Andrew:
In a message dated 10/14/98 7:43:25 AM Pacific Daylight Time,
[log in to unmask] writes:
<< Hi all, wonder if anyone has any suggestions re differential
diagnoses and treatment for this case:
59 yr. old female complaining of her feet being "on fire". Duration
of condition one year with sudden onset. The burning is exacerbated
by walking. She limits her footwear to running shoes as others are
too uncomfortable.
Brief medical history: EENT - nil; Resp - nil; C.V. - angina;
G.I. - nil; Renal - frequent urination; Endo - negative for
diabetes, hypothyroid; Derm - nil; MuscSk - Fibromyalgia; Neuro -
nil.
Meds: Prednisone, Tylenol#3, Cytotec, Famitidine, Methotrexate,
Folic Acid. No known drug allergies.
O/E: Joint ROM's WNL. No significant biomechanical fault. No skin
lesions, Skin temp warm, skin and appendages all WNL. DP and AT
pulses weak, PT pulses strong. Capillary refilling time (Iknow
Craig!) is exactly 3 secs. Decreased plantar vibratory sensation
wih 128 hz tuning fork in the forefoot area bilaterally.
Your comments as well as suggestions for further investigation are
most welcome. >>
I have had a few patients who have been on similar medications have similar
symptoms. I would especially be concerned regarding the methotrexate. When
did the patient start on the methotrexate in relation to the initiation of her
symptoms? Just a thought.
Sincerely,
Kevin
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Kevin A. Kirby, D.P.M.
Assistant Clinical Professor of Biomechanics
California College of Podiatric Medicine
Private Practice:
2626 N Street
Sacramento, CA 95816
Voice: (916) 456-4768 Fax: (916) 451-6014
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