Intense Foot Pain

[mdhall]

I am a 54 YO male, 350#,6 ft 2 in, with mild diabetes and veinous insufficiency. Over the past 6 months, it has become increasingly painful to walk any distances at all (even 50 feet!).  I grit my teeth and wait while a certain numbness takes over and makes it generally bearable to walk but even then, every step is painful. It feels like the pads of my feet are inflammed 24/7 and the pain gives way to a bearable numbness only when all weight is removed. I usually need at least 24 hours of rest after any walk over 200 feet to get the pain back within tollerable ranges. I don't feel that my diabetes or veinous condition are the main culprits although I am sure there might be some associated factors. I only feel the pain in the forward bottoms of my feet.  When I try to stand when in pain, it is sometimes so intense, I have no foot control over my balance for a few seconds, and even then I have to carefully place each foot down when walking. As I get used to the pain, it becomes easier to control each step but the pain never ceases. I have heard about muscle enzyme imbalances and I am hoping that it is just a matter of getting someone who knows about these things to do something. I have a PCP doctor and an overworked podiatrist but they just seem to want to blame all on the diabetes and veinous situation and tell me that this is just the way life will be.  I don't believe that for a minute and I believe that it is an inflammation that can be easily treated and I can get my life back. Everyone tells me to lose weight and the reduced pressure on my feet will fix everything. How do you lose weight when you can't walk 50 feet? I am an ex-racketball player and I used to be extremely active on my feet and I have easily carried my increased weight until recently. Can you help me? I need suggestions on what will get my doctors off the dime and on a course of action.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Without examining you, it is difficult to say what you have.

There are several possibilities for foot pain.  Of course, diabetes leading to peripheral neuropathy and venous insufficiency are always possibilites.

However, her are some other considerations.  The first would be plantar fasciitis  (inflammation for the plantar fascia).  First line treatment would include high dose anti-inflammatories.  Other therapies to consider would include shock wave therapy or surgery - these are solutions that you may want to discuss with your podiatrist.  

Other possibilities may include Haglund's syndrome (a prominent enlarged bony protrusion that can be treated with orthotics), heel spurs, or piezogenic papules (herniations of fat that occur as painful papules at the medial inferior border of the heel).  These conditions can be discussed with your podiatrist.  

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.

Thanks,
Kevin, M.D.