DEAR DR. ROACH: My daughter and her friend went to a concert and had to climb stairs, walking about 2.5 miles in total. After returning home, my daughter had severe pain in both of her feet and was unable to stand or walk on them. She said it felt like someone was crushing them.
The pain did not get better, so she went to an emergency room a few days later. A doctor there performed an X-ray and said that the pain was due to bunions, although the doctor did not even look at her feet. She also saw a foot specialist, who told her that the diagnosis was neuropathy of the feet and recommended Neurontin for pain. He asked her if she has diabetes, but she does not. They told my daughter that she will have to live in pain for the rest of her life.
The doctor recommended some tests on her nerves at the hospital, but she doesn’t have money to pay for these tests. What can be done to help her? How is it possible that the pain started so suddenly? She is in constant pain and is unable to walk. — K.B.
ANSWER: “Neuropathy” is not a diagnosis; it’s a name for a diverse group of diseases that cause damage to the nerves and may signify nerves of the brain and spinal cord, or those outside.
The idea of getting nerve testing done is correct. This does sound like neuropathy from the little bit of information I have, although neuropathies do not typically begin with exercise the way you described. I have seen several cases where muscles have become terribly inflamed and even break down after a period of unusually strenuous exertion (this usually gets better with time), but I would have expected the doctors to make that diagnosis.
There is a compressive neuropathy in the foot (tarsal tunnel syndrome) where the nerve is damaged by pressure from muscles, bones and connective tissue, but for that to happen with both feet at the same time would be surprising. Metabolic neuropathies, like B12 deficiency, cause symptoms on both sides but do not begin suddenly. I’d be worried about the lower spine.
I don’t know what your daughter’s financial situation is, whether she might be eligible for Medicaid or the Affordable Care Act, or whether there is a free medical clinic near you. I have had many patients make just enough money that they don’t qualify for Medicaid but can’t afford commercial insurance and don’t get it through work.
DEAR DR. ROACH: What is your opinion of laser therapy for joint pain? What are the risks and benefits? — M.J.
ANSWER: Low-level laser therapy, sometimes called cold laser, is thought to improve circulation, lessen inflammation and decrease pain sensitivity when applied to the skin over a joint with osteoarthritis, such as the knee.
In several reviews of small studies, laser treatment provides a modest benefit in decreasing pain, disability and stiffness when compared to a treatment that appeared the same to the participant but did not use the same kind of laser. (In the most stringent studies, even the person using the laser didn’t know whether it was set to the effective treatment or not.) Muscle strength was also increased. In these studies, no adverse effects were noted.
However, this therapy is still regarded as experimental, so it is not usually covered by insurance. Generally, insurance companies will cover treatments once enough evidence accumulates to prove them effective.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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