Discussions By Condition: I cannot get a diagnosis.

Is this diabetic foot problem emergency?

Posted In: I cannot get a diagnosis. 7 Replies
  • Posted By: BesideMyself
  • January 8, 2008
  • 07:42 AM

Type 1 diabetic, no history of neuropathy, but I do have leg ulcers on the left leg. Left foot became red in the crease under the big toe recently, and I put some neosporin on it and the space between the toes. It went away, so I thought everything was ok. Today I woke up feeling like something is stuck between my big toe and the toe next to it of the same leg. Moving the toe feels weird but not painful. There is a bit of redness in the same crease under big toe. Skin is white between the toes, but is usual for me in cold weather. No unusual heat in the foot. My feet do swell pretty up often. Leg ulcers do not appear to be infected as far as I can tell and no heat there either. Walking is uncomfortable because I have a sensation like something is stuck between those two toes and my ball of my foot feels a bit weird too. There is no numbness or pain, more a feeling of tightness. I generally take an ecotrin daily for circulation and to help the ulcers heal. I have never had ulcers on my foot, just the shin where circulation in everyone is weak.

I do not think this is neuropathy, because there is no pain, no tingling, and no history. My legs grow hair down to the foot which my doctor said is a good sign, and a test of my feet and legs with ultrasound showed normal results a few months ago. I have been a diabetic since age 2 and not had foot problems other than chillblains some winters on the other heel.

What could this be other than neuropathy? Is it an emergency? I need to know, because I have gone to the hospital in the past when the ulcers got infected and they treat me like I am overreacting. I would rather see my podiatrist, but I could not see him as quickly. I am worried he will say neuropathy just because of the diabetes and I want to know what else to be tested for. People tend to assume that, and then it always turns out not to be and this has happened to me for a couple decades now. It's very expensive to be misdiagnosed for that. I am wondering if this is something circulatory. It is very cold here.

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  • well, I'd be more comfortable if the podiatrist took a look at it...how soon can you get in??? Could be a neuroma or something...
    Monsterlove 2921 Replies
    • January 8, 2008
    • 08:16 AM
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  • My guess probably not for several days and maybe not until Friday since he is catching up after the holidays. I am most concerned about a foot infection because although it does not look infected, that red in the toe crease worries me. I am of course also concerned about nerve or circulatory or bone damage. Last time I had a chillblain the podiatrist declared that I had Buerger's or vascular disease, and I was sent to both a dermatologist and a cardiovascular surgeon who first informed me that with most type 1 diabetics you can scrape their toes off with an Xacto knife and they won't feel it. Then she told me I would be dead soon. She then tested me with the ultrasound device and a cuff inflation thing, asked about pain in my calves (don't have any), asked how far I can walk, and sort of said oh er...actually I don't think this is Buerger's or a cardiovascular problem. Your circulation and sensation tests are normal. Not much fun for me, her bedside manner. Dermatologist took one look at it and said oh, that's a chillblain. Seen a lot of those this year because Californians don't own warm enough clothes. Whew. I go through a lot of this stuff. They have 9 specialists the GP sends me to now, all expensive, and they all pronounce doom when I first see them and then say oops. I smoke and I know it's BAD. I am trying to quit, but the doomsayers are what keep stressing me to the point where I can't quit. Typically they all think everything is diabetic, down to a sore throat, and it takes them all kinds of expensive tests before they are willing to admit whatever is wrong with me is something else. I am living on a trust fund at the moment because the telecommuter job I had went bye in a merger. I cannot afford much more misdiagnosis (or much more smoking from stress, either). The best way around that I have found is to know the non diabetic possibilities before I go in and insist they test for those at the same time and if possible in the same visit by the same doctor. They are not bad doctors, they just don't understand my financial reality. I do have glucose highs in the morning due to the Dawn Phenomenon, but I am in the mid 70s before meals. The one time I was hospitalized for ketosis as an adult, I had the flu, and my A1C was 5.5. I wish they could see me as a person, not just a brittle diabetic. I might be able to go to a movie once in awhile.
    BesideMyself 41 Replies
    • January 8, 2008
    • 08:54 AM
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  • Monsterlove is probably right in that it's a neuroma. Here's a list of do's and don'ts. If you are already doing everything right, then I'd think diabetic problems. E-mail this page Morton's Neuroma What is a Neuroma? Symptoms of a Morton's Neuroma What Causes a Neuroma? Diagnosis Treatment When is Surgery Needed? What is a Neuroma? A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. "Intermetatarsal" describes its location - in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot. The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage. Symptoms of a Morton's Neuroma http://www.footphysicians.com/NR/rdonlyres/DC75184E-F55F-4134-BBEF-D0EABA68094D/0/mortons.jpgIf you have a Morton''s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring: Tingling, burning, or numbnessPainA feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.The progression of a Morton's neuroma often follows this pattern: The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.Over time the symptoms progressively worsen and may persist for several days or weeks.The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.What Causes a Neuroma? Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet, or more flexible feet—are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma. Diagnosis To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed. The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton's neuroma greatly lessens the need for more invasive treatments and may avoid surgery. Treatment In developing a treatment plan, your foot and ankle surgeon will first determine how long you've had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include: Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.Icing. Placing an icepack on the affected area helps reduce swelling.Orthotic devices. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.Changes in shoewear. It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.Injection therapy. If there is no significant improvement after initial treatment, injection therapy may be tried.
    rad-skw 1605 Replies
    • January 8, 2008
    • 10:28 AM
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  • Thank you. I don't think it is neuropathy problem because I have no history and have had diabetes a long time, and I have heard people who are going to get neuropathy usually get it before now. I am really hoping it is not. I would probably prefer it to be the neuroma. Still would not explain the red toe crease at the underside base of that toe, but neither does neuropathy and there was nothing in the slippers or my socks to irritate that area. I think/hope it came on rather quickly to be neuropathy. My understanding of neuropathy is that you usually don't just wake up one day with something like this. Also I have full feeling there and everywhere else. I was really hoping it might be arthritis, but there is no joint swelling. I hope I'm not in for surgery. I do not heal quickly. Still a bit concerned about the red mark, that it might be some type of infection there irritating the nerve. That area was initially itchy last time before I used Neosporin. There's no scaliness or cracking, so I don't think it is Athlete's Foot but it is true I have been wearing socks because of the cold here, and I do not usually wear socks because of concerns about circulation. I did cut the socks down the front past the ankle so they don't bind. I am not doing exercise and indeed am entirely sedentary right now because of the leg ulcers. I do have a bad habit of shoving my feet forward in the slippers. I switched to old loose slippers and that seems to help a little, but I still feel sort of like I have a string tied around the base of my big toe where the toe crease is. I take Ecotrin already. Think taking more may be unwise because I am on Prevacid for acid reflux. It does look like from the diagram that it is probably along a nerve, just on a different part of the foot. My feet do swell these days because I sit for long periods. It is possible the slippers were compacting my toes a bit with the socks on.
    BesideMyself 41 Replies
    • January 8, 2008
    • 11:53 AM
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  • Thank you. I don't think it is neuropathy problem because I have no history and have had diabetes a long time, and I have heard people who are going to get neuropathy usually get it before now. I am really hoping it is not. I would probably prefer it to be the neuroma. Still would not explain the red toe crease at the underside base of that toe, but neither does neuropathy and there was nothing in the slippers or my socks to irritate that area. I think/hope it came on rather quickly to be neuropathy. My understanding of neuropathy is that you usually don't just wake up one day with something like this. Also I have full feeling there and everywhere else. I was really hoping it might be arthritis, but there is no joint swelling. I hope I'm not in for surgery. I do not heal quickly. Still a bit concerned about the red mark, that it might be some type of infection there irritating the nerve. That area was initially itchy last time before I used Neosporin. There's no scaliness or cracking, so I don't think it is Athlete's Foot but it is true I have been wearing socks because of the cold here, and I do not usually wear socks because of concerns about circulation. I did cut the socks down the front past the ankle so they don't bind. I am not doing exercise and indeed am entirely sedentary right now because of the leg ulcers. I do have a bad habit of shoving my feet forward in the slippers. I switched to old loose slippers and that seems to help a little, but I still feel sort of like I have a string tied around the base of my big toe where the toe crease is. I take Ecotrin already. Think taking more may be unwise because I am on Prevacid for acid reflux. It does look like from the diagram that it is probably along a nerve, just on a different part of the foot. My feet do swell these days because I sit for long periods. It is possible the slippers were compacting my toes a bit with the socks on.
    BesideMyself 41 Replies
    • January 8, 2008
    • 00:19 PM
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  • Perhaps you should see a doctor today and make the appointment with the podiatrist for later in the week. That one doctor had no business talking with you like that...you might consider reporting her to the medical board.
    Monsterlove 2921 Replies
    • January 8, 2008
    • 07:05 PM
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  • Yeah, once your foot gets better, go kick the butt of that cardio-surgeon.But seriously, you can make a complaint to your county medical board.
    rad-skw 1605 Replies
    • January 9, 2008
    • 00:29 PM
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