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Question:

From New York, USA:

I am a 32 year old diabetic of 16 years. In the last year I have had terrible pain and inflammation, and lumps on the balls of my feet. Also, it is difficult to curl my toes. My doctor says tendonitis, but could this actually be neuropathy already? Thanks for your help!

Answer:

Without being able to see you and take a more elaborate history I am not sure how helpful I can be through the medium of e-mail. I am assuming that you have also talked to your doctor about the possibility of gout. The popular image is of swelling and pain in the big toe; but this is by no means always the case. A serum uric acid assay would give the answer.

Since you describe actual lumps and inflammation this is unlikely to be neuropathy; but diabetes is associated with a variety of disorders of tendons, fascia and tendon sheaths. Most often these affect the upper limbs; but they can occur in the feet. These are variously ascribed to glycosyation of tendon collagen causing contractures or to some related autoimmune condition. This group of complications are rather poorly understood in molecular terms so that treatment still tends to be palliative, manipulative or sometimes surgical. The one exception to this is the stiff man (hand) syndrome in which plasmapheresis of GAD antibodies has been rather successful albeit expensive.

DO'B

Original posting 15 Mar 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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