Thanks Zoo,

it's very interesting that osteoporosis can cause flares. My X-rays, just a month back) showed osteopania and it might still persist, though given my diet and weight lifting i doubt it played a role in the injury, it might be playing a role in my current symptoms. I'm still at about 40% ROM in my toes so at least i have something to work on that might help.

I think perhaps you misunderstood my mention of osteoporosis and pain flares. It was just an example. Anything that causes pain like arthritis, chrohns disease, CRPS, IBS etc., that have a base line of what would be considered tolerable or normal pain levels that suddenly increase with or without a trigger is considered a pain flare or even a symptom flare. The reason I used osteoporosis as an example in your case was simply because previously you mentioned being positive for osteopenia which can contribute to pain, more prone to bone fractures and if it continues or progresses into osteoporosis then yes pain is likely. In your shoes I wouldn't say it didn't play a role in your fracture(s) since having osteopenia at your age especially considering you do lift weights and eat healthy this particular diagnosis (osteopenia) should be further investigated. As I mentioned in a previous post to you it is highly unlikely that the osteopenia was caused by CRPS given your symptoms and reduced pain levels since injury. In your shoes I would seek out an internal medicine doctor who can do a complete workup of your blood, endocrine etc., that would explain osteopenia at your age & fitness level.

As far as ROM goes it is not uncommon to have reduced ROM for even up to 2 years after a fracture. I would think that for the toes this could be longer since the normal ROM is quite small and they really aren't doing big movements throughout the day. My most recent fracture of my ankle was just this past July and I've only gotten about 50% ROM back at this point also and pain is still there with certain movements but nothing like the pain I feel in my legs from CRPS. It is pain from stiffness/swelling and stretched tendons/ligaments. I know this to be true because the pain improves with resting and elevation and worsens with use. CRPS pain does not improve with rest, elevation or anything else for that matter.. it is there the minute you open your eyes until the minute I manage to fall asleep - at least this is the way it is for me.

As long as your pain is improving or stays in the low levels and the bone is healing I would continue to remain positive and be patient with your healing.

** I see in another post that you mentioned you do get increased pain at the same time everyday? Is this in the morning or night and what are you doing before this increase in pain?

Thanks a lot zookester,

The osteopenia showed up around month 3 in the toes,your 100% right i should explore this with my doctors so i understand what might have caused it. I see some literature relating stage 1 CRPS with patchy bone loss, but its unclear what the cause effect is.

I hope it doesn't take 2 years to restore ROM, but i wouldn't be surprised.

My Symptoms: warmth, redness, odd twinges, small electric shocks. The foot often feels sore to walk on, but I feel this could easily be part of the recovery process. These are the symptoms and pain level that I have had for the last month or so.

My symptoms seem to increase as the day goes on. Starting with no symptoms (0 pain) in the morning and increasing tell around 7-9pm (2 pain). Around 7-9 their seems to be a slight boost in symptoms. Which then fades around 10-11 (1 pain).

Symptoms increasing/decreasing don't seem to be correlate with how much i exercised that day. Squatting plus a mile of walking resulted in less pain then days when I only do mild walking.

Driving (pressing the petal) seems to be the most uncomfortable activity.

Regarding the osteopenia showing up at month 3 - unless you had a base line prior to month 3 there would be know reason to believe that this was caused from CRPS. Osteopenia in CRPS is usually a much later stage of disease process or in those with a severe case in which by your history this is not the case for you - so I do hope you get it checked out.

Your symptoms above sound more like the healing process - it would not be uncommon for pain to increase in the morning after sleeping as this is when inflammation and stiffness occur due to disuse while sleeping it is also a common symptom as an inflammatory response to the normal healing process, as is the increase in warmth and even twinges of nerve pain.

It also makes total sense the the most uncomfortable thing for you is the driving as this would be when you would utilize the small bones (toes) the most. Have you ever used a 'balance board' for therapy? It is often utilized for ankle sprain/brakes but,I would bet it would be good for you for your toes as well.

Lastly, regarding ROM in your toes - there are many worse body parts to have reduced ROM .. keep up with your fitness routine and don't forget to massage your foot (especially the toes) to facilitate healing and brake up any scar tissue that is forming. Massage + epsom salt soaks + physical therapy = speedy healing and if it truly turns out to be CRPS then all these things will have helped you already.

Will do!

My pain is at its lowest after I wake up (usually no symptoms), it usually increases slightly throughout the day.

Yes actual! I used one in therapy the very day you posted this.

Ok, the only thing I haven't tried is the epsom salt soaks. I'll have to look into it, I thought they were for de-sensitizing the area to reduce pain. Do they offer some healing benefit?

Epsom salt soaks and/or Morton Epsom lotion will help with the
circulation in your foot.

Did anyone explain what happens during a bone crushing injury?

You get damage to the skin, ligaments, the lining around the toe bone (the periosteum) and the bone itself.
http://www.britannica.com/EBchecked/...978/periosteum

You can have lingering inflammation to the ligaments, which have nerves in them, or crushing to the nerves themselves, and the periosteum has to regenerate to do its job with bone remodeling. It is damaged, then it will take time to regenerate.

The magnesium in either the epsom salts or the Morton's I recommended to you before, will help the blood flow to your foot. This will help speed healing and lessen the inflammation caused by Cox-2 cytokines, which tend to cause the blood vessels to constrict where there is injury.

If you get the lotion, which is far more concentrated and convenient than epsom salt soaks, apply it to the ankle, and top of the foot. That is where most of the poor circulation is. It will drift down to your toe. Sometimes the BEST intervention is a simple one.

Make sure your socks do not leave constrictive marks on your lower leg, and that your shoes are not too tight, or tied too tightly. This will compress both nerves, and small blood vessels and impair the circulation to your foot. The redness and warmth may be the blood returning after a long day with some issue preventing good blood flow.

Magnesium does 3 main things.
1) increases blood circulation where it is applied
2) blocks the NMDA pain receptors
3) relaxes muscle and works opposite to calcium which contracts
muscles. So magnesium tends to prevent twitching and cramping.

Yes, Epsom salt soaking helps with the inflammatory response which in turn will reduce scar tissue formation (scarring of soft tissue increases pain and stiffness), this will also reduce pressure upon nerves due to swelling/inflammation and increase circulation which is needed in order to heal. Your body needs proper circulation of blood flow in order to heal. You can give your body a little help by using epsom salt soaks, massage, physical therapy, rest, moist heat and even by using compression socks and or KT tape - all good measures regardless of whether or not you have CRPS.

Another follow up and thank you.

I saw my new internal doctor and tests came back that i was mildly low in vitamin D. Given that I started drinking 2-3 cups of milk about only month ago, it stands to reason i might have been more then mildly low 6 months ago.

I'll have to revisit my diet/lifestyle choices and see if there is something i'm missing.