pain when walking

[angiebee]

Hello, my problems started last summer my left foot and shin fell asleep while walking it was a bit painful around my ankle but not unbearable. When I got home from my walk, I sat down and the pain went away. Over the next few months this happened again several times. After about 5 or 6 months I could not stand or walk for more than 15-20 minutes without my foot going to sleep followed by excruciating, I can't walk pain. The pain feels like its on the inside of my leg and my muscles don't tighte. It isn't  always in the same place, sometimes my lower leg, sometimes my upper leg, but never goes above mid thigh, up to this point it was always my left leg. Sitting always relieves the Pain. Now the same issues started in my right leg. In addition, my feet tingle, have a burning sensation or an odd electric type feeling (not really shocks just electric feeling, I hope this makes sense) also, in the last few weeks my shoulders and back feel lightly sunburned even though its not. My lower back has been hurting too, although I don't know if its related or not.  I have been to the neurologist, EMG/NCS was normal and my blood work was all normal except slightly and I mean slightly low but within normal limits B12 (it was 350) and slightly high rheumatoid. The neurologist feels my problem is small fiber neuropathy,  I have been taking neurotin 900 mg 3x daily for 3 weeks,  at this point its not helping. I am supposed to start cymbalta tomorrow.  After a long explanation I am wondering if this kind of pain is normal with small fiber neuropathy?? I am feeling kinda lost I went from being able to walk a few miles to barely being able to walk a few blocks. Any input anyone can add would be greatly appreciated.

[angiebee]

Hello again,
I asked my doctor for an MRI of my lower back. Could you please help me with the results?? I have a follow up appt but not till the end of August. I would like to know what's the best treatment.
I only copied the impression of MRI rather than the whole report. Thank you for your opinion, it is very much appreciated.

IMPRESSION: Spondylolisthesis due to spondylolysis at L5 -S1 in combination with disk disease, resulting in severe foraminal narrowing bilaterally.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Pain with walking that is relieved with rest (usually over several minutes of rest) is a condition called neurogenic claudication. If the pain improves with walking hunched over like you are pushing a shopping cart, it may be a condition called spinal stenosis. An MRI of the low back would be helpful with this diagnosis. It is important that you and your physicians also rule out vascular claudication. This is important especially if you have risk factors of high cholesterol, diabetes, smoking, high blood pressure, or heart disease. Tests that would help with this diagnosis include ABI, PVR, and segmental blood pressure readings of the legs.

It is good that you have had an EMG/NCS to rule out large fiber neuropathies. Small fiber neuropathies, which are usually described as burning or buzzing or other vague sensory change, require other tests for diagnosis instead of EMG/NCS such as a skin biopsy and QSART (which looks at the sweat produced by the skin). Causes of small fiber neuropathy include diabetes, vitamin deficiencies, and autoimmune disorders.

Your vitamin B12 may be on the low end of normal, but it would be important that an MMA is also checked. Symptoms can occur in some people with low normal levels.

I recommend that you continue working with your neurologist with your condition. If not already done, an MRI of the low back may be helpful in the workup. Also, it is important to remember that neuropathies do take time to treat.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.