Is my podiatrist making stuff up about nerve damage and rashes?
August 27, 2012 4:18 PM   Subscribe

Is my podiatrist making stuff up about nerve damage and rashes?

YANMD, etc., etc.

I've got terrible feet. Huge, painful bunions, constant pain just under the metatarsals (probably a result of being born with metatarsus adductus), and more recently, a large patch of numb skin accompanied by an itchy, scaly rash on my left ankle that extends to the top of the foot. I've had it for about two years. If you touch the numb area, I actually FEEL the sensation up near my toes. My podiatrist had a name for this, but I honestly cannot recall what it was. She also recommended nerve conduction studies and bunion surgery. The x-ray showed pretty advanced arthritis for a person in her mid-30s. She gave me some Ammonium Lactate 12% for the scaly rash and told me that it was probably a result of underlying nerve damage.

Does this explanation sound reasonable? If it doesn't sound reasonable, would it make sense to get a second opinion from a different podiatrist or should I see another type of doctor altogether?

(If it makes any difference, I do have tinea versicolor, but I treat it with dandruff shampoo and it has no effect on this weird patch of numb skin.)
posted by xyzzy to Health & Fitness (11 answers total)
I would see a rheumatologist. Does "dermatomyositis" ring a bell as what the podiatrist might have identified as a possible diagnosis?
posted by Sidhedevil at 4:24 PM on August 27, 2012

Best answer: You should see a rheumatologist about the arthritis anyway.
posted by Sidhedevil at 4:24 PM on August 27, 2012

Response by poster: It definitely wasn't dermatomyositis--she was referring not to the rash, but the misplaced sensation where I would "feel" pressure and tingling up near my toes when she was touching the numb area. It's on the tip of my tongue, but I just can't remember what she called it.
posted by xyzzy at 4:35 PM on August 27, 2012

Why would your doctor make stuff up? That's unlikely.

She could be mistaken. That's more likely. Why not get a second opinion?
posted by J. Wilson at 4:38 PM on August 27, 2012 [1 favorite]

Best answer: I just wanted to add that if you are considering any kind of surgery you should be talking to a board-certified orthopedic surgeon specializing in feet and ankles, not a podiatrist.
posted by foxy_hedgehog at 6:15 PM on August 27, 2012

Best answer: There are a lot of medical issues that have both peripheral neuropathies and rashes as symptoms. I would still start by seeing a rheumatologist, who may refer you to a neurologist and/or an endocrinologist. Also, as foxy_hedgehog says, you need to follow up about the surgery recommendation with an orthopedic surgeon.

What does your primary care doctor think about all of this?
posted by Sidhedevil at 6:38 PM on August 27, 2012

Response by poster: My podiatrist is also an orthopedic surgeon--but she only performs surgery once a week. Most of the time she's doing diagnostics and fittings for orthotics, etc.

My primary care doctor is mystified, which is why she referred me to a specialist. She is aware of, and diagnosed, a rather extreme level of osteoporosis for my age (she says I have the spine of a 75 year-old woman), brought on by a combination of anorexia nervosa, thyroid cancer, and unusually low levels of estrogen resulting in long-term amenorrhea. This is how we got onto the whole foot thing because my problems with my feet cause me to fall fairly often, and I broke my wrist just by bumping it when I fell in my kitchen. My body is a freaking party. :) She's already checked for diabetes, which seems to be a major cause of neuropathy of the extremities.

I think, based on the advice I've received here, that I will return to my primary and ask her for an alternative treatment path. The podiatrist seemed obsessed with my bunions, but the costs associated with that surgery are prohibitive. I'm much more concerned about the random neuropathy and the rash that won't die.
posted by xyzzy at 7:00 PM on August 27, 2012

Best answer: xyzzy, given the additional information you've provided, I would recommend asking your doctor about seeing an endocrinologist. They specialize in thyroid and hormone issues and it sounds like your issues go beyond the run of the mill.

Either endocrinologists or rheumatologists may be consulted about unusual cases of osteoporosis as well.

I think seeing one or both of those specialists will be a good start, although if you've been advised to get nerve conduction studies checked then that sounds like something that could also be very helpful. The thing about seeing someone like a podiatrist, or even an orthopedist, is that they focus on only one system. Endocrinologists and rheumatologists also have a focus on a specific system but they also have an internal medicine residency under their belts and so they have more of a systemic perspective.

Not all reasons for rashes and numbness in your foot have anything to do with your foot itself, that's why having someone think about your issues in a more systemic manner is important.

To answer your question directly though, yes, nerve damage (neuropathy) can cause dermatologic issues. Here is a link to an eMedicine article describing the dermatologic manifestations of neurologic disease - specifically I'm linking you to the subpage about disorders associated with peripheral neuropathy. Although I'm showing you this link to answer your question, what you describe (at least in this very brief description) does not sound very typical for any of the disorders listed on this page. IANYD.
posted by treehorn+bunny at 7:35 PM on August 27, 2012 [1 favorite]

I have surgery related nerve damage to my knee and have the referred sensation/pain that you describe. My doctors have only ever called it nerve damage.
posted by geek anachronism at 9:45 PM on August 27, 2012

My podiatrist is also an orthopedic surgeon--but she only performs surgery once a week. Most of the time she's doing diagnostics and fittings for orthotics, etc.

Sorry but that doesn't sound like an orthopaedic surgeon to me. An orthopaedic surgeon is a medical doctor who has specialised in bone/joint surgery. They tend not to deal with orthotics and the like. A podiatrist can perform surgery but goes down a different training pathway and is more focused on the feet.
I can't see anyone who has trained as an orthopaedic surgeon doing days when they fit orthotics because, to be blunt, it is a waste of time and skills (and you could be billing people for knee replacements instead!).

But that sounds... really weird. I know other people have detailed every possible specialist one can see, but I would like to throw 'dermatologist' in the mix. Weird rashes - it's what they're for!

Does neuropathic pruritis ring a bell? It's a descriptive term that doesn't actually tell you what's wrong, just means "nerve-disease itching", but it might help remember what your podiatrist said.
posted by chiquitita at 1:54 AM on August 28, 2012

Best answer: Chiquita is right. Your podiatrist may do surgery, but she is not an orthopedic surgeon and does not have an MD. The symptoms you are talking about are serious business, and no one except a highly trained professional should be cutting into your body. I encountered this distinction when dealing with my own severe foot problems and I'm glad someone made it clear for me. Your podiatrist may also be fixating on the bunions and surgery because she'll get a bundle for it, when a) an actual surgeon would know that surgery is a last resort when pain becomes chronic and unbearable, and b) most bunion surgery patients are never fully satisfied with the results. This behavior and her blurring of the distinction between herself and an MD makes me think you should seek medical care for your feet elsewhere and not return to her.
posted by foxy_hedgehog at 6:47 PM on August 28, 2012

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