DH with severe nerve pain in foot

[SarahC50]

Hi,
I'd be very grateful for any advice or suggestions regarding my DH foot.

For context he is 53 and very fit he teaches pilates and is a hill runner normally running five times a week. He is in good health apart from suffering from Raynaud's disease and mild arthritis in a few fingers.

Two months ago he started feeling like he had a stone in his shoe when walking. This progressed to his foot going numb with a total loss of sensation for a few hours. Next severe nerve pain from the ball of his foot to the toes then progressing into the whole of the sole of the foot. With associated massive swelling of foot and toes as well as the whole foot looking red and very veiny, foot only.

Tests - bloods normal slightly elevated WBC which gp said irrelevant, foot x-ray no fracture or stress fracture,us normal ruled out Morton's neuroma. Referred to orthopaedics and neurology as needs a MRI this wait could be nearly a year to see neuro as non urgent.

Seeing podiatrist and given orthotics,had Doppler foot cold but circulation good. On 50mg amitriptyline which is very sedating and if he cuts the dose at all the severe nerve pain flares up.

Unable to wear a shoe except Birkenstocks,obviously not running.

Diagnoses suggested Morton neuroma now discounted,metatarsalgia?. The GP have no clue and no real interest in getting to the bottom of it, the podiatrist similarly has no idea.

Seeing physio next week for the first time.

Basically in agony with swollen,red foot for over two months. We are at a loss of what to do. He is oversedated and exhausted on the high dose medication but it does help the pain.

Any ideas or suggestions of tests to have or similar pain or symptoms it would be great to hear from you. He is very flat mentally and struggling with this

Thankyou in advance x

I suffer with nerve pain (not in my foot) and my osteopath is a god send. They can normally tell from where the pain in, what nerve is being pressed on. For example My friend had numb fingers, and they could tell from which ones were numb which muscle wasn’t working correctly and massage it out and give gentle physio recommendations to build the strength back up.

I am also on amitryptaline 50mg and don’t find it sedating anymore, I never really did to be honest apart from maybe the first few days. Although I did notice I couldn’t sleep for a couple of weeks when I came off of briefly. How long has he been taking it?

Has DVT been ruled out ?

Sorry he's having a hard time. It's rough when you can't get any proper answers. I can only say that in my experience of nerve pain (down my thigh, shin and into foot on one side), I was eventually prescribed Gabapentin and it has been a life saver for me and I don't find it sedative. Best of luck getting some answers.

I've had 3 Morton's neuromas removed, none of them showed up on scans beforehand yet all were substantial in size and after each removal my foot pain improved considerably.
Can he get a second opinion and see a clinical podiatrist attached to a hospital? They may have a different view.
The other thing that helps me - if it is a neuroma - is footwear with a bouncy thick sole, such as fit flops. This is because neuromas tend to be towards the bottom of the foot, and for me at least, were aggravated by thin shoe soles

Thankyou all for your really useful replies.

Yes DVT ruled out, gabapentin sadly made his BP crash hence the change to amitryptiline.

Osteopath sounds a good idea

@Iamnotavicar can I ask how they detected the neuromas if not via an us. He had a v detailed us and she ruled it out however most of his symptoms point to it. Can I ask did you have swelling and redness? His podiatrist currently is the hospital one and she's referred him for orthotics x

I also have nerve pain. When I took amytriptyline I took it in the evening for the 24 hours as it helped me sleep through the pain, and then I was awake enough to work in the day.

I'm now on duloxetine - there is a whole raft of possible nerve pain meds he can try if amytriptyline is too sedating.

For my neuromas - done at 2 different places and different surgeons - they decided the symptoms merited surgery even if the scans looked normal. I didn't have any redness, but I did have a lot of pain, like feeling that I had a nail in my foot. I would describe it as hot angry nerve pain.
I wasn't offered orthotics, but I did have steroid injections before surgery. These were very painful but after the initial pain had gone they made no difference to the pain of the neuromas

Thankyou it may be worth him trying other meds for nerve pain@Iamnotavicar that's interesting and helpful, can I ask what type of doctor saw your foot and did the surgery? Was it a neurologist then neurology? Thanks for your reply x

The first 2 ops were done by a podiatric surgeon at a specialist day surgery unit, the 3rd one was a general surgeon in a local hospital, all NHS

@Iamnotavicar thankyou. He's seeing a private podiatrist tomorrow just to get a second opinion x

@Iamnotavicar he has just been diagnosed with the equivalent of carpal tunnel syndrome in his foot. The podiatrist touched a point in his ankle which instantly made his foot numb. He was the private guy and said the scans etc should have extended to his ankle not just foot and it would have shown the inflammation. He said it's repetitive strain from running and it will heal in time. He ruled out mortens neuroma. Thanks x

Well I'm pleased that an answer is forthcoming. Does that mean surgery, as it usually does for carpal tunnel in the wrists? (I sound like I'm an expert - I'm not, but my brother has had surgery for this)

Try switching to Gabapentin. It is a nerve pain blocker, and has a large range of doses to work with, and I don't find it sedating.

The op said gabapentin caused him hypotension.

The sedating effect of amitriptyline does wear off over time op, so hopefully he will find that get less of a problem soon. I hope he’s on the mend soon. Will he need surgery for that?

Hi everyone, It was a private podiatrist who diagnosed him so not sure if the NHS will recognise the diagnosis. He said that the pain receeding and it was improving and that conservative treatment should work. It's been ten weeks so very slow. He's seeing NHS podiatrist and physio next week so will see them and see if they confirm diagnosis. It's certainly good to have an answer. He's on the waiting list to see neurologist by the time he sees them it might be better or he will mention surgery as you say that's what they do for wrists x

Tarsal tunnel syndrome - I had steroid injections which helped significantly and have not had any recurrence. Perhaps ask about that at his appointment?

@handmademitlove thankyou I'll get him to ask about that, thats fantastic you've had no reoccurance x

How do you have any update on this? I am in similar situation now.

Hi there, no still waiting for his MRI it might not be till the new year. Still on amitriptyline and still red,swollen and sore.

He saw the NHS foot surgeon who thinks it's tarpal tunnel syndrome but needs the MRI to confirm then it would be surgery.

It's a horrible condition. Have you seen anyone?

Can you not get a private MRI? They’re £200 in my area, no referral required.

@DottyMacaroon I didn't realise they were that cheap I thought they'd be £1000s. I'll look into that thankyou

I know, crazy isn’t it! Results within 7 days at that price. For an extra £100 is within 2 working days.