Warning signs as to nerve pain.


1  you have no signs. Once again it sounds strange however the biggest concern is the lack of recognition of not having normal sense. If you are a diabetic/have vascular disease or have had a traumatic injury you should be evaluated as to the extent of neuropathy


2 persistent tingling. The onset of constant/intermitant tingling is a dramatic change of nerve supply that needs to be evaluated. Episodes of tingling has been in my experience often associated with biomechanical influences, i.e. how your foot works that is producing local nerve injury.


3 hot or cold sensation. Each type of nerve does a different job so your complaints of persistently hot or cold feet also indicates there maybe a generalized nerve issues that needs to be evaluated.


4 Stability. Feel like you are not as sure as you once where on your feet? This is often related to not just getting older if it happens to be implied by other health care providers. But related to significant nerve injury and or damage.


5 traumatic injury. If you have had a significant foot or leg injury. (ex. burns, fractures which required surgery, crush injury, direct impact ie dropping heavy objects on foot, especially those injuries which has lead to limitation of motion around joint/s) You need to be evaluated and educated as to precautions and treatment regimens available to you.


 Neuropathy


This is a term usually saved for general nerve injuries. Often times by the time I see the patient it is a chronic problem. Although this is not insurmountable it requires patience on the patients part  as much as myself. Social issues and mental effects of such chronic pain processes all need to be addressed.  The complex nature of the problem does not allow a more through discussion at the web site, however will be elaborated on once the patient is present. The picture to the right 

demonstrates the nervous system in yellow.  There are

options for treatment that effective treatment without

the need for chronic use of pain medication. 





Nerve pain

the nerve diagram above and to the right is an accurate dipection of your nerve supply to your feet and legs. Any where along its track a nerve can get injured and result in pain. Also in various gradiants and

intensity of pain. Typically the longer the injury persists the harder it is to resolve. But combination therapy is usual the key. Simple biomechanical control with local nerve treatment does well on a conservatie approach. Simple nerve blocks with local anesthesia is an effective way to determine level and location along with ruling out nerve injury higher up the leg or even the back.  Moreover nutritional issues may need to be addressed. Often times poor dietary choices and chronic pain go hand In hand.

Numbness

sorry had to put on gross picture on the web site. If it helps someone pay attention it is worth it.  Numbness is just another version of neuropathy as it can have many different subjective symptoms. Perhaps the most dangerous is the potential of injury with out the persons knowledge. .The hardest thing for me to demonstrate to patients and have them accept is the fact that they can get injured and not feel it. A simple clinical exam can give a very good picture to what extent there is a problem. The typical response once the numbness is noted with clinical exam and is explained. Is that they have pain when they hit there foot in a cabinet for example. However, the problem is a low level injury or a sharp object would not be felt. Or if it is may not be enough to stop there activites and do a self examination.  I have had patients leave watches in there shoes and walk on it all day, combs, toothpicks getting stuck in the foot. Moreover, they might see it but not act on it. Infection sets up and you are left with what we see to the right. It is ok to have numbness and not treat it specifically as long as does not effect stability or is denied by the patient.