FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER NEEDS EXPLANATION OF FOOT PAIN OR NEW DOCTOR

Question: I've had terrible pain in my feet, particularly my toes, for the past year. I went to my family doctor who sent me to an orthopedic doctor. He said that there is nothing that can be done for me. How can that be?

Answer: The doctors you have seen are in a much better position than I am to determine the cause of your pain, and the cause determines to a great extent what treatments are available. As a general principle, however, there are several things that cause chronic pain in the feet. There are relatively obvious causes such as chronic skin conditions, and less obvious causes such as difficulty with circulation and/or nerve injury.

I'm confident that your foot and toe pains are not the result of a skin problem because you and your doctors would have noticed it by now. That leaves less obvious problems such as poor circulation. The amount of blood flow in your feet can be accurately measured by a painless and relatively quick Doppler flow test. I assume that your doctors have ordered this type of test to be sure your pain is not due to circulation problems. If not, you should ask one of them to recommend a vascular specialist who will do this examination.

Several disorders of the nerves that bring sensation from the feet back to the brain can also produce foot pain. Sometimes the problem is mechanical "pinching" of a nerve due to a disease such as arthritis or a ruptured disc in the back. More commonly, illnesses that keep the nerves from functioning properly like diabetes and pernicious anemia are the culprit.

Diabetes is an amazingly common condition. In the United States, 13 million people have it. That is one out of every 20 individuals! Ninety percent of diabetics have the adult onset variety. In individuals with this type of diabetes, foot pain can be the first symptom of the illness. On the other hand, in diabetes that begins early and requires insulin, chronic foot pain is usually a problem that develops late in the course of the disease. If your doctor hasn't checked your blood sugar, please ask him to do this important test for diabetes.

Pernicious anemia, a particular type of anemia caused by the lack of vitamin B12 in the blood, results in the malfunctioning of the nerves carrying sensation from the feet. Chronic, burning pain in the feet just like you have been experiencing and numbness are common symptoms. Some medications can cause interference with the normal operation of nerves from the feet, too. This is a side effect rather than a desired "therapeutic" effect of the drugs. Chemotherapy drugs and the anti-tuberculosis drug isoniazid are commonly implicated.

You see, it takes some detective work to figure out the cause of your symptoms. Once the cause is clearly identified, however, your doctors can talk with you about the treatments that are available. Some conditions are totally curable while others aren't treatable at all, and most fall somewhere between the two extremes. I don't know if your doctor told you there was nothing that could be done for you because you have an untreatable condition or because he didn't feel like doing any more detective work but you should know. Ask him to clearly explain your diagnosis. If he can't or won't, get copies of your records and take them to a new doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.