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Foot pain, stiff and painful muscles, feeling cold and hot. Wearing orthotics. Taking Lipitor for high cholesterol

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Practicing since : 2009
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I am a 40yr old male who has been having foot pain on and off the last couple of years. Over the last year it has been pretty constant. The pain is symptoms are numerous and include:
1) stiff and tight aching muscles in the morning and throughout the day after sitting for 30min or more. Once up and walking the pain subsides somewhat.
2) Burning aching pain throughout the day and I have experienced extremely cold or hot feet at times.
3) There is also pain on the outside of the foot when the foot is squeezed just down delow the ankle.
4) If i massage my feet, there is pain all in the muscles as I push into them and even pain as i pres on the bones.
To sum it up, I am having every kind of foot pain imaginable. I have been to many doctors, have had injections, physical therapy (including soft tissue manipulation). I recently had blood work done and the XXXXXXX test came back positive. this was borderline a little over a year ago. As a result I was sent to a rheumatologist who did more blood work for things like Lupus and RA. Everything came back fine. I have been wearing orthotics, doing stretching regimens and also glucosamine. Other health issues include lipitor for high cholesterol, a blood clot 2 yrs ago in left calf (hematologist found no cause) and a minor disc herniation back in February. At night, my muscle on the side of my knee tightens up as well (i think its called the IT band) and I have experience muscle pains in other areas (ie calves). I feel like i always need to rub my legs to work out muscle aches. I am otherwise healthy and workout 5 times a week including cardio (eliptical) and weight training. I am 5'6 and 155 lbs, so weight is not an issue either. Any thoughts/advice you could give would be greatly appreciated, as I'm not sure what to do at this point.
Posted Tue, 25 Sep 2012 in Bones, Muscles and Joints
Answered by Dr. Arnab Maji 1 hour later

Thanks for your query.

Your description of pain is suggestive of pain due to peripheral neuropathy. Spinal cord trauma, disc herniation, diabetes mellitus, alcohol abuse, neurodegenerative diseases are the common causes of peripheral neuropathy. You should consult a neurologist and take his opinion because it’s very much necessary to examine you properly especially to examine you for lower limb muscle power, jerks and reflexes and also its essential to exclude wasting of those muscles.

Again you have told that lupus and RA have been excluded by your doctor which was really needed in this condition.

You also told that you had a blood clot 2 yrs ago was detected in left calf. Though your hematologist found no cause for that, I will suggest you to have a colour Doppler study of arterial and venous system of your lower limbs because persistence of clot may present with pain in the lower limbs. So this investigation is needed to exclude clot.

Hope I have given you some possibilities of your disease. I think you will be benefitted if you follow the advice. If you want to know further you can write back to me freely. I am always here to help you.

I should thank you for giving such detailed history.

Wishing you quick recovery.

Dr Arnab Maji
Above answer was peer-reviewed by
Follow-up: Foot pain, stiff and painful muscles, feeling cold and hot. Wearing orthotics. Taking Lipitor for high cholesterol 13 hours later
A couple other Items to mention: the foot pain started a couple years ago one morning after I had played basketball the prior day. I got out of bed and both heels were in pain. this was the first time I had ever had any foot issues. I found it odd that it started in both feet at the same time. Ever since then, all the symptoms have been bilateral. In addition to plantar faciitis diagnosis, I was also diagnosed at some point with tarsal tunnel syndrome. The symptoms from that in particular have subsided, except for the occasional burning, but maybe it hasn't subsided. Also, I had an MRI done of my left foot back in XXXXXXX and it did show signs of arthritis, which the RA doctor suggest at this point is osteoarthritis. Can typical arthritis be causing all this pain i'm experiencing? My primary pain seems to be more muscle/soft tissue related and not necessarily the joint.

Also, would neuropathy cause these numerous symptoms? I have been tested for diabetes as well and that came back negative. What type of neurologist would you suggest I see?

The other thing I wanted to mention was that there are times when the symptoms are not there and I can't even reproduce the pain when squeezing near the heel. It's odd. not sure why it comes and goes. Also, as i lay in bed in the am, i typically will stretch my feed and rotate them to get blood flowing. As I do this it literlaly feels like someone is opening the valve to my blood and i can feel it start to flow through my ankles and feet and with that the stiffness recedes like a hairline. Very difficult to explain, but thought it worth mentioning.

Thanks you for your reply.
Answered by Dr. Arnab Maji 1 hour later


Thanks for writing back.

Peripheral neuropathy can explain all your symptoms.

As your pain is more of muscular origin rather than joint origin it is not likely to be from arthritis. Moreover your doctor has already excluded rheumatoid arthritis and what you had in the past was traumatic arthritis i.e. following a trauma during basketball game. But only arthritis cannot explain all these symptoms, at least osteoarthritis cannot explain.
Rarely rheumatoid arthritis can explain as it is a systemic disease with muscular component. Discuss with your rheumatologist to rule out other arthritis including rheumatoid arthritis.

What you are feeling in your foot is most likely paresthesia which can be explained by peripheral neuropathy.

Another differential diagnosis can come in your scenario is polymyalgia rheumatica (PMR) which has symptomatology like your but it most commonly involves large joints like shoulder and hip joints. Foot muscles and calf muscles also can be involved in PMR. Physiotherapy and steroid treatment will be of help in PMR. You should also discuss your neurologist on this issue.

And obviously peripheral vascular diseases (PVD) as I have said earlier can present with these symptoms. So please you should also have colour Doppler study of both arterial and venous system to exclude PVD.

I will suggest you to take consultation from a neuromedicine specialist. Discuss the issues which I have mentioned here with your neurologists. I hope you will be benefitted.

If you have further queries you can ask me. I am always here to help you.

If you are satisfied with this answer and have no further follow up, kindly write a review on my answer.

Wishing you quick recovery...

Dr Arnab Maji
Above answer was peer-reviewed by
Follow-up: Foot pain, stiff and painful muscles, feeling cold and hot. Wearing orthotics. Taking Lipitor for high cholesterol 2 hours later
Thanks so much for your feedback. This is great information. I had another basketball injury to my back, which was the start of any chronic pain for me back in XXXXXXX of '09. I injured pretty badly my SI joint. The blood clot followed 3 weeks later. not sure if that could cause that or not. Anyhow, It took me multiple doctors and 6 months before the SI joint issue was diagnosed. when i found the right doctor, he performed an injection and sent me off to do the proper PT. That was the initial start of my back pain. I'm wondering if an injury of that nature could have done something to the nerves that run down my legs and into my feet, because it is my lower extremities (legs, feet) that are impacted. Ever since that injury I've had issues with what feels like sciatica, where i feel inflammation down the back of my legs and sometimes in front, just above the knee. Could there be some sort of pinched nerve or something causing the pain from the back down to the feet?

So summarize, I had no chronic issues up until the back injury in XXXXXXX '09. Then july '09 I developed the clot (about 3-4 weeks after the SI injury). From three I developed Sciatica type issues on and off while sitting at work. Then in Aug 2010 is when I woke up one day to bi-lateral foot pain. Was sent to PT as it was diagnosed as Plantar Faciitis and it had pretty much resolved itself by Dec. 2010. Then, between XXXXXXX 2011 and April 2011 is when the other foot issues started happening related to Tarsal Tunnel (pain, aching and burning while standing, no seeming as if there was enough padding/cushion on my feet. From there, I did more PT and by July/August it seemed to subside somewhat, enough to the point I was able to run a half marathon in October 2011. Felt ok after the run until one day in December 2011 when i had arch pain in one foot. From there all the other issues started again progressively including arch pain, medial arch pain, pain on side of feet, stiffness, aching, burning, cold feet/hot feet, etc. So here I am today, 9 months later still trying to find a diagnosis. (thought I'd sum it up from beginning for you as it is a lot to follow).

If this is some type of peripheral neuropathy issue, how is something like this treated?

Thanks so much for your response.
Answered by Dr. Arnab Maji 21 hours later

Thanks agian for your reply and detailed history.

That spinal injury may cause peripheral neuropathy that may cause your present symptoms. I have already mentioned spinal trauma as a cause of peripheral neuropathy.

If it is peripheral neuropathy our primary aim will be to find out the cause of peripheral neuropathy and treat for that. Sometimes treatment with vitamin B complex, gabapentin may give you some relief if peripheral neuropathy is due to medical causes. But if it is due to surgical causes like spinal issue with nerve compression then surgical treatment is needed to relief your pain.

Please discuss the issues which i have previously mentioned with your neuromedicine specialist so that you can get some cause found out along with local examination by neurologist. Because if a definite cause is found then treatment of the cause can only relieve your symptoms.

Hope i have answered your queries. If you have further queries you may write back to me. Kindly write a review on this answer.

Best Regards,
Dr Arnab Maji
Above answer was peer-reviewed by
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