You mentioned in an earlier post that you have seen multiple doctors.

Have any of them given you their professional opinions of an actual diagnosis for you?

Yes birchlake,

9/3/2014 ~ second visit to Dr. M ~ he suggested it might be rsd/nerve damage/etc... he ordered a bone scan at ----- hospital.

9/13/2014 ~ dr. E at utmc diagnosed with CRPS and I have a nerve block done in right foot. I believe 3 shots of in the postival nerve of steroid kenalog - 10. hcl 1 percent. Before nerve block i feel only a level 1 pain, no pain from any part of the foot being touched. It should be noted that this was in the morning and the mornings are generally a little bit better then at night.

9/17/2014 ~ See dr. A at utmc. Dr.A is a CRPS specialist. Dr. A remarks that “you don’t have the symptoms of CRPS, but i'm not sure what else it could be". He suggests two weeks of a lidocaine 5 percent.patches to be worn for 12 hours to reduce pain. He also remarked that the right foot (trauma foot) was colder, which was interesting because it has always felt warmer to me. Though i didn’t test it at the same time. In retrospect the foot has felt less hot sense the nerve block.

9/18/2014 ~ Dr C diagnosed wtih CRPS type 1. Dr. C is a CRPS specialist Recommended Lumber nerve block and Gabapentin.

My understanding is that CRPS is hard to diagnosis, but that in many cases it's by ruling out other possibilities. That's why i'm trying to figure out what else it could be. For one, because i want it to be something else. Secondly because if it's not then i need to treat what ever that is.

I see dr. A on 10/1/2014 for a follow up. My expectation is that he too will diagnosis it as CRPS.

Hi HD, "
Not to sound a bit off here but you need to look at it as "It is what it is" and let the docs do their thing.
It may or may not be CRPS. If it is, then good to know so it can be treated. If it's not, even better. But dxing a problem is best left up to the experts. Just be sure they're experts!
That's my humble opinion...

One thing to be aware of, though it's really rare, there is a "warm crps". The temperature fluctuations in crps are caused by Autonomic Dysfunction. Basically your body is unable to regulate basic things like temperature, and pigmentation. A lot of the severe discolorations and temperature changes are not only Autonomic Dysfunction but coupled with severe swelling (ie Edema) and can actually be very harmful as it can cut off blood and oxygen supplies which cause a whole lot of other series of problems.
I'm not a doctor, but it doesn't seem like crps to me at all. Possibly a neuropathy of some kind, but maybe not crps. I would maybe suggest you try to find a Crps or Neurologist or Physiatrist specialist in your area. It's never a bad idea to seek out a second opinion before resorting to drastic procedures or diagnoses.
Oh just an FYI, Peripheral Neuropathy can kind of mimic some of the symptoms of crps. They have a list of VERY similar symptoms. However a HUGE key for crps is the "out of proportion to injury or stimulus pain". PN can cause minor discolorations, very slight temperature changes, and swelling.
On another note. The year before my injury that led to my crps I broke my ankle. The ER had failed to find the break in the x-rays. So what would have been a somewhat simple case of 3 months of using the R.I.C.E. treatment (rest, ice, compression, and elevation), turned into extreme swelling for 8 months almost having surgery and very prolonged pain. Because the ER didn't see the break, I was diagnosed with a moderate sprain (stage 2). I kept asking for another X ray, but they wouldn't. I had to argue with the ER doctor to get a "boot" and crutches. Even though I couldn't bear ANY weight on that foot without screaming. Anyways, long story longer, I was told to only use the crutches for 3-5 days. 5 weeks later I was still telling my doctor that I couldn't walk on it, (I was calling or seeing that doc at least once a week trying to get them to take another X ray to prove it was broken as I suspected) and an MRI was ordered the same day. The Orthopedic Specialist who read the results said I was extremely lucky. I had been correct, and had I even stepped wrong it would've broken the bottom of my tibia off and would've had to have surgery. The healing process was extremely retarded since I had been told to walk on it as much as possible. Nice hug? And it was reeeally swollen still. I was even elevating it and putting ice on it when at work. 4 weeks later and even though the bone was starting to heal, the swelling wasn't any better. So I was put on what basically amounted to bed rest, I even had to elevate it (constantly) at night. My point with this story is if you started using it too soon, too often, it can extremely retard the natural healing process.
Again I would highly recommend that you get a second opinion. Neurochic, was spot on when she explained the specific criteria for crps. The reason being that there are quite a few other autoimmune and neuropathic disorders that can present a few similar symptoms. But you MUST fit at least 3 of the defining symptoms to be diagnosed with crps.
Before your doctor does anymore unnecessary procedures or medications, I seriously can't believe he gave you lidocaine patches or a nerve block with no definite crps presentation, Seek a Second (technically 3rd lol) Opinion!!!!
And Good Luck! Let us know what happens even if it isn't (iI'll pray for you its not!) Crps! We care about each other in this community!

Thanks CRPSsongbird,

I started using my foot way to soon. I was horrible mix of arrogant and ignorant. I buddy taped it but never used the immobilization boot until 3 months in. I drove on it, walked on it, etc...

The only upside was that at work and home I didn't have to do barley any walking.

When i See my Doctor again i'll make double sure they understand my history.

I haven't yet seen a neurologist yet, I had trouble finding one that also had a background in CRPS. It might be worth a 3rd opinion.

Is the nerve block something to be worried about?

I'm sorry to hear how things turned out for you. Best of luck in the future.

I do understand how hard it is to find a specialist. But I would really recommend getting another opinion. Your symptoms really don't fit the crps diagnosis parameters. Check out this site

Wwwrsdhope.com
Www.mayoclinic.com -and search CRPS/RSD on their search'

It lists many symptoms. But you have to closely fit at least 3 symptoms. And that is only AFTER ruling any other conditions/syndromes out. There's is not a single test that can prove Crps, and even though early diagnosis can be key to recovery, should only be given when all else has been ruled out. It really comes down to a process of elimination, given a history of certain symptoms. Also it has 2 "types" Crps I- without a specific injury or trauma and Crps II- a defined injury or trauma. Either of those types can be the cold or warm crps. My left arm ranged from 8-12 degrees colder than my right for example. But it comes and goes and will present in patches or specific areas and sometimes will be the entire arm. Regardless you should print out the symptoms and diagnosis criteria and have your doctor go over it with you. I maybe he has a good reason for giving you the diagnosis he did, and you just need clarification!

I would like to thank everyone for sharing their comments, I understand my condition is much much better then many of yours. I like using these posts as a sounding board for ideas.

After reading everyone's comments I decided to dig a bit deeper into how to diagnosis CRPS. In a couple hours the best I could find was this set of criteria talked about in "Proposed New Diagnostic Criteria for CRPS" See Table 3.

This paper does a great job explaining the sensitivity vs specificity trade off's.

This is how I have broken down my condition based on those categories.


---- 1 ----
1.1 maybe: My pain hasn’t been out of proportion to the injury but has been abnormal in its duration.

---- 2 ---- symptoms ( things reported to doctor)
2.1. Maybe: No hyperesthesia. Maybe allodynia.
2.2. POS: I have had temperature asymmetry (foot felt warm, no longer does) and skin color changes (redness). Though currently, after two days of measuring they seem to be about the same temperature.
2.3. Maybe: No sweating. Possible Edema.
2.4: POS: Injured toe discolored, though improving. only 40% ROM in plantar flexing the toes.

----3 ----
Signs are the same as symptoms only their observed by doctor at evaluation. I'm not sure what my doctor observed or how to take this into account.

----- 4 -----
4.1 The doctors haven’t offered another diagnosis that better explains the signs and symptoms.

-------------------------------------
Questions I have to resolve:

1.1 Could my duration be due to mis-treatment of foot and toe?
2.1. Have I had allodynia? That is, could the warmth in my toes be considered allodynia? We should note that warmth and redness are always as result of walking or sitting. My research suggests no, it doesn’t match the symptoms of allodynia.
2.3: Could the swelling, (mild and local to the toe, in line with what you would expect) be considered Edema? Would this count as a condition?
3.1 Same as 2.1
3.3 Same as 2.3

4.1 (Same as 1.1): Could I still just have delayed healing due to poor management (not enough rest and immobilization).

----------------------------------------------

So far as I can tell this creates two scenarios.

It’s a fracture that took a long time to heal due to mistreatment.
It’s CRPS with statistically unlikely set of mild symptoms.

I know I have two diagnosis of CRPS, but after consulting the literature i’m not sure that really settles the matter, given the preference in the medical community to avoid False negatives. The sensitivity and specificity rates in that paper make it clear its very easy to diagnosis this incorrectly. My next step is to bring these concerns to my doctor (10/1/2014) and if he can’t rule it out to investigate further tests and opinions.

Thanks for everyone's suggestions!