Numb feet-slow onset-not diabetes, feet not cold

[fastermx]

I'm retired, living in Mexico, for the past 18 years. When I first came here, I had some numbness near the tips of my toes. It was bothersome, no more. Today, it has spread to encompass my feet, and is starting up the leg.

I know a neighbor lady who has no feet - diabetes was the problem for her. I don't think I have diabetes, even though it runs on the maternal side of my family.

My doc has checked, and there's no significant temperature difference. Nor are they turning blue. The most highly affected areas, on the soles of my feet, are actually a deadly-looking white, but usually the foot has to be wet to see it clearly. The areas above are much more pink. I'm sure I have some circulatory problems (I have mild high blood pressure for one, and am faithful taking my meds), but my feet don't seem to be starved for blood. So it isn't likely to be phlebitis.

There is also pain. It comes and goes, and affects first one area and then another, but most often on the tops of my feet. There is no swelling or inflammation that I can detect. At times, there is a burning sensation involved in the pain.

Sometimes my numb and painful feet keep me awake, and sometimes wake me up at night. Massaging the foot helps, at least some.

When I walk, it feels as though I had a thick padding of fat on my soles. This makes it hard to sense textures, although I can sense pressure - but it isn't doing it normally. There are times when I can't tell if my slippers are on or not. The skin is very dry, but that's my age - and to a certain degree, this climate. Still, when I flex my feet, the skin feels as though it had turned into cardboard - a kind of crinkly feeling. This is so even when they are wet or I apply a cream to them, although a moisturizer minimizes it a little.

I am a smoker, and my doc blames everything wrong on smoking, and he's probably right most of the time. It could have a big hand in this, too, but I'm not convinced it's the ONLY factor involved. Besides, it doesn't tell me WHAT  is happening in my feet, specifically. I want to know what is going on that makes them this way. Knowing the cause would surely help, but isn't enough.

I'm taking Caudaline. It is a medication I was given when I had trouble using my right hand. I couldn't even hold a full mug of coffee! I had to get my cleaning lady to cut up food for me, because I couldn't. And it hurt. The pad of the palm beneath the pinky finger and close to the wrist, was red and hurt. I still have much of the redness, but no more pain (except a bit of tingle/numbness) and I can use my hand normally. Could Caudaline be helping that, but exaggerating the foot problem?

I have nerve damage from a C6-C7 surgery in 1990. I've been a pain patient ever since. It has progressed, very slowly, over the years, but inexorably. I can hardly walk more than a minute. I get unbearable pain very quickly and have to sit down - fast. So I have to do all my cooking in a high stool with a backrest. My condition makes me a hermit, entirely against my will. I hardly ever can leave home except to see the doc or do my banking. Other people help me with other chores and errands, because I can't.

I have had some numbness/tingling in the last 3 fingers of both hands - which upset me terribly, because it makes it hard to play my piano. It doesn't interfere with much else, though, and doesn't seem to be getting worse in the last ten years since it started. I had a nerve test done at that time, which located the problem at C6-C7. I'm not sure my foot numbness is from the same source, but it certainly might be. But this gets worse; my fingers don't, although my back pain does, and the source is the same for my fingers and back.

Is it possible the nerve damage is causing my numb feet? Like my back pain, it has been worsening, very slowly, over the years. But that wouldn't explain the deadly-white color on the soles. Or would it?

Other than smoking, I take vitamins daily and try to eat a very well-balanced diet. I can't exercise, though. But my feet have no bearing on my inability to walk much. They can take whatever I dish out in that regard. The back (and hip) pain is the problem there.

[fastermx]

As I said, there is no problem with my feet being cold. It may have a very slight difference, but I don't feel any. BTW, I'm 68 years old, female, somewhat overweight, mostly in my abdomen, because I can't exercise.

Nor do I have any redness. As I mentioned, the problem is whiteness of, mainly, the soles. It's a deadly corpse-like white, more easily visible when wet. There is no swelling.

BTW, I take a vitamin B complex supplement every day. Have, for several years. After reading your comment, I'm even more glad now that I do.

You mentioned spinal stenosis, but I don't know what that is. Since I'm living disabled in Mexico because of a spinal surgery, I wish I knew more about stenosis. It has given me tingling in the last 3 digits of my left hand for at least 10 years.

The problem does NOT go away when I sit. It's just worse at night when I'm trying to get to sleep. During the day, it is often quite unpleasant. Though its intensity does go up and down, the basic numbness stays pretty much the same. It's just the tingling and the pain which are variable. But I know of nothing that makes it be that way. My legs don't feel particularly weak. My back pain gets better quickly when I sit down, but whatever level my feet are in at the time, doesn't. The pain I get in my feet is often of a quality like burning. Tingling, numb, PAIN and burning. The pain moves around; it isn't just in one place, but mostly on the tops of my feet. The white is mostly on the soles. It's not painful on my feet to walk on them. The soles just feel "fat", limiting my sensation considerably.

Because my feet are NOT cold, I suspect this is more a nerve problem than a circulatory one. Or maybe a kind of mixture, but not enough to have coldness.

I do smoke. But my doc is so hooked on the idea of getting me to quit, he'd probably tell me a mosquito bite was caused by it. I KNOW how important it is to quit, and I also KNOW that I'm one of the hard-core addicts; the habit OWNS me. I've tried often during my life, and even quit for a month, twice, but the minute I smelled a cigarette, I was right back on it. I'll never get rid of the cravings, and those cravings would dominate every minute of my life if I quit. I can't live like that. I know smoking will kill me. But in every other way, I live healthy, lots of fruits and vegetables, and I do not drink alcohol, or abuse any drug. I take supplements from A to E daily, the D comes with calcium. And I don't take A daily; just when I think I haven't eaten enough foods with A in them; never more than twice a month.

I feel this may have a neurological basis. My C6 C7 surgery in 1990 left me a permanent pain patient, which is why I've lived in Mexico since 1994. I get pain treatment here that is good enough to keep me from dreaming of dying. It isn't enough, but nothing CAN be. So I am as content as possible. I've reduced my intake of my pain meds, due to the cost, but I'm allowed up to 5 doses of Tylex CD, which is equivalent to Tylenol-3 up there. I wish I could have more, but I'm not wealthy. I let myself have only one a day, which lets me sleep reasonably well, but days are much more painful at this low dosage.

The problem from my surgery is a nerve that was damaged at that C6 C7 level. It's permanent, and gets worse all the time, VERY slowly. By now I can hardly walk more than a minute.

What I'd also like to know is how far this foot problem can go. It's already starting to go up in my ankles. Am I likely to need the feet amputated? That kind of scares me since I have enough trouble walking as it is.

[Red_Star]

Peripheral Vascular Diseases instantly comes to mind reading your symptoms. Peripheral Vascular Disease (PVD) is primarily the result of atherosclerosis (hardening of the arteries). This causes the arteries to become narrower and the walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed.

Higher risk of PVD is if you have a personal or family history of coronary artery disease (heart disease) or cerebrovascular disease (stroke), diabetes, smoking, hypertension, or kidney disease involving haemodialysis.

The classic symptom of leg pain on walking that stops with rest is a good indication of PVD. However, only about 40% of people with peripheral vascular disease have intermittent claudication. Other symptoms include, but are not limited to, one or both legs or feet feel cold or change colour (pale, bluish, dark reddish), numbness, tingling, or weakness in the legs, burning or aching pain in the feet or toes while resting.

The most common test done for PVD is the Ankle/Brachial Index (ABI). An ABI above 0.90 is normal; 0.70 - 0.90 indicates mild PVD; 0.50 - 0.70 indicates moderate PVD; and less than 0.50 indicates severe PVD. The diagnosis may be confirmed by other certain tests.  

Treating PVD requires addressing each risk factor that led to the development of PVD. Permanent abstinence from cigarette smoking is the most important factor in regards to a better outcome with intermittent claudication. Electronic cigarettes is worth trying out. I would recommend testing homocysteine levels too. A healthy level is 6.3umol/L. Vitamin B6, B9 and B12 helps lower homocysteine. A great book on the subject: "The H Factor Solution: Homocysteine, the Best Single Indicator of Whether You Are Likely to Live Long or Die Young" by James Braly MD, Patrick Holford.

The most common entity that mimics PVD is spinal stenosis. Additional conditions to consider are acute embolism, deep or superficial venous thrombosis, restless legs syndrome, systemic vasculitides, nocturnal leg cramps, muscle or tendon strains, peripheral neuropathy, and arthritides.