Foot pain, what is it?
October 8, 2011 3:10 PM Subscribe
My 85 year old diabetic mother-in-law has been having what she describes as throbbing pain in her foot for several months now. Could this be plantar fascitis or neuropathy?
So, she has always had a little foot pain but when given a fentanyl pain patch (low dose) for her arthritis back pain over a year ago she said it helped her foot. But now, the pain has gotten worse and she describes it as throbbing on the bottom of her foot, it hurts her during the day but it really starts hurting her worse when she goes to bed. She says as soon as she lays down it starts and keeps her awake all through the night. She says she gets relief sometimes, not always, by massaging her leg or moving her foot different ways to try to work it out. She has tried topical ointments: Activon, Neuragen, Capsaicin. I took her to a doctor and doctor seemed to think it was plantar fascitis and she was given a Depo Medrol shot and told to get shoe orthopedic inserts and to treat bottom of foot by rubbing with ice bottle. It has been 4 days and she can't tell the shot helped at all. From everything I have read about plantar fascitis it hurts when you get out of bed in the morning, not as soon as you lay down. Can anyone help me figure out what this might be so we can get her some relief? It is hard for her to make many trips to the doctor, she gets very weak and ill.
So, she has always had a little foot pain but when given a fentanyl pain patch (low dose) for her arthritis back pain over a year ago she said it helped her foot. But now, the pain has gotten worse and she describes it as throbbing on the bottom of her foot, it hurts her during the day but it really starts hurting her worse when she goes to bed. She says as soon as she lays down it starts and keeps her awake all through the night. She says she gets relief sometimes, not always, by massaging her leg or moving her foot different ways to try to work it out. She has tried topical ointments: Activon, Neuragen, Capsaicin. I took her to a doctor and doctor seemed to think it was plantar fascitis and she was given a Depo Medrol shot and told to get shoe orthopedic inserts and to treat bottom of foot by rubbing with ice bottle. It has been 4 days and she can't tell the shot helped at all. From everything I have read about plantar fascitis it hurts when you get out of bed in the morning, not as soon as you lay down. Can anyone help me figure out what this might be so we can get her some relief? It is hard for her to make many trips to the doctor, she gets very weak and ill.
My father has diabetic neuropathy in his feet and describes it as burning and throbbing. It does seem to be worse when he lays down.
I, on the other hand, had plantar fasciitis a couple years ago and can confirm what you have read. There was no pain at night or at rest. It was worst when I got out of bed in the morning and first stretched the tendons by putting weight on my foot and walking. I had to wear shoes with an insert at all times from the second I got out of bed. I used ice massage as well.
IANAD but the diagnosis of plantar fasciitis does seem odd given she doesn't really match the profile and she has an elevated risk of neuropathy from her diabetes. In any case, a massager meant for the lower back with a long handle could be effective for her legs and feet. It might get her through the next little while to see if the treatment for plantar fasciitis works and she can build her strength for another doctor's appointment. She really needs a second opinion here.
posted by pixlboi at 3:44 PM on October 8, 2011 [1 favorite]
I, on the other hand, had plantar fasciitis a couple years ago and can confirm what you have read. There was no pain at night or at rest. It was worst when I got out of bed in the morning and first stretched the tendons by putting weight on my foot and walking. I had to wear shoes with an insert at all times from the second I got out of bed. I used ice massage as well.
IANAD but the diagnosis of plantar fasciitis does seem odd given she doesn't really match the profile and she has an elevated risk of neuropathy from her diabetes. In any case, a massager meant for the lower back with a long handle could be effective for her legs and feet. It might get her through the next little while to see if the treatment for plantar fasciitis works and she can build her strength for another doctor's appointment. She really needs a second opinion here.
posted by pixlboi at 3:44 PM on October 8, 2011 [1 favorite]
Sounds a little like restless leg syndrome, which in some patients is associated with--you guessed it--peripheral neuropathy.
posted by valkyryn at 5:12 PM on October 8, 2011
posted by valkyryn at 5:12 PM on October 8, 2011
Has she tried a podiatrist?
Given that she's a diabetic (and especially if she's been diabetic for a long time) she is at risk for peripheral neuropathy and it is certainly worth asking the physician why they think it is plantar fasciitis vs. peripheral neuropathy in her case.
If peripheral neuropathy it is often treated with medications used for neuropathic pain like gabapentin (Neurontin). Narcotics like fentanyl will relieve any sort of pain, but have addictive/tolerance properties and can make elderly people confused and drowsy. IANYD.
posted by treehorn+bunny at 6:31 PM on October 8, 2011
Given that she's a diabetic (and especially if she's been diabetic for a long time) she is at risk for peripheral neuropathy and it is certainly worth asking the physician why they think it is plantar fasciitis vs. peripheral neuropathy in her case.
If peripheral neuropathy it is often treated with medications used for neuropathic pain like gabapentin (Neurontin). Narcotics like fentanyl will relieve any sort of pain, but have addictive/tolerance properties and can make elderly people confused and drowsy. IANYD.
posted by treehorn+bunny at 6:31 PM on October 8, 2011
IANAD, but I have restless legs and guarantee it's not that. I've also had plantars fascitis, and would not hurt if I wasn't walking on that foot, but was excruciating when I was, though maybe it occurs in degrees. So I'd vote for neuropathy, though I know nothing about it.
posted by Camofrog at 8:25 PM on October 8, 2011
posted by Camofrog at 8:25 PM on October 8, 2011
Best answer: I have had type 1 diabetes for 56 years and I vote with treehorn+bunny. If your M-I-L has type 1 diabetes, I would most definitely advise her to see a podiatrist, and I would seek one that specializes in diabetic neuropathy. How to find? Call a local hospital and ask to speak to the in-house nurse who specializes in diabetic care. Tell the nurse your situation and ask for the name of a podiatrist who specializes in treating diabetic neuropathy. If the hospital has no specialist diabetic nurse, or if that nurse cannot provide you with a podiatrist's name, call other hospitals until you find a nurse or diabetic clinic who can.
You did not say how long your M-I-L has had diabetes, or if it is type 1 or 2. The longer one has diabetes the better the chance of developing circulatory issues. As a diabetic ages, diminished circulation in peripheral areas of the body generally begins to cause problems with nerves and muscles causing areas to hurt, cramp, and sometimes exhibit shooting pains or a burning sensation in the legs and feet. Loss of sensation or a complete lack of feeling in the feet and legs is also common, as well as in the arms and hands (and other places in the body for that matter).
It is important that all diabetics have a good relationship with a podiatrist. A loss of sensation or a complete lack of feeling in the feet can lead to an unnoticed cut or scrape to the feet which could get infected. Without proper circulation in that area, it is extremely difficult for that part of the body to heal, and may lead to the loss of a toe, foot or even a leg, as the infection spreads.
As for whether the problem might be neuropathy, plantar fascitis or something else, if you are in the podiatrist's office, you are at the best place to get advice for any treatment to your feet.
Here is a FAQ page that deals with the many questions about diabetic neuropathies.
Good luck!
posted by konig at 10:09 PM on October 8, 2011 [1 favorite]
You did not say how long your M-I-L has had diabetes, or if it is type 1 or 2. The longer one has diabetes the better the chance of developing circulatory issues. As a diabetic ages, diminished circulation in peripheral areas of the body generally begins to cause problems with nerves and muscles causing areas to hurt, cramp, and sometimes exhibit shooting pains or a burning sensation in the legs and feet. Loss of sensation or a complete lack of feeling in the feet and legs is also common, as well as in the arms and hands (and other places in the body for that matter).
It is important that all diabetics have a good relationship with a podiatrist. A loss of sensation or a complete lack of feeling in the feet can lead to an unnoticed cut or scrape to the feet which could get infected. Without proper circulation in that area, it is extremely difficult for that part of the body to heal, and may lead to the loss of a toe, foot or even a leg, as the infection spreads.
As for whether the problem might be neuropathy, plantar fascitis or something else, if you are in the podiatrist's office, you are at the best place to get advice for any treatment to your feet.
Here is a FAQ page that deals with the many questions about diabetic neuropathies.
Good luck!
posted by konig at 10:09 PM on October 8, 2011 [1 favorite]
Those shots in your feet for PF work almost instantly (they did for me). The doc may have not placed it exactly correctly, or it may not be PF.
Take her to a podiatrist. You don't want to fuck around wiht foot issues in a diabetic.
posted by misanthropicsarah at 11:14 PM on October 8, 2011
Take her to a podiatrist. You don't want to fuck around wiht foot issues in a diabetic.
posted by misanthropicsarah at 11:14 PM on October 8, 2011
You don't want to fuck around wiht foot issues in a diabetic
A thousand times this. Neuropathic pain is the tip of a nasty iceberg of potential problems. Go to a diabetic foot specialist!
posted by Coobeastie at 2:55 AM on October 9, 2011
A thousand times this. Neuropathic pain is the tip of a nasty iceberg of potential problems. Go to a diabetic foot specialist!
posted by Coobeastie at 2:55 AM on October 9, 2011
A neurologist may also be in order to properly diagnose peripheral neuropathy.
posted by apartment dweller at 11:11 AM on October 10, 2011
posted by apartment dweller at 11:11 AM on October 10, 2011
This thread is closed to new comments.
posted by iconomy at 3:23 PM on October 8, 2011