you relief.
Try the original ones...not the others.
http://www.walgreens.com/store/c/salonpas-pain-relief-patches-topical-analgesic2.56-in.-x-1.65-in./ID=prod4526-product?ext=gooMedicines_ampersand_Treatments_PLA_ Hot_ampersand_Cold_Therapy_prod4526_pla&adtype={ad type}&kpid=prod4526&sst=2c7bbf3f-0bc9-a1c8-d226-00004f5d8f2a

They are not expensive and are surprisingly effective.
Patches like this can be very effective when you have a specific target to put them over. And you do.

When a person has PN....that will hurt in some way even when there is no motion. Pain that only seems prominent with movement is often mechanical and inflammatory. Pain all the time can be from some internal process (autoimmune) and/or inflammatory/metabolic issues which are systemic.

if in the future you do have to have an emg/ncs scheduled, most people who have had them dont find them to be all that bad discomfort wise. i have had ten of them already and would not hesitate to do them again if necesssary. they arent pleasurable and i wouldnt have one done for fun but they are not terribly painful. some people dont seem to be able to handle them, but most do. IT is part of the process of making a diagnosis for PN. I wouldnt avoid it and be misdiagnosed.

Hi Koi
 

Yes, I had two surgeries on my ankle. I had ganglion cysts, that went into the ankle joint. I have three more of those now which they are afraid to remove. I have three torn ligaments which would require tendon transfers, all of that is out because this PN developed. Doc. is afraif of this progressing to more serious RSD issues. I do have trouble walking with all these issues, so I do take medications to stay on my feet.
Hope you get some resolution. I am taking B12 and that has helped over the last year. ginnie

Thanks for the info and help!

I went to Costco and got the Salonpas (140 for $8.50). I will give them a try.

What you stated regarding PN is what my one doc stated. PN is a constant pain and mine is more of a pain issue caused by pressure (stepping off). I am also NOT getting any other symptoms of myelin sheath damage like numbness, strange sensations, burning, etc.

As far as the muscle fasciculations. I was told that there is such a thing as BFS (Benign Fasciculation Syndrome). It's a muscle twitch that has no real diagnosed origin and does not do anything besides become annoying and can cause some cramping or muscle stiffness. It can be brought on by stress/anxiety or sometimes a viral thing but they don't know for sure.

Maybe I have BFS and just bad foot mechanics? I did notice that when I got stressed my fasciculations increased A LOT in my calf and foot arches.

Magnesium usually helps with those fasics.

You can put the Salonpas up the shin some. I am doing that now
for my swollen left ankle. I find that they work there well for my whole foot! Must be blood vessels near the skin so the active methyl salicyclate can get into the blood there and move into the foot. So now I apply them 2-3 inches on the lower leg in front,
BEFORE the ankle. So do try them there.

Also if rotate your placement. I find days in a row say 3 or more,
and my skin can get irritated by the adhesive. Not seriously, but it itches etc. I've also moved the patch to the lateral side of the lower leg with good results. The sural nerve goes down to the foot on that side.

For the ball of the foot, I place the left edge of the patch just below where the big toe bends and loop it around the upper arch..not ON the ball of the foot (skin is rather thick there), but
very near the edge where it starts. This really helps any tendonitis from those sesamoids. I do this at night because this placement can come off during the day walking around etc.

I get my Salonpas at Costco too. I use them alot, so Costco is very cost effective. Once I open the green envelope and take the first one out, I use a Ziploc baggie to keep the rest...this keeps them fresh. You can also cut them and wrap around the big toe...which I have done sometimes too.

These work very well for arthritis, and tendonitis in the foot, and when you reduce that inflammation, you might find your calf nerves that twitch, stop doing that also.