Question
QUESTION: Hi, 3 months ago I was put on Macrobid for a possible urinary track infection.  For the next 2 days I had tingling in my left foot.  On the third day it felt like my foot was burning.  (By the way, around this time I had some mild pain in the middle of back in the thoracic spine.  The only time I ever had pain in the middle of my back was about 8 years ago when I finished shoveling snow.).  A few days later my left hand and arm started burning a little.  Then over the next few days my right foot started burning.  The burning has let up a little in the last few weeks but it is still there.  The burning is worse on days when I work and sit in a chair for almost 7 hours.  When I sit on certain things, like a toilet, for more than 10 minutes my feet start 'falling asleep' and this has never happened before.  The burning gets worse when I am nervous about something or when I get upset.  The burning gets worse as the day goes on so the best time of day for me is in the morning.  I am thinking it might be peripheral neuropathy.  I just had an MRI or my lower spine since for years my lower back would start hurting if I stand in one spot too long (my entire lower back will hurt but it hurts more on the right side).  To get relief I would sit down and lean forward for a few minutes.  Here is my MRI results:

Clinical History / Reason for exam: Low back pain.

Technique: Sagittal and axial T1 and T2 weighted images and sagittal inversion recovery images of the lumbar spine were obtained on the 1.5 Tesla magnet without administration of intravenous contrast.

Findings: There is normal alignment of the lumbar spine. The tip of the conus medullaris is normal in position and signal and terminates at T12-L1.

The vertebral body heights are well-maintained. There is loss of height and T2 signal of the decubitus and L3-4 and L5-S 1. The remaining intervertebral disks demonstrate normal signal intensity on sagittal T2 weighted images and are well hydrated.

At L1-2 and L2-3 there is no evidence of disk herniation, spinal canal or neuroforaminal stenosis.

At L3-4 there is diffuse disk bulge with a moderate bilateral facet and ligamentous hypertrophic change resulting in mild flattening of the thecal sac and no significant spinal canal or neural foraminal stenosis.

At L4-5 there is mild diffuse disk bulge with mild to moderate bilateral facet joint with hypertrophic change with no significant canal or neural foraminal stenosis.

At L5-S1 there is diffuse disk bulge with mild lobe facet joint with hypertrophic changes opinion mild effacement of epidural fat and mild/moderate bilateral foraminal narrowing left worse than right.

Small focus of signal abnormality is noted at L4 which is hyperintense on T1 and T2 weighted images and demonstrates a dropout of signal on inversion recovery consistent with a vertebral hemangioma. Mild endplate degenerative L3-4 and L4-5 There is no other bone marrow signal abnormality. The pre-and paravertebral soft tissues are unremarkable.

Impression:
1.  Mild-to-moderate degenerative changes of the lumbar spineW3-4 through L5-S 1 as described above.

2.  Disk desiccation L3-4 and L5-S1.

I do not understand how serious my back problem is based on these results.  I want the burning feet to stop.  Assuming my problems are caused by my back and not the Macrobid can you answer the following?

Based on my MRI results of my lower back, can any of that cause by burning feet?  Can the pain in the middle of my back (I didn't get an MRI of it yet) cause burning feet?

Is the 'vertebral hemangioma' serious?  Do I definitely have this since it says 'consistent with'?  Does it have to be treated and what treatment is recommended?

Will losing weight (I am 50 pounds overweight) help my back problems and possibly stop the burning?

Will physical therapy and exercise help?

What treatments are there besides surgery?

I plan on getting an MRI of the middle of my back since that has been hurting more and more lately.

Sorry for all of the questions but they are all related.  Any insight into my MRI results and any other advice will be appreciated.  Thank you.

ANSWER: Thank you for your question.

First, it is important that you speak with your physician about your symptoms.

Burning sensations of the feet is not a side-effect observed with Macrobid. Sometimes, numbness and tingling or pin-prick sensations in the feet may be observed with Macrobid.

Your MRI essentially identifies osteoarthritis of the low back. You have some degenerated and mildly compressed discs which may or may not produce low back pain; however, these results would not be correlated with burning sensations in the feet.

Typically, loss of excess weight, physical therapy, and chiropractic manipulation may be used to treat patients who have low back symptoms associated with degenerative spinal changes, in addition to medication if needed. There is nothing in the MRI results you provided to suggest a need for surgical intervention.

Hemangiomas of the spine are technically benign tumors of blood vessels; they are clinically insignificant, and represent incidental findings on MRI scans.

A rare cause of burning sensation in the feet in the U.S. is a vitamin B5 deficiency; much more commonly, diabetic neuropathy produces such symptoms. Skin infection would also need to be ruled out. Your feet symptoms warrant the need for a medical evaluation immediately.

Please see this link to the Mayo Clinic for additional information on burning feet:

http://www.mayoclinic.com/health/burning-feet/MY00409

I hope this helps to answer your question.




---------- FOLLOW-UP ----------

QUESTION: Hi again, than you for the detailed answer.  I had a blood test and the B6 and B12 came back normal.  I thought those are the ones that have to do with the nerves.  I am not sure of the B5 results.  I did go to a neurologist and he sent me for the MRI.  He also wants to do an EMG which I think will determine if I have peripheral neuopathy.  Do you know how painful the test is and if it can do more nerve damage?  Also, for years I have been scratching my ankles and sometimes they bleed and get very red (infected?).  I have stopped scratching them when my symptoms began because I thought that that might be causing the neuropathy.  It took a few weeks for my ankles to finally heal.  Could that have caused all of this?  Sometimes I get tingling/slight burning in my hands/arms and my upper back near my shoulders.  And my feet burn more when I sit for long periods of time.  Lying down relieves it. Thanks again.

Answer
I would not describe an EMG as the most comfortable test in the world, but neither would I characterize it as torture. No, it can't cause more nerve damage. Please see the following link from the Mayo Clinic on what to expect with an EMG study:

http://www.mayoclinic.com/health/emg/MY00107/DSECTION=what-you-can-expect

I do not know what other factors may be contributing to your current symptoms, as I do not have the means to provide you with a diagnosis over the Internet.

I wish you the best of luck in your testing and treatment.