RSD feet treatment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Reflex sympathetic dystrophy syndrome(RSDS) is a painful disorder usually resulting from an injury to an arm or leg.

The theory is that excessive numbers of nerve impulses are sent to the injured site, resulting in pain, changes in skin texture and weakening of bones and tissues in that area.

The injury that triggers reflex sympathetic dystrophy syndrome can be anything from frostbite, a burn, a bruise or cut, to a serious impact wound (gun shot, stabbing, shrapnel). Surgery and conditions such as heart attack, stroke or cancer may also cause reflex sympathetic dystrophy syndrome.

Usually reflex sympathetic dystrophy syndrome begins in the hands or feet but it can spread, especially if not treated early.

RSDS is a progressive disease that can be divided into three stages. Symptoms of one stage may overlap.

Stage one symptoms (1 to 3 months)

• Burning pain - usually in the hand or foot but, can occur in other areas.
• Swelling and tenderness - affected area is swollen and sore to the touch.
• Temperature and color change - skin may feel warmer or colder than normal skin and have a shiny, dry, red or tight look to it.
• Sweating - excessive sweating of the affected area occurs.
• Rapid hair and nail growth
• Loss of movement - joints in affected areas become stiff and mobility is reduced.
• Muscle spasms - spasms can be very disturbing.

Stage two symptoms (3 to 6 months)

• Extreme sensitivity - light touch, breezes, bed sheets or air conditioning can cause extreme pain.
• Radiating pain - pain may spread from feet or hands up to the hips or shoulders.
• Change in hair and nails - hair growth decreases and nails become cracked, brittle, grooved and spotty.
• Swelling - the affected area may become swollen, pale, and waxy looking.
• Bone and joint damage - osteoporosis mat develop and joints thicken and mobility becomes restricted.
• Muscle atrophy - muscles shrink and weaken from lack of use

Stage three symptoms (6 months and longer)

• Severe bone, muscle and skin damage - the changes in affected bone, muscle and skin become irreversible.
• Constant pain - The pain is unbearable.
• Severe mobility problems - there is muscle atrophy and severely limited mobility of the affected area.

RSDS can strike at any age, but is most common between the ages of 40 and 60. It affects women more often than men.

It is estimated that up to 20 percent of individuals with hemiplegia (paralysis of one side of the body) will suffer from RSDS.

Reflex Sympathetic Dystrophy Syndrome is primarily diagnosed through seeing the sequence of symptom development:

1. Presence of initial injury
2. Pain is more than expected from injury
3. Change in appearance of affected area
4. No other cause of pain or altered appearance of the limb can be found

Thermography (measurement of blood flow) to test temperature changes and three-phase bone scanning sometimes can make the diagnosis.

It is important to make an early diagnosis. Prompt treatment provides the greatest opportunity for recovery.

Among the modalities that are sometimes used are biofeedback and exercise.

Another common approach to treating RSDS in its early stages is injecting an anesthesia into the nerves (ganglionic block) to block the impulses flowing into the injured area. This provides pain relief and allows for physical therapy which helps maintain flexibility and strength in the muscles.

Physicians use a variety of drugs to treat RSDS, including corticosteroids, vasodilators, and alpha- or beta-adrenergic-blocking compounds. Elevation of the extremity and physical therapy are also used to treat RSDS. Injection of a local anesthetic, such as lidocaine, is sometimes useful. Injections are repeated as needed. TENS has helped some patients in relieving chronic pain.

In extreme cases surgical sympathectomy (the cutting of the nerves) may be used to stop the pain but, may cause loss of sensation in the area.

There is no known cure for RSDS. If treatment begins within three months of the first symptoms, the prognosis is better. Because RSDS is a progressive disease, it may become an irreversible, crippling disorder.

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