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Getting burning sensation on lower legs and have sweaty feet. How to diagnose my symptoms?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Neurologist
Practicing since : 1994
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Current problems: Burning sensation for lower legs on contact with pants and sweaty feet.

It has started one and half year ago, after doing some yard work, i felt numb feeling all over my body but mostly on the hips and down to the feet. After some PT, the numbness got better but i have started getting the knee pains. I have suffered from some muscle imbalance which doctor diagnosed as patella femoral pain syndrome and after 6 months i have got IT band syndrome and been going to PT/chiropractor to get the treatment and got little bit better in recent time. But now for the last couple of months (after winter started), i have started developing rug burn sensation on my legs. the sole of my feet gets sticky after walking a little while. It is really bothering my skin when the knee/leg area rub against the pants.
Posted Fri, 22 Feb 2013 in General Health
 
 
Answered by Dr. Sudhir Kumar 32 minutes later
Hi,

Thank you for posting your query.

I can understand the discomfort you are facing on account of your symptoms.

Your symptoms are referred to as hyperesthesia and dysesthesia- abnormal increased sensibility and touch being perceived as pain/burning respectively.

These are due to sensory nerve involvement. Common causes are peripheral neuropathy (disease of the peripheral nerves) and compression of nerves at the lower back.

You would benefit from pregabalin or duloxetine capsules.

Investigations helpful in finding out the cause are: serum vitamin B12 level, thyroid profile, blood sugar, nerve conduction studies, XXXXXXX etc.

I hope it is helpful. Please get back if you have any more queries.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
 
Follow-up: Getting burning sensation on lower legs and have sweaty feet. How to diagnose my symptoms? 4 hours later
Thank you Dr. XXXXXXX for your reply.

You mentioned it could be due to compression of the nerves at low back. I have a chronic back pain for a long time. The numbness started (one and half year ago) after sitting on the cement slabs(patio) with a bad posture for a long time (doing some work), the next day i got numb. The first thing my doctor suggested was to get MRI of low back. But i was told it was normal. Does it mean, there is no nerve issues at low back. I have uploaded the MRI, could you please take a look?

As you can see from my original post, i have also been suffering from knee pain (IT band syndrome). It got better but still having difficulty walking. Is there any chance that the nerve problems could cause the knee pain (or slow down the recovery)?

I have got EMG, fiber neuropathy. How do you treat small fiber neuropahy?

I have used Gabapentin for one month 1 tablet at bedtime. I did not see any relief for my burning sensation, i was asked to increase it 3 tablets per day but because of the side effects i discontinued that medication.
Right now my doctor suggested Nortriptyline 10 mg as an alternate to gabapentin. Just started 3 days ago. First 1 capsule at bedtime for 1 week, 2 capsules for 1 week, 3 capsules next. Please let me know if you think it will help.

Thanks in advance
XXXXXXX
 
 
Answered by Dr. Sudhir Kumar 25 minutes later
Hi,

Thank you for getting back with more details.

Your MRI looks normal, which rules out any significant compression of the back nerves.

Knee pain is not related to the nerve problem and I agree with your doctor's advice on that.

If NCV is normal, then small fibre neuropathy is the most likely diagnosis in your case.

Nortryptiline is a good drug for this. However if you do not improve, then pregabalin should be tried.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Getting burning sensation on lower legs and have sweaty feet. How to diagnose my symptoms? 2 days later
Hello Doctor,
Thanks you for your further clarification. I would like to give you more details which i have not mentioned before. Please reply with your comments.

Although my doctor said, it could be small fiber neuropathy, he did not confirm 100%, and is sending me for skin biopsy to confirm that. I have also been to a different neurologist and he had me take brain MRI, T-spine MRI and 2 hour Glucose Tolerance, TSH, Serum Protein Electrophor, Serum Immunoelectrophor and nerve testing Median, Tibial, EMG/NCV (R arm, L arm, R Leg and L leg). I do not know yet, if these tests revealed anything. I have an appt with that doctor next month.

There are also symptoms in my hands, my left hand palm feels weird (not completely numb) and my hands gets numb some times in the sleep.

Also, i feel some kind of nerve irritation at the lateral knee area (outer side - above knee cap - right leg) when doing leg stretches and strengthening exercises for my knee pain. i always wondered if the nerve that is passing through knee joint may be compressed/pinched. Does it make any sense?

In my earlier post, i described my main concern is the burn sensation and the sweaty feet. I want to let you know, when i work from home (wearing shorts and just socks) i do not feel the pain but when i go to office these symptoms becomes worse towards afternoon as my pant touches my knee which causes some knee pain (i pull up my pants up to expose the knees while sitting at my desk) and also feels the sweaty feet due to shoes. Do you have any suggestion to relieve these symptoms (may be some external means)? I am using Nortryptiline, how long will it take to know if it works or not?

After i started using the Nortryptiline (01/23), i am feeling slight numbness on my lips. Not sure it is side-effect or in the process of getting used to the medicine. what do you think?

Thanks in advance
 
 
Answered by Dr. Sudhir Kumar 4 hours later
Hi,

Thank you for getting back with more details.

1. The tests you mentioned are done to find out the underlying cause of the small fiber neuropathy. If any tests show abnormality, specific treatment for that would be started.

2. Skin biopsy is sometimes done, as there are small nerve fibers located in the skin, which can be studied in skin biopsy.

3. Your symptoms in hands and palms may not be significant (as it may happen due to mechanical compression over nerves during sleep) or it may be a part of small fiber neuropathy.

4. Sensations around the knee area also do not point to a specific pathology.

5. As I mentioned earlier, paresthesia and dysesthesia are symptoms seen in small fiber neuropathy.

6. Numbness on lips is not a specific side effect of nortryptiline. However, if it is due to that, it should stop in a few days.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Getting burning sensation on lower legs and have sweaty feet. How to diagnose my symptoms? 3 days later
Hello Doctor,
Thank you for your reply.

One of the other side effects to the nortryptiline i am experiencing is hard stool with stomach upset. I also have some history of piles and it seems this medicine aggravating them and it results in pain and bleeding while going to stool. It happened with Gabapentin (that is why i discontinued) and also a pain killer which i used in the past . I control my diet, eating fruits, vegetables but still no use. Because of this side effect, I am planning to stop it. Please advice? Do you think i need check with gastrologist to see if i have any problem with my digestive system?


Also for my burning and sweaty feet problems, do you suggest any other treatments to treat the symptoms? Acupuncture or massage, anything? Or any external ointment to relieve the symptoms?

Thanks in advance
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Hi,

Thank you for getting back with more details.

You may stop nortryptiline in view of side effects.

Pregabalin is an option for you, which is a relatively safer medicine.

Acupuncture if done by a trained person is also effective.

Gastroenterologist opinion would also be useful.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Getting burning sensation on lower legs and have sweaty feet. How to diagnose my symptoms? 23 minutes later
Thank you Doctor.

I looked for side effects of Pregabalin, it also has constipation as side effects. Every time i used a medicine with that side effect, i always experience the constipation symptoms.
I keep using these medicines for a while but non of them to the full course because of these symptoms. I am worried that it is waste. I dont get chance to see if a particular medicine works or not.
Do you think i have any problem with my digestive system?
Any chance that could be linked to these nerve symptoms?
Do you think i need to address the piles which are causing painful stools?
I am just concerned, please advice.

Thank you
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Hi,

Thank you for getting back with more details.

I feel you should first see a Gastro, and get your digestive system checked up, and piles treated.

As you mentioned, you have to give enough time (at least 4-6 weeks) to the medicines to work. This can happen if you are able to tolerate the drugs without the side effects.

Your constipation and digestive symptoms are not linked to nerve problems.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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