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Family Medicine (Expert Forum)
Foot
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Foot
by Mike-87, Feb 28, 2006 12:00AM
Doc,
The past 12 months or so have been pretty traumatic for me. I think it all started with some viral bug I caught. I had a brief sore throat followed by some lymph node sensitivity, stomach cramps and period of weight loss. Now pretty much recovered except for persistent weird pain/feelings in my feet (see below) and to a much lesser degree my hands. I tested negative (Ab and DNA) out past 9+ months for all STDs. Other than marginally high cholesterol and confirmed diagnosis of primary hyperparathyroidism (Ca & PTH) several blood work-ups including the following are all unremarkable. Further – I have been told by both a podiatrist and two neurologists that I do not have peripheral neuropathy after being tested. Two sets of X-Rays of my feet were also normal. Oh yeah! And no swelling, inflamation (inflammation), warmth, redness, whatsoever!
ESR = 1
ANA < 1.0
CRP < 0.6
Rheumatiod Factor = 33 IU/ML (< 44, non-reactive)
CK Total = 165
Low normal Thyroid #'s
B12 & Folic Acid both normal
Hemo A1C 5.5 (not diabetic, fasting glucose also normal)
Feet – Discomfort started in both arches. Some electric nerve zaps. Pain in and around balls, arch and heel now with some ankle stiffness. Random throughout the day/night. Some better than others. Sometimes tingling. It is really difficult to explain “where” I feel what I do. It does not seem to be in my joints; more tissue, muscle or ligament related.
Hands – Similar situation but to a much, much lesser degree.
Could this be caused by my hyperparathyroidism / high calcium which is running 10.5 to 10.8 lately?
What type of doctor should I see? What other forum should i post under?
Any help or advice is most appreciated!!
Thanks in advance!!
The past 12 months or so have been pretty traumatic for me. I think it all started with some viral bug I caught. I had a brief sore throat followed by some lymph node sensitivity, stomach cramps and period of weight loss. Now pretty much recovered except for persistent weird pain/feelings in my feet (see below) and to a much lesser degree my hands. I tested negative (Ab and DNA) out past 9+ months for all STDs. Other than marginally high cholesterol and confirmed diagnosis of primary hyperparathyroidism (Ca & PTH) several blood work-ups including the following are all unremarkable. Further – I have been told by both a podiatrist and two neurologists that I do not have peripheral neuropathy after being tested. Two sets of X-Rays of my feet were also normal. Oh yeah! And no swelling, inflamation (inflammation), warmth, redness, whatsoever!
ESR = 1
ANA < 1.0
CRP < 0.6
Rheumatiod Factor = 33 IU/ML (< 44, non-reactive)
CK Total = 165
Low normal Thyroid #'s
B12 & Folic Acid both normal
Hemo A1C 5.5 (not diabetic, fasting glucose also normal)
Feet – Discomfort started in both arches. Some electric nerve zaps. Pain in and around balls, arch and heel now with some ankle stiffness. Random throughout the day/night. Some better than others. Sometimes tingling. It is really difficult to explain “where” I feel what I do. It does not seem to be in my joints; more tissue, muscle or ligament related.
Hands – Similar situation but to a much, much lesser degree.
Could this be caused by my hyperparathyroidism / high calcium which is running 10.5 to 10.8 lately?
What type of doctor should I see? What other forum should i post under?
Any help or advice is most appreciated!!
Thanks in advance!!
Doctor's Answer
by Kevin Pho, MD, Mar 01, 2006 12:00AM
, Mar 01, 2006 12:00AM
Other than the calcium level, it seems that most of the workup has been non-revealing thus far.
It may be possible that the calcium may be causing the symptoms - although typically, the levels need to be significantly more abnormal to cause such symptoms.
I would consider obtaining a vitamin B-12 level and obtain electrodiagnostic testing to rule out any nerve conduction deficit. Another neurological opinion - preferably at a major academic medical center - can be considered.
If the neurology workup continues to be non-revealing, a dermatology referral can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
It may be possible that the calcium may be causing the symptoms - although typically, the levels need to be significantly more abnormal to cause such symptoms.
I would consider obtaining a vitamin B-12 level and obtain electrodiagnostic testing to rule out any nerve conduction deficit. Another neurological opinion - preferably at a major academic medical center - can be considered.
If the neurology workup continues to be non-revealing, a dermatology referral can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
The only, only thing I have found after pouring over diseases, conditions, etc. on numerous medical websites that even comes close to describing what I may have going on in my feet and hands to a lesser degree is tarsal tunnel and carple tunnel.
I wonder if the combination of my low normal thyroid and hyperparathyroidism combined is enough to manifest in these symptoms.
Any other thoughts / comments?
Thanks again,
Mike