Brief Answer:
Consistent with neuropathy...but the question is WHAT/WHY/WHERE?

Detailed Answer:
Good afternoon sir. Thank you for your question. To my knowledge you are my FIRST physician/patient on this network and come to think of it....I'm not sure I've had any physicians on any other network.....MEDICAL STUDENTS...yes, talk about a group of worry warts! LOL.....But, I LEARN any awful lot! HA!

So, I've read your concerns and appreciate the fact that you're not diabetic which would be an obvious GOTO differential....Your symptoms are consistent with a distal neuropathy and as you know this can be caused by several distinct entities.

But now, let me ask you this....have you recently gotten your A1C checked? And if so, what about your random glucoses vs. FASTING glucoses....have you compared those? Other question is whether or not you're certain that you are not slightly insulin resistant/insufficient vs. glucose intolerant? If you're not quite sure about the last couple of items then, a GTT might be in order since abnormal GTT's are known to result in symptoms o peripheral neuropathy which may be much more latent and protracted over time compared to fulminant diabetes.

Also, keep in mind that peripheral neuropathies as you describe are mostly caused by metabolic problems and the most common ones (aside from diabetes) would be things such as B12, folate, Vit. D, and thyroid deficiencies. Also, add to that list testosterone (total and free).

So, for the metabolic panel I would suggest order the follow:

1. Serum Vit. B12 (<400 could be clinically significant and may need to be corroborated by a homocysteine and methylmalonic acid (MMA))
2. Serum Vit. D (total), D2, and D3 (for neurologists we like at LEAST a 40 if not 60-80 which is my preference)
3. Thyroid--- I would do BOTH a TSH and FT4 and if that and everything else were negative then, I would do a FULL thyroid panel to include microsomal enzymes, Anti-thyroglobulin Ab, and Anti-thyrotropin Ag. And if you really want to impress your endocrinologist....get the receptor antibodies as well! LOL
4. Folate (almost NEVER abnormal....even in ETOH abusers....but we get it anyways)
5. Serum Testosterone TOTAL and FREE--- has a lot more to do with neuropathic presentations nowadays than we'd ever thought in the past...but funnily enough....estrogen in females DOES NOT have the same linkage.
6. And then, one should always keep the vasculitic profile in mind in order to rule out things such as SLE, RA, and other entities....but for those I tend to just screen with ESR, CRP, and LA

Of course, I might also suggest that you be looked at by a NEUROLOGIST for this problem if the podiatrist is not able to ferret anything out because neuropathy leads the differential diagnosis in first, second, and 3rd place. The challenge is to find the culprit. Could it be spinal cord or even brain? Probably less likely in the absence of back pain or signs of any sort of radiculopathy. Are your DTR's good? Again, that's probably not something podiatrists check a whole lot....AND do you have any sensory difficulties in the upper extremities or even farther north than the feet? Did they do a good pin prick, vibration, and hot/cold set of tests?...proprioception?

I would put BRAIN as the source of this problem lower on the list but not entirely ruled out such that if everything came out negative....I might just consider an MR of the head....but then, maybe not....depends on the history and other elements of the neurological examination.

Doctor, if I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 24 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---