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What Causes Intermittent Painful Discomfort In My Feet?
Question: I have pain/discomfort in my feet from time to time. It feels like a severe throbbing itch/pin stick which lasts from an half hour to up to 2 hours in duration. The discomfort is not on the surface but occurs anywhere on my feet on the inside. I've been tested for vitamin B deficiency, pre-diabetes and had an MRI. All tests came back normal. Any suggestions/advuce would be helpful. Thank you.
Brief Answer:
RLS or peripheral neuropathy most likely
Detailed Answer:
I read your question carefully and I understand your concern.
Judging from that description the most probable causes for your symptoms would be restless legs syndrome (RLS) and peripheral neuropathy.
RLS would typically manifest that way. However characteristically for that condition symptoms are associated with an urge to move, alleviated by the patient standing and walking. Symptoms are also more pronounced in the evening when going to bed. So if you have these features RLS would be the most likely cause, otherwise unlikely.
If these features are present then I believe peripheral neuropathy to be the cause. You have had some tests for main neuropathy causes such as diabetes and vitamin B12 deficiencies but those do not rule out neuropathy. Apart from there being many other causes which could be tested for, in about 25% of neuropathy cases even after extensive testing no cause is found. Nerve conduction studies are done to search for nerve damage, but even when no such damage is found they do not exclude the diagnosis as they can't detect changes in the small nerve fibers. So when symptoms are typical a diagnosis of peripheral neuropathy can be done even with normal laboratory tests. I believe your symptoms qualify as such a case (although if you've been seen only by your primary physician a neurologist consult would be advised to confirm that) and treatment to alleviate the symptoms should be tried. Most common alternatives would be anticonvulsants such as gabapentin, pregabalin or antidepressants such as duloxetine.
I remain at your disposal for other questions.
RLS or peripheral neuropathy most likely
Detailed Answer:
I read your question carefully and I understand your concern.
Judging from that description the most probable causes for your symptoms would be restless legs syndrome (RLS) and peripheral neuropathy.
RLS would typically manifest that way. However characteristically for that condition symptoms are associated with an urge to move, alleviated by the patient standing and walking. Symptoms are also more pronounced in the evening when going to bed. So if you have these features RLS would be the most likely cause, otherwise unlikely.
If these features are present then I believe peripheral neuropathy to be the cause. You have had some tests for main neuropathy causes such as diabetes and vitamin B12 deficiencies but those do not rule out neuropathy. Apart from there being many other causes which could be tested for, in about 25% of neuropathy cases even after extensive testing no cause is found. Nerve conduction studies are done to search for nerve damage, but even when no such damage is found they do not exclude the diagnosis as they can't detect changes in the small nerve fibers. So when symptoms are typical a diagnosis of peripheral neuropathy can be done even with normal laboratory tests. I believe your symptoms qualify as such a case (although if you've been seen only by your primary physician a neurologist consult would be advised to confirm that) and treatment to alleviate the symptoms should be tried. Most common alternatives would be anticonvulsants such as gabapentin, pregabalin or antidepressants such as duloxetine.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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