I have found through my experience in health care and now as a patient that both subjective and objective data is crucial. You mentioned increased sweating as noted by PT, this is subjective. If you had a QSART test, also known as a sweat test, and the results we positive that would be objected.

What scares me more than anything is knowing there are physicians that would give this diagnosis without properly ruling out other conditions. Are you diabetic? Have you been tested for autoimmune disorders?

You mentioned bone loss, which is atypical for a person of your age and activity level. I would wonder if your delayed healing time is a result of the noted bone loss. I have broken many toes during my 13 years of playing soccer, so I can relate. I do remember being too stubborn to rest and let it heal before getting back on the field. The healing time was so varied from weeks to months, depending on where the break was and what treatment I received.

I noticed you mentioned Toledo a while back, and I am in no way suggesting that the physicians are not qualified, but have you thought about going to the Cleveland Clinic. Before I considered attempting a more invasive procedure I went to the Clinic for another opinion. Dr Stanton-Hicks is an considered an expert in CRPS and is one of the authors in articles you have mentioned. I saw both him and Dr. Bruce Vrooman, another well published physician, and the examined me and went over all of my test results and physician notes. It was after seeing them, 5 months after my official diagnosis, that I accepted the the CRPS diagnosis.

In my honest opinion I would be a little hesitant of doctors who aren't more conservative in their treatment. Refresh my memory please as to what was done before the nerve block. I would suggested desensitization therapy, including mirror therapy.

One other thing is I have a huge problem with the word "normal" being used in medicine. As I would tell my patients what is "normal" for me may not be "normal" for you. I believe that when we think that what we are experiencing is not "normal" we often get fixated on fear of not being "normal".

Sorry for such a long post.

I would like to point out, that erythromelalgia, is a possibility for your foot.

http://emedicine.medscape.com/article/200071-overview

This condition is often not diagnosed accurately by doctors today.

Also as far as nerve damage or Peripheral Neuropathy goes, there are over 100 causes of PN. In your case trauma appears to be likely.

To heal from damage to nerves you need certain nutrients.
Vit D
B12
folate
B6
Omega-3 fatty acids (flax oil and fish oil).
magnesium

If your diet is lacking these nutrients healing will be poor, or slow. The feet are well known to be slow in healing anyway since circulation to them is poor.

Tight shoes, tight lacing habits, or wearing boots, that constrain the feet alot, are not good for circulation that the feet need.

RSD is only one outcome from a foot injury. And this is statistically not nearly as common as Peripheral Neuropathy.

Fair point. I'll look into it.

I don't know if i'm diabetic. I have worried about this but unless I have been
diabetic for a long time it doesn't make sense to me as I haven't had any changes.


I haven't been tested for autoimmune disorders, i'm not even sure what that is.

I didn't immobilize the foot properly at all. I wore crocs and walked on my heal, for
3 months untill i got the immobilization boot. I made all my doctors aware of this.

Thanks for the recommendation. I'll have to look into this. I'm sure it would
be out of network, but the cost might be minimal compared to the gain.

I updated my extended bio with my history of symptoms.

I don't know. I don't know anything about what falls into the range of normal
healing for a toe fracture. I had assumed that if i were anywhere close to that
then my ortho wouldn't have refered me to another ortho who would then promptly
gave me a nerve block.

No need to apologies for a long post, your helping me. Time, effort, stress on
top of everything else you have to deal with.

I admit I don't understand how to view my condition in lue of the McGill Pain Scale. Maybe the McGill scale reflects the worse case?

This is very interesting. Some of the symptoms don't seem to match mine (itching,
I tolerate heat just fine), but many do (burning/warmth sensation, tenderness, swollen,
redness, pain walking, cooling and elevation help)

Sure, I haven't had time to read about PN.

Hmm, For my own edification I made sure I get some foods from each of the groups
you listed. I think i'm doing ok.

Vit D - My internal doctor just informed me i'm a little low in this, despite my
glass of milk everyday for the last month. Maybe i need more sunlight?
B12 - I eat lots of salmon, red meat, milk
Omega-3 I love salmon, i eat it at least twice a week.
folate - I eat lots of fruits and veggies
B6 - Beef, avocado's, spinach, bananas, fish, pistachios

Though, when i was injured i was eating a lot less fish, milk, and a lot more
Mediterranean food.

I have been wearing sandals and just bought a pair of super wide toe box shoes
which i have great hopes for. I live in north so winter is coming.

[/QUOTE]

Yea, I keep telling myself how unlikely this all is!

There is not enough vit D in milk to
Provide the amount you need daily.
Have a test asap and get a level so you
Can supplement with D3 at a proper dose.
Do not use D2 which doctors still prescribe.
Low D will impair any bone healing.

Low D promotes osteopenia and osteoporosis.

If you drink alcoholic beverages this also
Affects the feet and nerves. Same with smoking,
As smoking reduces blood flow to the legs and
Feet.
The dose for D3 is 1000IU daily for every 10 points
You need to raise. Use 50 as your goal.
So for example-- a level of 20 needs 3000IU daily.
Also, go to Walmart and get the Morton Epsom lotion
And apply to the top of your foot and ankle about
A quarter sized dollop and rub it in daily. This will help with
Pain and swelling better than epsom salts. $5.95 in the first aid
Section.
Sorry to be brief but typing on this phone is difficult!

The Epson Salt lotion can also be purchased on Amazon.

Yes, thanks....they sell Morton on Amazon too, but you have that shipping to deal with. (unless you buy $35)

I've heard that Walgreen's is now carrying Morton's too.

The magnesium is absorbed quickly from Morton's. I use mine every day!. It works within 5 minutes for me for neck spasms and even reduces tinnitus I sometimes get which is annoying.

When inflammation is present blood flow gets all mixed up and often the feet and fingers don't get the nutrient they need. So oral supplements tend to fail then. The lotion bypasses most circulation snafus and gets to the target very well. It even takes down swelling for me. The lotion is so convenient too. A wonderful little miracle for only $5.95!

CVS used to make one, but they discontinued it. The lotion base was not as efficient either in releasing the magnesium IMO.

Epsom-IT tends to be much more expensive and I haven't tried it.
Also there is a cream from Kirkman, but that is pricey too.

@Harry:

Harry, you know, people are all different genetically. They have subtle, but different chemistries all directed by DNA.

Hence diagnosis of some disorders remains observational...and hence subject to interpretation, and opinion. Diagnosis in these cases, may really just be an opinion by the doctor.

The foods we eat in regular amounts do not have high amounts of nutrients in them. When you are sick or injured and have tissue damage, there may not be enough nutrients absorbed from your food to get to the periphery...that is why PN attacks the feet and hands most commonly first.

I suggest you take therapeutic amounts of fish oil or krill oil until you have healed better.

Also there ARE studies from Europe about using Vit C for RSD prevention. Some posters here even post about IV C for RSD management. In the past we had a poster Vic who recommended another antioxidant... grapeseed extract.
C and grapeseed scavange free radicals which are numerous after injury. They are inexpensive and benign with no side effects. I think they are worth a try in your case to enhance healing. The doses suggested for this were, 500mg a day or 1000mg a day for 2 months. A dose for grapeseed extract would be 500mg -1000mg a day.

This is just one study on the Vit C --there are several papers on PubMed about this:
http://www.ncbi.nlm.nih.gov/pubmed/19840748

Keep in mind that not all research or papers are totally honest also. There is much coming out about manipulation by Big Pharma and Device manufacturers slanting studies in their favor.
Merck went so far as to create a fictitious medical journal showing their products favorably and released it in Australia.
There was a doctor in California who fabricated post surgical pain papers in favor of Pfizer products. And a Japanese anesthesiologist who published over 180+ false papers.
Many drugs today were manipulated this way. There was a huge controversy among journal publishers not too long ago where doctors names were used without their permission on study titles of drugs, so that the papers would have more weight when used by drug reps to detail those products. This ghostwriting was pretty rampant at one point. Harvard had a huge scandal in their child psychiatry department over use of antipsychotics in toddlers! example here:
http://ethicalnag.org/2010/10/23/toddlers-on-drugs/

The human body seems to be resistant to labeling and generalizations. In the case for erythromelalgia, some patients have developed it out of the blue, or just after an exercise workout. An obvious injury lacking for them. So one really needs to remain open to other causes for a problem. Prematurely focusing and labeling something closes doors for healing, exposes you to unnecessary invasive treatments, etc.
Thinking outside the box may open a path for better healing for you. (doctors don't really "heal" you know. They objectify, label, and give drugs for symptoms. But they don't really heal, YOU heal yourself).

Thanks for all your messages,

* I have being doing the epsom salt baths for about a week and they seem to be helping.
* My internal doctor suggested i pick up a vitamin D supplement, i think your right that it makes sense to get D3. I can probably stand to get more sunlight as well.
* I can't see why taking a vitamin C supplement would hurt.