Vitamin B12-the nerve vitamin

Cobalamin is the scientific name for Vitamin B12. Vitamin B12 plays a critical role in the maintenance of nerve myelin- the protective sheath surrounding the nerves. A demyelinating disease is a disease characterized by damage to the myelin sheaths which cover the nerves. Myelin acts as an electrical insulator, ensuring that impulses move quickly down the length of a nerve, and when a nerve becomes demyelinated, these impulses can slow or stop. In a sense, a demyelinating disease strips the body’s wiring of its insulation, and just as a house’s electrical systems would go haywire if all of the wiring was abruptly exposed, the body experiences a variety of problems as the nerves lose their protective layers of myelin. It is generally accepted in the medical community that prolonged B12 deficiency in healthy individuals can lead to nerve degeneration and irreversible neurological damage.

 Foods that contain Vitamin B12

Clams, Oysters, and Mussels-Shellfish are a great source of vitamin B12 and can be eaten raw, baked, steamed, fried, or made into chowder.

Liver-Often appearing on the culinary scene as pâté, liver can also be prepared steamed or fried with onions and herbs. The liver of most any animal is packed with vitamin B-12, the highest on the list are: Lamb, beef, veal, moose, turkey, duck, and goose respectively.

Fish-Known for their omega 3 fats and for being a high protein food

Beef-In addition to being a vitamin B12 rich food, beef is also a good source of protein, zinc and iron

Cheese-Despite being a high source of cholesterol cheese is a good source of calcium, protein and the Vitamin B.

Eggs-When it comes to chicken eggs the raw yellow has most of the vitamin B-12

 Vitamin B12 supplements

According to the Mayo Clinic the recommended dietary allowances (RDAs) are 2.4 micrograms daily for adults and adolescents aged 14 years and older, 2.6 micrograms daily for adult and adolescent pregnant females and 2.8 micrograms daily for adult and adolescent lactating females. Because 10-30% of older people do not absorb food-bound vitamin B12 efficiently, those over 50 years of age should meet the RDA by eating foods fortified with B12 or by taking a vitamin B12 supplement. For vitamin deficiencies causing peripheral neuropathy, daily dosage recommendations range from 125mcg to 2000mcg or greater.

Sublingual Vitamin B12

The sublingual form is the easiest and fastest and most effective way to take vitamin B12. Sublingual simply means you put in under your tongue. The membranes that are underneath your tongue are stimulated by the tablet to produce saliva, which dissolves the tablet and it’s absorbed directly into your bloodstream.

 Neurontin-Gabapentin

About gabapentin

Gabapentin is an oral medication approved by the FDA for the treatment of seizure for patients who have epilepsy. Gabapentin is classified as an anticovulsant medication. It is also indicated to help relive nerve pain associated with shingles (also called postherpetic neuralgia). While this medication is one of the most prescribed, it was a not developed as a primary treatment for any type of peripheral neuropathy.

There are many side effects associated with the drug with most being, drowsiness, memory problems, lethargy and a sensation of fogginess.” There are many other side effects as well including, allergic reaction, dizziness, headache to name just a few. Neurontin will not reverse damage but may reduce neuropathy pain. It will not restore feeling in the foot.

Lyrica-Pregabalin

About Lyrica

Lyrica is an oral medication that is chemically related to Nerontin. It has been approved by the FDA only for the management of pain from diabetic neuropathy. It also has been approved by the FDA for other conditions including pain form shingles (postherpetic neuralgia), fibromyalgia and as adjunctive therapy (meaning working in combination with other medications). Lyrica has not been approved by the FDA for treatment of other kinds of peripheral neuropathy. The side effects are quite similar to Neurontin.  Lyrica will not reverse damage but may reduce neuropathy pain. It will not restore feeling in the foot.

Cymbalta

 About Cymbalta

 Cymbalta is an antideoressant medication. It is used to treat major depressive disorders and general anxiety disorder. It is in the category of antidepressants called selective serotonin and norepinephrine reuptake inhibitors—SSNRI’s.  Cymbalta has also been approved by the FDA to manage pain associated with diabetic peripheral neuropathy.  It is used “off label” to treat other types of neuropathy pain.

Like the other medications mentioned, Cymbalta will not reverse damage but may reduce neuropathy pain. It will not restore feeling in the foot.

Cymbalta will not reverse damage but may reduce pain caused by diabetic peripheral neuropathy. Side effects include drowsiness, weight gain, nausea constipation or diarrhea, dry mouth sleep disturbances among many others.

Should I take any of these drugs for my neuropathy?

 Great question and there is no right answer. You have to weigh the benefits versus side effects. Some of my patients relate that the adverse effects of these drugs are actually as a bad or worse than the neuropathy pain. Talk to your physician before starting any of these medications and express your concerns. A word of caution-do not stop taking any of these medications without informing your doctor as sudden withdrawal can lead to seizures.

Living with peripheral neuropathy can be quite challenging. Neuropathy is defined as damage to the nerves away from the brain and spinal cord. It primarily affects the feet-causing pain, burning, numbness and tingling sensations in the feet and toes.

The following suggestions can help in the management of peripheral neuropathy:

• Keep your feet healthy-this is especially important if you have diabetes. Check your feet daily for signs of blisters, cuts or calluses. Tight shoes and socks can worsen pain and tingling and may lead to sores that won’t heal. Wear soft, loose acrylic socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet. Problems such as ingrown toenails, plantar warts and fungal infections should be treated by a podiatrist.
•  Exercise regularly- exercise is beneficial to the circulation in the legs and feet. If your medical condition limits your activities, walking or the use of a stationary bike is recommended.
• Use topical lotions, creams and patches to “fool the nerve endings.”  If the pain and the odd sensations are uncomfortable, you might try topicals to divert the pain. Topical, over-the-counter preparations, often contain menthol and eucalyptus which can be soothing to the nerve endings. Some products in this category include Nerve Health Relief Cream, Biofreeze, Sombra and Bengay.
•  Massage can be helpful-Massage can increase local circulation in the feet. Massage has a calming effect as well. You can purchase a home foot massager such as MediRub Foot Massager a Homedics unit.

With neuropathy-attitude is everything!

Living with a chronic condition such as peripheral neuropathy can be challenging and at times disheartening.

• Acknowledge the condition but don’t give in!  Decide which tasks you need to do on a given day, such as paying bills or shopping for groceries, and which can wait
•  Divert the discomfort by staying active- get involved in a hobby or visit a friend, go to a movie or take a short walk if possible.
• It’s ok to ask for help-take advantage of the number of resources that are available.  It isn’t a sign of weakness to ask for or accept help when you need it. In addition to support from family and friends, consider joining a support group. They can be good places to hear about coping techniques or treatments that have worked for others. You’ll also meet people who understand what you’re going through. To find a support group in your community, check with the Neuropathy Association (neuropathy.org). The Neuropathy Association is a prime resource for those who suffer from peripheral neuropathy. There are many local support groups across the country under the auspices of this organization.
• Try to not to get overwhelmed-Everyday problems can be exacerbated the additional stress of dealing with neuropathy. If something especially stressful is coming up in your life, such as a move or a new job, knowing what you have to do ahead of time can help you cope
• Seek the help of a professional- Talk to a counselor or therapist.  Anxiety, depression and sleep difficulties are possible complications of peripheral neuropathy. If you experience any of these, you may find it helpful to talk to a counselor or therapist in addition to your primary care doctor.

 Peripheral neuropathy is due to damage to the nerve cells and nerve fibers. Nerve can be damaged in two ways: The cover of the nerve, the myelin sheath, can be stripped away or the “tail” of the nerve, the axon, can be destroyed. Peripheral neuropathy is usually an acquired condition but in some cases it may be inherited.

Diabetic Neuropathies

 Diabetes is the most common cause of peripheral neuropathy. It is estimated that approximately 70 percent of all persons with diabetes develop some form of peripheral neuropathy.

Neuropathies Caused by Chemotherapy

The development of peripheral neuropathy following chemotherapy treatment is a fairly common occurrence. Chemotherapy agents that aggressively “attack” cancer cells often have a neurotoxic effect, damaging the nerve cells as well. The extent of nerve damage depends on the cumulative dose and the type of drugs used.

Neuropathy Caused by Spinal Problems

The nerves of the lower spinal column innervate the feet. Damage of the spinal column, causing spinal stenosis (narrowing of the spine) or protruding vertebral discs can “pinch” the nerves of the spinal cord causing pain, burning, numbness and tingling sensations in the feet

Neuropathy Caused by Excessive Alcohol Intake

Prolonged and excessive use of alcohol will invariably have a toxic effect on the nerve tissue. Studies have shown that the incidence of alcoholics who develop peripheral neuropathy ranges from 25 to 50 percent. Nutritional deficiencies often associated with alcohol abuse can exacerbate neuropathy symptoms.

Neuropathies Caused by Toxins and Drugs

 As noted previously, exposure to certain toxins such as arsenic, lead, mercury, thallium, chemical solvents and nitrous oxide, can cause nerve damage. Some insecticides may also cause peripheral neuropathies symptoms. Certain anticonvulsant, antiviral and antibiotic drugs man result in pain, burning, tingling and numbness.

 Neuropathies Caused by Nutritional Imbalance

Deficiencies of vitamins B12 (cobalamin), B1(thiamine), B6 (pyridoxine) or vitamin E can cause peripheral neuropathy symptoms. Vitamin B12 plays an important role in neurologic function. It should also be noted that overuse of some vitamins may actually cause peripheral. This includes taking mega-doses of B6 and B12. Caution should also be used when taking higher doses of vitamin E as well, since this is a fat-soluble vitamin and can accumulate in the body’s tissue.

 Neuropathies Caused by Infection

It is estimated that nearly one-third of people with HIV/AIDS experience peripheral neuropathy. Nerve damage can be caused by the medication, the actual virus or a combination of both.

Neuropathies Caused by Autoimmune Diseases

 An autoimmune disease is a condition in which the immune system destroys or attacks its own bodily tissues. Rheumatoid arthritis, Systemic lupus erthematosus and Guillian-Barre syndrome are autoimmune disease that is linked to peripheral neuropathy. Chronic inflammatory demyelinating polyneuropathy(CIDP) is thought to be another form of this syndrome.

Neuropathies Caused by Cancer

Different types of cancers can have varying effects on nerves. Multiple myeolma is type of cancer that affects the plasma cells in the bone marrow. It can cause destruction to the axon part of the nerve cell. Certain blood cancers—chronic lymphocytic leukemia and lymphoma—can also cause peripheral nerve damage.

Neuropathy Caused by Hereditary Conditions:

Charcot-Marie-Tooth is the most commonly inherited neurological disorder. Damage to the nerves is caused by gene mutation.

Neuropathy Caused by Injury

Injury or excessive pressure on a particular nerve can result in nerve damage causing peripheral neuropathy symptoms.  Carpal Tunnel and tarsal tunnel are common neuropathies as a result of injury or repetitive motion.

Idiopathic Neuropathies

Neuropathies in which no specific cause can be identified are called idiopathic neuropathies.

 Studies have shown that over 70% of people with peripheral neuropathy experience problems with walking and balance. There are many reasons why neuropathy sufferers have balance difficulties. By definition, peripheral neuropathy is a condition whereby the nerves in the feet are damaged.  Essentially there are three bodily components to good balance: feet, inner ear and eyes.  If any one of these structures malfunctions, the end result will inevitably lead to poor balance. Today I will focus of the feet as a key element on proper balance.

Sensory nerves-You are what you feel

Sensory nerves supply feeling to the feet. When one looses the ability to feel his/her feet, balance can be severely affected. The brain and spinal cord, which are the computers of the central nervous system, are not properly communicating with the lower extremities. The brain sends signals to the feet, which allow the feet to adjust to a variety of factors. As we move from one surface to another – for example from a hard cement sidewalk to an uneven grassy lawn – the brain will allow us to compensate for these changes. If people have lost feeling in their feet, they lose this ability and are more prone to unsteadiness and falling.

No one likes to experience pain! Yet pain is an important protective mechanism for our bodies. For examples, if we sprain our ankle, the brain sends pain signals and our natural reaction is to avoid putting pressure on this area. People with nerve damage often lose this ability, which is referred to as loss of protective sensation.

Odd Sensations Contribute to Balance Problems Peripheral Neuropathy patients at the Foot Pain Center describe these sensations in many ways – the feeling of walking on sandpaper, cardboard, rocks, marbles or pins are just a few. When people have the sensation of walking on rocks or marbles, it does interfere with the normal walking pattern. A person who experiences these sensations is distracted when walking and cannot effectively concentrate on the normal heel-to-toe gait.

Loss of Proprioception: Ability to Know Where Your Feet are Positioned Relative to the Ground

Proprioception is often referred to as the sixth sense. Our brain sends out impulses and allows us to sense where a particular body part is situated without visually seeing it. A test that has been previously described is called the proprioception sensation test. This test consists of having a patient sit in an examination chair with eyes closed. The examiner moves a body part, usually the great toe in an upward or downward position. A person with adequate proprioceptive ability can differentiate the different positions of the toe.

It is extremely important for good balance to be able to sense where your feet are situated at all times. Picture an astronaut floating around in his space vehicle. Without the sensation of “being grounded” it is most difficult to remain orientated to your surroundings. The same holds true for a person with peripheral neuropathy. If this person does not feel where his/her feet are relative to the ground, unsteadiness and imbalance will occur.

Improving balance

Improving balance requires various approaches depending on the cause of the balance problems. Here are some tips for improving balance:

• Exercise keeps the foot and leg muscles strong-and prevents muscle atrophy. A daily work-out doing some type of exercise is beneficial. There are a number of home programs such as Improve Your Balance Now DVD –can help improve the function of the feet, eyes and inner ear. Regular exercise such as walking can help strengthen the muscles of the feet and legs.
• Enroll in a Tai Chi, yoga or Pilates class-these disciplines emphasize balance
• Wear proper shoes-a good walking shoe with a built-in medial arch can ease foot fatigue
• Use a walking aid such as a cane, walker or walking poles. These devices can improve balance and confidence when walking. A new device called the U-step Walker is revolutionary in that it emits a laser light on the ground that actually assists in both stability and gait training.

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Sleep disturbances can  impact a person’s emotional and physical well-being
People who sleep poorly are also susceptible to depression and other mood disorders, changes in eating, decrease in physical activity, and an overall decline in health. People who sleep poorly are also susceptible to depression and other mood disorders, changes in eating, decrease in physical activity, and an overall decline in health.

How to get a good night’s rest

There is no one simple solution to tackling insomnia stemming from neuropathy/foot pain. The following are practical suggestions to help you get a fitful night’s sleep:

• Maintain a regular sleep/wake schedule-it is often helpful to go to bed about the same time each night
• Develop a routine before going to sleep- such as taking a warm bath or reading light material
• Limit or eliminate caffeine four to six hours before bed and minimize daytime use
• Avoid alcohol and heavy meals before you go to bed
• Avoid watching television before going to bed
•  Adopt relaxation techniques to help induce sleep (e.g., give yourself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day. Doing meditation or other relaxing discipline can also be helpful.
• Create a comfortable sleeping environment (e.g., make sure your bedroom is dark, quiet, and well-ventilated; use bed and pillows that are comfortable; elevate the bed sheets so that it is not in direct contact with your legs and feet).
• Seeking Your Doctor’s Help to Address Sleep Disturbances
  If sleep problems persist and interfere with your ability to function, it may be time to consult your doctor. You will want to describe your sleep symptoms; effects of sleep symptoms on your daily activities and neuropathy; medication history (because many prescription medications can also affect the quality of your sleep, including some herbal remedies). Your health care practitioner may recommend over-the-counter medications such as Advil PM or Tylenol PM. In severe instances where insomnia affects the quality of life, he or she may prescribe sleep medications such as Ambien® or other sedative hypnotics. This class can be helpful in treating insomnia however there are a number of side effects including dependency.

Alternative Treatment Options for the Management of Diabetic Neuropathy

Volume 22, Number 1, Spring 2012

According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 60%-70% of people with diabetes have some form of neuropathy (1).  Many of these patients are treated by a wide variety of prescription medications including anticonvulsants, antidepressants, and analgesics.  These medications may be effective in relieving neuropathic pain; however, many patients report side effects that make the drugs difficult to tolerate.  For example, commonly prescribed anticonvulsant drugs often result in drowsiness, difficulty concentrating, confusion, and weight gain.  In addition, patients with neuropathy usually have existing medical problems and are already taking other medications.  They may be resistant to taking even more medication and seek treatment alternatives.  The following case presentation illustrates that there are viable, alternative treatments for diabetic neuropathy that should be considered when traditional medications are not an option.

Case history

Tim is a 61-year-old man with Type 1 diabetes.  He was diagnosed with diabetes at age 36, and he currently takes Lantus (insulin glargine).  He has severe peripheral arterial disease and has undergone three vascular reconstruction procedures for femoral occlusion.  In 2003 he developed a non-healing ulceration on the right foot.  He was given 75 hyperbaric treatments at Long Beach Memorial Medical Center.  The limb was salvaged, but amputation of a toe was necessary.

Tim first presented to my office in September 2005 complaining of numbness and a dull ache and “pins and needle” sensations in his feet.  He related that symptoms were worse when standing while at work as an elementary school teacher and also at bedtime.  He was evaluated by a team of specialists including an endocrinologist, a vascular surgeon, and a neurologist.  Tim was diagnosed with diabetic neuropathy and was placed on gabapentin 300 mg (2), three times a day.  He had difficulty tolerating the medication, reporting that he experienced extreme fatigue.  Other medications were prescribed, including pregabalin (3) and duloxetine (4), however, the patient could not tolerate these medications either.  Diagnostic testing confirmed diabetic neuropathy characterized by loss of light touch perception, using the Semmes-Weinstein 10-g monofilament, and loss of vibration perception, measured with a 128-Hz tuning fork.

An alternative treatment plan was instituted using iontophoresis and microcurrent electrical therapy together with a self-contained garment system.

Non-invasive treatment using iontophoresis

Iontophoresis is a non-invasive method of delivering drugs into the body using direct electrical current.  A direct current facilitates the transdermal delivery of local ionizable anesthetic and anti-inflammatory agents.

Iontophoresis is based on the electrical magnetic principle that opposite poles attract and like poles repel.  When a solution consisting of specific drugs of one polarity is placed on a skin patch with the same polarity as the energy source, the solution is repelled and is driven transdermally through the skin.

Medications carrying a positive charge are drawn to cathode electrodes and repelled by anode electrodes, while negatively charged medication compounds display the reverse behavior (5).  Whereas iontophoresis was initially thought to drive the ions through the skin and into underlying tissue, recent research suggests that it promotes transdermal penetration by increasing the permeability of the stratum corneum (6).

Physical therapy clinics are generally equipped to administer medications  via iontophoresis, but the patient must bring the prescribed ionic medication solution, which is formulated by a compound pharmacist.  When selecting the drugs for this treatment it is important to be aware of the polarity of the drugs selected (7).  For example, lidocaine hydrochloride is a positively charged medication and thus the power source needs to set to a positive polarity to deliver the drug through the skin.  Other positively charged medications include hydrocortisone and magnesium sulfate; negatively charged medications used for chronic pain include dexamethasone and salicylates.

Contradindications to the use of iontophoresis include its use in individuals with a cardiac pacemaker or other electrically sensitive implanted device, or during pregnancy.  It should not be used when there is a known sensitivity or an adverse reaction to the drugs to be administered, or an adverse reaction to the application of electrical current.  The skin patches should not be used on damaged skin or recent scar tissue, and they should not be applied to the temporal region, anterior cervical region, or carotid sinuses.  Care should be taken to prevent skin damage due to adhesive irritants used on electrodes and to prevent exposure to the accumulated pH changes that may occur beneath the electrode (6,8).

Tim’s treatment course

The drugs chosen for Tim’s treatment were gabapentin 4% concentration and ketamine 2% concentration in a clear solution.  He was scheduled for three treatments per week for eight weeks.  Following each treatment, he received a light foot and leg massage.  Additionally he received a conductive sock garment for home use along with a microcurrent electrotherapy device.  This system differs from a traditional TENS unit by emitting a smaller electrical charge that mitigates pain as opposed to TENS, which blocks pain signals.  The sock allows treatment to be given over a greater surface area.

The contraindications for the garment system are similar to those for TENs therapy.  The garment should not be used in patients who have a cardiac pacemaker or other electrically sensitive implanted device; it should not be used during pregnancy; it should be used cautiously in patients with a spinal cord stimulator or an intrathecal pump; and the electrodes should not be placed on irritated skin.

Tim received two socks since his condition was bilateral and symmetrical.  Initial treatment was started in October 2005.  The patient noted improvement after six iontophoresis treatments and application of the socks on a regular basis.  He related that he experienced fewer “pins and needles” sensations in his feet, and he was more comfortable at work and at bedtime.  He continued to have numbness in his feet, and on physical examination it was noted that he had absent pain-touch and vibratory sensations.  Currently, Tim continues to be seen on an as needed basis.  As with most patients with neuropathy, he has periods of flare-ups and remissions.  He states that the treatments and the home device are helpful in relieving discomfort.  Other than the treatments described he takes no medication for neuropathic pain.

Conclusion

Tim’s case illustrates the many challenges faced by health care professionals when treating diabetic neuropathy.  Like Tim, many patients have difficulty tolerating the various medications used in the treatment of neuropathic pain.  In formulating a treatment plan, the social implications must also be considered.  For example, Tim needs to be alert and highly functional as he is responsible for the care of elementary school children.  Tim is satisfied with his treatment at the Foot Pain Center.  Although he continues to experience some neuropathic pain and numbness in his feet, he relates that his quality of life has improved.  He is able to continue teaching and he takes no additional medication for neuropathic pain.

MARC SPITZ, DPM, graduated from the California College of Podiatric Medicine in June 1973 and did his podiatric residency at Magnolia Hospital, Long Beach, California, from July 1973 to July 1974.  He has been in private practice in Seal Beach, California, from 1974 to present and has had hospital privileges at Fountain Valley Regional Hospital, Fountain Valley, California from 1976 to present.  Soon after establishing a private practice, Dr. Spitz noted ever increasing numbers of patients presenting with peripheral neuropathy symptoms, prompting him to establish the Foot Pain Center in Seal Beach focusing on peripheral neuropathy.  Being the group leader for the Orange County Neuropathy Support Group has afforded him with the opportunity to interact and understand the challenges faced by people who suffer from neuropathy.  He is the co-author of The Numb Foot Book:  How to treat and prevent peripheral neuropathy and has established Footpaincenter.com, a website with information, articles, and additional resources on the condition.

A famous philosopher –it was either Aristotle or Moe from the 3 Stooges-said, “when my feet hurt-I hurt all over.”  Whoever said it- foot pain is no laughing matter!  Over 40 million Americans will experience some degree of foot pain in their lifetime.   Foot problems no knows age barrier. Certain conditions may affect a particular sex more frequently, however men and women experience foot pain in equal numbers.

Foot pain that affects more women than men

Rheumatoid arthritis

Rheumatoid arthritis affects women three times more often than men. Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues. In addition to causing joint problems, rheumatoid arthritis can also affect your whole body with fevers and fatigue

Bunions

Although there are many causes of bunion deformities, shoes are the one instigating factor. Traditionally women tend to wear shoes with a higher heel and pointed toe-which over time can cause bunion deformities. A bunion is an irregular bony prominence (a bump) on the joint where your big toe meets the main bones of your foot. The bunion causes the end of the big toe to bend toward the other toes and crowd them, while the bone at the base of the toe where it meets the foot moves outward beyond the normal limits of where the bone should be. Pain is caused by inflammation and the bone pressing against the shoe

Foot pain affects more men than women

Gout

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. An acute attack of gout can wake you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

Plantar fasciitis

There appears to be a slightly greater incidence in men. This can be attributed to a weight factor. It is for this reason that women who are pregnant are susceptible to acquiring plantar fasciitis. Plantar fasciitis involves pain and inflammation of a thick band of tissue, called the plantar fascia that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain.

Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Foot pain affecting men and women equally

Ingrown Toenails: An ingrown toenail is a common condition in which the corner or side of one of your toenails grows into the soft flesh of that toe. The result is pain, redness, swelling and, sometimes, an infection. An ingrown toenail usually affects your big toe.

Peripheral Neuropathy: Damage to the nerves that supply the feet causing pain, numbness, burning, and electric shock sensations. There are over 50 causes of neuropathy with diabetes being the most prevalent.

Flat Feet: Flat feet, also known as fallen arches, is a foot condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground.

Diabetic foot problems: Diabetic foot problems can be extremely serious due to that fact diabetes can cause poor circulation in the feet as well as nerve damage- diabetic neuropathy. Diabetics are especially prone to infections, ulcerations and amputation.

Fungal Toenails

 A nail fungus is an infection causing one more changes in the appearance of the nail: The nail can be thick, discolored (yellow or black), with a build-up of tissue under the nail and can be foul smelling. In some cases the thick toenail can cause a secondary ingrown toenail.

Diagnosing peripheral neuropathyis often difficult because the symptoms are highly variable. One of the most important more aspects of the diagnosis process is obtaining a thorough history ascertained from the patient This includes the patient’s symptoms, work environment, social habits, exposure to any toxins, history of alcoholism, risk of HIV or other infectious disease, and family history of neurological disease). Since diabetes is one of the most common causes of peripheral  neuropathy, this is always a strong consideration during the history-taking process.

A general physical examination and related tests may reveal the presence of a systemic disease causing nerve damage.  Blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity.  An examination of cerebrospinal fluid that surrounds the brain and spinal cord can reveal abnormal antibodies associated with neuropathy.  More specialized tests may reveal other blood or cardiovascular diseases, connective tissue disorders, or malignancies.  Tests of muscle strength, as well as evidence of cramps or fasciculations, indicate motor fiber involvement. Evaluation of a patient’s ability to register vibration, light touch, body position, temperature, and pain reveals sensory nerve damage and may indicate whether small or large sensory nerve fibers are affected.

Based on the results of the neurological exam, physical exam, patient history, and any previous screening or testing, additional testing may be ordered to help determine the nature and extent of the neuropathy.

Magnetic resonance imaging (MRI) can examine muscle quality and size, detect any fatty replacement of muscle tissue, and determine whether a nerve fiber has sustained compression damage.

Electromyography (EMG) involves inserting a fine needle into a muscle to compare the amount of electrical activity present when muscles are at differentiate between muscle and nerve disorders.

Nerve conduction velocity (NCV) tests can precisely measure the degree of damage in larger nerve fibers, revealing whether symptoms are being caused by degeneration of the myelin sheath or the axon.  During this test, a probe electrically stimulates a nerve fiber, which responds by generating its own electrical impulse.  An electrode placed further along the nerve’s pathway measures the speed of impulse transmission along the axon.  Slow transmission rates and impulse blockage tend to indicate damage to the myelin sheath, while a reduction in the strength of impulses is a sign of axonal degeneration.

Nerve biopsy involves removing and examining a sample of nerve tissue, most often from the lower leg.  Although this test can provide valuable information about the degree of nerve damage, it is an invasive procedure that is difficult to perform and may itself cause neuropathic side effects.

Skin biopsy is a test in which doctors remove a thin skin sample and examine nerve fiber endings.  This test offers some unique advantages over NCV tests and nerve biopsy.  Unlike NCV, it can reveal damage present in smaller fibers; in contrast to conventional nerve biopsy, skin biopsy is less invasive, has fewer side effects, and is easier to perform.

Computed tomography, or CT scan, is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues.  X-rays are passed through the body at various angles and are detected by a computerized scanner.  The data is processed and displayed as cross-sectional images, or “slices,” of the internal structure of the body or organ.  Neurological CT scans can detect bone and vascular irregularities, certain brain tumors and cysts, herniated disks, encephalitis, spinal stenosis (narrowing of the spinal canal), and other disorders.

Before I attempt to answer the question, let me clarify some terms. What exactly are statin drugs? Statin drugs are classified as cholesterol-lowering-lipid controlling drugs. Lipid-regulating drugs are among the most commonly prescribed medications in this country. Lipitor® and Crestor® are popular statin drugs. One of the side effects associated with statin drugs is a condition called peripheral neuropathy.  Neuropathy is classified as nerve damage. It often affects the feet and lesser occasion the hands as well. Some of the more common symptoms include burning, tingling, numbness and “pins and needles sensations.” It often affects a person’s balance-causing a predilection to falling. The Center of Disease Control and Prevention reports that falls in older adults is the leading cause of injury and injury deaths.

Getting back to the question at hand-do the statin drugs cause peripheral neuropathy-and if so should I take lower-cholesterol medication? Numerous studies do in fact indicate that statin drugs can cause peripheral neuropathy. A famous Danish study of neuropathy as a side effect of statin use concluded that an individual who is a long term user of statin drugs has anywhere from 4 to 14 times greater risk of developing peripheral neuropathy than a person who does not take statin drugs.

Besides peripheral neuropathy, the statin drugs have been associated with other side effects as well, including:

Muscle pain and muscle weakness-many people experience aching in the shoulders, pain in the jaw muscle pain in the legs with difficulty walking

• Memory loss and other cognitive problems-with dementia type symptoms
• Mild increase in diabetes risk associated with statin use
• Decrease in coenzyme Q10 – decrease in coenzyme Q10 can harm the mitochondria, which are the power producers in our cells.

With all these side effects, should you take the statin drugs to lower cholesterol levels?  In most instances I would say yes to statin drugs. Of course certain adverse reactions such as muscle weakness can quite serious with significant repercussions. In these cases the prescribing physician needs to be notified immediately. Overall my feeling is that the benefits outweigh the down-side risks. The benefits of statin drugs are well proven. By lowering the “bad cholesterol”, the drugs in this category can reduce the risk of heart disease, stroke and arterial disease. In my opinion the benefits in preventing these potential life-threatening diseases, outweigh the risk of developing neuropathy. If you do have concerns about the risk versus reward scenario, I suggest that you talk to your physician.