24/7 Pain

24/7 Pain in ankle/foot/toe areas...been 3 months straight now

Back in April my boyfriend started having slight pain in foot/ankle/heel/toe areas...Went to orthopedic doctor who told him to ice it and take motrin and that there was some swelling in the ankle...He said if no better after 10 days to come back for xrays...No relief/got worse...Got xrays which showed pretty much nothing...Went to an ankle surgeon...Dr said could be pinched nerve or MS or diabetes...Got EMG done from lower back down to toes...No nerve damage shows...No diabetes...Went for MRI...showed no tarsal tunnel and only a few slight bone spurs..Again, no help...Told to get tested for gout...Tested and no gout...No rheumatoid arthritis either...Primary said to go see a Rhematoid doctor (which is today's visit)...Do you feel we should be going to see a podiatrist or what could this be...When I say 24/7 pain I mean that...He gets no relief from ice/heat packs...He now walks with a cane and has to use the electric driving cart at Walmart for shopping..This came out of nowhere and my boy fiend (who normally can withstand lots of pain)is now depressed and possibly suicidal over it.
Please help

RESPONSE

Hi,

I wish I knew how old your boyfriend is. When I see the word "boyfriend" I assume that means relatively young, but not necessarily. In an older individual there are a lot more conditions that could cause the relentless pain that he is experiencing.
In general, when there is a pain in the foot is it usually localized to a specific part of the foot. The heel may hurt, OR, the big toe joint, as an example.
However, when the whole foot and possibly the ankle hurt that usually tells me that the source of the pain is coming from someplace else, further up the leg all the way to the lower back.
An MRI and x-ray in most cases would show pathology in the foot if there was a problem specifically in the foot. It does not.
He has had nerve conduction studies which in theory should rule out nerve damage.
My next statement is a very general statement that I have seen over the years regarding nerve conduction studies and that is neurologists generally are not very good at "thinking outside the box" meaning if the studies are normal, then there is no nerve pain. Well....sometimes you have to go by the symptoms the patient presents with and in cases of pain in the whole foot, the two areas I would look at are either neurological (nerves) or vascular (circulation). Again, I wish I knew your boyfriend's age.
So what can you do? Yes, you could go see a podiatrist, may or may not help. Another consideration would be to immobilize the foot and make him non-weightbearing on the affected foot for at least six weeks to see if that alleviated the pain.
The last suggestion, and probably the one I am leaning to, is to see a pain management doctor. This type of doctor is usually an anesthesiologist. The reason I am suggesting this is because 1. he or she would be better equipped to manage the pain and if you think your boyfriend is suicidal then goal number one for now is to manage the pain while you continue to research the cause of this pain. 2. pain management doctors tend to be more in tune with neurological sources of pain and might look beyond the neurological tests that have been performed in an effort to find the cause of this much pain.

Marc Mitnick DPM
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