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RSD

Posted by Dr. Zuckerman on 8/22/00 at 17:30 (026045)

I had a patient come into my office for an ESWT consultation. She was on crutuches, in alot of pain. Had a diagnosis of plantar fasciitis.
The foot was cold compared to the other foot. Casting made the pain increase . She had RSD. This is rare but a very real diagnosis. She was referred to an anesthologist for an epidural nerve block . Alot of PT and probaby steriods .If this diagnosis is missed then the foot pain is forever. Must be treated very early. I am not trying to scare any one, but I bet there is someone with alot of pain on this board with this problem. Very hard to diagosis except in the very early stages after that very easly to miss.!!

Re: What does RSD stand for?

Kim B. on 8/22/00 at 17:45 (026048)

Please elaborate. (My feet are cold too, could be the ice packs I have them on.) What are the possibilities of having RSD in both feet? I am serious and would like to know more about this diagnosis.

Regards, Kim B.


Re: What does RSD stand for?

Dr. Zuckerman on 8/22/00 at 17:54 (026053)

I am not sure of the incidence with both feet. This is the first time that I have seen this condition at this early of its presentation.
In its later presentation everyone is thinking its Reflex Sympathetic
Dystropy. Another name is Sudeck's Atropy. I took foot x-ray both feet with this patient because the other foot was ok. There was demineralization of the tarsal bones (bone density decrease due to blood flow changes to the bone.) in the painful foot. This was proof of this condition. She had mri, bone scans etc done which were negative. If you have any question that you think you may have this there are specialists in this field. There are RSD clinics in some hospitals. Very hard to make the diagnosis at the later stages. You have to understand and know this condition to make a diagnosis in the early stages. I always had an interest in this condition and have read alot about this ove the years. Was a great evaluation by me but a bad one for this patient. I hope that she is going to response to the treatment. The best change is my ealy diagnosis.

Re: Thank you Dr. Zuckerman,

Kim B. on 8/22/00 at 17:59 (026055)

I wish Texas was closer to New Jersey. :-) Kim B.

P.S. My regards to the wife that shares you with us.


Re: Thank you Dr. Zuckerman,

Dr. Zuckerman on 8/22/00 at 18:40 (026059)

Speaking of my wife she isn't very happy with my time I spend on this board. I am in the process of installing a cable modeum in my office so that I can do this on office time and less on home time. Dr. Biehler is going to be more active on this board. I am trying to get other doctors involved but it is hard to talk them into this . There has to be a way to get more doctors involved. I like to answer questions on this board. In addition I owe this board alot If this board wasn't there I would never have met John Warlick from Healthronics who gave me the opportunity to be involved with ESWT technology so early in its life. This board helps me treat patients better and to understand how the patient feels about the lack of knowledge about heel and foot pain. So if you have ever wondered why I do this now you know some of the reasons. I do get referrals from this board and that has been very nice. I have been in involved in podiatry all of my life. My father was a podiatrist his office was in our home .If you wanted to talk to him you just went into the office and into the treatment rooms. He never kept me out of the office but never pushed podiatry on me. I once asked me how he practiced for fifty years, without being bored. He told me that feet can get boring but so long as there are people you will never be bored with people. If you don't like people don't be a doctor.

Re: DR. Zuckerman, you care...

Susan S on 8/22/00 at 20:35 (026068)

about people, that is a big difference between you and a lot of the podiatrists or even doctors. You take time to explain, and this tells me you listen to your patients. Thank you

Re: DR. Zuckerman, you care... RSD/Symptoms?

Beverly on 8/22/00 at 22:28 (026074)

Dr. Z,

We sure are glad you are here.

This RSD. What are the symptoms? You said something about a cold foot.
My feet are often cold, but I think they have always been that way.
(Sometimes have cold hands too.) I always attributed my tendency to cold feet to poor circulation. So, I don't think my cold feet are anything new, and it seems like I notice that less since I have been on thyroid meds (low thyroid). But since you mentioned this rare condition in regards to cold feet, I am curious. I did have one pod ask me if my feet are cold alot. I guess he noticed my cold feet.
I have PF in both feet.
So, what are the symptoms of RSD?
Beverly


Re: DR. Zuckerman, you care... RSD/Symptoms?

Dr. Zuckerman on 8/23/00 at 00:05 (026076)

This just a short list. I will try to find out either a web site or literature.

1. Pain that is much greater then should be either after surgery or an injury.

2. Vasomotor changes . such as color change, temperature, in the skin,

3. Alot of time the patient won't let you touch the foot.

4. The patient is very anxious and nervous.

5. The pain or injury doen't heal in the time frame that it usually does, or the amount of pain increased instead of decrease.

6. There are usually no objective testing that is a given. Bone scan
it at the right time will be positivel

7. In this case I caught the boney changes by comparing the x-rays but the bone scan and mri didn't really show anything pointing to this diagnosis.

8. You must either know about this or better yet see this disease before.

9. I will look this up and get the exact clinical description for each stage.


Re: DR. Zuckerman, you care... RSD/Symptoms?

Dr. Zuckerman on 8/23/00 at 00:25 (026078)

Type in the phase. Reflex Sympathetic Dystropy, on the search engines. Alot of information about this disease. I just found out the national association is in next town where I live ten minutes away.

Re: DR. Zuckerman/Thank you

Beverly on 8/23/00 at 23:26 (026114)

Dr Z,

Thank you for that symptom list. I think I'm ok as far as this rare condition goes. I have a few of the symptoms, but certainly not most of them. Like your RSD patient, I was not able to tolerate a cast. In my case, the walking boot cast made my foot tingle, go semi-numb, and feel warm. And my feet are sometimes cold, but if they are cold, both feet are equally cold, and there is nothing unusual about my feet being cold
(long history of sluggish circulation). Nor, are they cold all of the time. It comes and goes.

My pain has increased over time when on my feet, but that does not seem to be unusual for PF from what I've seen on the board. My foot got worse over time partially because in the early months, everytime it was a little better, I pushed it too far, had a setback, and each setback is harder than the one before. I don't mind having my foot touched, and I can tolerate massage just fine. In general, the pain level ebbs and flows. If I'm not on my feet much, I'm not too bad. If I am on my feet more than I can handle, I'm limping in pain.

I don't see any color changes.
But I printed off this information about RSD. My orthopedic surgeon specializes in sports medicine of the lower body. If may run this by him when I see him, but my hunch is that he will say I read too much.

Thanks,
Beverly


Re: DR. Zuckerman/Thank you

Dr. Zuckerman on 8/24/00 at 18:35 (026159)

I don't think you have RSD , from what you are telling me. Ask your doctor what he thinks anyway. There is usually a period sometime in the history of this disease when you are in extreme pain that hurts like !@@#$

Re: What does RSD stand for?

Kim B. on 8/22/00 at 17:45 (026048)

Please elaborate. (My feet are cold too, could be the ice packs I have them on.) What are the possibilities of having RSD in both feet? I am serious and would like to know more about this diagnosis.

Regards, Kim B.


Re: What does RSD stand for?

Dr. Zuckerman on 8/22/00 at 17:54 (026053)

I am not sure of the incidence with both feet. This is the first time that I have seen this condition at this early of its presentation.
In its later presentation everyone is thinking its Reflex Sympathetic
Dystropy. Another name is Sudeck's Atropy. I took foot x-ray both feet with this patient because the other foot was ok. There was demineralization of the tarsal bones (bone density decrease due to blood flow changes to the bone.) in the painful foot. This was proof of this condition. She had mri, bone scans etc done which were negative. If you have any question that you think you may have this there are specialists in this field. There are RSD clinics in some hospitals. Very hard to make the diagnosis at the later stages. You have to understand and know this condition to make a diagnosis in the early stages. I always had an interest in this condition and have read alot about this ove the years. Was a great evaluation by me but a bad one for this patient. I hope that she is going to response to the treatment. The best change is my ealy diagnosis.

Re: Thank you Dr. Zuckerman,

Kim B. on 8/22/00 at 17:59 (026055)

I wish Texas was closer to New Jersey. :-) Kim B.

P.S. My regards to the wife that shares you with us.


Re: Thank you Dr. Zuckerman,

Dr. Zuckerman on 8/22/00 at 18:40 (026059)

Speaking of my wife she isn't very happy with my time I spend on this board. I am in the process of installing a cable modeum in my office so that I can do this on office time and less on home time. Dr. Biehler is going to be more active on this board. I am trying to get other doctors involved but it is hard to talk them into this . There has to be a way to get more doctors involved. I like to answer questions on this board. In addition I owe this board alot If this board wasn't there I would never have met John Warlick from Healthronics who gave me the opportunity to be involved with ESWT technology so early in its life. This board helps me treat patients better and to understand how the patient feels about the lack of knowledge about heel and foot pain. So if you have ever wondered why I do this now you know some of the reasons. I do get referrals from this board and that has been very nice. I have been in involved in podiatry all of my life. My father was a podiatrist his office was in our home .If you wanted to talk to him you just went into the office and into the treatment rooms. He never kept me out of the office but never pushed podiatry on me. I once asked me how he practiced for fifty years, without being bored. He told me that feet can get boring but so long as there are people you will never be bored with people. If you don't like people don't be a doctor.

Re: DR. Zuckerman, you care...

Susan S on 8/22/00 at 20:35 (026068)

about people, that is a big difference between you and a lot of the podiatrists or even doctors. You take time to explain, and this tells me you listen to your patients. Thank you

Re: DR. Zuckerman, you care... RSD/Symptoms?

Beverly on 8/22/00 at 22:28 (026074)

Dr. Z,

We sure are glad you are here.

This RSD. What are the symptoms? You said something about a cold foot.
My feet are often cold, but I think they have always been that way.
(Sometimes have cold hands too.) I always attributed my tendency to cold feet to poor circulation. So, I don't think my cold feet are anything new, and it seems like I notice that less since I have been on thyroid meds (low thyroid). But since you mentioned this rare condition in regards to cold feet, I am curious. I did have one pod ask me if my feet are cold alot. I guess he noticed my cold feet.
I have PF in both feet.
So, what are the symptoms of RSD?
Beverly


Re: DR. Zuckerman, you care... RSD/Symptoms?

Dr. Zuckerman on 8/23/00 at 00:05 (026076)

This just a short list. I will try to find out either a web site or literature.

1. Pain that is much greater then should be either after surgery or an injury.

2. Vasomotor changes . such as color change, temperature, in the skin,

3. Alot of time the patient won't let you touch the foot.

4. The patient is very anxious and nervous.

5. The pain or injury doen't heal in the time frame that it usually does, or the amount of pain increased instead of decrease.

6. There are usually no objective testing that is a given. Bone scan
it at the right time will be positivel

7. In this case I caught the boney changes by comparing the x-rays but the bone scan and mri didn't really show anything pointing to this diagnosis.

8. You must either know about this or better yet see this disease before.

9. I will look this up and get the exact clinical description for each stage.


Re: DR. Zuckerman, you care... RSD/Symptoms?

Dr. Zuckerman on 8/23/00 at 00:25 (026078)

Type in the phase. Reflex Sympathetic Dystropy, on the search engines. Alot of information about this disease. I just found out the national association is in next town where I live ten minutes away.

Re: DR. Zuckerman/Thank you

Beverly on 8/23/00 at 23:26 (026114)

Dr Z,

Thank you for that symptom list. I think I'm ok as far as this rare condition goes. I have a few of the symptoms, but certainly not most of them. Like your RSD patient, I was not able to tolerate a cast. In my case, the walking boot cast made my foot tingle, go semi-numb, and feel warm. And my feet are sometimes cold, but if they are cold, both feet are equally cold, and there is nothing unusual about my feet being cold
(long history of sluggish circulation). Nor, are they cold all of the time. It comes and goes.

My pain has increased over time when on my feet, but that does not seem to be unusual for PF from what I've seen on the board. My foot got worse over time partially because in the early months, everytime it was a little better, I pushed it too far, had a setback, and each setback is harder than the one before. I don't mind having my foot touched, and I can tolerate massage just fine. In general, the pain level ebbs and flows. If I'm not on my feet much, I'm not too bad. If I am on my feet more than I can handle, I'm limping in pain.

I don't see any color changes.
But I printed off this information about RSD. My orthopedic surgeon specializes in sports medicine of the lower body. If may run this by him when I see him, but my hunch is that he will say I read too much.

Thanks,
Beverly


Re: DR. Zuckerman/Thank you

Dr. Zuckerman on 8/24/00 at 18:35 (026159)

I don't think you have RSD , from what you are telling me. Ask your doctor what he thinks anyway. There is usually a period sometime in the history of this disease when you are in extreme pain that hurts like !@@#$